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Addressing Substance Abuse in Pregnancy: Opportunity for Change. Jeanne Mahoney Director, Provider’s Partnership American College of Obstetricians and Gynecologists 2005. Overview. Why group tobacco and substance use together? Epidemiology / costs Interventions that work

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addressing substance abuse in pregnancy opportunity for change

Addressing Substance Abuse in Pregnancy:Opportunity for Change

Jeanne Mahoney

Director, Provider’s Partnership

American College of Obstetricians and Gynecologists

2005

overview
Overview
  • Why group tobacco and substance use together?
  • Epidemiology / costs
  • Interventions that work
  • Involving health care providers
tobacco and substance use
Tobacco and Substance Use
  • Women unable to give up smoking during pregnancy are at great risk to use/abuse alcohol and other drugs
  • Tobacco is an addictive substance. Intervention for tobacco use similar to alcohol and drugs
  • Both issues best addressed in preconception period – distinct effects early in fetal development and through entire pregnancy
slide4
Smoking is the single most important modifiable cause of poor pregnancy outcomes in the United States(Orleans , 2000)
prevalence of prenatal tobacco use
Prevalence of prenatal tobacco use
  • Varies by state
    • Highly dependent on tobacco taxes and regulations.
  • Varies by race/ethnicity
    • American and Alaskan natives greatest use
  • Varies by age
    • Teen rate highest rate in early pregnancy
    • Women over 35 highest rate of continued smoking
public health results of perinatal tobacco use
Public Health Results of Perinatal Tobacco Use
  • Annual smoking-attributable health care costs at delivery for problems caused by smoking during pregnancy - $366 million in 1996
  • 2/3 of these babies were born to mothers on Medicaid
  • About $704 per maternal smoker

CDC, 2003

national perinatal tobacco initiatives
National Perinatal Tobacco Initiatives
  • Partnership to Help Pregnant Smokers Quit
  • Great Start Quitline
  • March of Dimes
  • Partnerships
  • ACOG Training Programs
partnership to help pregnant smokers quit
Partnership to Help Pregnant Smokers Quit
  • Developed by SmokeFree Families and supported by RWJF
  • 60 national organizations involved
  • 6 work groups
  • Products:
    • Medicaid tool kit
    • Worksite tool kit
    • Legislative attention
    • Campaigns for Native American smokers
great start quitline
Great Start Quitline
  • Supported by American Legacy Foundation
  • Tied into state and (soon) national quitlines.
  • Does proactive and responsive counseling
  • Developing a postpartum relapse prevention program
march of dimes
March of Dimes
  • All chapters involved in perinatal tobacco initiatives
  • Most include hospital grand rounds, provider and OB staff training and public health fairs
  • Have developed medical briefs on perinatal smoking
tobacco partnership initiatives
Tobacco Partnership Initiatives

AMCHP, PPFA and ACOG state partnership teams – 10

  • Funded by CDC and WTPN
  • Involve team development and planning
  • Have succeed in state policy changes, provider training, resource identification and collaboration.
acog tobacco provider partnership nevada
ACOG Tobacco Provider Partnership - Nevada

Example – Nevada Smoke Free Babies

Who - Public health and ACOG previous collaboration

Why – High rate of perinatal smoking

Catalyst - New Quit-line – Pending legislation

Result – Statewide diverse team, passed tax legislation, received grant funding for perinatal demonstration project

acog materials
ACOG Materials
  • Tool kit for clinicians to counsel on perinatal smoking
  • Lecture guide/CD ROM to teach counseling
  • Chart stickers
  • Patient workbook
  • Pregnancy and Beyond – virtual clinic tutorial CD ROM (Dartmouth University)
slide14

Perinatal Substance Abuse

Fetal alcohol syndrome (FAS) is the most common preventable cause of mental retardation. It is 100% preventable.

Women rarely abuse single substances, those who abuse illicit substances frequently use alcohol and or tobacco.

fasd prevention
FASD Prevention
  • Surgeon General’s Report
  • CDC’s stronger messages
  • Initiatives involving Women’s Health Care providers
involving ob gyns in tobacco and sa initiatives
Involving OB/GYNs in Tobacco and SA Initiatives

Why

  • Direct access to patients
  • Strong legislative voice for policy change
  • It takes a physician to reach a physician

How

  • Schedule meetings early in AM, lunch time, evening
  • Patch in clinician on conference call
  • Tighten up process
  • Use clinician as an advisor
slide17

Contact information

Jeanne Mahoney

Director, Provider’s Partnership

ACOG

409 12th Street, SW

Washington, DC 20024

202-314-2352 FAX 202-484-3917

[email protected]

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