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A Tobacco Cessation and Relapse Prevention Program Designed for use in a WIC Clinic

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Quitting for Keeps aims to increase access to tobacco relapse prevention and ... Quitting for Keeps was funded by a grant from the American Legacy Foundation ... – PowerPoint PPT presentation

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Title: A Tobacco Cessation and Relapse Prevention Program Designed for use in a WIC Clinic


1
  • A Tobacco Cessation and Relapse Prevention
    Program Designed for use in a WIC Clinic
  • Jennifer Jordan, MPH
  • Lane County Public Health
  • Eugene, OR

2
Background
  • In Lane County Oregon, smoking rates during
    pregnancy have risen significantly since 2001 and
    are now higher than the state average (15.2 vs.
    12.6).
  • Smoking during pregnancy is the single most
    preventable cause of illness and death among
    mothers and infants.

3
Targeting Womenagain
4
Background
  • Low-income women and those with less than 12
    years of education are more likely to smoke
    during pregnancy and have less access to
    cessation support.
  • Pregnancy is a unique window of opportunity to
    influence behavior change.

5
Background
  • Approximately 20-30 of women who smoke before
    pregnancy quit when they learn they are pregnant
    and an additional 20-30 quit after entering
    prenatal care.
  • Unfortunately, at least half of these women
    resume smoking within the first 6 months
    postpartum and 80 relapse within the first year
    postpartum.
  • The Women, Infants, and Children (WIC) program
    serves over 42 of all pregnant women in Lane
    County

6
Purpose
  • Quitting for Keeps aims to increase access to
    tobacco relapse prevention and cessation services
    among low-income pregnant and postpartum women
    utilizing WIC services.
  • This community-based participatory research
    project collaborated with WIC staff and clients
    to modify the traditional 5As cessation
    intervention to a briefer 3As model that was
    tailored for the WIC setting and more easily
    incorporated into a clients visit.

7
Materials Methods
  • Lane County Public Health partnered with the
    Oregon Research Institute (ORI) to tailor ORIs
    3As (Ask, Advise, Arrange) brief cessation
    intervention model for the WIC setting (see
    diagram).

8
Flow Chart
9
QFK Logic Model
10
Materials Methods
  • Three focus groups were conducted with WIC
    clients and staff to identify opportunities and
    barriers to providing brief tobacco cessation and
    relapse prevention interventions.
  • The input was used to adapt resources and tools
    for staff and clients, including a staff
    training, fact sheets on tobacco use and
    pregnancy, and a Quitting for Keeps resource
    guide.

11
Materials Methods
  • In a Quitting for Keeps training on the 3As
    brief intervention technique, we included
    strategies for dealing with defensive clients,
    motivating clients who have previously been
    unsuccessful, using nonjudgmental approaches,
    communicating the potential health effects of
    tobacco, and referring clients to community
    resources.

12
Materials Methods
  • In November 2007, the counselors began
    incorporating the intervention in their client
    visits.
  • Additionally, a Quit Information workshop was
    available every three months that met clients
    class requirements to receive their WIC vouchers.

13
Materials Methods
  • Clients responded to follow-up phone surveys at 6
    weeks, 6 months, and 12 months post-intervention.
  • Reports summarizing the number of interventions
    completed, the number of quit dates set, and
    client satisfaction were shared and discussed
    with WIC counselors at their monthly staff
    meetings.

14
Results
  • 3As Staff Training Results (pre/post)
  • Knowledge scores increased from average of 52 to
    83 (p lt .05) confidence scores also increased,
    but not significantly (n11)
  • Intervention Data
  • 327 women received the 3As
  • 62 pregnant 38 postpartum
  • 84 were current smokers
  • 17 (n57) set a quit date during the
    intervention

15
Results
  • 6 Weeks Post-Intervention Survey
  • 60 (n160) response rate
  • 65 felt staff advice was useful 55 reported
    the materials were useful
  • Of those who had not quit, 75 reported trying to
    quit in the last six months and 58 reported they
    were seriously considering quitting in the next
    30 days

16
Results
  • Preliminary 6 Month Post-Intervention Data
  • 46 response rate (n45)
  • 19 report cutting back and 20 report quitting
    and remaining quit

17
Status of Women Receiving Intervention (n-327)
18
Smoking Status at 6 weeks (n120)
19
Lessons Learned
  • Systematic cessation and relapse prevention
    training among WIC staff can successfully
    increase counseling practices.
  • Periodic feedback on the effectiveness of smoking
    interventions and opportunities for input are
    important motivators for providers to implement
    cessation promotion and relapse prevention.
  • Challenges include making the intervention a
    priority attrition on follow-up surveys client
    recruitment for the cessation support class and
    staff turn over.

20
Acknowledgements
  • We would like to thank the Lane County WIC staff
    for their invaluable support of Quitting for
    Keeps and the great work they do every day.
    Thanks also to Ed Lichtenstein at ORI for his
    advice and feedback. Quitting for Keeps was
    funded by a grant from the American Legacy
    Foundation and weve truly appreciated the
    technical assistance and support provided by
    Robin Scott and Scott Thomas. Additional thanks
    to Laura Hammond, Connie Sullivan and Karen
    Gillette for their support, assistance, and
    encouragement.
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