University of Wisconsin–Madison Medical College of Wisconsin

Helping Low Income Pregnant Women Quit Smoking: Improving the First Breath Program

Kristine Alaniz, MPH; Bruce Christiansen, PhD; Emily Tingting Sullivan, BS; Lisette Khalil, MS, JD; Michael C. Fiore, MD, MPH, MBA

WMJ. 2019;118(3):120-125.

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Background: Maternal smoking during pregnancy can have dire consequences for both baby and mother. In 2000, the Wisconsin Women’s Health Foundation developed the First Breath program to address this challenge, particularly among low-income women. While this prenatal smoking cessation program was successful, 2 factors necessitated changes in the program: changes in the health care reimbursement environment and a high postpartum relapse rate.

Methods: The First Breath program was revised using the concepts of implementation science and included focus groups of First Breath clients, a randomized control trial to test new postpartum services, and an implementation project to test the new method of delivering First Breath.

Results: A year after implementing the new First Breath program, results are encouraging. First Breath expanded its reach by 34% over 2017. Eighty-eight new First Breath sites (to a total of 235 sites) have been added, resulting in increased diversity. While there was significant relapse within the new program from prenatal abstinence to 1-month postpartum abstinence (from 13.6% to 7.3% abstinence, biochemically verified, intent-to-treat) there was not additional relapse through 6 months postpartum.

Conclusion: Sustaining a valuable community-based tobacco dependence intervention program serving a vulnerable population requires continuous improvement built on measured outcomes and response to changes in the health care delivery system. First Breath may serve as a model program to aid underserved pregnant women who smoke.


Author Affiliations: Wisconsin Women’s Health Foundation, Madison, Wis (Alaniz, Sullivan, Khalil); Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, Wis (Christiansen, Fiore).
Corresponding Author: Bruce Christiansen, PhD, Senior Scientist, Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, 1930 Monroe St, Suite 200, Madison, WI 53711; phone 608.262.4087; email
Acknowledgement: The authors would like to acknowledge Wendy Theobald, PhD, for her assistance in preparing this manuscript. We would also like to acknowledge the many organization partners of the First Breath program. Finally, we want to recognize the thousands of Wisconsin women who wanted a healthier life for their baby and thus enrolled in the First Breath program.
Funding/Support: The First Breath program has had financial support from many sources across the years. These include the Wisconsin Tobacco Prevention and Control Program, the Wisconsin Bureau of Maternal and Child Health, the Wisconsin Partnership Program of the University of Wisconsin School of Medicine and Public Health, SSM Health, the March of Dimes, and the UW-Madison Clinical and Translational Science Award (CTSA) program through the National Institutes of Health National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427.
Financial Disclosures: None declared.
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