Tobacco control partnerships with family/maternal health programs – 8/25/09

Q: The Texas Tobacco Prevention & Control Program is looking at expanding our partnerships with our family and maternal health colleagues. The overarching goal is to reduce smoking among women so the partnerships may relate to secondhand smoke and cessation.

What are other states doing to target women, mothers, and children? I’m looking for examples of what other states may have done as it relates to partnerships with family planning, Breast & Cervical Cancer Control Programs and injury prevention (specifically car seat) programs.

A:

1. Alabama - Alabama hasn't specifically targeted these programs for separate interventions.
    
2. Iowa - The Iowa Department of Public Health has in the past partnered with our MCH program to implement systems change at all Planned Parenthood of Greater Iowa clinics.  Funded in part through a grant from ACOG and AMCHP, state staff trained health care providers in these clinics to implement Ask, Advise, Refer as a standard practice of care, chart tobacco use in the medical records, and conduct fax referrals to our state quitline.  For information you can contact Aaron Swanson at aswanson@idph.state.ia.us or Jerilyn Quigley at jquigley@idph.state.ia.us.
    
3. Illinois - Illinois is working with the Illinois Breast and Cervical Cancer Program and WISEWOMAN program to link participants directly to the Illinois Tobacco Quitline.
    
   During health assessments in each of these programs, once it is determined that the participant is a tobacco user and expresses a desire to quit (Transtheoretical Model/Stages of Change) a fax referral form is completed and faxed to the Illinois Tobacco Quitline (information about the referral is also documented in Illinois’ MIS system that collects the minimum data elements for those programs.)  The fax referral form includes participant contact information, best time of day to be contacted, and any comments that the healthcare provider may have about the appropriateness for pharmaceuticals (NRT, Chantix, Bupropion, etc.)  Once the Quitline receives the fax, the cessation counselor calls the participant and begins the enrollment process.
    
   The Fax Referral Form can also be “branded” with the logo of the referring agency or program.  The Quitline tracks the numbers of referrals made with each branded form, so that data can be returned to the program about numbers of participants that have followed through with cessation counseling.
    
   This has been a mutually beneficial partnership because calls to the Quitline have increased, the referring programs are addressing a need (yet they don’t have to be the experts in tobacco cessation), and the participants are one-stop shopping, essentially.
    
   Please see one version of the Illinois Tobacco Quitline Fax Referral Form. Other programs have branded the form as well (Statewide Diabetes Program, Local Health Departments, Community Based Organizations, etc.) The possibilities for partnership are endless!
    
4. Massachusetts - Massachusetts TCP has not worked with family planning or injury prevention programs recently, but we do partner with both the free breast and cervical cancer screening office as well as the WIC office to reach low income women.  These five year partnerships have focused on promoting free tobacco treatment counseling (w/o meds) to women via provider fax referrals to the state quitline.  We have seen steady referral rates over several years, though they are not as high as when we have had the opportunity to include NRT.
    
   We have had positive feedback from the Cancer and WIC offices and from the providers using the referral service.  Over the longer term, however, we believe it would be even more valuable to encourage our DPH partners to incentivize or possibly require their contractors to intervene with clients for tobacco.  This systems-level approach is really what would drive increased referrals and ultimately change provider practice around tobacco.
    
5. New Hampshire - New Hampshire is engaged in a quality improvement process using “plan-do-check-act.” Please see the attached blank sample documents, Performance Improvement Workplan and Plan Do Study Act Approach Worksheet. There is a real gap in understanding the US Public Health Service Guidelines, implementation and reporting as well as referrals made to the quitlines.
    
6. North Carolina - In North Carolina Division of Public Health, the Tobacco Prevention and Control Branch (TPCB) works with the Women's and Children's Health Section in several ways:
    
   We participate in WATCH (Women And Tobacco Coalition for Health). This is a multi-agency, multi-disciplinary coalition whose purpose is to share and disseminate information around women's health and smoking.  WATCH uses its collective synergy to broaden the efforts of existing programs to influence, advocate, and educate around women's health and smoking issues.  Representatives participating in WATCH include public health, non profits, academic and community organizations.  We recently participated in the WATCH subcommittee to advise on the grant funded You Quit Two Quit program found at www.youquittwoquit.com.
    
   We are working with the Women's Health Branch on a 5As documentation form that can be used for 5As/tobacco cessation and documentation for healthcare providers working with women and children in the local health departments, WIC programs, and with private providers. 
    
   We have also worked with the Women's Health Branch to update the Guide for Counseling Women Who Smoke and the DVD, Counseling From the Heart. 
    
   Currently, the TPCB, the Women's Health Branch and the Children and Youth Branch are meeting regularly to discuss producing a 5A’s/Stages of Change web based cessation training that the Women's Health Branch perinatal outreach coordinators conduct regionally.  This web based program will decrease the need for travel and make the training more widely available.
    
