1. Clean Air for Healthy Children and Families Health Care Professional Training in Smoking Cessation Counseling Techniques Edward G. Rendell, Governor Calvin B. Johnson, M.D., M.P.H., Secretary of Health Pennsylvania Chapter American Academy of Pediatrics In partnership with Pennsylvania Area Health Education Center (AHEC)
2. Program Development PA DOH Funding to Fox Chase 1989-1994 PA DOH Funding to PA AAP 1996-Present Clean Air Program Adopted 1996 AAP Policy 2001 Primary Contractors 2002 Curriculum Revised & Updated 2004, 2006 PA DOH Funding to AHEC to PA AAP 2005-Present ACS 1997 CPG, ACOG 2000
3. Program Goal Every clinician, who interacts with pregnant women, mothers, caregivers of young children, teens and others, will deliver effective smoking cessation advice and counseling.
15. Comparative Causes of Annual Deaths in the U.S. USDHHS, CDC (TIPS): Comparative Causes of Annual Deaths in the United States
16. Smoking Prevalence Men Women Pregnant Women 2004 National Health Interview Survey {(MMWR 2005(54)44} 2005 PA Behavioral Risk Factor Surveillance System PA DOH Vital Statistics Resident Live Births 2004 Table B-25 National Vital Statistics Reports: Births: Final Data for 2003 (Martin, J. A. et al.)
17. Smoking During Pregnancy USDHHS, Smoking During Pregnancy-United States, 1990-2000. MMWR, 2004;53(39):911-915
18. Smoking During Pregnancy High School > High School < High School National Vital Statistics Reports: Births: Final Data for 2003 (Martin, J. A. et al.), Table 31
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20. “ We’ve known for decades that smoking is bad for your health...the toxins from cigarette smoke go everywhere the blood flows. There is no safe cigarette...the only way to avoid the health hazards of smoking is to quit completely or to never start smoking.” U.S. Surgeon General Richard H. Carmona News Release, 2004, SGR, The Health Consequences of Smoking News Release 06/27/06, SGR, The Health Consequences of Involuntary Exposure to Tobacco Smoke “ The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults.” The Debate is Over
21. The Life Cycle of the Effects of Smoking on Health SIDs Bronchiolitis Meningitis Infancy Low Birth Weight Stillbirth Neurologic Problems In utero Asthma Otitis Media Fire-related Injuries Influences to Start Smoking Nicotine Addiction Cancer Cardiovascular Disease COPD Adulthood Adolescence Childhood Aligne CA, Stodal JJ. Tobacco and children: An economic evaluation of the medical effects of parental smoking. Arch Pediatr Adolesc Med. 1997;151:652
31. Addiction The repeated, habitual use of a substance that affects a person’s mood and the course is chronic, progressive, and ultimately fatal.
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34. The Process of Behavior Change Preparation Contemplator Relapse Action Maintenance Ex-Smoker Pre-Contemplator Prochaska and DiClemente, 1983
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37. Requirements for Change X = BASIC Motivation (Should I?) Self-Confidence (Can I?) Commitment (Will I?)
38. Motivational Interviewing/ Consulting A patient-centered counseling style for obtaining behavior change by helping patients explore and resolve ambivalence
49. A combination of pharmacotherapy and intervention doubles a patient’s chance of successfully quitting smoking
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51. Pharmacotherapy and Pregnancy “ If the increased likelihood of smoking cessation, with its potential benefits, outweighs the unknown risk of nicotine replacement and potential concomitant smoking, nicotine replacement products or other pharmaceuticals may be considered.” ACOG. (2005). Committee Opinion: Smoking Cessation During Pregnancy , Number 316. Concomitant = accompanying
56. PA DOH Free Quitline transitioning from 1-877-724 -1090 to 1-800-QUIT-NOW 1-800-784-8669
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58. Optional Materials See Appendix B of the Clean Air program manual for additional patient handouts and practice tools Clean Air Website: www.cleanairforhealthychildren.org
66. Implementing into a Healthcare Setting Create A Quit Smoking Team Step 1. Develop administrative commitment Step 2. Involve staff early Step 3. Assign one coordinator Step 4. Provide training Step 5. Adapt procedures to your setting Step 6. Monitor and provide feedback What will it take to implement this intervention into your office?
77. Good Luck! Please feel free to contact: Dottie Schell (484)446-3002 or (800)375-5217 (PA only) [email_address]
78. Clean Air for Healthy Children Program PA Chapter of the American Academy of Pediatrics Rose Tree Corporate Center II 1400 N. Providence Road, Suite 3007 Media, PA 19063-2043 www.paaap.org
86. Step 1: Develop Administrative Commitment Restricted by the allocation of limited resources such as staff time Strengthened by mandates of institutional governing boards or accrediting agencies Effective problem solving for implementation of smoking cessation program Consider requirements of funding agencies or availability of reimbursement for smoking cessation services Administrators and supervisors who are committed to providing smoking cessation services to their patients
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Hinweis der Redaktion
We are very limited in time today so am going to be giving a didactic presentation today, but we are available to come to your office to give a interactive presentation with your staff. We have trainers throughout the state that are available.
I am not going to speak the physiology of smoking and pregnancy, as to why things happen.
Page 58 of CPG
Page 58 of CPG
The National Health Interview Survey was quoted in the MMWR, November 11, 2005/ vol. 54/ No. 54
Patient said she could not quit smoking I would still discuss the 5 R’s. Show her the pages of the (blue) magazine (4) that discusses how babies grow. Tell her “The best thing would be for you to quit smoking but since it is real to me that you are not going to cut down are there any changes you can make right now ?” Clearly suggest she; Quit smoking Cut down Smoke only when a away from the home Smoke outside the house or apartment Smoke in one room only Not smoke while; holding, feeding, bathing or in car with child or baby
Your plan may consist of; Ideally for you to do counseling or some sites can refer to an on-site cessation counselor Use the (blue) magazine (pages 8-15) Steps to quitting along with Prenatal Quit Plan Tear off Sheet (30/folder-non pregnant, B-123,manual) Quitline – at a minimum for sites who do not have time to counsel and so not have an on site cessation counselor you can do a quick assist by referring patients to the Quitline Do Quitline slides Bring back for follow-up visit no matter what stage they are in
Bring back for follow-up visit no matter what stage they are in
A smoking survey that is sent to patients Up until April 2004 only the first four questions were asked Now most clinicians advise, and discuss the 5 A’s intervention and pharmacotherapy
Hospital are required to give tobacco education counseling to patients who 2 out the 4 following medical conditions – congested heart failure,; myocardial infarctions; community inquired pneumonia; and/or pregnancy
Refer to CPG page 167 There is a diagnosis code for Tobacco Dependence If you check this the insurer will know there is a need to counsel
Refer to CPG page 167 There is a diagnosis code for Tobacco Dependence If you check this the insurer will know there is a need to counsel
These are just the suggested coding disorders affiliated with Smoking Cessation Intervention Need to check off that you did something
