1. SUPPORTING SMOKE FREE FAMILIES IN SOUTHEASTERN OHIO Project Team: Barry Oches Lesli Johnson Regina Warfel Jennifer Collins Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

2. TELL US ABOUT YOURSELF  Name  Organization  Role  What smoking cessation resources do you know about?  What smoking cessation resources do you wish you had? Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

3. SIDsBronchiolitisMeningitis Infancy Low Birth Weight Stillbirth Neurologic Problems In utero Asthma Ear Infections Fire-related Injuries Influences to Start Smoking Nicotine Addiction Cancer Cardiovascular Disease COPD Adulthood Adolescence Childhood HEALTH EFFECTS OF TOBACCO USE Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs CITATION: Aligne, C.A., Stoddard, J.J. (1997). Tobacco and Children: An Economic Evaluation of the Medical Effects of Parental Smoking. Archives of Pediatrics & Adolescent Medicine, 151(7), 648-53.

4. SECONDHAND SMOKE EXPOSURE HARMS CHILDREN  Secondhand smoke has similar effects as it does to the smoker themselves.  Approximately 6,200 children die each year in the U.S. as a result of secondhand smoke exposure.  Approximately 5.4 million childhood diseases are attributed to secondhand smoke exposure. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs CITATION: Aligne, C.A., Stoddard, J.J. (1997). Tobacco and children. An economic evaluation of the medical effects of parental smoking. Archives of Pediatric and Adolescent Medicine, 151(7), 648-53.

5. BENEFITS OF QUITTING 20 minutes Blood pressure and heart rate return to normal 8 hours O2 level returns to normal; nicotine and CO levels reduced by half 24 hours CO is eliminated from body; lungs begin to eliminate mucus, debris 48 hours Nicotine is eliminated from body; taste and smell improve 72 hours Breathing is easier; bronchial tubes relax; energy levels increase Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs 2 to 12 weeks Circulation improves 3 to 9 months Lung function increases by up to 10%; breathing problems reduced 1 year Heart attack risk halved 10 years Lung cancer risk halved 15 years Heart attack risk same as for someone who has never smoked CITATION: 1990 Surgeon General’s Report

6. SMOKERS WANT SUPPORT TO QUIT  70% of smokers report wanting to quit and almost two-thirds of smokers who relapse want to try quitting again within 30 days.  Even for patients who aren’t yet willing to make a quit attempt, brief interventions enhance their motivation and increase the likelihood of future quit attempts.  Most have made at least one quit attempt, and most cite their motivation to quit was caused by the advice of a health expert. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs CITATION: Centers for Disease Control and Prevention. (2002). Cigarette Smoking Among Adults- United States, 2000. Morbidity and Mortality Weekly Report, 51(29), 642-5.

7. GOAL OF THIS PROJECT Support women in the community to quit smoking ODH Ohio University Team Providers Family and Friends Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

8. SUCCESS BY THE NUMBERS County total population: _________ Target Population: Women, ages 18 to 44: _______ Goal #1 : Reach 50% of target population: _______ Of which 20% smoke, to apply 5 As: _______ Goal # 2: 50% accept referral to Ohio Quit Line (or other) _______ Goal #3 : at least 75% referred will quit for at least one day _______ Goal #4 : at least 10% referred will quit for 30 days _________ Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

9. 5AS QUIT SMOKING PROGRAM 1. ASK about tobacco use2. ADVISE to quit3. ASSESS willingness to make a quit attempt4. ASSIST in quit attempt5. ARRANGE follow-up Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

10. OHIO QUIT LINE SUPPORT  Quit lines are staffed by trained cessation experts who tailor a plan and advice for each caller.  Free to most callers. Those not covered will be referred to other resources.  Fax referral services are available.  Patches, gum, and lozenges are free for a four week course. They are mailed directly to the client. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

11. 5As AND QUIT LINE EFFECTIVENESS  Even simple advice to quit increases quit rates by an estimated 2.3%.  Low intensity counseling (3-10 minutes) increases quit rates by approximately 5.1%.  High intensity counseling (>10 minutes) increases rates by an estimated 11.2%.  Quit-line counseling increases rates by an estimated 4.2%. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs CITATION: Fiore M.C., Jaén, C.R., Baker, T.B., et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

12. STEPS TO SUCCESS THE OU TEAM WILL: Provide ongoing support and refresher trainings to offices as they implement the 5As program Provide free 5As training to as many providers as possible and design a system of data collection for the community Assess the work flow of provider offices and provide assistance to implement the 5As as seamlessly as possible Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

13. SUCCESS STORIES  A married couple, pregnant with their first baby, were motivated to stop smoking. They were both smoking about a half pack a day each and once they found out that they were pregnant, they have been trying to cut down and quit. They had cut down on their own so that the wife was down to 2 cigarettes per day, one in the morning and one in the evening, and the husband was smoking about 6 cigarettes a day, the 2 with his wife, 1 on his way to work, 1 on his way back from work, and 2 during work breaks. They expressed a strong willingness to completely stop smoking by the time the baby was born. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

14.  Provider discussed their smoking triggers and together they figured out which cigarettes to drop from their “routine.” They would both stop smoking the morning cigarette and instead prepare a hot breakfast. They were going to start walking in the evenings after dinner, to overcome the urge to smoke.  The husband agreed to stop smoking in the car on the way to and from work, and instead play music, put his cigarette pack in the trunk of the car, and have gum in the glove compartment at all times. This was an important change since they did not want anyone to smoke in the car once the baby was born. The husband also said that he would consider letting his friends at work know that he was trying to stop smoking and ask for their support and recommend other activities for break time. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs SUCCESS STORIES

15.  The couple succeeded in refraining from smoking in the morning and in the evening. The wife completely quit, and the husband was still working on the 2 cigarettes at work.  They established a smoke-free home and cleaned their house (including carpet cleaning).  The couple told their families, who were smokers, that they were quitting smoking and that they wanted their support to create a safer environment for their baby.  The wife planned to talk to her mother about creating smoke-free rooms in her house for when she was going to watch the baby when the wife returned to work at 6 weeks. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs SUCCESS STORIES

16. TAKE AWAY MESSAGE  Patients and families expect health care providers to discuss tobacco use.  If counseling is delivered in a non-judgmental manner, it is usually well-received.  Even small doses are effective – and cumulative!  As a service provider, YOU have a huge influence on whether women in your community quit smoking. Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs CITATION: Fiore M.C., Jaén, C.R., Baker, T.B., et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008.

17. Questions?

18. CONTACT US Project website: www.smokefreeseohio.org www.smokefreeseohio.org Barry Oches Lesli Johnson Senior Project ManagerAssistant Professor Phone: 740.593.9799 Phone 740.593.9739 Email: oches@ohio.eduEmail: johnsol2@ohio.eduoches@ohio.edujohnsol2@ohio.edu Regina WarfelJennifer Collins Research Associate Phone: 740.597.1664Phone: 740.593.9701 Email: warfel@ohio.eduEmail: collinj@ohio.eduwarfel@ohio.educollinj@ohio.edu Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs

19. SUCCESS BY THE NUMBERS County total population: _________ Target Population: Women, ages 18 to 44: _______ Goal #1 : Reach 50% of target population: _______ Of which 20% smoke, to apply 5 As: ________ _______ Goal # 2: 50% accept referral to Ohio Quit Line (or other) _______ Goal #3 : at least 75% referred will quit for at least one day _______ Goal #4 : at least 10% referred will quit for 30 days _________ Ohio Partners for Smoke Free FamiliesOhio Department of HealthOhio University Voinovich School of Leadership and Public Affairs