Tobacco remains the leading cause of preventable deaths in the United States. Since 1991 the Robert Wood Johnson Foundation has given high priority to reducing smoking, expending more than $142 million on a wide range of tobacco-control activities. The Foundation's efforts were singled out by Joel Fleishman in his book The Foundation: A Great American Secret, as one of 12 foundation-driven initiatives that have achieved high impact.
Previous volumes of the Anthology have featured 10 chapters on the Foundation's tobacco-control work. In this chapter, Fen Montaigne examines a single program, Smoke-Free Families, which was designed to find ways to help pregnant smokers quit. Set in the context of a clinical guideline issued by the U.S. Public Health Service recommending ways (called the 5 A's) that physicians can help their patients stop smoking, the Smoke-Free Families program funded research on counseling techniques and other ways to motivate pregnant women to stop smoking; demonstration programs to test apparently effective methods; and broad dissemination of methods that have been shown to be workable, so that they become a standard component of prenatal care.