Find State ESMs

Measure Status: Active

Evidence Level: Expert Opinion. Aligns with MCHbest strategy "Health Education" (https://www.mchevidence.org/tools/strategies/14-1-2.php). Find other NPM 14 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percentage of primary caregivers who report using tobacco or cigarettes at Family Visiting enrollment and received information on and/or were referred to tobacco cessation counseling or services within 3 months of enrollment

Numerator: # of primary caregivers who report using tobacco/cigarettes at Family Visiting enrollment and received information on and/or were referred to tobacco cessation counseling or services within 3 months of enrollment (excludes those already in services)

Denominator: # of primary caregivers who report using tobacco/cigarettes at Family Visiting enrollment

Significance: Smoking is a known risk factor for both preterm birth and maternal morbidity, thus impacting both the mother and infant's health.

Data Sources and Data Issues: Efforts to Outcomes Database

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy 14.1.1 "Counseling". Find other NPM 14.1 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Direct services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: To increase the number of pregnant women who receive Smoking Cessation Reduction in Pregnancy Treatment (SCRIPT) services.

Numerator: Number of SCRIPT services provided to Healthy Start clients.

Denominator: N/A

Significance: Smoking during pregnancy creates risks for adverse outcomes.

Data Sources and Data Issues: Well Family System

Year: 2020

Unit Type: Simple Count, Unit Number: 50,000

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy 14.1.1 "Counseling" (https://www.mchevidence.org/tools/strategies/14-1-1.php). Find other NPM 14.1 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: By 2022, increase by 5% the number of pregnant smokers who call the quitline annually.

Numerator: # of pregnant smokers who call the Maryland tobacco quitline

Denominator: N/A

Significance: Women who smoke during pregnancy are more likely to experience a fetal death or deliver a low birth weight baby. Further, secondhand smoke (SHS) is a mixture of mainstream smoke (exhaled by smoker) and the more toxic side stream smoke (from lit end of nicotine product) which is classified as a “known human carcinogen” by the US Environmental Protection Agency, the US National Toxicology Program, and the International Agency for Research on Cancer. Adverse effects of parental smoking on children have been a clinical and public health concern for decades and were documented in the 1986 U.S. Surgeon General Report. The MDH Center for Tobacco Prevention and Control launched a Pregnancy Rewards Program in 2014, which offers pregnant and postpartum women (up to six months) rewards for series of completed calls with a Quit Coach. Though initially requiring referral by physician, that barrier was removed and now a pregnant smoker can simply call and let the Quitline know that she is pregnant and interested in the rewards/incentive program. This ESM will measure the impact of the Pregnancy Rewards Program and accompanying media campaigns/health communication interventions on the number of pregnant Quitline callers.

Data Sources and Data Issues: 2016-2022 MDH Center for Tobacco Prevention and Control Quitline Data

Year: 2020

Unit Type: Simple Count, Unit Number: 200

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Counseling" (https://www.mchevidence.org/tools/strategies/14-1-1.php). Find other NPM 14.1 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities related to systems-building

Goal: Increase the percentage of women using the statewide smoking quitline who are pregnant

