1. Welcome to “STARSS in Action” A Partnership with the Canadian Prenatal Nutrition Program and York Region Community and Health Services September 16, 2011 Reference: AWARE Action on Women’s Addictions- Research and Education Presenters: Rosemary Lamont Helen Tunney www.york.ca

2. Objectives Enhance understanding of women and tobacco use Enhance professional practice through increased understanding of the STARSS philosophy strategies and resources Enhance capacity to incorporate STARSS into existing programs Exchange ideas and next steps to implement STARSS

3. Introductions What is your “burning question” you need answered today?

4. Review: Women and Smoking Why do women smoke? Understanding tobacco addiction Red flags

5. Women and Smoking Women often smoke to help them deal with life issues Smoking rates are higher for single mothers, low-income, Aboriginal and Francophone women Women make more attempts to quit before they are successful

6. Tobacco Myth or Fact

7. Myth or Fact Nicotine is the harmful ingredient in tobacco smoke Myth It is the other 4000 chemicals, +50 of which cause cancer that are the major problem for health. Nicotine is the addictive chemical in tobacco

8. Myth or Fact More people could quit if they had will power Myth Nicotine is as addictive as cocaine or heroin. There are strategies and medications that work to help people quit. It may take an average of 7 attempts before long term quitting success is achieved.

9. Myth or Fact Nicotine patch, gum, lozenge and inhaler can be used to cut down on amount smoked Fact NRT can be used to help reduce the number of cigarettes smoked. It is best for health to quit altogether and cutting down to quit is an option.

10. Myth or Fact Smoking helps alleviate depression Fact Nicotine is a stimulant and increases mood. Often people with depression self- medicate by smoking

11. Myth or Fact A person is addicted to nicotine when they smoke daily Myth People can experience addiction and withdrawal before daily smoking occurs. In fact, youth can experience addictive symptoms long before they have initiated daily smoking

12. Myth or Fact Second-hand smoke (shs) exposure increases risk for breast cancer, diabetes and heart disease Fact Women exposed to second-hand smoke have 50-70% increase in breast cancer Exposure to shs increases rates of heart disease and diabetes especially if prolonged exposure occurs from an early age.

13. Myth or Fact Coffee, alcohol, driving, telephone calls are examples of triggers to smoke Fact There are many triggers in daily activities making quitting a challenge. Changing our environment and routines are important when quitting or reducing shs.

14. Myth or Fact There is such a thing as third-hand smoke Fact Third hand smoke is the dust that is left long after smoking has ended. It lands on furniture and toys. Cleaning toys regularly is a way of reducing third-hand smoke

15. Red Flags Smoking is a red flag for: Mental health issues Associated addictions to other drugs/alcohol Poor pregnancy outcomes Short and long term developmental, physical and cognitive problems in children exposed to second-hand smoke

16. Circle of Care to Reduce Second-hand Smoke Mother and Child(ren) CPNP staff Family and Friends Health Care Providers

17. Philosophy Harm Reduction  Not smoking cessation  “Success” is measured by small steps Strengths based  Acknowledges the love moms have for their children  Positives are emphasized and self-efficacy is nurtured Cognitive approach  Encourages moms to think through their behaviors to make changes  Gives moms skills to help them make a quit attempt when ready Goal setting strategy  Builds on every change a mom makes (no matter how small) to the larger goal of smoking outside (not quitting)

18. Philosophy Empowerment  Gives moms a sense of control over their smoking and their lives  Setbacks are not failures but an opportunity to try a different approach Participant focused  Moms guide the entire process  We meet them where they are in their process Flexible  Can be used in existing programs or be a program on its own  Can be used one-on-one or in a group setting  Can be introduced formally or informally

19. Understanding Stages of Change STARSS was developed to support women who are not ready to quit smoking Precontemplation - the smoker is not thinking about change Contemplation - the smoker is thinking about the pros and cons of change but doesn’t feel the quitting is possible right now

20. Precontemplation and Contemplation Develop rapport Raise consciousness of risks - avoid scare tactics Avoid action statements - concentrate on listening Show interest and curiosity Avoid commands/accusations

21. Holding Our Own: Strategies During Pregnancy and Motherhood to Stop Smoking

22. Getting the most out of “Holding Our Own” What were your beliefs and attitudes about smoking during pregnancy before viewing the video? What are they now? What scene, character, or messages had the greatest impact on you? What new strategies will you attempt to incorporate into your practice?

23. How to Use STARSS Posters and handouts and pamphlets, newsletters Discussions over lunch or breaks Incorporate STARSS messaging Star activities and or crafts Provide incentives – snacks, decorations, Resources- website: www.aware.on.cawww.aware.on.ca STARSS specific workshop or individual session

24. Finding your voice Things to consider: Be sensitive to the stresses in her life and the role tobacco plays Silence is condoning You don’t have to “fix” the problem Plant a seed I believe in you Small steps are steps forward

25. Example: Talking like a Star During the program, you notice that mothers watch each other’s children so they can take turns going out for a smoke. How might you talk like a Star to introduce STARSS? I notice that you have a great plan to cover each other off so you don’t have to take your kids outside with you to smoke- which protects them from second-hand smoke. Sometimes it can be more of a challenge to do that at home. I have some information on reducing SHS further. May I share it with you? Worksheet #1 and 3

26. Scenario 1 Mother’s day is coming up and the centre is planning a celebration. Using the STARSS workbook and resources, plan a STARSS activity that fits with the Mother’s Day theme For: children For: mothers Using the STARSS materials how do you talk like a Star to introduce the STARSS topic?

27. Scenario 2 You overhear one mother say to two of her friends “well I finally quit smoking, but it’s so hard!” Her friend says “I’ve cut down but can’t seem to give up those last few.” Using the STARSS materials, how might you talk like a Star? What resources could you provide?

28. Scenario 3 Your centre has put up STARSS posters and resources. It’s working because you hear women talking about reducing second-hand smoke. One woman tells you she doesn’t smoke but her father-in-law who lives with her does. Using the STARSS materials how do you talk like a Star? What resources could you provide?

29. Scenario 4 Getting back to pre-pregnancy weight is a hot topic in the group you are running. One member has told you that she wants to quit smoking but last time she quit she gained a lot of weight. You suspect there may be others in the group with similar concerns. Using the STARSS materials how might you talk like a Star to introduce the topic of smoking and weight gain? What resources could you provide?

30. Points to Ponder Even minimal interventions are effective More intensive interventions are manageable and even more effective It is all in the approach we take! “It was easy to piggyback STARSS into our existing programs. We were able to fully integrate it into everything we do. So instead of it being one in a long list of programs that we offer, STARSS became part of everything that we offered.”

31. Next Steps Ongoing consultation and partnership with public health staff to implement STARSS Opportunities to enhance skills STARSS Community of Practice Pursue further collaboration (champion, Smokers’ Helpline, workshop, group sessions, policy development)