First Breath: Initiating Prenatal Smoking Cessation Services in Communities of Color

1. First Breath:Initiating Prenatal Smoking Cessation Services in Communities of Color Kate Squire, MPH, CHES Wisconsin Women’s Health Foundation

2. Presentation Overview • Brief description of the First Breath Program • 5 practical strategies for outreach • Impressions, challenges, summary

3. First Breath in a Nutshell….. • Integrated into existing prenatal care facilities • Available to all pregnant women in WI • Best Practice Standards • Train providers in program protocols and cessation counseling • Clinicians enroll women in the program at their site and provide cessation support during every visit

4. Wisconsin Women's Health Foundation UW-CTRI State of Wisconsin Division of Public Health APS Healthcare Inc First Breath Sites Community Health Center Sites Public Health Sites Private Healthcare Sites Native American Clinic Sites Pregnant Smokers/First Breath Clients Organization & Management of First Breath

5. 2001 Pilot Sites 7 Pilot Sites in 7 Counties

6. 2002 Pilot Sites 15 Pilot Sites in 12 Counties

7. 2003 Statewide Program75 Total Sites in 47 Counties

8. 2004 Statewide Program114 Sites in 62 Counties 14

9. Program Successes • 35% of First Breath participants have quit smoking during pregnancy • Enrollment has doubled each year since program inception, serving 1,240 women in 2004 • Projected to serve 6,000 women over the next 4 years • Average Wisconsin Medicaid program savings of $1,274 per woman who quits smoking through First Breath, a 9 to 1 ROI

10. Pregnancy smoking rates in special populations in WI: • 29% of WIC clients and 40% of Medicaid • 37% of Native American women (19.7% nationally) • 18% of African American women (8.8% nationally) 2003: 70% of First Breath clients were Caucasian

11. Project Goal Initiate First Breath in Wisconsin’s communities of color

12. First Breath Strategies

13. 1. Build Capacity • Secure funding: American Legacy Foundation, Circle of Friends Small Grants Program • Grant period: January 1, 2004 – December 31, 2004 • $48,000 grant award • Dedicate staff to outreach efforts

14. 2. Identify Target Communities • Wisconsin Interactive Statistics on Health (WISH) • County specific birth certificate data (includes race and smoking status at time of delivery) Result: 7 counties that reported strong Native American and African American women smoking during pregnancy were identified

16. 3. Engage New Providers • Work with key players to identify potential sites in target communities • Great Lakes Intertribal Council (GLITC) • Black Health Coalition • Minority Health Officer in WI • Leaders in the tobacco movements/tobacco coalitions • Existing First Breath sites • Attend relevant events, presentations and conferences • Promote First Breath at community events • Outreach identified providers Result: Recruited 22 new providers from target communities

17. 4. Recruit Pregnant Smokers • Train providers in First Breath program and smoking cessation counseling • Create referral system to First Breath Result: 100% increase in enrollment among women of color

18. 5. Increase Cultural Awareness • Include cultural awareness component in provider training • Create Native American brochure Result: 99% of providers reported that their cultural awareness increased “a little bit” or “a lot”

20. Provider Perspective “The clients’ eyes light up when they see the baby on the cover and they begin to read through it right away instead of putting it immediately away in their folders. They tell me, ‘Isn’t that baby adorable?’ ‘Isn’t that a beautiful picture?’” “As a health educator, I know that this is one brochure that is being read and shared with others. The pictures and the language are sensitive to the community.”

21. 202 Women Enrolled in 2004

22. Native Americans: 83 women enrolled 12/25 (48%) quit 3T 4/16 (25%) quit PP 3 miscarriages 8 deliveries – healthy babies 5 not smoking 3 still smoking Preliminary Outcomes African Americans: • 119 women enrolled • 16/43 (37%) quit 3T • 13/38 (34%) quit PP • 16 deliveries – healthy babies • 6 not smoking • 10 still smoking

23. Impressions/challenges Native American clients: • Quit smoking message difficult due to cultural use • Helpful if tobacco movement is strong in their tribal community • Difficult to garner support; SHS major issue among family and work environment • Culturally specific materials critical; Different program incentives • Frequently move from home to home

24. Impressions/challenges African American clients: • Many women dealing with critical social issues making quitting difficult • May be set on quitting on their own • Family members who smoke make quitting more difficult • Family support high among clients living with sisters, mothers • Abstain from smoking while breastfeeding – tap into motivations?

25. Contributions to Success • Systematic identification of target communities • Networking with culturally specific organizations and tobacco leaders • Establishing relationships with individual sites • Training in best practice standards • Collaborating with stakeholders (sites and clients)

26. First Breath: Future Plans • Culturally relevant materials • Ongoing support to newly established sites • Web-based trainings • Regional sharing sessions • First annual First Breath statewide meeting • Education to providers of women of reproductive age

27. Thank You Kate Squire, MPH, CHES Wisconsin Women’s Health Foundation 2503 Todd Drive Madison, WI 53713 Tele: 608-251-1675 Fax: 608-251-4136 katesquire@tds.net www.wwhf.org