Evaluation studies for SCRIPP included 94% of the Medicaid-eligible pregnant smokers in Birmingham-area county prenatal health clinics.  Behavioral impact and cost-effectiveness analyses, supported by the National Institutes of Health, have been performed (Abstracts #1, #2, #3).  SCRIPP increases normal patient quit rates (Q) and significant reduction rates (SR) from 2% (Q) to 14%-20% (Q) and from 7% (SR) to 18%-30% (SR). 

The estimated cost benefit of dissemination to the Alabama Medicaid obstetrical cohort has been assessed (Abstract #3).  The potential behavioral impact of dissemination of these methods to the annual US birth cohort (Abstract #5) and associated clinical impact and excess health care costs for the 1990 decade have been evaluated (Abstracts #6, #7, #8).  Prevalence surveys by the Centers for Disease Control and Prevention identified substantial reductions in smoking rates among Alabama’s Medicaid-supported public prenatal patients:  white, 50% (1985) to 32% (1995); black, 25% (1985) to 7% (1995).  Two comprehensive meta-evaluations of smoking and pregnancy intervention studies confirm that SCRIPP is effective for Medicaid patients (Abstracts #4 and #8). 

According to the Institute of Medicine, every low birth weight infant averted saves $12,000 to $30,000 (1990 discounted inflation-adjusted estimate).  Sensitivity analyses applied to the annual Alabama and US Medicaid cohort indicate that for every $1 spent on SCRIPP smoking cessation methods for pregnant women, as estimated $7 to $17 in medical costs may be saved (Abstract #4). This cost reduction does not include the long-term direct and indirect emotional impact incurred by the family.  SCRIPP is one of the most efficacious and cost- effective methods available to achieve the Healthy People 2000 managed care health and tobacco prenatal goals for pregnant smokers. 

SCRIPP has also been tested and evaluated in North Carolina (Abstract #10), Florida, Michigan (Mayer 1990), Montana, Ohio, Kentucky, Massachusetts, and Washington, DC (Coates 1991), as well as in Sweden (Valbo 1991), Norway (Hjalmarson 1991); Australia and multiple Canadian provinces (O’Connor 1992).  The program is also being used by Healthy Start in Birmingham.  In 1996, a Robert Wood Foundation dissemination expert panel identified SCRIPP as one of five national programs recommended for routine use in prenatal care as "a best clinical practice method for pregnant smokers." 

REFERENCES 

Coates, D., Maxwell, J. (1990)  Lessons learned from the better babies project.  March of Dimes Birth Defects Foundation:  White Plains, NY. 

Mayer, J., Hawkins, B., Todd, R. (1990)  A randomized evaluation of smoking cessation interventions for pregnant women at a clinic.  American Journal of Public Health (80)76-78. 

Windsor, R., (1990)  The handbook to plan, implement and evaluate smoking cessation programs for pregnant women.  March of Dimes Birth Defects Foundation:  White Plains, NY. 

Hjalmarson, A.I.M., Hahn, L., and Svanberg, B. (1991)  Stopping smoking in pregnancy: effect of a self- help manual in a controlled trial.  British Journal of Obstetrics and Gynaecology (98)260-264. 

Valbo, W.F., Schioloborg, P (1991)  Smoking Cessation in Pregnancy, mode of intervention and effect.  Acta Obstet Gynecol Scand (70)309-313. 

O’Connor, A.M., Davies, B.L., Dulberg, C.S., Buhler, P.L., Nadon, C., McBride, B.H., and Benzie, R.J. (1992)  Effectiveness of a pregnancy smoking cessation program.  Journal of Obstetrics, Gynaecology, and Neonatal Nursing (21)385-392. 

Windsor, R. (4th Edition)  A Pregnant Woman’s Guide to Quit Smoking.  Ebsco Media Publisher (1990).