Smoke Free Families

The OPQC statewide Smoke Free Families collaborative project aims to reduce smoking among pregnant women in order to decrease the effects of smoking on maternal and infant health.


The Ohio Vital Statistics reported that in 2015 over 20% of pregnant women within the state smoked at some point during their pregnancy. Maternal smoking is a modifiable risk that can have a direct effect on birth outcome and infant mortality. Tobacco use during pregnancy can lead to increased rates of miscarriage, preterm birth, low birth weight, and birth defects. However, women who quit using tobacco before or during pregnancy can significantly decrease these risks. 

The OPQC SFF project will build on the Ohio Colleges of Medicine Government Resource Center 2015 improvement effort which included participation from Reproductive Health Wellness Program (RHWP), Ohio Infant Mortality Reduction Initiative (OIMRI), Women Infant and Children (WIC), Help Me Grow (HMG), and Federally Qualified Health Centers (FQHC).

In 2017, the work of Ohio Smoke Free Families expanded to the Ohio Perinatal Quality Collaborative (OPQC) and the Ohio Chapter of the American Academy of Pediatrics (Ohio AAP) to build on the accomplishments of previous tobacco cessation initiatives and expand resources and interventions for pregnant women and new mothers.

SFF uses the 5A’s Intervention strategy, an evidence-based approach in tobacco cessation efforts

  1. Ask – Identify and document tobacco use for every patient at every visit.
  2. Advise – In a clear, strong, and personalized manner, urge every tobacco user to quit.
  3. Assess – Is the tobacco user willing to make a quit attempt at this time?
  4. Assist – For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit.
  5. Arrange – Schedule follow up contact – in person or by telephone – within the first week after the quit date.


Maternity care practices participating in the OPQC Smoke Free Families project will be provided with instruction on Motivational Interviewing techniques, education on the 5A’s and pregnancy specific smoking cessation resources to help improve smoking cessation efforts. In addition, we have adapted our data collection methods, making them more streamlined and less burdensome.

Participating teams are asked to:

  • Attend monthly virtual meetings for an estimated duration of six months and one in-person Learning Session.
  •  Utilize the PRAF 2.0 (Pregnancy Risk Assessment Form) for all Medicaid/MCP patients.
  •  Complete PDSA’s on best practices felt to improve patient care. 

Benefits of Participation 

Participating teams will receive:

  • Education provided by subject matter experts on Motivational Interviewing techniques, 5A’s, pharmacotherapy, connecting with referral sources and much more.
  • Tools to assist smoking cessation efforts.
  • Quality improvement coaching to help your team overcome barriers and successfully implement effective smoking cessation counseling and spread improvement efforts to others within your organization.
  • Site specific data to help guide improvement efforts.