Numerator: Number of pregnant women who contact the statewide smoking quitline

Denominator: Number of women who contact the statewide smoking quitline

Significance: According to the Surgeon General’s report, “Tobacco use remains the number one cause of preventable disease, disability, and death in the United States. Approximately 34 million American adults currently smoke cigarettes, with most of them smoking daily. Nearly all adult smokers have been smoking since adolescence. More than two-thirds of smokers say they want to quit, and every day thousands try to quit. But because the nicotine in cigarettes is highly addictive, it takes most smokers multiple attempts to quit for good…the evidence is sufficient to infer that proactive quit-line counseling, when provided alone or in combina¬tion with cessation medications, increases smoking cessation…and the evidence is sufficient to infer that tobacco quit-¬lines are an effective population-based approach to motivate quit attempts and increase smoking cessation.” https://www.hhs.gov/sites/default/files/2020-cessation-sgr-full-report.pdf As of 2015, 17% of pregnant women who smoked reported quitting smoking during the first trimester of their pregnancy, according to the National Health Interview Survey. This proportion is short of the HP2020 target of 30%. https://www.healthypeople.gov/2020/data-search/Search-the-Data#objid=5364. 1-800-QUIT-NOW quit-lines provide free and confidential services in English and Spanish, and translation for other languages, by a trained quit coach to stop smoking. Quit coaches connect callers with quit-smoking resources through the caller’s community programs, and callers may be able to receive free nicotine replacement therapy. http://makesmokinghistory.org/quit-now/what-is-the-helpline/

Data Sources and Data Issues: Massachusetts smoking quit-line data

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Moderate. Aligns with MCHbest strategy "Incentives" (https://www.mchevidence.org/tools/strategies/14-1-3.php). Find other NPM 14 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: By September 2025, increase the percentage of pregnant women, postpartum women or their household members who have quit smoking or decreased the number of cigarettes smoked in the past 12 months.

Numerator: Number of pregnant or postpartum women or their household members who quit by using NRT, quit without NRT, or reduced the number of cigarettes they smoked.

Denominator: Number of women and household members who participate in an incentive-based smoking cessation program.

Significance: Tobacco is the greatest cause of preventable death and illness in the United States. In Idaho, 14.7% of adults report being regular smokers (United Health Foundations, 2019; CDC, 2019). In 2016, 4.6% of mothers smoked in the final 3-months of their pregnancy, a substantial decrease from 8% in 2011 (IDHW, 2018; IDHW, 2014). The Idaho Tobacco Prevention and Control Program correlates well with the CDC recommendations for comprehensive statewide programs that focus on preventing initiation of tobacco use among youth, promoting quitting among adults and youth, eliminating exposure to secondhand smoke, and identifying and eliminating tobacco-related disparities among populations groups (CDC, 2020). One of Idaho’s state priorities is to decrease substance abuse among maternal and child health populations. MCH collaborates with the Idaho Tobacco Prevention and Control Program to provide a smoking cessation program tailored for pregnant or postpartum women and their household members. The Diapers and Wipes Program is evidence-based, modeled from the Baby and Me-Tobacco Free program, and incentive-driven. Providing tobacco cessation services to pregnant women, postpartum women, and their household members may decrease the occurrence of smoking-related infant morbidity and mortality and decrease the percent of children who live in households where someone smokes.

Data Sources and Data Issues: Source: Idaho Tobacco Prevention and Control Program

Year: 2020

Unit Type: Simple Count, Unit Number: 500

Measure Status: Active

Evidence Level: There is limited research in the evidence base to support this strategy.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities related to systems-building

Goal: To increase the percentage of women who have a documented Plan of Safe Care (POSC) prior to delivery, to reduce the harmful effects of substance use and improve perinatal outcomes, and to provide supportive services during the perinatal period

Numerator: Number of women whose infant was monitored for the effects of in utero substance exposure and who had a Plan of Safe/Supportive Care (POSC) documented

Denominator: Number of women who delivered during the measurement period, whose infant was monitored for the effects of in utero substance exposure

