The moms smoking cessation support program
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The “MOMS” Smoking Cessation Support Program

Linda Daniel, RN, MSN, CCM

Matthew Hoffman, MD, MPH

Claire Gardner, RN, BSN


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Special Thanks and RecognitionThe Division of Public Health Community Contract.Funding for the contract is provided by the Delaware Health Fund and managed by the American Lung Association of Delaware.


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The “MOMS” Program

  • Hospital-based telephone service

  • Participating obstetrical providers

  • Electronic capture of clinical data

  • Facilitate communication

  • Experienced MCH nurses

    • Risk screening

    • Care Coordination


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Why focus on Smoking Cessation in Pregnancy?

  • Cigarette smoking is the leading preventable cause of perinatal illness and death

  • Adverse effects of maternal smoking

  • Pregnancy can motivate women to quit

  • Enhance health of the community

  • Financial Benefits


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The “MOMS” Smoking Cessation Support Program

  • Objectives:

    • Reduce the number of pregnant smokers

    • Reduce the incidence of low birth weight and preterm deliveries

  • Method:

    • Evidence-based approach

    • Collaborative design


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Evidence Based Approach

  • “Treating Tobacco Use and Dependence: A Clinical Practice Guideline” The “5-A” approach

  • Evidence-based clinical guidelines assessed in OB/GYNS. (Grimley et al., 2001)

    • 93% ask 90% advise clients to quit

    • 28% assist  24% arrange follow-up


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Collaborative Design

  • Physician participation in “MOMS”

  • “MOMS” nurse identifies smokers

    • Initiates contact each trimester & PP

    • Completes a health assessment

    • Provides education and support

  • Data electronically captured

  • Link smoking status to birth outcomes


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Initial Contact

  • Current weeks gestation:

  • Are you currently smoking?

    • Yes, currently smoke – Yes but cutting down – No - quit smoking

  • How much are you currently smoking?

    • 1-4 cigarettes/day – 5-10 cigs/day – 11-20 cigs/day – > one ppd

  • Have you ever tried to quit before?

    • Yes – No, but interested in trying – No interest in quitting

  • Assess exposure to second hand smoke

    • Other(s) in home smoke – Work environment – Social activities

  • Has your care provider told you about the benefits of quitting? Yes No

  • May I share the benefits of quitting with you? – Yes – No, not interested

  • Assess motivation to quit (using Likert scale)

    • (No motivation) 0 1 2 3 4 5 (Highly motivated)

  • Assess confidence in ability to quit (using Likert scale)

    • (No motivation) 0 1 2 3 4 5 (Highly motivated)

  • Assess desire for lifetime quit (using Likert scale)

    • (No motivation) 0 1 2 3 4 5 (Highly motivated)




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Limitations

  • Ability to consistently reach women through out their pregnancy and postpartum.

  • Self-report of smoking status

    • Reliability

    • Validity

  • Postpartum Smoking Status – what if we asked 6-months to a year after delivery?