A Fresh Start for WIC: Tailoring Smoking Cessation

for WIC Participants and Their Families

Laura A.Van Dyke, CSW Saint Vincent Catholic Medical Centers

New York City(212)604-7572

Background Information

Saint Vincent Catholic Medical Centers (SVCMC) received a three-year grant from NYS DOH

Three staff hired to implement smoking cessation program at system’s 9 WIC sites

WIC is a supplemental nutrition program for qualified women, infants and children

Program Planning

Met with WIC site directors in each region (Brooklyn/Queens, Manhattan and Staten Island) and conducted needs assessment

Researched perinatal smoking cessation techniques

Partnered with American Cancer Society to receive training in Make Yours A Fresh Start Family (MYFSF) model and ongoing technical assistance throughout the year

MYFSF Program Description MYFSF is a comprehensive package for

health care providers to assist them in counseling their pregnant and parenting clients to stop smoking

Based on U.S. Public Health Service Clinical Practice Guidelines for Treating Tobacco use and Dependence

Adaptation of MYFSF for

WIC Population Met with WIC directors and nutritionists

regarding capacity to implement brief cessation counseling

Collaborated with WIC staff on the development of data collection tools

Developed brochure to introduce program for WIC participants and offer phone counseling

Provided 3 MYFSF Training Sessions

to WIC Staff in each region Smoking facts and figures Smoking cessation and the process of behavior

change The 3-5 minute brief counseling technique (based

upon stage of change theory and 5A’s of intervention)

Use of progress chart to track smoking behavior/ exposure to ETS

System of chart identification (red dots or log) Role Plays

Program Implementation

By Feb.1, 2002 all sites trained and ready to implement MYFSF program

Expectations:

Smoking status asked at every visit and an intervention offered based on stage of smoking behavior

Materials/magazines offered to all smokers and those exposed to ETS

Efforts documented and filed in participant’s chart Red dots used to flag charts Follow-up at subsequent visits to facilitate

movement along stages of change

Technical Support Provided by Tobacco Cessation Program Phone support to all WIC staff Phone counseling to WIC participants seeking

additional support Participation in health fairs at WIC sites (nutrition

month and breastfeeding fairs) Attendance at WIC staff meetings Provide educational materials (brochures,

literature, videos) and varied incentives to quit smoking

Relationship Building: Creating a Partnership Between WIC Staff and

our Tobacco Cessation Program Enhanced by our status as employees of SVCMC Involved WIC directors and staff in every step of

program development Encouraged environment for open discussion of

concerns Prioritized staff recognition luncheons Identified environmental barriers to program

success (i.e. facilitated child-friendly environments)

Program Assessment

and Evaluation Conducted process evaluation with

nutritionists via focus groups and surveys Conducted chart review to determine

utilization of progress charts and assess follow-up

Our Findings

8 of 9 sites implemented program 90% of nutritionists think they can have positive

effect on smoker’s behavior 60% think brief cessation counseling is an

important part of their job the other 40% indicated that it is important, but

need more strategies for making time 292 charts (of women, infants and children) were

flagged as smokers or as exposed to second-hand smoke

Findings (continued)

Chart review conducted on 122 of the total 292 charts

52% asked about smoking status at subsequent visits

48% documented that materials were provided 56% of charts revealed some movement (micro-

movement) along the stages of change (this figure includes women who spontaneously quit due to pregnancy)

Barriers to

Program Implementation Limited time for counseling patients and

documenting efforts due to high caseloads (1:890)

Lengthy waiting period in often crowded and chaotic environment

Nutritionists’ personal views about smoking Introduction of new computer system

(WICSYS) impedes counseling process

Strategies

Modify intervention to core elements: ask, offer, document

Create child-friendly environments Empower nutritionists Meeting with WIC at state level to discuss

problems with computer tobacco screen

Ongoing Improvements

Maintain the partnership with ACS that has enabled us to achieve our success to date

Continue to build relationship with WIC staff and be responsive to their suggestions

Consultation with NYS WIC department as they pilot the MYFSF model in two WIC sites in NYS

Expansion into SVCMC outpatient clinics

Special Thanks Elena F. Deutsch, MPH, Director, Tobacco

Control, American Cancer Society, NYC Patricia M. Lamberson, MPH, Senior

Health Educator, SVCMC Lupe Flores, BA, Health Educator, SVCMC