The “ MOMS” Smoking Cessation Support Program

1. The “MOMS” Smoking Cessation Support Program Linda Daniel, RN, MSN, CCM Matthew Hoffman, MD, MPH Claire Gardner, RN, BSN

2. 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.

3. The “MOMS” Program • Hospital-based telephone service • Participating obstetrical providers • Electronic capture of clinical data • Facilitate communication • Experienced MCH nurses • Risk screening • Care Coordination

4. 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

5. 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

6. 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

7. 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

8. 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)

9. Continuum of Care Findings

10. Smoking Status and Outcomes

11. 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?

12. QUESTIONS?