Smoking Control in Maternal Child Health Clinics: Dissemination Strategies


The purpose of this study is to evaluate two strategies to disseminate the IT'S TIME smoking cessation program and the AHCPR guidelines to maternal and child health (MCH) public health clinics. The smoking cessation program was previously tested in public health clinics, is consistent with the AHCPR guidelines, and provides protocols and tools to facilitate guidelines application. Two Illinois Public Health and Human Services agencies will serve as influential intermediaries for the program dissemination. The dissemination strategies to be tested are: a) 'academic detailing' or outreach visits (Soumerai, 1990), and b) access to a centralized telephone counseling service.

Effectiveness of these strategies will be assessed in a randomized experimental design with baseline and experimental phases, three study groups:

  1. The usual train-the-trainer event (control);
  2. Centralized counseling service;
  3. Both academic detailing and centralized counseling service and 18 local health departments (6 per study group).

Effectiveness will be measured on the following outcomes:

  1. Degree of implementation of the program's office tools to promote delivery of interventions to patients (chart reminder system and intervention documentation);
  2. Degree to which the program's intervention components are delivered to patients (percent of eligible patients who receive interventions, how many of the multiple recommended components are received, and how many completed an adjunct counseling component).

Program impact will be assessed by analysis of the effect of exposure to intervention on smoking cessation outcomes among smokers seen in the clinics. To help explain the above outcomes, health care providers at the study sites will be surveyed before and after program dissemination to assess predisposing, enabling and reinforcing factors regarding smoking cessation interventions with their patients. Cost/effectiveness analysis will be conducted relative to the effect of the dissemination strategies in producing better: a) program implementation, and b) smoking cessation outcomes.

Research Partner(s)

Illinois Department of Public Health
Illinois Department of Health Services
Cook County Bureau of Health Services and other county health departments in Illinois

Funding Agency

U.S. Department of Health and Human Services, Agency for Health Care Research and Quality (Grant No. 1R01 HS10544-01A1)

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About this grant

This study was completed in 2004. The principal investigator was Clara Manfredi, PhD; the co-investigators were Myrtis Sullivan, MD, MPH, Surrey M. Walton, PhD, and Richard B. Warnecke, PhD.

Related publications

Manfredi C, Cho YI, Warnecke R, Saunders S, Sullivan M. Dissemination strategies to improve implementation of the PHS smoking cessation guideline in MCH public health clinics: Experimental evaluation results and contextual factors. Health Educ Res. 2011 Apr;26(2):348-360. [See abstract.]