Significance: The CDC reports that between 1999-2014 the US had seen an increase of four times the amount of infants experiencing Neonatal Abstinence Syndrome (NAS). New Hampshire (NH) saw a spike in overdose deaths in 2014 in the general population. In 2015-2017 the NH Maternal Mortality Review Committee has seen the effect of this opioid epidemic in pregnant and postpartum women. The leading cause of maternal deaths during this time was accidental drug overdose. The NH Maternal Mortality Review Program reported this in the annual report to the NH Health and Human Services Oversight Committee. The report also showed that almost all of the maternal deaths occurred in the postpartum period. In the same timeframe of these maternal deaths the Governor’s Perinatal Exposure Task Force brought a multidisciplinary group of stakeholders together to develop the work plan for NH on Plans of Safe Care (POSC). The Child Abuse Prevention and Treatment Act (CAPTA) was amended in 2016 to require that states create a plan that would result in all infants affected by prenatal drug or fetal alcohol exposure have a Plan of Safe Care (POSC). NH RSA 132-10e and 10f provides details for the NH plan for women and providers on the development of these POSC. NH emphasizes supports for women during the perinatal period. The POSC, through conversation with providers, engages women to connect to local resources. The NH POSC template allows providers to connect with women around the future for themselves and their families. The template includes treatment services and services that are offered in the area. Knowledge of services and discussion with providers about the available services has potential to enroll more families. The development of a POSC between provider and a woman, especially when initiated prenatally, can be a critical tool to keep mothers engaged and supported, which will contribute to the improvement of health and social well-being for women and families.

Data Sources and Data Issues: NH DHHS Vital Records As NH has newly created a mechanism for collecting this data from Birth Certificates, baseline data for this new measure will be gathered in 2020.

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy 14.1.1 "Counseling" (https://www.mchevidence.org/tools/strategies/14-1-1.php). Find other NPM 14.1 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: Increase the percent of Maternal Health clients who are screened for tobacco use with Ask, Advise, Refer

Numerator: Number of maternal health clients who have been screened for tobacco use using the Ask, Advise, Refer

Denominator: Total number of maternal health clients served

Significance: Ask, Advise, Refer is an evidence based product to screen for tobacco use with women. This will ensure Title V staff are appropriately screening and referring clients who need tobacco cessation services.

Data Sources and Data Issues: Title V data system. Ensure agencies are documenting the screening and education appropriately.

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: This ESM measures access to/receipt of care, thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities related to systems-building

Goal: Reduce the prevalence of pregnant people insured by Medicaid who smoke during the last three months of pregnancy from 14.4% (in 2018) to 11% (in 2025).

Numerator: Number of pregnant people insured by Medicaid who smoke during the last three months of pregnancy

Denominator: Number of pregnant people insured by Medicaid

Significance: The prevalence of smoking while pregnant was 7.1% (2018, PRAMS) overall, however, women who are enrolled in Medicaid are nearly five times more likely to smoke during pregnancy (14.4%, 2018, PRAMS) compared with women who are enrolled in private insurance (2.8% 2018, PRAMS).

Data Sources and Data Issues: Pregnancy Risk Assessment Monitoring System (PRAMS)

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs (https://www.mchlibrary.org/evidence/state-esms-results.php?q=screening&NPM=14&State=&RBA_Category=&MCH_Pyramid=&Recipient=&Status=Active) for this NPM or search for other strategies or promising practices (https://www.mchevidence.org/tools/npm/14-smoking.php).

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 1. Assess and monitor population health

Service Recipient: Activities directed to families/children/youth

Goal: Reduce the percentage of pregnant women who smoke during pregnancy

Numerator: Number of PRAMS respondents who report that a doctor, nurse, or other health care worker asked if they were smoking cigarettes during any prenatal care visits

Denominator: Number of total PRAMS respondents

Significance: Tobacco smoke contains a deadly mix of more than 7,000 chemicals; hundreds are harmful, and about 70 can cause cancer. Smoking during pregnancy is a public health problem because of the many adverse effects associated with it. These include intrauterine growth restriction, placenta previa, abruptio placentae, decreased maternal thyroid function, preterm premature rupture of membranes, low birth weight, perinatal mortality, and ectopic pregnancy. Children born to mothers who smoke during pregnancy are at an increased risk of asthma, infantile colic, and childhood obesity. Secondhand prenatal exposure to tobacco smoke also increases the risk of having an infant with low birth weight by as much as 20%. Smoking by women during pregnancy has been shown to increase the risk for Sudden Infant Death Syndrome (SIDS). Providers and public health professionals should provide support mothers to stop perinatal smoking. Public health awareness of the risks associated with smoking and substance use during pregnancy can reach more of the population by mass media. Knowledge of available resources may help reduce the risk of adverse birth outcomes associated with smoking and substance use. Public health initiatives could lead to a decrease in smoking by pregnant women and nonpregnant women of reproductive age by providing access to smoking cessation programs.

