The objective of the Alabama Tobacco Free Families (ATOFF) Program, a multi-component, multi-channel health communications and policy change program, is to reduce the smoking prevalence rate among a representative sample of pregnant females whose maternity care is supported by Medicaid. This will be achieved by reducing the rate of females of childbearing age in eight targeted counties by changes in social norms. The proposed study is an extension of two decades of public health education studies conducted by the University of Alabama at Birmingham (UAB) tobacco research team in partnership with the ADPH's Bureau of Family Health Services (BFHS). ATOFF will expand this partnership to include the ADPH Bureau of Health Promotion and Information. It is designed to enhance the capacity of the state's Tobacco Use Prevention and Control Program (TUPC), funded by CDC in 1999. UAB and ADPH will implement statewide and local partnerships targeting females of childbearing age to be tobacco-free prior to and during pregnancy. ATOFF will be evaluated using a time series design and analysis with multiple, quarterly baseline and follow-up measures of prevalence across the eight targeted counties. Process and behavioral impact evaluations will be conducted. The four specific aims to be accomplished by the proposed study will be to: 1. Identify and select a representative sample of patients from a randomly selected sample of Medicaid-supported maternity care sites to serve as the ATOFF clinic population, and to recruit a representative sample of females (14-44) to participate in a telephone-based survey to serve as the ATOFF community cohort; 2. Develop and implement a multi-component, multi-channel program focused on females of childbearing age and their families in eight target counties and consisting of: (a) a mass media-health communications component, (b) a community organization component, and (c) a professional practice component; 3. Document the implementation success (process evaluation) of the media messages and community initiatives to change beliefs, behaviors, and social norms related to tobacco use among the samples of females in Aim number 1 by conducting clinical and community assessments in Years 01, 02, 03 and 04; and 4. Document, be self-reports and saliva continine tests, the effectiveness (impact evaluation) of ATOFF's program to reduce the prevalence among the clinic population at entry (first visit) into Medicaid maternity care, and by self-report via telephone of the females in the community population.
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