1. Smoking Cessation Pathway Reducing the infant mortality rate in Cincinnati and Hamilton County

3. 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

4. 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

5. 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.

6. 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]

7. 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.

8. 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

9. 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.

10. 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

11. Stages of Change 5 R’s of Quitting Tobacco

12. Medicaid billing

13. Quit Line Fax Referral Form Printable versions on: http://www.healthy.ohio.gov/~/media/He althyOhio/ASSETS/Files/tobacco%201 %20of%202/odhquitlinefaxreferralform. ashx http://www.healthy.ohio.gov/~/media/He althyOhio/ASSETS/Files/tobacco%201 %20of%202/odhquitlinefaxreferralform. ashx Soon available on our website under ‘Healthcare Professionals’ resources

14. 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

15. Other resources available Refer patients to http://women.smokefree.gov/ for great advice on managing stress, health benefits and other quitting tipshttp://women.smokefree.gov/ Text the word QUIT to this number: 47848 (iQuit) Encourage patients to seek out a smart phone Quit-App that appeals to them

16. 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)

17. Questions ? www.cradlecincinnati.org Phone: 513-803-1285