1. STARSS Follow-Up Session for NWT Start Thinking About Reducing Secondhand Smoke: A harm reduction support strategy for low- income mothers who smoke Developed by AWARE: Action on Women’s Addictions – Research and Education info@aware.on.cainfo@aware.on.ca www.aware.on.cawww.aware.on.ca

2. Who Benefits from STARSS STARSS was designed to meet the needs of women who: live on a low-income are single parents (which may mean they have a part time partner) have children under age 6 living with them receive support from a service provider are not ready to quit smoking

3. Not Ready to Quit Abstinence is healthiest for everyone – no known safe level of smoking BUT: abstinence not always possible Focus on positives of reducing smoking: – Smaller, more manageable steps – Accomplishments can increase confidence – Can eventually move to quitting – Keeps participant engaged

4. 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 behaviours in order to make changes  gives moms skills to help them make a quit attempt when they’re ready Goal setting strategy  builds on every change a mom makes (no matter how small) to the larger goal of smoking outside (not quitting)

5. 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

6. STARSS Message Women wanted an approach that supports the role of moms (especially if they are sole parents), acknowledges the love they have for their children, and affirms measures moms already take to protect their children in a variety of ways

7. STARSS Message The posters emphasize the many things moms do to protect children and includes smoking outside as one of those things “Just because I smoke doesn’t mean I don’t love my children.”

8. Contents The Guide to STARSS Strategies (a training manual for service providers) The I’m A STAR! Journal (a workbook for moms) Series of posters Magnets, window clings, stress “squeezies” How To Be a STAR! train-the-trainer guidebook Newsletters and other resources from the website

9. Take a Walk Through... … the STARSS section of the website Go to www.aware.on.ca/starss www.aware.on.ca/starss www.aware.on.ca/starss/starss-resources www.aware.on.ca/starss/starss-newsletter www.aware.on.ca/starss/starss-mom-newsletter www.aware.on.ca/starss/starss-showcase www.aware.on.ca/starss/starss-action www.aware.on.ca/starss/starss-presents www.aware.on.ca/starss/starss-training

10. Worksheets Worksheet #1Short Term Goal Examples Worksheet #2Cigarette Fading and DEEDS Worksheet #3 How to Choose a Smoking Place Worksheet #4Positives & Negatives of Smoking Worksheet #5How to Identify Your Triggers Worksheet #6Ideas to Keep Your Hands Busy Worksheet #7Coping With Cravings Worksheet #8Deep Breathing/Muscle Relaxation Worksheet #9Coping With Stress Worksheet #10Some Ideas to Help You Quit

11. Handouts (reduction focussed) What works! Effects of SHS on children Information for STARSS moms How to help your mom be a STAR! Help my mom be a STAR! Ideas to help protect your children from SHS

12. Handouts (cessation focussed) Ideas to help you quit smoking when you’re ready Why it’s so hard to quit smoking What smoking cost in November 2009 What happens when you quit smoking Smoking cessation aids fact sheet

13. How To Use STARSS 1.Posters and Handouts Put up posters Leave out the following handouts:  What works!  Effects of Second-hand Smoke on Children  What Smoking Costs  How to Be a Star! Second-hand Smoke Protection Rotate posters and handouts Make sure there aren’t other posters/handouts that contradict the STARSS message Have snacks in the shape of stars Hang/decorate your organization with stars Have kids do a star activity Good way to first introduce topic of smoking into your organization Generates interest among participants Increases staff confidence to discuss smoking issues

14. How To Use STARSS 2. Handouts and Worksheets in Existing Groups Put out What works! Handout before a group This may start discussion or promote questions Introduce the topic starting with the positives that moms already do to protect their kids Distribute and discuss worksheets or handouts. The following are good ones to use (may only have time for one):  Worksheet 1: Short term Goal Examples  Worksheet 3: How to choose a Smoking Place  Worksheet 2: DEEDS  Worksheet 4: Positives and Negatives of Smoking  What Works! Handout Have a discussion/activity that talks about the facts and myths of second hand smoke Keep the discussion away from quitting

15. How To Use STARSS 3. STARSS Workshop or Series Once your participants are familiar with the STARSS materials, you can offer to hold a specific discussion group. Could be one session or 2 – 3 sessions. Talk about and validate the reasons women smoke and why it is hard to quit Discuss all the ways women protect their children and introduce STARSS as one other way she can protect her child from second-hand smoke. Distribute and discuss Worksheets 1 - 4

16. How To Use STARSS 4. Individual or One-to-One Sessions Each session can be delivered as part of regular contacts you already have with women There are 7 sessions:  First 2 take a little longer but the remainder take no more than 20 min each Sessions do not need to be every week Participant led – depends on the woman’s readiness to move on

17. Women’s Voices I don’t like any of the stuff the kids say or bring home from school about how we’re going to die if we smoke. It adds to the guilt and turns kids into cops. I want stress relievers, like exercise or yoga classes. I don’t want ideas about doing exercises at home. I want to be able to get out to do things. We need to do things with our kids in a smoke free environment. But it’s all part of having access to free childcare. Anything that helps with reducing the stress in my life is a benefit. If you help reduce my stress, you will help reduce my smoking.

18. Learnings from the National Rollouts STARSS is easy to use and integrate Implementing STARSS does not add a burden to work loads Make it FUN! Good buy-in from staff & participants Self efficacy of staff greatly improved Participants respond well There have been adaptations and ripple effects locally and regionally

19. Learnings from the National Rollouts Integration of STARSS strategies depended upon site capacity Some offered all of the different methods of delivery Others originally offered minimal or informal strategies only However, these sites were able to do far more than they originally thought Minimal and informal strategies were the easiest to integrate and were effective with participants

20. Moms’ Stories “I was attracted to STARSS because they weren’t trying to pressure me to quit smoking or trying to make me feel guilty. I wouldn’t have gotten involved in the first place if they were trying to get me to quit.” “I’m not ready to quit smoking again. But being involved with STARSS has made a number of big changes in my life.”

21. Service Provider Stories “I learned how to stay hopeful and involved, even if the women didn’t quit smoking.” “Before STARSS, I was reluctant to talk about smoking with moms. It felt like such a huge issue and I really didn’t know what to say or do. I was reassured you didn’t have to get moms to quit smoking; it’s just as important to develop a rapport about secondhand smoke and protecting children.”

22. Points to Ponder Even minimal interventions are effective More intensive interventions are manageable and even more effective It’s all in the approach we take! “It was easy to piggyback STARSS onto 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.”