Most strategies to help pregnant women stop smoking have relied on cessation advice provided by health care professionals during prenatal visits and/or printed materials designed to encourage self quitting.1 Two meta-analyses of smoking cessation studies conducted within health care facilities1 2 revealed that repeated contact with multiple providers (physicians and non-physicians) in multiple formats (face-to-face, telephone, printed material) resulted in better cessation outcomes than single intervention offerings.

The current study built upon this earlier research and tested the impact of physician/midwife advice to stop smoking accompanied by printed materials with and without proactive telephone peer support provided by a woman ex-smoker between routine prenatal visits. The provision of proactive support, initiated by the support person, has shown promising results with non-pregnant smokers.3 A meta-analysis of 13 studies comparing cessation rates for proactive telephone support versus controls revealed a modest significant effect for proactive telephone support.4 The combined approach of health professional advice plus proactive telephone peer support enables the professional to legitimise concerns about smoking while permitting the woman ex-smoker to assist the pregnant woman in accomplishing her smoking change goals. Furthermore, the provision of support by telephone bypasses traditional barriers to assistance (for example, cost, transportation, child care) and enables the support to occur frequently and repeatedly. Finally, referral to proactive telephone support requires little time, making it a practical way to support smoking cessation activities in a busy practice setting. This study was designed to test the impact of proactive telephone peer support added to physician/midwife advice to help pregnant women stop smoking.