7. Virginia - The Virginia Tobacco Use Control Project has recently formed a partnership with the state WISEWOMAN program to promote use of the state tobacco quitline for enrollees who use tobacco and want to quit. TUCP provides educational materials and technical assistance to local administrators of the WISEWOMAN program.
    
   In addition, TUCP promotes the Quitline to Medicaid recipients, including pregnant teenagers. For FY 2009-2010, TUCP will receive state funds to expand eligibility for Quitline counseling services for youth ages 12-18 years. In the area of surveillance, the tobacco epidemiologist collaborates with the PRAMS Coordinator to analyze data on prenatal (and postnatal) use of tobacco.
    
8. Washington - Washington does have partnerships with the WIC program. Additional information is available upon request.
    
9. West Virginia - The West Virginia Bureau for Public Health’s Division of Tobacco Prevention maintain various and on-going activities with partners statewide to increase the knowledge that tobacco use has many adverse effects on women, mothers, and children.  This population is addressed with a variety of initiatives and programs at the community, regional, and statewide levels.
    
   Ten full-time regional tobacco prevention coordinators (housed throughout the State in lead agencies covering five county areas) assist in these local efforts.  One main goal of this network that assists with all tobacco-related disparities is passage of a comprehensive CIA regulation in each local health department.  Through these RTPCCs and their lead agencies, mini grants for specific community projects (many that deal specifically with women’s issues) are made available each year.
    
   Another overarching tobacco prevention network involves school-based Regional Tobacco Prevention Specialists, who mainly work in middle and high schools to facilitate our very successful, highly visible, and widely recognized Raze youth empowerment program.  Our main partners in the Raze program are the American Lung Association of WV and the WV Department of Education.  The school-based RTPSs are trained to provide technical assistance to specific special and minority populations.  Learn more about the RTPSs and raze at: www.razewv.com.
    
   Our main DTP’s Cessation Program goals are to address all residents tobacco use issues, educate users on the dangers of all forms of tobacco, and to provide successful ways to quit including using the Statewide Tobacco Cessation Quitline.  The WV Tobacco Quitline, administered by beBetter Networks of Charleston, has been in operation since July 2000, and it easily is one of the busiest per capita quitlines in the country (it has received well over 200,000 calls and enrolled more than 45,000 individuals, maintaining an impressive, successful quit rate for both smoking and spit tobacco use).  There is a specific program and quitline protocol for pregnant tobacco users.  More information is available here.
    
   Workplace initiatives through the Wellness Council of West Virginia (WCWV) reach a significant number of the family/maternal and minority-related populous throughout the State.  The WCWV is committed to positively impacting a workplace’s ability to succeed by improving the health and well-being of its most vital asset, the employee.  WCWV strives to demonstrate that a healthy workforce is a productive workforce and that with healthier workers, absenteeism declines, health benefit costs are lowered, and work satisfaction, recruitment and retention increases. Offering a variety of programs and services, including specific workplace training for tobacco prevention, cessation, and policy the WCWV is an essential partner for organizations seeking to contain health and disability costs, and improve worker health and productivity. Learn more about the WCWV at: http://www.wcwv.org/.
    
   West Virginia leads the nation in the number of women who report they smoke while pregnant.  The DTP maintains a Tobacco-Free Pregnancy Initiative to target these pregnant tobacco users with cessation education and services. The DTP also participates on the statewide Perinatal Partnership, and collaborates as much as possible with Medicaid on this issue (up to 90 percent of the pregnant smokers are of the Medicaid population).  The Tobacco Free for Baby and Me Program administered by the Charleston Area Medical Center-Women’s and Children’s Hospital is now in its third year of providing tobacco cessation counseling through its high-risk obstetrics clinic. The WVDHHR Office of Maternal Child and Family Health offers tobacco counseling during in-home visits through the Right from the Start network. The Day One Project offered by the WV Hospital Association is providing education on the dangers of second-hand smoke to new mothers and their families after the child is born.  The Women, Infants and Children (WIC) Office of Nutrition Services is partnering with DTP to distribute educational materials to those women who receive services through the 55 clinics throughout WV.  Click here to learn more about the Tobacco-Free Pregnancy Initiative.
    
   West Virginia DTP’s has done many media ads specific women; pregnant women; and families. Many of our award-winning media ads can be found online here. Specifically, look at the Tobacco-Free Pregnancy ad.
    
   Utilize these resources in any way you can and be in touch if we need to fill in any blanks on our on-going efforts! Kathy Danberry is able to respond to specific program questions, especially regarding to our women’s cessation projects, etc.

Back to Table of Contents