Campaign To Reduce Smoking In Young Women In Bartholomew County

1. Campaign To Reduce Smoking In Young Women In Bartholomew County QUIT NOW ASK HOW 376-5033 Presented by: Peggy Voelz, Coordinator of Tobacco Prevention Programs For Bartholomew County

2. Overview • Indiana’s and Bartholomew County’s Toll • Complications during Pregnancy • Health of Unborn Child and Young Child • Bartholomew County’s Approach to the Problem • Successes, lessons learned….the ongoing story

3. Indiana’s Toll...babies are smoking and not by choice! • 18% of women in Indiana smoked during pregnancy • 17% in Bartholomew County • 64 of Indiana’s 92 counties have a smoking during pregnancy rate higher than the Indiana average • Indiana ranks 2nd in the nation for smoking! • 39% of 18-24 year olds smoke in Indiana

4. Women’s Fertility • More difficulty becoming pregnant • Higher risk of never becoming pregnant • Greater chance of complications during pregnancy • Premature birth • Low Birth Weight (LBW) Infants • Stillbirth and Infant Mortality

5. Health of Unborn Child • Low Birth Weight-babies of smoking mothers often weigh less than 5.5 pounds. • LBW babies have less muscle mass and more fat. • Nicotine constricts blood vessels in the umbilical cord and womb thus reducing the amount of oxygen and blood to the baby. • Some association with increased risk of oral clefts and infantile colic.

6. Health of Infants & Young Children • Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a Class A carcinogen, known to cause cancer in humans. • SIDS-Sudden Infant Death Syndrome. Infants exposed to secondhand smoke after birth have double the risk. Babies of mothers who smoke before and after birth are 3 to 4 times more likely to die from SIDS.

7. Infants & Young Children (continued) • In the first two years of life, children exposed to secondhand smoke (SHS) have more than a 50% increased risk of bronchitis and pneumonia. • Infants and young children exposed to SHS have higher rates of asthma, increased severity of asthma attacks, ear infections, and respiratory diseases. • SHS can reduce the amount of Vitamin C, a disease fighting nutrient in children.

8. Additional Findings • The Surgeon General Reports: There is NO risk free level of exposure to secondhand smoke. • Secondhand smoke at home or work increase the risk of developing heart disease by 25 to 30 percent and lung cancer by 20to 30percent. • Breastfeeding-research has shown that smoking may contribute to inadequate breast milk production.. • Cervical Cancer-women who smoke have up to 4 times higher risk of developing cervical cancer.

9. Bartholomew County’s Healthy Communities Initiative –Sustained Success Through Local Community Partnerships • Passion • Commitment • Sustainability • Results Tobacco Awareness Action Team, a Healthy Communities Initiative since 1995…promoting healthy lifestyles

10. Community Smoking/Pregnancy Task Force • Summer of 2006 gathered key partners together to brainstorm solutions including: • Volunteers in Medicine Free Health Clinic • Bartholomew County Health Department • WIC • OB/GYN offices • Young Mothers Educational Development (YMED) • March of Dimes • Tobacco Awareness Action Team • Caring Parent Mentoring Program • Pregnancy Care Center

11. Action Items Generated by Brainstorming Session • Medical practices/OB offices want training to counsel patients • Other agencies who interact with pregnant women also want training • Tools to use in their conversations with pregnant women • A public awareness campaign • Coordinated effort by the Tobacco Awareness Action Team

12. Educate – Every Chance You Can Get The 3 C’s Campaign: Consistent Message – Quit Now, Ask How! Cover The Community: Publications (newspaper, editorials, Wellness brochures, websites, etc.) Convince Key Leaders: hospital leadership, legislators, community leaders

13. First Steps… QU T NOW ASK HOW 376-5033 Ask a patient –Do you smoke? Assess – Would you like to talk about quitting? Assist – Call 376-5033 for information about Tobacco Cessation Clinics and quitting. • In celebration of the Great American Smoke-out • Something bold – buttons and posters • Get the hospital on board. • Mass distribution to all medical offices/dental offices • Distribution to other agencies

14. QU T NOWASK HOW?376-5033 PLEASE WEAR A BUTTON Ask a patient –Do you smoke? Assess – Would you like to talk about quitting? Assist – Call 376-5033 for information about Tobacco Cessation Clinics.