Data Sources and Data Issues: Nevada Pregnancy Risk Assessment Monitoring System (PRAMS); Data represents 2018 calendar year births. Nevada PRAMS receives data in fall of the preceding birth year, resulting in a year lag (2019 data is not received until fall 2020). That is why 2018 calendar year was used. 2018 Nevada PRAMS data had a response rate of 39.4% which is under the Centers for Disease Control and Prevention (CDC) required response rate threshold of 55% to publish data. Interpret data with caution due to the response rate.

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Counseling" (https://www.mchevidence.org/tools/strategies/14-1-1.php). Find other NPM 14 patient/practice-level strategies in MCHbest.

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities related to systems-building

Goal: Reduce the number of Vermont women who smoke during and after pregnancy.

Numerator: # of pregnant smokers who register with the QuitLine or QuitOnline

Denominator: # of pregnant smokers

Significance: Quit Lines and online Quit support are proven strategies to increase quit attempts and sustained quitting. Vermont's pregnancy protocol includes: 9 calls with a personal coach, text messaging support available for free, fee Nicotine Replacement Therapy with doctor’s prescription, and up to $65 in incentive payments

Data Sources and Data Issues: Data sources: 802Quits Network registration information; and Vermont’s Vital Statistics birth certificate data. Data issues: we are not able to track the number of pregnant women participating in Quit-in-person, so we are limited to contacts by phone or internet.

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Counseling" (https://www.mchevidence.org/tools/strategies/14-1-1.php). Find other NPM 14 system/provider/patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 4. Support and mobilize partners

Service Recipient: Activities related to systems-building

Goal: To increase the proportion of women during pregnancy, childbirth and the puerperium in health care organizations providing recommended screening, education and referral for women who smoke during pregnancy

Numerator: Number of health organizations receiving information, technical assistance, and/or support for maternal and/or infant health care improvement annually through DSHS MCH programs to increase practices supportive of smoking cessation among women of chil

Denominator: NA

Significance: The American College of Obstetricians and Gynecologists document the importance of education, assessment, screening, and intervention for tobacco and nicotine use during pregnancy and in the interpregnancy period for reducing the percent of women who smoke during pregnancy and maintaining smoking cessation. Behavioral pharmacotherapy interventions, such as recommended by the U.S. Preventive Services Task Force , have demonstrated efficacy for smoking cessation. Screening for tobacco and nicotine use and providing resources and interventions for smoking cessation should be incorporated into routine maternal care as well as targeted care for women at risk of maternal morbidity, such as women with opioid use disorder. Guerby, P., Garabedian, C., Berveiller, P., Legendre, G., Grangé, G., & Berlin, I. (2020). Tobacco and Nicotine Cessation During Pregnancy. Obstetrics and gynecology, 136(2), 428–429. https://doi.org/10.1097/AOG.0000000000004033 American College of Obstetricians and Gynecologists, & Society for Maternal-Fetal Medicine (2019). Obstetric Care Consensus No. 8: Interpregnancy Care. Obstetrics and gynecology, 133(1), e51–e72. https://doi.org/10.1097/AOG.0000000000003025 Siu AL. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.S. Preventive Services Task Force Recommendation Statement. U.S. Preventive Services Task Force. Ann Intern Med 2015;163:622–34. Krans, E. E., Campopiano, M., Cleveland, L. M., Goodman, D., Kilday, D., Kendig, S., Leffert, L. R., Main, E. K., Mitchell, K. T., OʼGurek, D. T., DʼOria, R., McDaniel, D., & Terplan, M. (2019). National Partnership for Maternal Safety: Consensus Bundle on Obstetric Care for Women With Opioid Use Disorder. Obstetrics and gynecology, 134(2), 365–375. https://doi.org/10.1097/AOG.0000000000003381

