1. North Country Healthy Heart Network, Inc. Administrative Office Saranac Lake, New York

2. North Country Healthy Heart Network, Inc. Mission Statement  To decrease the incidence of heart disease and stroke in Franklin, Jefferson, Lewis and St. Lawrence County through education and the promotion of wellness.

3. North Country Healthy Heart Network, Inc. Heart Network Member Organizations  Four county public health departments  Nine Hospitals Adirondack Medical Center - Franklin County Adirondack Medical Center - Franklin County Alice Hyde Medical Center – Franklin County Alice Hyde Medical Center – Franklin County Canton Potsdam Hospital – St. Lawrence County Canton Potsdam Hospital – St. Lawrence County Carthage Area Hospital – Jefferson County Carthage Area Hospital – Jefferson County Claxton Hepburn Hospital – St. Lawrence County Claxton Hepburn Hospital – St. Lawrence County Clifton Fine Hospital - St. Lawrence County Clifton Fine Hospital - St. Lawrence County Lewis County General Hospital – Lewis County Lewis County General Hospital – Lewis County Massena Memorial Hospital – St. Lawrence County Massena Memorial Hospital – St. Lawrence County Mercy Health Care of NNY – Jefferson County Mercy Health Care of NNY – Jefferson County

4. North Country Healthy Heart Network, Inc. County Profile U.S. Census Bureau - State and County QuickFacts County Land Area Sq. Miles Population2000Population Per Sq Mi Per Capita Income ‘99 Poverty Rate ‘99 Franklin1,63251,13431.3$15,88814.6% Jefferson1,272111,73887.8$16,20213.3% Lewis1,27626,94421.1$14,97113.2% St. Lawrence 2,686111,93141.7$15,72816.9% Total6,866301,747 45.5 average $15,697 average 14.5% average NYS47,21418,976,457401.9$23,38914.6%

5. North Country Healthy Heart Network, Inc. Target Population  Low-income people that use tobacco and have at least one other risk factor for heart disease.

6. North Country Healthy Heart Network, Inc. Challenges  How to make access easy.  How to let people know about our services.  We wouldn’t even talk about the weather.

7. North Country Healthy Heart Network, Inc. Program Design Access  One-on-One  Mobile  Unlimited number of meetings  Face-to-Face; Telephone, E-Mail  Free  Flexible meeting sites and hours  Track for one year on a quarterly basis

8. North Country Healthy Heart Network, Inc. Program Features Evidence Based Interventions  Counseling  Medication  Support within the helping relationship  Support development within the participant’s primary network Clinical Practice Guideline – Treating Tobacco Use and Dependence, Public Health Service, June 2000 Clinical Practice Guideline – Treating Tobacco Use and Dependence, Public Health Service, June 2000

9. North Country Healthy Heart Network, Inc. Helping Model Integrated Strategies to Meet the Needs of Each Individual  Services tailored to the individual’s stage of readiness Transtheoretical Model/Stages of Changes, Prochaska & DiClemente Transtheoretical Model/Stages of Changes, Prochaska & DiClemente Motivational Interviewing- Motivational Interviewing- Increase importance & confidence will see movement towards action.Increase importance & confidence will see movement towards action. Stephen Rollnick, Health Behavior Change,Stephen Rollnick, Health Behavior Change, Miller & Rollnick, Motivational InterviewingMiller & Rollnick, Motivational Interviewing  Basic Counseling, Gerard Egan, The Skilled Helper Strength Based Strength Based Problem Solving Model Problem Solving Model

10. North Country Healthy Heart Network, Inc. The Helping Process  Program Participants screened at each meeting.  0-5 Importance  0-5 Confidence  How soon do you want to quit?  Interventions are then tailored to increase self efficacy & importance.  When ready quit plans are developed: physical, psychological & activities of daily living.

11. North Country Healthy Heart Network, Inc. Outreach How to make program visible  Clinicians Offices  Human Service Organizations that serve low-income people  Program material placed at locations frequented by target group  Minimal paid advertising  Partnership with Tobacco Coalitions in region.

12. North Country Healthy Heart Network, Inc. New Challenges  Uninsured participants cannot afford medication.  Lack of discrete start and stop times makes program monitoring and evaluation difficult.

