Implementing the 5 A’s with pregnant women – 10/14/05

Q: We are working with local health departments to try to impact smoking rates among pregnant women (and post-partum). I'm interested in getting feedback from other states on innovative interventions that have produced results. We have implemented the 5A's — or similar in to WIC and prenatal clinics, and are now looking for interventions beyond that.

A:

1. Alabama: Alabama Tobacco Division has collaborated with Perinatal coordinators for the State of Alabama to conduct 5A’s training with OBYGN’s/GYN’s around the state. The coalition for a Tobacco Free Alabama has received a grant for EPA and are in the process of implementing a program where they will provide baby wipes (tub) with dangers of secondhand smoke information to new mothers (especially those who smoke or smoked before becoming pregnant).
   
   Alabama has also implemented a fax referral system for their Quitline. Steps for referring a patient, training contact information, and forms are in the process of being printed and will be mailed to over 4,000 physicians that are members of the Medical Association for the State of Alabama (MASA). IQH, Alabama’s Quitline vendors plans on attending the MASA conference in mid 2006 to conduct training on the fax referral system.
   
   
2. Florida: Florida Department of Health (DOH) has a number of activities aimed at reducing prenatal smoking. Pregnant women are asked on the Healthy Start Prenatal Risk Screening Instrument to self identify if they have smoked during pregnancy. Those who say they smoke are eligible for Healthy Start smoking cessation services. The number of women receiving these services rose from 5,155 women in 2003 to 5,839 in 2004. The guidelines for providing these services are in Chapter 10 of Healthy Start Standards and Guidelines.
   
   In June 2004, four regional trainings were provided using the Make Yours A Fresh Start Family model of prenatal and postnatal tobacco cessation. Over 100 CHD and Healthy Start staff received the training including at least two people from each Healthy Start coalition who were trained as trainers. At least one person from each county was trained to be a trainer. DOH unit teamed with the Florida AHEC Network on three Spring 2005 initiatives to promote further prenatal smoking cessation. There were ten in person trainings for public and private sector prenatal care providers in each of the 10 AHEC regions which were attended by over 360 providers. There were 2 web enhanced audio teleconferences engaging 432 participants.
   
   The DOH and the AHEC network combined resources to run a two week prenatal smoking cessation media campaign targeting the eight counties with the highest rates of smoking during pregnancy. PSAs were broadcast on 18 radio stations and 19 television stations throughout Florida. The television and radio stations targeting these counties reached 38 of Florida’s counties. The campaign reached an estimated 510,746 women between the ages of 18-34. The stations internet sites also included tobacco cessation banners. Fifty-eight pregnant women called the Quit for Life Line during the time these ads ran compared to 1 pregnant caller during the previous 2 weeks.
   
   Prenatal smoking data and smoking cessation services for pregnant women are reviewed during Maternal and Child Health Quality Improvement visits with county health departments and Healthy Start coalitions. When prenatal smoking rates are higher than the state average or are rising, the chd or coalition develops and implements a corrective action agreement. Other technical assistance is ongoing as needs are identified or as requested. Those wishing to quit smoking can also get help by calling the Florida Quit-For-Life Line toll-free at 877-U CAN NOW. The hotline is available in English, Spanish, and TDD for the hearing impaired. The County Health Department Guidebook includes a technical assistance guideline on "Smoking Cessation Guidelines for Men and Women of Reproductive Age." The Infant, Maternal and Reproductive Health unit routinely updates county health department smoking cessation contacts on new resources and effective tobacco cessation strategies.
   
   
3. Hawaii: The folks at the HealthCare Partnership at the University of Arizona have developed a great basic tobacco intervention skills training program for WIC staff working with perinatal populations. It is both health professional and community outreach staff friendly. The contact person is Louise Strayer at lstrayer@u.arizona.edu.
   
   
4. Illinois: We have an ongoing partnership with the WIC/Family Case Management programs, Department of Human Services and Healthcare and Family Services (formerly known as Public Aid) to use a fax referral program for promotion of the Illinois Tobacco Quitline. A letter was also mailed to all the Public Aid Providers to introduce the Quitline services, referral form and reimbursement procedures for smoking cessation products covered by Public Aid.