Falling Through the Cracks of Early Intervention and Prevention: Missed Smoking Cessation Referrals for Mothers in Early Head Start


  • Elyse Shenberger
  • Katherine Zinsser




smoking cessation, pregnancy, Early Head Start, referrals


Introduction. Smoking rates have decreased overall but smoking during pregnancy remains a challenge with impacts to mother, child, and family. Referrals are a critical component in accessing cessation, yet research identifies several barriers to access. Early Head Start (EHS) is one avenue for referrals, and we wanted to understand which characteristics describe those who have received prenatal smoking cessation referrals from EHS. Methods. This project utilized secondary data from the EHS Family and Child Experiences Study (N = 144). We conducted three hierarchical logistic regressions based on the following characteristics pulled from the literature—demographics (e.g., race, ethnicity, age, education, marital status, and partner at home), smoking behavior, and accessibility (e.g., language, location, siblings in EHS, length of time (LOT) in EHS, and program type)— removing non-significant variables at each stage of the hierarchy. Results. Results indicated no significant differences in referral rates across demographics (ps > .32). Results also showed smoking during pregnancy predictive of referral receipt (OR = 10.35, p < .05). Lastly, results showed longer LOTs with EHS (OR = 4.41, p < .01) and siblings in EHS (OR = 10.98, p < .05) significantly associated with referral receipt. Discussion. We found equity among referrals, consistent with EHS’s anti-racist foundation. We found mothers only reporting smoking history were missed. Finally, we found when EHS knows about a pregnancy, either from early referral to EHS or from other children receiving services, the referral mechanism is most successful. Future work should include an emphasis on recruiting earlier in gestation.