Every month, Cynthia Edwards breathes through a machine that can tell if she’s been smoking. If the machine registers a low enough number, she takes home a $25 voucher to help her pay for diapers for her five-month old son, Justus.
This voucher system is part of a program known as Baby & Me Tobacco Free. In 2013, Indiana became one of several states that use Baby & Me protocols, and so far the state has reported positive results. Of more than 400 participants, nearly three out of four were able to quit.
About one in six babies born in Indiana has a mother who smoked while pregnant. Maternal smoking can lead to a lot of problems--low birth weight, preterm birth, and asthma--and it’s linked to most leading causes of infant death. Last month, Indiana announced an initiative to reduce the number of children dying before their first birthday.
Laurie Adams is director of the national Baby & Me Tobacco Free organization. Adams says that while many cessation programs emphasize long-term reasons to quit, Baby and Me works by providing an immediate incentive: In addition to counseling, moms get monthly diaper vouchers for a year after giving birth, as long as they can pass the carbon monoxide test.
“We see these moms during the pregnancy phase four times at least, and then we see them 12 times a year,” says Adams. “There’s a theme there of constant encouragement, testing and being rewarded that is of value in those behavioral changes, and this program has done it differently than any other one out there.”
With the success of Indiana’s pilot sites, the State Department of Health will provide another round of funding for the program later this year, although there aren’t currently any plans to expand it as a statewide initiative.
The nicotine found in tobacco smoke is extremely addictive -- it ranks up there with heroin and cocaine -- so getting women to suddenly stop smoking can be difficult. Cynthia Edwards has a long history with nicotine to fight against. She’s 27 now, and she started smoking at age ten.
She eventually got up to three packs a day, and she smoked through her first two pregnancies. A few years later when she found out she was pregnant, she wanted to quit. But nicotine gum only seemed to feed her addiction, and she struggled.
“I really ran out of options,” says Edwards.
She told her doctor she needed help, and the doctor referred her to Jennifer Murphy, a health educator at the Marion County Department of Health who uses the Baby & Me protocols. Murphy says the vouchers aren’t always enough to overcome nicotine addiction—some women will go back to smoking. So part of her job is to provide support even after the baby arrives.
“If they're able to get back on track, I actually offer a little bit of grace because quitting is hard,” says Murphy.
One of the main topics Murphy confronts is how to deal with stress, which triggers the desire to smoke for some women.
“I always encourage them, even if you go smoke, the problem is still there,” she says. “And now you’ve done more damage in the long run than you would have if you had just sipped a cup of tea or used another coping mechanism.”
For Cynthia Edwards, one of those coping mechanisms is chewing gum. She uses it when her kids misbehave. But her kids are also a source of encouragement as she tries to stay tobacco free.
“My daughter told me ‘ Mommy, I’m glad you stopped smoking. I'm proud of you,’” says Edwards. “I was so ecstatic.”