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Developing a smoking

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on 29 March 2016

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Transcript of Developing a smoking

Fun Fact
Background Info /Literature Review
Defining the issue
Adapt knowledge to local context
Discuss findings from youth surveys
Next steps: PPYMSS
Wrap up/ Questions
Consider This:

A number of studies have found that group counseling is an excellent opportunity for women to learn effective cessation techniques in a mutually supportive environment
(Kessler et al, 1981; Ortner et al, 2002; Pisinger & Jorgensen, 2007).

Many tobacco control professionals recommend group counseling for women because they tend to be much more comfortable in a group setting and more willing to share their perspectives and advice to members within the group
(Ortner et al, 2002, WHO, 2010).

CAN-ADAPTT: The Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment
National guideline development, dissemination and exchange project.
Smoking in pregnancy
Increases risks of complications in pregnancy & can cause serious adverse fetal outcomes
low birth weight
neonatal asphyxia
decreased fetal growth or IUGR
premature birth
still births
placental abruption
SIDS (Health Canada, 2007; WHO, 2010)

Quitting smoking during pregnancy can substantially improve health outcomes for both women and fetuses, and reduces health problems for children born to mothers who smoke (Health Canada, 2007).
..although the rate of resuming smoking after pregnancy is exceedingly high (70-90% by one year after birth) (Gardner et al, 2011; Klesges et al, 2001) ).
Women who continue to smoke postnatally expose their children to second-hand smoke (SHS)
Long-term side effects of SHS include (but are not limited to):
Respiratory infections(Pneumonia, Croup, Bronchitis)
Sudden infant death syndrome (SIDS)
Neurodevelopmental abnormalities
Risk of childhood cancer
Childhood asthma
Learning or behavioral problems
Some women are able to quit smoking during pregnancy....
Nicotine dependence
Smoking in the City of Hamilton
The City of Hamilton has implemented a # of very effective smoking cessation services
Smokers' Helpline
Public Health Quit Smoking Clinic (no-cost NRT, individualized counseling, withdrawal management and ongoing nurse-guided support)
**Services are not being accessed or well-utilized by the City’s youth**
**In particular, pregnant teens and young parent populations within Hamilton**
Why is this an issue?
HIGHER INCIDENCES of TEEN PREGNANCIES in Hamilton compared to Ontario as a whole: 4.7 % of all Hamilton pregnancies were among teens aged 15 to 19 in 2008, compared to the Ontario average of 3.6 % .
CITY AVERAGE for SMOKING during PREGNANCY is HIGH (16.7%) compared to province (12.4%)
Under 20 smoking during pregnancy rate of 40.1 (Hamilton) and 39.2 (ON) (BORN 2008)
HPHS aims to develop effective smoking cessation supports targeted toward pregnant & parenting youth that are evidence-informed and based on best practice guidelines.

OUr Target Audience...
Our Target Audience for offering smoking cessation supports
Pregnant youth & their partners aged 16-24, who smoke
Focus on teens within five postal code areas (FSA):
L8H, L8K, L8L, L8M, L8N
Highest rates of smoking & teen pregnancy and lower socio-economic status in Hamilton

These 5 PC's are home to 55% of mothers under twenty who have DOUBLE THE RISK of delivering a low birth weight baby

THEREFORE we questioned if it would be appropriate to PILOT a group smoking cessation programs at TEEN ACCESS SITES within these areas

Young Parent Resource Centers:
Angela’s Place, St. Martin’s Manor & Grace Haven
(provide teen pregnancy support groups)
By giving out surveys & asking focused Questions we hoped to:

GAIN their PERSPECTIVE of what they would like to see in a smoking cessation program
Their INPUT on effective METHODS for quitting smoking
LEARN how we can help them in their efforts to quit
For knowledge translation to be successful, it is important to capture the wisdom and engage end users throughout the process in order to define, customize and implement the best suited and most sustainable action plan
The Trans-theoretical Model
choosing a Kt model
The TTM of Intentional Behavioural Change
Asserts that
behavioral change
is a
unfolds over time
through a
series of stages
and describes
specific processes of change,
which should be
in order
for advancement through the stages
to occur
Notion of recycling is a key, distinguishing feature
-> frames the process of cessation within a social-learning perspective that can reduce unrealistic expectations and provide long-term optimism for success
TTM is appropriate for addressing smoking cessation among pregnant teens:

offers a
and the coinciding processes that may be beneficial as they transition through the stages of change & try to break the habit

• Open discussion on benefits of quitting smoking
• Discuss ways their smoking affects those important to them
• Discuss what may be helpful in reducing number of cigarettes smoked
• What activities/coping actions reduce cravings for cigarettes?
• Write down or discuss rewards they could use for reaching their goals to reduce smoking or quit
• Re-assess their stage and readiness to make a change periodically

