1. Collaborative strategies to reduce tobacco exposure among low-income families Katie Marble, CHES Joan Orr, CHES Healthy Community Coalition

2. Learning Objective You will be able to identify cost-effective strategies to reduce prenatal and secondhand smoke exposure in low-income families through multi-agency collaboration.

3. Service Area Population of service area: 40,000 Classified as “very rural” with just 17.4 people per square mile. Franklin County has lowest adult smoking rate in Maine at 17% (Maine’s adult smoking rate is 23.5%) ( Maine BRFSS, Community Health Profile 2000)

4. Health Assets Healthy Community Coalition of the Franklin Community Health Network Healthy Maine Partnerships/Fund for Healthy Maine

5. Prenatal Smoking Statistics * Maine Pregnancy Risk Assessment Monitoring System Survey, 1997-1999.

6. Prenatal Smoking Statistics 25% return to smoking postpartum 66% of premature births in Franklin County were to women who smoked. Women who continue to smoke during pregnancy are almost exclusively low- income. –90% have a household income of less than 24,000 (140% of poverty). * Maine Pregnancy Risk Assessment Monitoring System Survey, 1997-1999.

7. Prenatal Care (*Maine Children’s Alliance, 2002)

8. Tobacco-Free Franklin Families 3 year pilot program funded by the American Legacy Foundation Priority Population Grant. Goals to: –Reduce prenatal smoking –Reduce postpartum relapse –Reduce the # of children 0-5 exposed to ETS –Build a system of effective tobacco-use reduction services for low-income families

9. Strategies Reach the maximum number of women with American Legacy Grant Have women repeatedly exposed to cessation messages Collaborate with Prenatal Care Providers & Agencies already reaching low-income women Target stress management

10. Founding Partners Pine Tree Women’s Care WIC Head Start Growing Healthy Families Franklin Childcare

11. Costs Trainings Meeting Support Resources Materials Incentives

12. Savings Agencies provide outreach through out the county (over 1697.81 square miles -1 1/2 times the size of Rhode Island), saving transportation costs or having to establish multiple sites Reach over 5000 families of 6194 families with a household income under $25,000 (more than our program could reach working alone:) Sustainable Strategy

13. Implementation Trained agency staff in the 5 A’s of intervention, nicotine addiction & the “stage of change” model. Established meetings to plan how intervention would take place in each agency. Each agency provides a different level of intervention. Home Visitors provide more in-depth intervention. Prenatal Care Providers at least a five minute intervention.

14. Implementation The intervention is guided by process evaluation, Tobacco Flow Chart. Assistance includes prenatal program Every Mother’s Wish, Maine Tobacco Helpline, Stress workshops Media campaign Established workgroup meetings and site visits to problem solve.

15. *Clarifying Success* Important to let healthcare providers there are many types of success within smoking cessation counseling. –Moving someone from one stage of change to another. –Making an impact by mentioning tobacco –Delayed reaction of participants –Getting tobacco smoke outdoors –Reducing the number of cigarettes smoked/day –Someone quits smoking

16. Preliminary Results This year over 72 health and social service providers have had in-depth training in the 5 A’s of intervention. (42 more than year one goal) The calls to the Maine Tobacco Helpline from Franklin County were double the number expected from Jan.-Mar. 2003 Tobacco status addressed as a vital sign with 100% of patients at Pine Tree Women’s Care.

17. Preliminary Results 81% of all women who smoke were provided with the 5 A’s of intervention at prenatal care offices 30 women completed Every Mother’s Wish Program in year one (out of 110) Additional agencies are requesting training on the 5 A’s of tobacco intervention

18. Lessons Learned: Partners are the key to a successful program Clearly define the role of both your agency and the partner agency Identify the roles of people within each partner agency Identify a champion at each site Create a bonding experience for that site Never Underestimate the power of incentives (aka. Food)

19. More Lessons Learned Bring the programs/training to the audience not the audience to the program (especially in rural areas). Listen, Listen, Listen, Listen, Act, & the Listen Again. REMAIN FLEXIBLE

20. Thank-you Contact us at: Healthy Community Coalition 207-645-3136 Check our web site: http://www.FCHN.org/HCC