Smoking Cessation Pathway

Reducing the infant mortality ratein Cincinnati and Hamilton County

Where we are today

543 infants have died in the past five years in Hamilton County.That puts Cincinnati at almost twice the national average.

6.05 7.7 9.2 11.3

*2012 CDC Data

Why Infant Mortality is so important

• Every life matters

• Cincinnati and Hamilton county have unacceptably high rates

• Indicator of the overall health of the community

• Reveals inequalities in our community

• Extremely expensive and that cost affects us all

Health Impact

• Ohio had the 4th highest infant mortality rate in the US in 2010; the highest IMR for African Americans

• Tobacco smoking during pregnancy is one of the most modifiable risk factors for poor pregnancy outcomes and infant death

This slide is from ODH Perinatal Smoking Cessation Program powerpoint.

Quick facts

• Self-reported data indicates 15% of Hamilton County women smoked during their pregnancy

• Mom’s in Hamilton County who smoke while pregnant are 44% more likely to have an infant death

• Infants who die from SIDS have higher concentrations of nicotine in their lungs and higher levels of cotinine (a biological marker for secondhand smoke exposure) than infants who die from other causes [CDC]

• Nationally, about 70% smokers report that want to quit - but don’t feel they have needed support to do so [CDC]

Perinatal Smoking Risks

• Smoking during pregnancy increases the risk of:

– Placenta previa

– Placental abruption

– Sudden infant death syndrome (SIDS)

– Prematurity

– Low birth weight

This slide is from ODH Perinatal Smoking Cessation Program powerpoint.

Our intervention

• Implementation of the Tobacco Cessation Pathway

– Engage patient in the 5 A’s Counseling method

– Promote the Quit-Line

– Distribute appropriate evidence-based literature to patients

– Repeat intervention at each subsequent visit

• Working to enhance support services and counseling in the community

• Helping mothers maintain smoke free status after pregnancy

Clinical Practice Guidelines (2008)

• Pregnancy is a good time to intervene

• Brief intervention (<10 minutes) with self help materials increases cessation rates by 30% - 70%, compared with only advice and no materials

• Intervention works best for light to moderate (<20 cigarettes a day) smokers

This slide is from ODH Perinatal Smoking Cessation Program powerpoint.

Tobacco Cessation Pathway

• The 5 A’s—Ask, Assess, Advise, Assist, Arrange,

– Ask: Get an honest response using the laminated sheet found in all patient rooms

– Assess: How important to the patients is it that they quit on a scale of 1-10

– Advise: Use strong, clear & personalized messages

– Assist: Walk them through the Quit-Line Referral Form

– Arrange: Follow up contact and additional appointments

Stages of Change

5 R’s of Quitting Tobacco

Medicaid billing

Quit Line Fax Referral Form

• Printable versions on: http://www.healthy.ohio.gov/~/media/HealthyOhio/ASSETS/Files/tobacco%201%20of%202/odhquitlinefaxreferralform.ashx

• Soon available on our website under ‘Healthcare Professionals’ resources

Free resources in Hamilton County

• UC Health/UC Cancer Institute Smoking Cessation Help

• Mercy Health Smoking Cessation Program

• Nicotine Anonymous

• Cincinnati Health Department 1on1 sessions

Other resources available

• Refer patients to http://women.smokefree.gov/ for great advice on managing stress, health benefits and other quitting tips

• Text the word QUIT to this number: 47848 (iQuit)

• Encourage patients to seek out a smart phone Quit-App that appeals to them

Pharmaceutical Intervention

• Maintaining a mother’s smoke free status after giving birth is vital to both her and her baby’s health

• Discuss different cessation methods—including additional counseling in combination with medication

– Nicotine replacement therapies

– Nicotine gum

– Nicotine patch

– Bupropion (Zyban)

– Varenicline (Chantix)

Questions ?

www.cradlecincinnati.orgPhone: 513-803-1285