• Discuss risks the pros & cons of changing smoking habits
• Provide information of community resources and local services offered to help with smoking cessation ie. Quit Smoking Clinic
• Discuss barriers to quitting smoking and means to remove some of the barriers
• Encourage and praise small incremental changes in daily routines
• Encourage teens to keep a log of smoking habits throughout the week to track any changes in smoking habits/behaviour patterns
• Re-assess their stage and readiness to change
• Ask group to refer to daily weekly log and make suggestions for how they may reduce their smoking in the following week
• Ask the group to write down activities they enjoy doing that reduce their cravings and find others in the group with similar activities
• Ask them to find a companion in the group and discuss amongst each other their “SMART” goals to break the habit
hold one another accountable
• Discuss with pregnant teens partner or significant other how they can help the teen mom attain her goals
come up with simple rewards with reaching different milestones
• Reassess their stage periodically

• Ask group to write down and discuss a personal plan or realistic strategies to reduce smoking
small steps toward their goal each day
• Have teens collaborate and plan healthy team-building activities
to enhance group trust and build relationships
• Ask teens to reflect on ways they can react to life stressors in a more health conscious way
• Ask the group to reflect on the benefits that they have already received from reducing smoking and what other benefits they hope to receive after prolonged reduction or cessation

• Ask teens to discuss the strategies that have been helpful to them so far and brainstorm how they could incorporate these strategies into every day routines
• Ask the teens to create a smoking reduction/cessation contract for themselves that outlines short-term and long-term goals for smoking cessation
• Ask them to devise a plan of what to do if they are having difficulty meeting their goals
• Ask them to reach out to mentors or important people in their lives and engage in discussions about their may be able to help her in reaching her goals
• Celebrate all of the little accomplishments each teen makes and create a safe, supportive group environment where group members can feel comfortable and be themselves
• Re-assess their stage periodically
Stage-Matched Interventions for smoking cessation Program
Next Steps in the process
what it's all about
The only way to develop effective interventions for this population is to gain greater insight into the experiences and vulnerabilities of the adolescent women who continue to smoke during pregnancy (Lumley et al, 2009).
Some things that need to be considered when working with these adolescent women- many suffer psychosocial disadvantage:
Psychological illness
Young early motherhood
Low educational attainment
Low literacy levels
Lack of social support
Limited employment
Low income
May be a victim of abuse

(Graham 2006, Limley et al, 2009).
Facts about Smoking:
Tobacco kills about 37,000 Canadians each Year
There are over 4,000 dangerous chemicals in cigarettes & many of these are cancer-causing
Diseases: COPD, coronary heart disease, Leukemia, circulatory problems & many types of cancer
Regular exposure to SHS increases risk of lung disease (25%) and heart disease (10%)
(Canadian Lung Association, 2014)
Barriers to change
SMOKING is RARELY the only HEALTH CHALLENGE young women face during pregnancy
food insecurity, financial strain, other substance use, inadequate housing, low educational attainment, poor support networks, domestic violence etc
Limited resources & inadequate social support = MAJOR STRUCTURAL BARRIERS to smoking cessation among young women of lower socio-economic status
Extreme SOCIAL STIGMA surrounding smoking in pregnancy can cause pregnant women to FALSELY REPORT their SMOKING STATUS/ SMOKING BEHAVIOUR to HCPs for fear that they will be harshly judged, reprimanded or harassed to quit
Barriers for Pregnant & Parenting Teens...
Consider This:
Intensive group treatment is considered a primary intervention for helping smokers quit. A number of reputable organizations including the American Lung Association, the American Cancer Society and Health Canada have developed group programs using cognitive and behavioural strategies to promote cessation (WHO, 2010).

Consider This:

A SYSTEMATIC REVIEW of interventions found that PARTNERS ARE RARELY INCLUDED in cessation treatments yet interventions that include partners, effectively enhance partner support for pregnant and postpartum women’s smoking reduction and cessation and drastically improve health-related outcomes for both partners
Where Does this Leave us?
Do we have enough information to develop a group smoking cessation intervention?

Do we know what pregnant and parenting youth really want/need to help them quit?

Do we know the most effective, cost-efficient means of supporting this population in their efforts to reduce/quit smoking?
Contingency management interventions (i.e. offering incentives) has shown to be helpful in promoting smoking cessation among pregnant smokers as they can enhance motivation and reduce the temptations of smoking during a quit attempt (Donatelle et al, 2004).
Important to consider
Offering incentives in conjunction with other intervention components (e.g. tailored information, counseling, partner/social support) have found to be quite effective amongst low-income, marginalized groups such as pregnant teen smokers in aiding their efforts to quit
(Donatelle et al, 2000; Greaves et al, 2011).
(MacDermid & Graham, 2009).
Help us understand the factors that influence young women's decisions to continue, reduce or quit smoking in pregnancy and postpartum
Determine the health needs of these young women & their motivations to make positive behavioural change
Explore young women's suggestions for smoking supports they think would be beneficial in order to develop strategic, multi-component interventions under various levels of influence
KT activity: Findings will be presented to all stakeholders
Developing smoking Cessation Supports for Pregnant & parenting youth
hamilton cessation services
(DiClemente et al, 1985; Glanz et al, 2002).