15. Collaboration of Educational Opportunities with March of Dimes Columbus Regional Hospital- CME Smoking Cessation Interventions For Professionals Providing Healthcare To Women And Their Families Phillip N. Eskew, Jr., MD St. Vincent Hospital Wednesday, January 31st, 2007 12:00 noon to 1:00 pm – Kroot Auditorium

16. More Intensive Tobacco Cessation Counseling Training Facilitate the change by making it easy to participate in the trainings Offer intensive training to all medical offices and other agencies who work with pregnant women. Continuous feedback and follow-up with participants…what else do they need?

17. A Clinician's Guide To Helping Pregnant Women Quit Smoking Course Objectives At the conclusion of this course, participants should be able to: Outline key components of state-of-the-art tobacco use cessation Identify the 3 basic components of nicotine addiction Summarize basic assessment tools for diagnosis of tobacco dependency Describe current drug therapy options, indication, and contraindications Describe behavioral modification techniques

18. 5 A’s Approach to Smoking Cessation • A 5-step smoking intervention proven effective for pregnant women • Consistent with strategies developed by the National Cancer Institute, the American Medical Association, and others • Adapted for pregnant women by ACOG

19. Smoking Cessation During Pregnancy • Evidence-based brief counseling is more effective than simple advice to quit • A trained cliniciancan improve cessation rates by 30% - 70% • Most effective for light to moderate smokers (< 20 cigarettes/day) • Melvin CL, et al. Recommended cessation counseling for pregnant women who smoke: a review of the evidence. Tob Control 2000;9(suppl III):iii80–iii84. • Fiore MC, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: US Department of Health and Human Services. Public Health Service. June 2000

20. The 5 A’s 1. Ask about tobacco use 2. Advise to quit 3. Assess willingness to make a quit attempt 4. Assistin quit attempt 5. Arrange follow-up © 2002 The American College of Obstetricians and Gynecologists

21. Assist In The Implementation Of Smoking Cessation Protocol Step 1. Develop administrative commitment Step 2. Involve staff early Step 3. Assign one coordinator Step 4. Provide training Step 5. Adapt procedures to your setting Step 6. Monitor and provide feedback

22. Power of Intervention • One-third to one-half of smokers will die from the habit. Of the 32 million smokers who want to quit, 10 to 16 million will die from smoking. • If the 2.5 percent cessation rate were increased to 10 percent, 2.4 million additional lives would be saved. • If the cessation rate rose to 15 percent, 4 million additional lives would be saved.

23. Community Cessation Clinics and In-house Tobacco Counseling Program On-going cessation clinics since 1999 Collaboration with the local health department since 2004 to offer free patches Columbus Regional Hospital SAK pack in-house tobacco counseling program since 2004

24. Quit Lines– A Well-Kept Secret • Quit Lines provide smokers with free cessation services including counseling, self-help kits, and cessation information. • They work. With repeat sessions, they can help smokers quit at the rate of 27 percent (12-month abstinence rate) in one California study.

25. Programs Demonstrate, Policy Perpetuates Recent successful educational campaign to raise cigarette tax by 44 cents will save lives and result in: 5-Year healthcare savings from fewer smoking-affected pregnancies & births: $12.1 million Number of smoking-affected births avoided over next five years: 7,100

26. Policy: Smoke-free Workplace Ordinances Save Lives, Too! Major cause of respiratory disease, sudden infant death syndrome, ear infections, and asthma attacks. There is no safe level of exposure to firsthand tobacco smoke or secondhand tobacco smoke. Good Smoke-free Workplace Policies will: Decreases the SHS exposure to unborn baby and mother Decreases SHS exposure to newborn babies

27. Expose The Truth…Women Are Being Exploited! Tobacco Industry’s Newest Scam:  Camel No. 9, has a name that evokes a women’s fragrance like Chanel No. 19, as well as a song about romance, “Love Potion No. 9.” Camel No. 9, a hot-pink fuchsia and a minty-green teal; its slogan, “Light and luscious;” and flowers surround the packs in magazine ads.

28. Bartholomew County’s 2007-2009 Work Plan In Progress Additional 5 A’s Trainings to ensure that we cover the community Assist in the implementation of consistent counseling procedures within each office Specific teaching aids to each medical office DVD for waiting rooms/patient rooms

29. Additionally… “Spokesperson” nurse or other professional to spread the word through media, radio, internet “Testimonials” from past quitters for ads, press releases Campaign to expand our ordinance to include bars/private clubs in Columbus And finally…. Results from surveys conducted by ITPC that show a decline in smoking status of pregnant women! Contact – Peggy Voelz pvoelz@crh.org