Kansas public health nursing and maternal child health annual conference may 3 5 2005
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Kansas Public Health Nursing and Maternal Child Health Annual Conference May 3 – 5, 2005 PowerPoint PPT Presentation

Kansas Public Health Nursing and Maternal Child Health Annual Conference May 3 – 5, 2005. Treating Tobacco Use During Pregnancy and Beyond: The “ 5 A ’ s ” Becky Tuttle, MA Outreach Coordinator Tobacco Use Prevention Program Kansas Department of Health and Environment.

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Kansas Public Health Nursing and Maternal Child Health Annual Conference May 3 – 5, 2005

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Kansas public health nursing and maternal child health annual conference may 3 5 2005

Kansas Public Health Nursing and Maternal Child Health Annual ConferenceMay 3 – 5, 2005

Treating Tobacco Use During

Pregnancy and Beyond: The “5 A’s”

Becky Tuttle, MA

Outreach Coordinator

Tobacco Use Prevention Program

Kansas Department of Health and Environment

Kansas Tobacco Quitline 1-866-KAN-STOP


Ways to help pregnant smokers quit

Ways to Help Pregnant Smokers Quit

  • Offering help through the healthcare system

  • Use of media

  • Research, evaluation, and surveillance

  • Policy

    • Price of tobacco products

    • Reimbursement for treatment

    • Tobacco-free environments

    • Community and worksite interventions


Spontaneous quitting and maintenance of cessation

Spontaneous Quitting and Maintenance of Cessation

Research has helped us to identify those most likely to quit on her own:

  • Higher income/education

  • Married or have partners

  • Having first child

  • Having a wanted pregnancy

  • Entering prenatal care early


Spontaneous quitting and maintenance of cessation1

Spontaneous Quitting and Maintenance of Cessation

Research has helped us to identify those most likely to quit on her own:

  • Experiencing nausea during first trimester

  • Intending to breastfeed

  • Are light to moderate smokers

  • With fewer smokers in their social circle

  • With stronger belief that smoking can harm their developing baby


The 5 a s approach to tobacco cessation

The “5 A’s” Approach to Tobacco Cessation

  • A 5-step tobacco intervention proven effective for pregnant women

  • Consistent with the strategies developed by the National Cancer Institute, the American Medical Association and others

  • Adapted for pregnant women by ACOG


Intervention makes a difference

Intervention Makes a Difference

  • Smoking cessation intervention by clinicians improves quit rates

  • Brief counseling (5 to 15 minutes total) is all that is needed to help many pregnant smokers quit

  • A woman is more likely to quit during pregnancy than at any other time in her life


Conclusions for behavioral intervention studies

Conclusions for Behavioral Intervention Studies

  • Pregnancy is a good time to intervene

  • Brief counseling works better than simple advise to quit

  • Counseling with self-help materials offered by a trained clinician can improve cessation rates by 30% to 70%

  • Intervention works best for moderate (less than 20 cigarettes per day) smokers


The 5 a s

The “5 A’s”

  • Askabout tobacco use

  • Advise to quit

  • Assess willingness to make a quit attempt

  • Assist in quit attempt

  • Arrange follow-up


Step 1 ask 1 minute

Step 1: Ask – 1 Minute

Which of the following statements best describes your cigarette smoking?

  • I have never smoked or have smoked fewer than 100 cigarettes in my life.

  • I stopped smoking before I found out I was pregnant and am not smoking now.

  • I stopped smoking after I found out I was pregnant and I am not smoking now.

  • I smoke some now but have cut down since I found out I was pregnant.

  • I smoke about the same amount now as I did before I found out I was pregnant.


Step 2 advise 1 minute

Step 2: Advise – 1 Minute

Clear, strong, personalized advise to quit

Clear: “My best advise for you and your baby is for you to quite smoking.”

Strong: “As your clinician, I need to you to know that quitting smoking is the most important thing you can do to protect your baby and your own health.”

Personalized: Impact of smoking on the baby, the family, and the patient’s well being.


Step 3 assess 1 minute

Step 3: Assess – 1 Minute

  • Asses the patient’s willingness to quit within the next 30 days.

  • If a patient responds that she would like to quit within the next 30 days, move on the Assist step.

  • If a patient does not want to try to quit, use the “5 R’s” to try to increase her motivation.


Step 4 assist 3 minutes

Step 4: Assist – 3+ Minutes

  • Suggest and encourage the use of problem-solving methods and skills for tobacco cessation.

  • Provide social support as part of the treatment.

  • Arrange social support in the smoker’s environment.

  • Provide pregnancy-specific self-help smoking cessation materials.


Strategies some women find helpful

Strategies Some Women Find Helpful

  • Set a quit date within 30 days

    and sign a contact.

  • Develop approaches to manage withdrawal systems

  • Remove all tobacco

    products from her home

  • Decide what to do in situations in which she usually smokes


Step 5 arrange 1 minute

Step 5: Arrange - 1+ Minute

  • Follow up to monitor progress and provide support

  • Encourage the patient

  • Express willingness to help

  • Ask about concerns or difficulties

  • Invite her to talk about her success


Patients who decline to quit

Patients Who Decline to Quit

Using the “5 R’s”

  • Relevance

  • Risks

  • Rewards

  • Roadblocks

  • Repetition


The 5 r s rewards

The “5 R’s” - Rewards

  • Your baby will get more

    oxygen after just one day

  • Your clothes and hair will smell better

  • You will have more money

  • Food will taste better

  • You will have more energy


The 5 r s roadblocks

The “5 R’s” - Roadblocks

  • Negative moods

  • Being around other smokers

  • Triggers and cravings

  • Time pressures


Overcoming roadblocks negative moods

Overcoming Roadblocks:Negative Moods

  • Suck on hard candy

  • Engage in physical activity

  • Express yourself (write, talk, etc.)

  • Relax

  • Think about pleasant, positive things

  • Ask others for support


Overcoming roadblocks other smokers

Overcoming Roadblocks:Other Smokers

  • Ask a friend or relative to quit with you

  • Ask others not to smoke around you

  • Assign nonsmoking areas

  • Leave the room when others smoke

  • Keep hands and mouth busy


Intervention effectiveness

Intervention Effectiveness

The “5 A’s” counseling approach can increase quit rates among pregnant smokers by 30% to 70%.


Postpartum relapse prevention

Postpartum Relapse Prevention

Predictors of Relapse

  • Concerns about weight gain

  • Intention to quit and self-efficacy

  • Intention to breastfeed

  • Smoking behavior of family and friends


Postpartum relapse prevention1

Postpartum Relapse Prevention

Strategies

  • Focus on benefits of quitting for women

  • Highlight harms associated with secondhand smoke for baby

  • Begin relapse prevention counseling and skill building toward the end of pregnancy


Questions

QUESTIONS???

CONTACT INFORMATION:

Becky Tuttle, MA

Outreach Coordinator

Tobacco Use Prevention Program

Kansas Department of Health and Environment

130 South Market, Suite 6050

Wichita, KS 67202

316.337.6056

[email protected]


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