1. Smoking Cessation Services in a Baltimore County Title X Family Planning Program CityMatCH Urban Maternal and Child Health Leadership Conference Albuquerque, NM, September 21, 2008 Diana Cheng, M.D. Medical Director, Women’s Health Maryland Department of Health and Mental Hygiene

2. Women’s Health in a Family Planning Program Guiding Principles  Pregnancy outcomes can be improved by improving women’s health (preconception health!)  Women of reproductive age need comprehensive health services that promote physical and emotional wellness beyond reproductive health  Premature death, chronic and acute disabilities can be prevented by reducing risk factors earlier in life.  A large gap exists between health services received (e.g. family planning) and health services needed.

3. WELL (Women Enjoying Life Longer) Services Immunizations Lab screening Counseling Smoking cessation Screening, Treatment, or Referral

4. Baltimore County Family Planning Clinic Sites

5. Baltimore County Family Planning Program by Race/Ethnicity, FY ‘07

6. Baltimore County Family Planning Program by Age, FY ‘07 <25 yrs 56%

7. Baltimore County Family Planning Program by Health Coverage, FY ‘07

8. Preconception Smoking Status by Race/Ethnicity Maryland PRAMS, 2001-2003

9. Preconception Smoking Status by Age Maryland PRAMS, 2001-2003

10. Preconception Smoking Status by Health Coverage Maryland PRAMS, 2001-2003

11. Maryland Title X Family Planning Program Contraception History and physical Pregnancy testing STD/HIV testing Cervical and breast cancer screening Rubella immunization Smoking assessment

12. Smoking Cessation Services Ask about cigarette smoking Advise –Contraception –Pregnancy –Second-hand smoke Assess and assist –5 A’s –Behavioral stages of change Arrange options –Maryland QuitLine –Nicotine Patches –Medications Bupropion (Zyban), varenicline (Chantix) –Refer

13. Smoking Cessation Service Integration Counselor Assess smoking (e.g. 5 A’s, behavioral stages of change), educate Clinician Confirm assessment, educate, prescribe treatment (QuitLine, counseling, class, nicotine patches, bupropion, varenicline), referral Exit Nurse Counsel, dispense treatment, refer Waiting Room Educational materials, service description

14. Referrals for Smoking Services, FY ‘07

15. Baltimore County Smoking Referrals, FY ‘07 Smoking cessation services (n=801) 83% Uninsured 60% White, 34% Black 50% <25 years of age

16. Barriers Problems –Additional work for already burdened FP staff –Funding Solutions –Involve staff in planning –Provide training –On-site services –Establish need for services and probability for success –Involve multiple partners –Provide feedback

17. Partners Title X Family Planning Program Baltimore County Title X Family Planning Program American Lung Association of Maryland Baltimore County Health Department, Tobacco Use Prevention/Smoking Cessation Program Maryland Department of Health and Mental Hygiene Center for Maternal and Child Health Baltimore County Health Department Child, Adolescent and Reproductive Health

18. Summary The Title X FP Program is an opportune site to offer young women with poor access to health care, services they would not otherwise obtain. Population at the Title X FP Program is at high risk for cigarette smoking. –Lack of private insurance, teens/young adults Public health implications for young women –Prevent adverse pregnancy outcomes –Prevent future acute and chronic disorders –Raise families in smoke-free environment