Data Sources and Data Issues: Data Source: DSHS HTMB Program data, including but not limited to data from the TexasAIM Program and the High-Risk Maternal Care Coordination Services Pilot Data Issues: None anticipated

Year: 2020

Unit Type: Simple Count, Unit Number: 100

Measure Status: Active

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs (https://www.mchlibrary.org/evidence/state-esms-results.php?q=provider+training&NPM=14&State=&RBA_Category=&MCH_Pyramid=&Recipient=&Status=Active) for this NPM or search for other strategies or promising practices (https://www.mchevidence.org/tools/npm/14-smoking.php).

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 8. Build and support a workforce

Service Recipient: Activities directed to professionals

Goal: To increase the number of health care workers who have had Help2Quit maternity care provider training

Numerator: Number of health care providers who have had Help2Quit maternity care provider training

Denominator: n/a

Significance: Decreasing the percentage of women who smoked during pregnancy and the percentage of children in households where someone smokes can reduce the following: rate of severe maternal morbidity per 10,000 delivery hospitalizations, maternal mortality rate per 100,000 live births, percent of low birth weight deliveries (<2,500 grams), percent of very low birth weight deliveries (<1,500 grams), percent of moderately low birth weight deliveries (1,500-2,499 grams), percent of preterm births (<37 weeks), percent of early preterm births (<34 weeks), percent of late preterm births (34-36 weeks), percent of early term births (37, 38 weeks), perinatal mortality rate per 1,000 live births plus fetal deaths, infant mortality rate per 1,000 live births, neonatal mortality rate per 1,000 live births, post neonatal mortality rate per 1,000 live births, preterm-related mortality rate per 100,000 live births, sleep-related Sudden Unexpected Infant Death (SUID) rate per 100,000 live births, and percent of children in excellent or very good health.

Data Sources and Data Issues: WV Perinatal Partnership

Year: 2020

Unit Type: Simple Count, Unit Number: 1,000

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Counseling" (https://www.mchevidence.org/tools/strategies/14-1-1.php). Find other NPM 14.1 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 2: Measuring quality of effort (% of reach; satisfaction)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities related to systems-building

Goal: Reduce household smoking (NPM# 4) by increasing referrals of pregnant women to Mom's Quit Connection.

Numerator: The number pregnant women referred to Mom's Quit Connection during the calendar year.

Denominator: The number of women delivering a newborn during the calendar year.

Significance: Maternal smoking is one of the most significant and preventable risk factors of adverse birth outcomes.

Data Sources and Data Issues: Mom's Quit Connection data

Year: 2020

Unit Type: Rate, Unit Number: 1,000

Measure Status: Active

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs (https://www.mchlibrary.org/evidence/state-esms-results.php?q=home+visit&NPM=14&State=&RBA_Category=&MCH_Pyramid=&Recipient=&Status=Active) for this NPM or search for other strategies or promising practices (https://www.mchevidence.org/tools/npm/14-smoking.php).

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: To increase the number of clients who are referred to smoking cessation services within the first 3 months of enrollment in a home visitation program.

Numerator: Number of women enrolled in home visitation who reported using tobacco or cigarettes at enrollment and were referred to tobacco cessation counseling or services within 3 months of enrollment.

Denominator: Number of women enrolled in home visitation who reported using tobacco or cigarettes at enrollment and were enrolled for at least 3 months.

