MODELS FOR PRACTICE

FOCUS AREA: TOBACCO USE

 

 

Program Name: Stickers-Suckers-Smokers Pregnancy Tobacco Cessation Program

Location: Mesa County, Colorado

Problem Addressed: Tobacco Use among Pregnant Women

Healthy People 2010 Objective: 27

Web Address: http://www.rmhp.org

 

 

SNAPSHOT

 

Smoking is associated with low birth weight infants and preterm deliveries. Stickers-Suckers-Smokers Pregnancy Tobacco Cessation Program is a collaborative effort to reduce the incidence of smoking-related preterm births and low birth weight infants in rural Mesa County, Colorado. The program addresses tobacco use among pregnant women through a program of screening, assessment, and cessation education. The founding agency for the tobacco cessation program, Rocky Mountain Health Plans (RMHP), has expanded its outreach to pregnant women to include a prenatal dental care program as well.

 

THE MODEL

 

Blueprint: The program represents a collaborative effort between Rocky Mountain Health Plans, Rocky Mountain Health Foundation (RMHF¾a 501[c][3]), Hilltop Community Resources B4 Babies and Beyond program, Mesa County Tobacco Education Coalition (MCTEC), and March of Dimes. The core staff consists of a Rocky Mountain Health Plans care coordinator and obstetrics (OB) screener/tobacco cessation counselor, and B4 Babies and Beyond provides intake staff, a director, and a paid counselor/statistician. B4 Babies is a unique program that provides a one-stop site for prenatal services to low-income women in Mesa County. MCTEC provides incentives and funding; the March of Dimes provides a grant for the B4 Babies counselor; and RMHF provides grant-writing services.

 

The program provides assessment, education, and incentives for patients. Caregivers get educational information, a chart sticker program that identifies smokers for follow-up and tracking, and “train-the-trainer” educational programs. Pregnant women who smoke are identified, through entry into the B4 Babies and Beyond program, by health care providers and by RMHP OB screeners.

 

Pregnant women who smoke and agree to participate in the program receive one-on-one assessment of stage and counseling at the point of entry (physician office, B4 Babies, or RMHP). They are sent quit kits, and their primary care providers are notified of the patient’s participation. The primary care providers play a vital role as screeners, educators, counselors, and supporters by closely tracking the patient’s progress at each prenatal visit.

 

One strength of the program is providing care providers with the tools to screen and counsel patients. Counselors and providers use the 5A’s Method (Ask, Advise, Assess, Assist, and Arrange) to help patients to quit or reduce smoking. Prochaska stages of change modified for pregnancy is also used.

 

Making a Difference: Birth certificate data from 2001 in Mesa County revealed a 28 percent smoking rate for pregnant women as compared to the Colorado state average of 12 percent. The B4 Babies and Beyond program showed a smoking rate of 35 to 45 percent of their clients. Prior to 2001, there was evidence of a greater prevalence of pregnant women smoking in Mesa County.

 

To date, 570 prospective clients have been seen, and 213 smokers have been identified. Of those, 100 clients agreed to enroll in the program. Of the 100 clients, 16 percent agreed to either quit or reduce their cigarette use to under five per day. The low birth weight rate in Mesa County declined from 7.1 percent in previous years to 6.3 percent in 2001. B4 Babies and Beyond program participant data are collected in a registry to track quit rates and reductions in smoking.

 

Beginnings: Rocky Mountain Health Plans spearheaded the development of the smoking cessation program for pregnant women in Mesa County. The county had one of the highest rates of smoking among pregnant women in the state. Rocky Mountain Health Plans case managers asked providers to identify at-risk patients and offer education and cessation options to patients; however, providers were unable to comply due to a lack of resources in the area. In response, Rocky Mountain Health Plans created the Stickers-Suckers-Smokers program to serve as a method to address the issue of smoking during pregnancy. The program began in June 2001.

 

The program is funded through a variety of sources. The Rocky Mountain Health Foundation obtained a grant from the March of Dimes to fund the program initially. Community businesses and organizations have also contributed to maintaining the program’s success.

 

Challenges and Solutions: Although the program has completed Year One, plans are underway to expand the program’s services and service area. The program hopes to expand the smoking cessation program to two additional counties.

 

The program has also expanded to include a dental care component specifically for pregnant women. Evidence indicates that there is a link between periodontal disease and preterm labor. Pregnant women can receive no-cost to reduced-cost dental care through the Marillac Dental Clinic.

 

The program is publicized through word of mouth, brochures, community programs, and presentations by the Rocky Mountain Health Plans case manager. She has presented to the Colorado Care Council, a statewide organization composed of obstetricians, perinatologists, neonatologists, and related practitioners. Rocky Mountain Health Plans has also mailed providers information about smoking education/cessation and Marillac Dental Clinic services.

 

PROGRAM CONTACT INFORMATION

 

Janice Ferguson, RNC, Rocky Mountain Health Plans Perinatal Care Coordinator

Stickers-Suckers-Smokers Pregnancy Tobacco Cessation Program

Rocky Mountain Health Plans

2775 Crossroads Blvd.

Grand Junction, CO 81506

Phone: (970) 244-7890

Fax: (970) 248-5012

E-mail: jferguso@rmhp.org