Smoking is a deadly threat to women's health. It is the most preventable cause of many chronic diseases and contributes to a gamut of other medical conditions. In addition to causing death and disease in women, smoking also impacts a mother and her develo

However, many people are unaware of the prevalence of smoking among pregnant women in our state. We hear comments such as, "Women don't still smoke while they're pregnant, do they? Doesn't everyone know how dangerous that is?" In actuality, in 1998, 18% of Wisconsin women reported smoking while pregnant—that's 11th worst in the nation. The national average was 13%. Furthermore, disproportionate numbers of women in Wisconsin's minority populations smoked during pregnancy. In 1997, the rates of smoking during pregnancy among American Indian, Hispanic, and African American women in Wisconsin were up to 3 times greater than the national averages for each group. The incidence of prenatal smoking among low-income women in Wisconsin is also alarming. In 1998, 29% of Wisconsin women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) and 40% of pregnant Wisconsin women in Medicaid HMOs were smokers. Because of these startling statistics, the Wisconsin Women's Health Foundation began looking for ways to help pregnant women stop smoking. We collaborated with the State Division of Public Health, Bureau of Family and Community Health, and Innovative Resource Group (IRG) to develop a smoking cessation program for pregnant women called "First Breath." With funding from the Wisconsin Tobacco Control Board, First Breath became a reality in December 2000. First Breath utilizes a comprehensive strategy to attack smoking during pregnancy. First, when women attend their Prenatal Care Coordination (PNCC) and WIC appointments at one of our 8 pilot sites (see sidebar) they receive intense smoking cessation counseling along with self-help and educational materials. Packets that contain information about the dangers of second-hand smoke and supporting each woman's effort to quit are also available for family members. The staff at our pilot sites contacts each woman's primary care physician, OB/GYN, and pediatrician (if she has older children). This is to inform them of their patients' involvement in First Breath, to ensure that they offer these women additional support and advice, and to make certain they feel comfortable referring other eligible women to the program. First Breath features local support groups at each pilot site. They vary across the state, from groups conducted in Spanish to groups on Native American Reservations, and from groups meeting at WIC sites, to groups of teens meeting at schools. The social support afforded by these groups is tailored to meet the needs of each population participating in First Breath. Women involved with First Breath are surrounded by different types of support and repeatedly receive the message that they can successfully quit smoking. It is this multi-disciplinary, encompassing approach that makes First Breath so promising. As the public health nurses involved in the program can attest, each woman attending her WIC or PNCC appointment wants to be the best mother she can be. Our approach is to capitalize on that motivation and point women to resources that will help them succeed. First Breath emphasizes that there is help available to women who want to quit and encourages them for each small achievement, even if it is only smoking one less cigarette per day. We have already experienced progress in First Breath's charter year. In late February, we conducted training in Stevens Point that was attended by public health nurses and dieticians from each pilot site. We provided education on in-depth, research-supported smoking cessation counseling strategies, traditional uses of tobacco in the Native American culture, and the physiological effects of nicotine. Mid-March, we embarked on a kick-off tour, holding press conferences and touring each site. The media interest in First Breath was remarkable, and we hope the attention will help us recruit more eligible women. At this point, we are adding new sites in Madison and Milwaukee, enrolling women in the program at each pilot site, distributing culturally sensitive materials, and building relationships with organizations and individuals who share our vision. First Breath is a very exciting initiative and we want to thank those who have made it possible. With the help and cooperation of other health care organizations and providers, we will be able to reduce the number of Wisconsin women who smoke during pregnancy and, in the long term, improve the health of newborns. However, the success of First Breath hinges on continuing to build partnerships with local and state leaders who share our vision of smoke-free, healthy pregnancies. We are excited to watch our program grow and to help make each baby's first breath a healthy breath.

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