Collaborative strategies to reduce tobacco exposure among

low-income families

Katie Marble, CHES

Joan Orr, CHES

Healthy Community Coalition

Learning Objective

• You will be able to identify cost-effective strategies to reduce prenatal and secondhand smoke exposure in low-income families through multi-agency collaboration.

Service Area

• Population of service area: 40,000 • Classified as “very rural” with just 17.4

people per square mile.• Franklin County has lowest adult smoking

rate in Maine at 17% (Maine’s adult smoking rate is 23.5%)

(Maine BRFSS, Community Health Profile 2000)

Health Assets

• Healthy Community Coalition of the Franklin Community Health Network

• Healthy Maine Partnerships/Fund for Healthy Maine

Prenatal Smoking Statistics

Mothers Who Smoked During Pregnancy, 1997-1999

19.3% 18.1%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Maine Franklin County

Per

cent

of M

othe

rs

* Maine Pregnancy Risk Assessment Monitoring System Survey, 1997-1999.

Prenatal Smoking Statistics

• 25% return to smoking postpartum

• 66% of premature births in Franklin County were to women who smoked.

• Women who continue to smoke during pregnancy are almost exclusively low-income.– 90% have a household income of less than

24,000 (140% of poverty).* Maine Pregnancy Risk Assessment Monitoring System

Survey, 1997-1999.

Prenatal Care

Percent of Live Births for which Prenatal Care Began in the First Trimester, 1999

88.7% 91.6%

0.0%20.0%

40.0%60.0%

80.0%100.0%

Maine Franklin CountyPe

rce

nt o

f all

Liv

e B

irth

s

(*Maine Children’s Alliance, 2002)

Tobacco-Free Franklin Families

• 3 year pilot program funded by the American Legacy Foundation Priority Population Grant.

• Goals to:– Reduce prenatal smoking– Reduce postpartum relapse– Reduce the # of children 0-5 exposed to ETS– Build a system of effective tobacco-use

reduction services for low-income families

Strategies

• Reach the maximum number of women with American Legacy Grant

• Have women repeatedly exposed to cessation messages

• Collaborate with Prenatal Care Providers & Agencies already reaching low-income women

• Target stress management

Founding Partners

• Pine Tree Women’s Care

• WIC

• Head Start

• Growing Healthy Families

• Franklin Childcare

Costs

• Trainings

• Meeting Support

• Resources Materials

• Incentives

Savings• Agencies provide outreach through out the

county (over 1697.81 square miles -1 1/2 times the size of Rhode Island), saving transportation costs or having to establish multiple sites

• Reach over 5000 families of 6194 families with a household income under $25,000 (more than our program could reach working alone:)

• Sustainable Strategy

Implementation

• Trained agency staff in the 5 A’s of intervention, nicotine addiction & the “stage of change” model.

• Established meetings to plan how intervention would take place in each agency.

• Each agency provides a different level of intervention. Home Visitors provide more in-depth intervention. Prenatal Care Providers at least a five minute intervention.

Implementation

• The intervention is guided by process evaluation, Tobacco Flow Chart.

• Assistance includes prenatal program Every Mother’s Wish, Maine Tobacco Helpline, Stress workshops

• Media campaign

• Established workgroup meetings and site visits to problem solve.

*Clarifying Success*• Important to let healthcare providers there are

many types of success within smoking cessation counseling.– Moving someone from one stage of change to another.

– Making an impact by mentioning tobacco

– Delayed reaction of participants

– Getting tobacco smoke outdoors

– Reducing the number of cigarettes smoked/day

– Someone quits smoking

Preliminary Results• This year over 72 health and social service

providers have had in-depth training in the 5 A’s of intervention. (42 more than year one goal)

• The calls to the Maine Tobacco Helpline from Franklin County were double the number expected from Jan.-Mar. 2003

• Tobacco status addressed as a vital sign with 100% of patients at Pine Tree Women’s Care.

Preliminary Results

• 81% of all women who smoke were provided with the 5 A’s of intervention at prenatal care offices

• 30 women completed Every Mother’s Wish Program in year one (out of 110)

• Additional agencies are requesting training on the 5 A’s of tobacco intervention

Lessons Learned:• Partners are the key to a successful program

• Clearly define the role of both your agency and the partner agency

• Identify the roles of people within each partner agency

• Identify a champion at each site

• Create a bonding experience for that site

• Never Underestimate the power of incentives (aka. Food)

More Lessons Learned

• Bring the programs/training to the audience not the audience to the program (especially in rural areas).

• Listen, Listen, Listen, Listen, Act, & the Listen Again.

• REMAIN FLEXIBLE

Thank-you

Contact us at:

Healthy Community Coalition

207-645-3136

Check our web site: http://www.FCHN.org/HCC