1. Reducing Prenatal/Postpartum Tobacco Use Healthy Babies - Born On Time TPHA Annual Conference “Health and Home - Where You Lives Matters” September 11, 2014 Laurie Adams, Cessation Specialist Executive Director BABY & ME – Tobacco Free Program

2. 1.Best-Practice Approach – Tenn. Data and Helping Patients Quit 1.Implement Policy Change/System Change-Screening for Tobacco Use, Motivating them to Quit 2.BABY & ME – Tobacco Free Program TPHA Presentation Objectives: Goal: We MUST reduce the burden of tobacco on our society Objective: To improve birth outcomes by reducing tobacco use among prenatal/postpartum women

3. Tennessee Data - Low Birth Weights 2012 March of Dimes: From 2002 – 2012 no change in low-birth weights Low-birth rates – less than 5 ½ lbs. Low-birth rates Tennessee 2002-2012

4. Tennessee Data - Preterm Births Preterm Births : Tennessee 2002-2012 2012 Tennessee Data: Between 2002 and 2012, the rate of infants born preterm in Tennessee declined 1.3%. Preterm – less than 37 weeks

5. Tennessee Smoking Rates Income and Insurance Smoking during pregnancy by income: Tennessee, 2009 Smoking during pregnancy by insurance: Tennessee 2009 *PRAMS report

6. Cost of Prenatal Smoking Health Care Dollars! Average cost of delivery to non-smoking woman: $3,500 per stay Average cost of complicated delivery: $12,000 per stay Average cost per day in Neo-natal Care: $72,000 per day *2007 March of Dimes, Cost of Prenatal Smoking

7. Quitting Smoking Improves Birth Outcomes…  Prevents Premature Births  Reduces Low-Birth Rates  Reduces Placental Abruptions & Stillbirths  Improves blood flow and oxygen to baby  Reduces the risks of SIDS (sudden-infant-death)  Reduces risks for future health and behavioral problems 2014 CDC Division of Reproductive Health, report Preventing Tobacco Use During Pregnancy

8. Best-Practice Approach -Helping Patients Quit US Department of Health and Human Services, Clinical Practice Guideline Treating Tobacco Use and Dependence (2008 Update) We MUST screen for tobacco use at every visit 5 A’s Model 1. Ask 2. Advise 3. Assess 4. Assist 5. Arrange

9. Follow the 5 A’s Model 1.ASK – Every visit … Every time 2. ADVISE – “I need to let you know that quitting smoking is the most important thing you can do for your health and the health of your baby! “We are committed to helping you quit.” 3. ASSESS - “Are you willing to give quitting a try?”

10. Follow the 5 A’s Model 4. ASSIST – - Provide or refer to counseling - Refer patients to programs that work - State Quitlines 5. ARRANGE – - Provide follow up at next visit

11. Motivational Interviewing Skills Reflective Listening – Low SES Population Craft response using statements such as: “It sounds like…” “I understand…” “May I share…” Why it works? Mindful, Respectful, Kind, Empathic, Helps direct your next steps….

12. BABY & ME – Tobacco Free Program  Evidenced-Based Prenatal/Postpartum Program  Researched from 2006 – 2009 NY State Dept. of Health, Bassett Research Institute  Consistent 60% + quit rate, at 6 months postpartum  Core Program Components:  Provides 4 prenatal sessions  Monthly postpartum visits, 12 months  Provides FREE Diapers,  Postpartum for up to one-year  Tested at every visit

13. BABY & ME – Tobacco Free Program Tennessee Project Trainings April – May 2014 56 Counties Participating 241 Staff Trained 976 Women – Enrollment Goal (2014 – 2017) Investment 1 million ROI (return-on-investment) – 68.3 Million

14. Mid-Cumberland Rural Health Regions West South CentralSoutheast East Northeast Upper Cumberland

15. Why the SUCCESS?…  Positively reinforces quitting tobacco and behavioral changes.  Win-Win for funders, doctors, agencies, mothers and babies.  HUGE ROI (return-on-investment) BABY & ME – Tobacco Free Program

16. New Book – Released Sept 2013

17. Media Messages -

18. Healthy Babies – Born On Time ….. Laurie Adams, Executive Director BABY & ME – Tobacco Free Program lauriea@windstream.net director@babyandmetobaccofree.com 716-484-3325 Lindsay Ball, Director of Program Services lindsay@babyandmetobaccofree.com 716-244-7227 Website: babyandmetobaccofree.org Facebook: Baby & Me Tobacco Free Twitter: @BabyAndMeHealth