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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
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

btuttle@kdhe.state.ks.us