PROJECT SUMMARY/ABSTRACT: PROJECT 4 (SCHEUERMANN) Smoking is one of the leading causes of mortality in the United States. Pregnant women who smoke expose themselves and their babies to a myriad of known carcinogens and are at risk for poor pregnancy outcomes. Currently, smoking rates among pregnant women are 8% with even higher smoking prevalence among low- income women. Twelve percent of pregnant women enrolled in The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) smoke. Low-income pregnant women are also less likely to quit. Even though guidelines recommend treating tobacco use among pregnant women, most pregnant smokers do not receive smoking cessation counseling and only one in 10 receive referrals to cessation services or follow-up care. WIC clinics are an ideal venue for initiating smoking cessation interventions for pregnant women. WIC serves approximately 40% of pregnant women and clinics have existing data systems to routinely document tobacco use. Effective smoking cessation interventions have been developed for pregnant women but quit rates are modest. Only a few intervention studies have focused on pregnant women enrolled in WIC, and one achieved significant, biochemically verified quit rates. Efforts to implement smoking cessation interventions programs in WIC show low sustainment and barriers such as time constraints among WIC staff and lack of referral resources and educational materials. The goal of this research is to develop and evaluate a novel smoking cessation intervention for initiation in WIC clinics that enhances text message cessation support with remotely delivered incentives. Developing an effective and scalable intervention for the WIC context could improve health equity for low-income women. We will use implementation science in planning our intervention by conducting formative studies to ensure feasibility and acceptability among WIC stakeholders. First, we will conduct interviews to determine end-user perspectives on the intervention and implementation strategies and identify adaptations to the intervention prior to implementation, using the FRAME framework to catalogue adaptations. In Aim 1, we will interview 15 pregnant current and recent smokers including both English and Spanish-speaking women enrolled in WIC. In Aim 2, we will conduct 12- 15 interviews with WIC staff key informants to elicit suggestions and feedback for modifications to the intervention and implementation plan. Based on stakeholder input (Aims 1 and 2), we will adapt our intervention and finalize our implementation plan and toolkit for our pilot trial (Aim 3). In our pilot trial we will determine the feasibility, acceptability, and preliminary effectiveness of the text message + incentives intervention with a sample of 50 pregnant smokers enrolled in WIC. We will employ a randomized controlled trial design with a text-message only control. This research program will impact the field by developing a scalable interv...