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.
- 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.
- 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.
- 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 email@example.com.
- 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.