1. Addressing Substance Abuse in Pregnancy: Opportunity for Change Jeanne Mahoney Director, Provider’s Partnership American College of Obstetricians and Gynecologists 2005

2. Overview Why group tobacco and substance use together? Epidemiology / costs Interventions that work Involving health care providers

3. Tobacco and Substance Use Women unable to give up smoking during pregnancy are at great risk to use/abuse alcohol and other drugs Tobacco is an addictive substance. Intervention for tobacco use similar to alcohol and drugs Both issues best addressed in preconception period – distinct effects early in fetal development and through entire pregnancy

4. Smoking is the single most important modifiable cause of poor pregnancy outcomes in the United States (Orleans, 2000)

5. Prevalence of prenatal tobacco use Varies by state –Highly dependent on tobacco taxes and regulations. Varies by race/ethnicity –American and Alaskan natives greatest use Varies by age –Teen rate highest rate in early pregnancy –Women over 35 highest rate of continued smoking

6. Public Health Results of Perinatal Tobacco Use Annual smoking-attributable health care costs at delivery for problems caused by smoking during pregnancy - $366 million in 1996 2/3 of these babies were born to mothers on Medicaid About $704 per maternal smoker CDC, 2003

7. National Perinatal Tobacco Initiatives Partnership to Help Pregnant Smokers Quit Great Start Quitline March of Dimes Partnerships ACOG Training Programs

8. Partnership to Help Pregnant Smokers Quit Developed by SmokeFree Families and supported by RWJF 60 national organizations involved 6 work groups Products: –Medicaid tool kit –Worksite tool kit –Legislative attention –Campaigns for Native American smokers

9. Great Start Quitline Supported by American Legacy Foundation Tied into state and (soon) national quitlines. Does proactive and responsive counseling Developing a postpartum relapse prevention program

10. March of Dimes All chapters involved in perinatal tobacco initiatives Most include hospital grand rounds, provider and OB staff training and public health fairs Have developed medical briefs on perinatal smoking

11. Tobacco Partnership Initiatives AMCHP, PPFA and ACOG state partnership teams – 10 –Funded by CDC and WTPN –Involve team development and planning –Have succeed in state policy changes, provider training, resource identification and collaboration.

12. ACOG Tobacco Provider Partnership - Nevada Example – Nevada Smoke Free Babies Who - Public health and ACOG previous collaboration Why – High rate of perinatal smoking Catalyst - New Quit-line – Pending legislation Result – Statewide diverse team, passed tax legislation, received grant funding for perinatal demonstration project

13. ACOG Materials Tool kit for clinicians to counsel on perinatal smoking Lecture guide/CD ROM to teach counseling Chart stickers Patient workbook Pregnancy and Beyond – virtual clinic tutorial CD ROM (Dartmouth University)

14. Fetal alcohol syndrome (FAS) is the most common preventable cause of mental retardation. It is 100% preventable. Women rarely abuse single substances, those who abuse illicit substances frequently use alcohol and or tobacco. Perinatal Substance Abuse

15. FASD Prevention Surgeon General’s Report CDC’s stronger messages Initiatives involving Women’s Health Care providers

16. Involving OB/GYNs in Tobacco and SA Initiatives Why Direct access to patients Strong legislative voice for policy change It takes a physician to reach a physician How Schedule meetings early in AM, lunch time, evening Patch in clinician on conference call Tighten up process Use clinician as an advisor

17. Contact information Jeanne Mahoney Director, Provider’s Partnership ACOG 409 12 th Street, SW Washington, DC 20024 202-314-2352 FAX 202-484-3917 Jmahoney@acog.org