Working with WIC offices to increase access to smoking cessation services – 11/15/11

Q: Vermont would like information about other states’ and territories’ efforts to work with WIC offices to develop systems to intervene with pregnant women who smoke and make referrals to their quitline. If your tobacco control program has worked in partnership with the WIC program to promote smoking cessation services,

• Please describe any programming you’ve implemented, especially referral programs.
• Please share any protocol documents that you’ve used with your WIC offices.

A:

1. California: In 2010, the California Smokers’ Helpline (CSH) launched a new partnership with the Public Health Foundation Enterprises Women Infant Children’s Program (PHFE-WIC) which serves over 320,000 clients each month at 62 centers throughout Los Angeles and Orange Counties.At the initial face to face screening with WIC applications, WIC counselors proactively identify pregnant smokers and offer them one of three referral options to the CSH:
    
   • a warm transfer to the CSH via a dedicated toll free number 1 800-987-2908
   • a fax referral, or a
   • gold card which provides the toll free numbers to the CSHincluding hours, website, and motivational messages
      
   The CSH coordinates reports of pregnant smokers identified by WIC and referrals to the Helpline on a quarterly basis.The CSH counselors are caring professionals trained in tobacco treatment.
    
2. Indiana: After meeting with the state Director of WIC and the Director of Nursing for WIC, we were given approval to present the Indiana State Quit Now Preferred organization program to the WIC field Steering Committee.The program included enrolling each WIC clinic statewide as a preferred organization.This enrollment allows inclusion of each clinic in the tobacco network. They would receive the support of individual tobacco specialists in their local communities who would support them in many ways such as staff training, etc.; they would become a part of the fax referring network to the Indiana Tobacco QuitLine which allows unlimited fax referral of their participants; they also qualify for free cessation materials and full access to the entire program. If the clinic is uncomfortable or does not have access to fax machine they supply the 1-800-QUIT-NOW information and are encouraged to call.
    
   Protocol documents were not necessary; special PowerPoint presentations were developed for comfort and acceptance from clinic staffs.
    
3. New Mexico: The New Mexico WIC Program provides quality nutrition education and health cooking classes.The program initiates promoting physical fitness and healthy living to all of its participants. The WIC Program provides services to pregnant women, women who have had a baby in the past six months, and parents, step-parents, guardians and foster parents of infants and children under 5.
    
   All WIC offices in the Region 4 area require an initial certification to its clientele.This initial intake includes several questions about tobacco use and is utilized during trimesters 1, 2, and 3.If the mother indicates that she currently uses tobacco or used tobacco products 3 months prior to finding out that she was pregnant, then it is required that she is referred to a local cessation program or 1-800-QUIT NOW.Prior to FY12, the WIC Program referred clients to an educational class.The educational class consisted of one of the following:attend a TUPAC contractor presentation, watch a secondhand smoke film or take part in a discussion with the WIC nutritionist regarding the effects of tobacco use and secondhand smoke.
    
   In FY11, WIC services were provided to approximately 11,653 participants in Region 4.Each participant is asked about tobacco use a minimum of four times.Originally, the questions only referred to the mother smoking.Recently, a question was added about secondhand smoke exposure in the home.
    
   In FY09 and FY10, the TUPAC contractors provided the education classes and updated DVD’s to the WIC Program in the county in which they were providing services.Also, in FY10 and FY11, the Roswell Regional Hospital Labor and Delivery Unit and Region 4 TUPAC Program began collaborating.Recently, the WIC Program joined in this effort.Approximately 80 women give birth each month and each new mom receives a diaper bag provided by the hospital and includes a “Tender Lungs at Work – Thank you for not Smoking in my Home and Car” bib, a Secondhand Smoke and your Baby Fact Sheet, 1-800-QUIT NOW magnet, WIC Breastfeeding Program brochure, breastfeeding at work information card, and a Pregnancy Risk Assessment Monitoring System (PRAMS) brochure.
    
   Future goals are to provide up-to-date educational DVD’s to each WIC office, provide 1-800-QUIT NOW cards and/or informational packets to each WIC office for each participant that has been determined to need the referral.Another goal is to expand this collaboration statewide.The WIC Program has quarterly meetings within each region for its staff.This would be a good opportunity for the TUPAC program to present information about our efforts, 1-800-QUIT NOW services offered, and the collaboration between both programs.Also, brief intervention training could possibly be provided to the WIC program staff during that time to begin the collaborative effort on a wider scale.
    
4. South Dakota: The state of South Dakota’s Department of Health (SD-DOH) is probably structured quite differently than Vermont’s. The state of SD only has one local health department in our state and no county health departments. The SD-DOH provides staff for County Health Offices (CHO), and the county provides office/clinic space and clerical support staff. So the WIC staff in each of the CHOs are actually employees of the SD-DOH. Our Office of Community and Family Health is where the WIC program is housed, and they are located in the same division as we are.
    
   That being said, every one of the CHO staff has received training about the SD-QuitLine, and how to refer their clients to it. Each office has fax referral forms and is able to refer tobacco users to the SD-QuitLine. Ask, Advise and Refer training was given to all staff; where the point was reinforced that 80% of pregnant women who quit smoking during their pregnancy will relapse and begin smoking at some point after the baby has been born. Since we don’t know when the relapse will occur, we can’t assume that the mother is still quit and that is why it is critical to ask about tobacco use at each and every interaction.
    
   The CHO is also where our Community Health Nurses (CHN) are located and they’ve also received AAR training and use the same protocol with all their clients. Due to rural nature of our state, and the distances between providers, many mothers also get their child immunizations from our CHN’s, so CHO staff have plenty of interactions and opportunities to refer to the SD-QuitLine.
    
5. Washington:Our approach with WIC was primarily with secondhand smoke and secondarily with cessation because SHS exposure was the measure that they had identified as the one they needed to address.
    
   The attached sticky note pads are used for WIC baby checks to record vital statistics of the baby.Moms often put these on the refrigerator to show how their child is doing. These items have been very popular with WIC folks and we go through them quickly.The tobacco program no longer oversees their distribution, with WIC distributing them directly now.
    
   The material was translated into Spanish so it’s English on one side and Spanish on the other side.

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