1. A Fresh Start for WIC: Tailoring Smoking Cessation for WIC Participants and Their Families Laura A.Van Dyke, CSW Saint Vincent Catholic Medical Centers New York City (212)604-7572

2. Background Information Saint Vincent Catholic Medical Centers (SVCMC) received a three-year grant from NYS DOH Three staff hired to implement smoking cessation program at system’s 9 WIC sites WIC is a supplemental nutrition program for qualified women, infants and children

3. Program Planning Met with WIC site directors in each region (Brooklyn/Queens, Manhattan and Staten Island) and conducted needs assessment Researched perinatal smoking cessation techniques Partnered with American Cancer Society to receive training in Make Yours A Fresh Start Family (MYFSF) model and ongoing technical assistance throughout the year

4. MYFSF Program Description MYFSF is a comprehensive package for health care providers to assist them in counseling their pregnant and parenting clients to stop smoking Based on U.S. Public Health Service Clinical Practice Guidelines for Treating Tobacco use and Dependence

5. Adaptation of MYFSF for WIC Population Met with WIC directors and nutritionists regarding capacity to implement brief cessation counseling Collaborated with WIC staff on the development of data collection tools Developed brochure to introduce program for WIC participants and offer phone counseling

6. Provided 3 MYFSF Training Sessions to WIC Staff in each region Smoking facts and figures Smoking cessation and the process of behavior change The 3-5 minute brief counseling technique (based upon stage of change theory and 5A’s of intervention) Use of progress chart to track smoking behavior/ exposure to ETS System of chart identification (red dots or log) Role Plays

7. Program Implementation By Feb.1, 2002 all sites trained and ready to implement MYFSF program

8. Expectations: Smoking status asked at every visit and an intervention offered based on stage of smoking behavior Materials/magazines offered to all smokers and those exposed to ETS Efforts documented and filed in participant’s chart Red dots used to flag charts Follow-up at subsequent visits to facilitate movement along stages of change

9. Technical Support Provided by Tobacco Cessation Program Phone support to all WIC staff Phone counseling to WIC participants seeking additional support Participation in health fairs at WIC sites (nutrition month and breastfeeding fairs) Attendance at WIC staff meetings Provide educational materials (brochures, literature, videos) and varied incentives to quit smoking

10. Relationship Building: Creating a Partnership Between WIC Staff and our Tobacco Cessation Program Enhanced by our status as employees of SVCMC Involved WIC directors and staff in every step of program development Encouraged environment for open discussion of concerns Prioritized staff recognition luncheons Identified environmental barriers to program success (i.e. facilitated child-friendly environments)

11. Program Assessment and Evaluation Conducted process evaluation with nutritionists via focus groups and surveys Conducted chart review to determine utilization of progress charts and assess follow-up

12. Our Findings 8 of 9 sites implemented program 90% of nutritionists think they can have positive effect on smoker’s behavior 60% think brief cessation counseling is an important part of their job the other 40% indicated that it is important, but need more strategies for making time 292 charts (of women, infants and children) were flagged as smokers or as exposed to second-hand smoke

13. Findings (continued) Chart review conducted on 122 of the total 292 charts 52% asked about smoking status at subsequent visits 48% documented that materials were provided 56% of charts revealed some movement (micro- movement) along the stages of change (this figure includes women who spontaneously quit due to pregnancy)

14. Barriers to Program Implementation Limited time for counseling patients and documenting efforts due to high caseloads (1:890) Lengthy waiting period in often crowded and chaotic environment Nutritionists’ personal views about smoking Introduction of new computer system (WICSYS) impedes counseling process

15. Strategies Modify intervention to core elements: ask, offer, document Create child-friendly environments Empower nutritionists Meeting with WIC at state level to discuss problems with computer tobacco screen

16. Ongoing Improvements Maintain the partnership with ACS that has enabled us to achieve our success to date Continue to build relationship with WIC staff and be responsive to their suggestions Consultation with NYS WIC department as they pilot the MYFSF model in two WIC sites in NYS Expansion into SVCMC outpatient clinics

17. Special Thanks Elena F. Deutsch, MPH, Director, Tobacco Control, American Cancer Society, NYC Patricia M. Lamberson, MPH, Senior Health Educator, SVCMC Lupe Flores, BA, Health Educator, SVCMC