Background:
Clean Air for Babies is a Global Bridges project to reduce smoking in pregnancy in a healthcare organization, 'Meuhedet', with 1.2M members. One aim is empowering health professionals to provide brief smoking cessation interventions. In this study we assessed the effectiveness of an education program for nurses and ultrasound technicians.

Methods:
The program consists of 8 hours, and includes smoking and ETS effects during pregnancy, practical tools and behavioral interventions. Evaluation includes before and after questionnaires based on Global Bridges tools, and focus groups. We are at the initial stage of analysis. We will conduct another round of questionnaires 3 months post intervention.

Results:
We conducted 6 courses for 120 maternal health nurses and 60 technicians. Qualitative analysis demonstrates ambivalence regarding ability to intervene (“This will damage the therapeutic space”) and identification with smokers (“I have seen how difficult it is to stop, my husband became unbearable.”). A second theme was hesitance in approaching Muslim or Jewish-Orthodox spouses due to gender-based hierarchies in the cultural context (“In our culture it is hard for the women to tell a man what to do…"). A common theme among technicians was insecurity regarding their role in smoking cessation.
We completed analysis of 29 nurses´ questionnaires pre and immediately post intervention. Using paired-t-test analysis we found a significant improvement in the level of knowledge (mean knowledge items 3.27 to 4.38 on a scale of 5, p< 0.001). No difference was found in self efficacy or reported behavior.

Conclusions:
Initial results indicate that it is possible to identify specific barriers among caregivers that create resistance to smoking cessation interventions. Addressing them creates an opportunity for real organizational change. The improvement in knowledge is indicative of the appropriateness of the training sessions. We expect that improvement in self efficacy and reported behavior at the 3 month evaluation.