Smoking during pregnancy is highly prevalent in populations of white, low socioeconomic status women who are more addicted to nicotine than most other groups within their social class. Qualitative and quantitative assessments conducted by this research team suggested that effective pregnancy smoking interventions should be offered in the context of high risk counselling that also addressed sources of stress, depression, negative family support, and the various problems associated with poverty.1-3 Because many of these women are in early stages of change for smoking cessation, they need an approach focused on motivation and decision making rather than advice or quitting guides. Motivational interviewing is an approach that addresses the motivational enhancement needs of these women, meets them at their stage of change, and therefore seemed particularly appropriate for these women.4

This project proposed using the existing prenatal high risk case management delivery system for motivational enhancement based smoking cessation counselling. The case manager's role is to give support and marshal resources to address emotional and environmental stressors for high risk pregnancies, a role supported by Medicaid in most states. In addition, we believed that the interaction style and counselling skills of case managers in the cooperating clinic network were compatible with the demands of an individualised, comprehensive, motivational approach to pregnancy smoking cessation.