After years of testing the best way to get pregnant women to quit smoking, researchers have identified a five-step counseling program that is successful in 30 percent to 70 percent of cases.

Now the program will be promoted nationally to doctors, community health advocates and insurance providers through a program administered by the University of North Carolina at Chapel Hill. The university, using a $1.2 million grant to be announced today from the Robert Wood Johnson Foundation, has established the Smoke-Free Families National Dissemination Office to publish research about the cessation program and to train health professionals to use it. The program is an amalgamation of smoking cessation methods that worked during clinical trials throughout the country. After identifying the key elements that were most effective, researchers devised a five-step plan: Ask, advise, assess, assist and arrange. "The idea is to identify women who say they are smoking when they enter prenatal care," said Cathy L. Melvin, director of the dissemination office. "Then we give them strong advice to quit." Whoever is counseling the woman would offer information about how smoking can damage the unborn child, causing premature birth, low birth weight or even death. After the woman has had a chance to consider such consequences, the counselor would then assess the woman's interest in trying to quit. After that, assistance is offered. The counselor might suggest the woman set up a help network among friends and colleagues and offer a healthy alternative such as walking instead of smoking. The final step is to arrange for the prenatal treatment to include encouragement and assistance. "This is an unprecedented opportunity to have an impact on one of the most intractable problems facing mothers and children," Melvin said. Nationally, 12.9 percent of women who give birth smoke during pregnancy, and the rate is higher, 14.9 percent, in North Carolina. Melvin said that for every $1 spent on prevention, the state can save $3 to $6 in hospital costs, medicines and therapies used to treat mothers who smoke and their babies.

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