13. North Country Healthy Heart Network, Inc. Heart Network’s Response  Pharmacotherapy Fund Two week voucher Two week voucher Active participation Active participation Prescription required Prescription required One vendor well positioned in region One vendor well positioned in region  Database developed – Holmes & Associates  Data Analysis – State University of New York at Albany- School of Public Health – Graduate Student Intern

14. North Country Healthy Heart Network, Inc. Database Peek

15. North Country Healthy Heart Network, Inc. One more peek

16. North Country Healthy Heart Network, Inc. Evaluation July 1, 2002 – June 30, 2003  Participants 310 people - 62% female – average age 45.5 310 people - 62% female – average age 45.5 Low Income Low Income 34.2% below $10,00034.2% below $10,000 57.1% below $20,00057.1% below $20,000 Insurance Insurance 28.7% Medicaid28.7% Medicaid 8.7% Medicare8.7% Medicare 15.5% Not insured15.5% Not insured One other risk factor for heart disease One other risk factor for heart disease 86.5%86.5%

17. North Country Healthy Heart Network, Inc. Evaluation Continued Tobacco History  Tobacco Use - Range from 3 to 66 years  Tried to Quit before: 90% Average attempts – 4.5  Talked to their doctor about quitting: 81.2% - 98.4% were told to quit by doctor.  36.3% live with a smoker

18. North Country Healthy Heart Network, Inc. Evaluation Sessions with Specialists  2,156 sessions 71.2% face to face 71.2% face to face 27.2% telephone 27.2% telephone 1.6% group 1.6% group.1% email.1% email  Average 5.7 sessions per participant

19. North Country Healthy Heart Network, Inc. Outcome Movement towards Action Importance, confidence and readiness increase with number of sessions.

20. North Country Healthy Heart Network, Inc. Movement towards Action

21. North Country Healthy Heart Network, Inc. Outcome Action - Maintenance  162 (52.3%) Quit for at least one day.  June 30, 2003 - 126 still quit (41%) 25.76 % 0-1 month25.76 % 0-1 month 28.03%1-3 months28.03%1-3 months 27.27%3-6 months27.27%3-6 months 7.58%6-9 months7.58%6-9 months 6.82%9-12 months6.82%9-12 months

22. North Country Healthy Heart Network, Inc. Outcome Profiles  Quit minimum of 1 month Doctor recommended Doctor recommended Have tried to quit before Have tried to quit before Relatively higher education Relatively higher education Relatively more confident Relatively higher income Relatively more confident Relatively higher income Several risk factors Several risk factors COPD, High cholesterol, diabetesCOPD, High cholesterol, diabetes  Quit less than 1 month  Doctor recommended  Relatively higher education  Relatively higher income  History of clinical depression  Relatively larger household size  High blood pressure  Family history of heart disease  Cholesterol not high

23. North Country Healthy Heart Network, Inc. Profile  Quit minimum of 1 month versus quit for less than 1 month. Do not have a history of depression Do not have a history of depression Are not overweight Are not overweight High cholesterol High cholesterol COPD COPD Asthma Asthma No family history of heart disease No family history of heart disease Not on other medication Not on other medication  People who did not make a quit attempt Do not have insurance Doctor did not recommend First quit attempt Live with a smoker Not confident Relatively lower education Relatively lower income Do not have high blood pressure

24. North Country Healthy Heart Network, Inc. Cost  Per Participant (310)$ 635.00  Per Session (2,156)$ 91.00  Per Quit/day (162)$1,215.00  Per Quit -6/30/03$1,563.00 (126)

25. North Country Healthy Heart Network, Inc. Closing  Mobility  Flexibility  Evidence Based Services  Helping relationship-participant controls the process & outcome, respectful, supportive, genuine interactions  Follow up  Data entry-retrieval system & analysis  Integration into health/human service system

26. North Country Healthy Heart Network, Inc. We Are So Grateful !  To the New York State Department of Health Tobacco Control Program Freedom to develop a program that focuses on the needs of rural tobacco users in NNYFreedom to develop a program that focuses on the needs of rural tobacco users in NNY Support to create a database and data analysisSupport to create a database and data analysis Encouragement to be here todayEncouragement to be here today