Significance: Decreasing the percentage of women who smoking during pregnancy and the percentage of children in households where someone smokes can reduce the following: rate of severe maternal morbidity per 10,000 delivery hospitalizations, maternal mortality rate per 100,000 live births, percent of low birth weight deliveries (<2,500 grams), percent of very low birth weight deliveries (<1,500 grams), percent of moderately low birth weight deliveries (1,500-2,499 grams), percent of preterm births (<37 weeks), percent of early preterm births (<34 weeks), percent of late preterm births (34-36 weeks), percent of early term births (37, 38 weeks), perinatal mortality rate per 1,000 live births plus fetal deaths, infant mortality rate per 1,000 live births, neonatal mortality rate per 1,000 live births, post neonatal mortality rate per 1,000 live births, preterm-related mortality rate per 100,000 live births, sleep-related Sudden Unexpected Infant Death (SUID) rate per 100,000 live births, and percent of children in excellent or very good health.

Data Sources and Data Issues: OMCFH Home Visitation Programs

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: No similar strategy found in the established evidence for this NPM. See similar ESMs (https://www.mchlibrary.org/evidence/state-esms-results.php?q=home+visit&NPM=14&State=&RBA_Category=&MCH_Pyramid=&Recipient=&Status=Active) for this NPM or search for other strategies or promising practices (https://www.mchevidence.org/tools/npm/14-smoking.php).

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: To increase the number of clients enrolled prenatally in the home visitation program who reported reduction or stoppage of smoking by time of delivery

Numerator: Number of clients enrolled prenatally in the home visitation program who reported reduction or stoppage of smoking by time of delivery

Denominator: Number of clients enrolled prenatally in the home visitation program who reported smoking at the time of intake

Significance: Smoking during pregnancy is a significant risk factor for the mother and her unborn baby, Tobacco smoke reduce oxygen flow to the placenta and exposes the developing fetus to numerous toxins. This increases the risk of spontaneous abortion and ectopic pregnancy. It can also result in poor health outcomes for the newborn, including low birthweight, intrauterine growth restriction, prematurity, birth defects, lung function abnormalities and respiratory symptoms and perinatal mortality.

Data Sources and Data Issues: MIECHV program

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: This ESM measures access to/receipt of care, thus doesn’t align with a specific evidence-based strategy. Consider developing an ESM for one of the specific strategies in your state action plan to measure performance. Check MCHbest for examples to connect to the evidence.

Measurement Quadrant: Quadrant 4: Measuring quality of effect (% of "is anyone better off")

Service Type: Enabling services level of pyramid

Essential Public Health Services: 7. Assure effective and equitable health systems

Service Recipient: Activities directed to families/children/youth

Goal: To decrease the number of households where someone smokes.

Numerator: Number of children ages 0-17 who live in households where there is household member who smokes.

Denominator: Number of children ages 0 through 17

Significance: Children have an increased frequency of ear infections; acute respiratory illnesses and related hospital admissions during infancy; severe asthma and asthma-related problems; lower respiratory tract infections; and SIDS

Data Sources and Data Issues: NSCH

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: There is limited research in the evidence base for this NPM to support this strategy.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 5. Create/champion/implement policy

Service Recipient: Activities related to systems-building

Goal: To support smoke free environments as the social norm

Numerator: Sports teams making initial tobacco-free pledge

Denominator: n/a

Significance: The measure is significant in that it underlies the social norm change affected by youth leaders publicly pledging to their school, peers, and community to be tobacco free. The number of sports teams taking the tobacco-free pledge will consist of sports teams which are making their initial pledge (excluding re-pledges in subsequent years).

Data Sources and Data Issues: Tennessee Tobacco Control Program data

Year: 2020

Unit Type: Simple Count, Unit Number: 88

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Clinic-based Counseling + Education Materials" (https://www.mchevidence.org/tools/strategies/14-2-2.php). Find other NPM 14 patient-level strategies in MCHbest.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: To improve health outcomes of children (0-17) through distribution of promotional materials and information to household members and caregivers that increase awareness, knowledge, and skill in reducing use of an exposure to tobacco.

Numerator: Number of materials distributed to household members and caregivers intended to raise awareness about the risk of infant and child exposure to tobacco per state fiscal year

Denominator: N/A

Significance: Exposure to secondhand smoke causes increased risk of sudden infant death syndrome (SIDS), acute respiratory infections, middle ear issues, and more severe and frequent asthma attacks. There is no safe level of exposure to secondhand smoke. As of 2016, the Centers for Disease Control and Prevention reports that Texas is one of the better performing states for maternal smoking, largely due to the high number of births to Hispanic women who are less likely to smoke. However, there is geographic disparity in this behavior with the higher rates of maternal smoking in the north and east of the state. The Community Guide recommends, as part of a comprehensive tobacco control program, information and technical assistance be provided to support evidence-based practices. Due to the breadth of stakeholders involved in these efforts a process measure to assess diffusion of information among the target population is appropriate.

Data Sources and Data Issues: Data Source: DSHS Maternal and Child Health Section (MCHS) Annual total number of materials distributed associated with tobacco control from the programs: - Pamphlet for Parents of Newborns During the 2005 regular legislative session, legislators pass SB 316, which requires hospitals, birthing centers, physicians, nurse-midwives, and midwives who provide prenatal care to pregnant women during gestation or at delivery to provide the woman and the father of the infant or other adult caregiver for the infant with a resource pamphlet. DSHS makes this pamphlet available online and for distribution from HHSC Warehouse in English and Spanish. DSHS reports on the number of pamphlet ordered from the warehouse each FY. - Parent’s Guide to Raising Happy Healthy Children As per HB 1240 enacted by the 81st Legislative Session the resource guide provides information relating to the development, health, and safety of a child from birth to five. This developmental resource guide is only available free of charge to prenatal care providers, including hospitals, birthing centers, physician, nurse midwives, and midwives, who provide prenatal care or deliver an infant of a pregnant woman enrolled in Medicaid. DSHS makes this pamphlet available online and for distribution in English and Spanish. DSHS reports on the number of guides ordered each Fiscal Year. Data Issues: None anticipated.

Year: 2020

Unit Type: Simple Count, Unit Number: 500,000

Measure Status: Active

Evidence Level: Emerging. Aligns with MCHbest strategy "Smoking Policies/Bans/Legislation" (https://www.mchevidence.org/tools/strategies/14-2-5.php). Find other NPM 14.2 state-level strategies in MCHbest.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Public health services and systems level of pyramid

Essential Public Health Services: 9. Conduct evaluation, research and CQI

Service Recipient: Activities related to systems-building

Goal: Reduce by 5% the proportion of children who live in a household with someone who smokes based on the National Survey of Children’s Health by September 30, 2025.

Numerator: Percentage of KY communities reporting comprehensive smoke free policies

Denominator: NA

Significance: Comprehensive smoke free policies have strong evidence that they reduce second hand smoke exposure, prevalence of tobacco use, increasing number of tobacco users who quit smoking, and reduction of tobacco use in adolescents/young adults. KY has a high rate of tobacco use including E-products. In areas of KY with higher rates of tobacco use, there are higher rates of asthma, birth defects, low birth weight and infant mortality.

Data Sources and Data Issues: KY Tobacco Cessation Program and Kentucky Center for Smoke Free Policy

Year: 2020

Unit Type: Percentage, Unit Number: 100

Measure Status: Active

Evidence Level: There is limited research in the evidence base for this NPM to support this strategy.

Measurement Quadrant: Quadrant 1: Measuring quantity of effort (counts and "yes/no" activities)

Service Type: Enabling services level of pyramid

Essential Public Health Services: 3. Inform and educate the public

Service Recipient: Activities directed to families/children/youth

Goal: To increase youth tobacco cessation.

Numerator: Number of social media posts promoting text-based cessation services

Denominator: n/a

Significance: Cessation-supporting text services have been shown to be effective for youth and young adults who are experimenting with or currently using tobacco products. TDH and partner promotions of these services through social media aims to increase text service utilization.

Data Sources and Data Issues: Tobacco Control Program data

Year: 2020

Unit Type: Simple Count, Unit Number: 24