Widely utilized in health promotion issues
(i.e. smoking) & is expected to be
useful to guide KT activities
that attempt to reduce smoking amongst teens.
(Gee, 1998; Glanz, et al, 2002).

back to smoking
after a sustained
period of
through the stages is considered
normal & expected

Recognized that the
addictive nature
combined with the
of adequately
completing tasks
each stage

easily allow for a
linear behavioural change
when attempting to quit
The Truth Is...
Public health messages be framed & communicated in a way that is sensitive, non-judgmental & relevant to circumstances these women face on a daily basis.
Evidence suggests:
women tend to trust services held at community-based women’s centers -> focus on issues of self-efficacy, empowerment and the underlying socioeconomic factors affecting these women’s lives.
Intervention approaches that avoid “blaming the victim” and seek to respect and accept individual values, capabilities & circumstances have the greatest impact for women of disadvantaged groups .
Social circles and the presence or absence of social supports are key factors in smoking reduction or cessation efforts
Living with others who smoke greatly increases the risk of smoking during pregnancy due to increased access & exposure to cigarettes & higher temptation to smoke
(Fang et al, 2004; Lumley, Oliver & Waters, 2000; Thompson et al, 2004; Ward et al, 2007)
Addressing these GAPS
Pregnant & parenting Young mothers smoking study
Helping youth quit smoking
City of Hamilton
CAN- ADAPTT: Clinical Practice Guidelines for Breastfeeding & Pregnant Women
5 Key Recommendations:
Smoking cessation should be encouraged for all pregnant, BF & postpartum women
During pregnancy & BF, counseling is recommended as first line treatment
If ineffective, intermittent NRT (e.g. Lozenges, gum) are preferred over continuous dosing (e.g. patch)
Partners, family members & friends should also be offered cessation interventions
A smoke-free home environment should be encouraged to avoid exposure to SHS
(Best, 2009; Cole, 2014; Gardner et al, 2011).
(Samet & Yoon, 2010).
(Samet & Yoon, 2010; Sussman, 2001).
(Greaves et al, 2011).
(Greaves & Hemsing, 2009).
(Greaves et al, 2011)
(Hemsing et al, 2011).
The End...
(BORN database, 2008; Wayland. 2012)
** Has additional resources that contain recommendations for assisting specific demographics with smoking cessation, i.e. Aboriginals and youth **
Expecting to Quit Project
A best-practices review of smoking cessation interventions for pregnant/postpartum girls & women
AIM: to identify most effective smoking cessation interventions for pregnant women & types of interventions that best prevented relapse postpartum
7 approaches to smoking cessation programs for pregnant women & 14 recommendations for practice
Key Informant executive Summary
Key messages from pregnant & parenting youth
Summary of Best Practice recommendations
Tailoring to the community
Women-centered care
Reducing stigma
Quit guides
Buddy support
Partner counseling/social context
Offering evidence-based information
Nicotine replacement therapies
Personal follow-up
Other types of follow-up
Feedback from the health care provider
Group support
Key Considerations Based on
Informant Responses
Vast majority of teens have Smart Phones & respond well to Apps
Teens are very involved with social media & have a high affinity for text messaging
Smoking cessation intervention offered should be multifaceted
Information delivered should be meaningful, evidence-based, non-judgemental, woman-centered & aim to improve self-esteem and self-efficacy
Should not solely focus on quitting for baby BUT quitting for themselves
Partners/significant others should be encouraged to join in program
Many girls reluctant to come forward & admit to smoking throughout pregnancy- important to reduce stigma & help build strong support networks
May want to build on existing prenatal teen groups & community cessation programs
Service must be free & offer multiple incentives to encourage recruitment & retention
R&R can be a challenge- PSA & advertisements in Dr.'s offices, community centers, schools, prenatal groups, etc is key
summary of survey data
respondents (21 female, 2 male)
75% respondents have had more than 100 cigarettes in their lifetime...
but none in the last month (34.8%), some in the last month (4.3%), at least one/day in last month (13%), at least 10 every day in last month (26.1%)
Tried to quit:
Cold Turkey (69.6%), NRT (17.4%), Quit and get Fit (17.4%), Self-help materials (8.7%), Individual counselling (4.7%), Quit contest (4.7%)
Planning to quit?
have already quit (30.4%), within the next month (21.7%), within the next 6 months or later (13%), not planning to quit (21.7%)
Methods they'd be interested in trying:
Quit contest (21.7%), Self-help materials (17.4%), Group cessation program (13%), NRT (13%), Smoker's helpline (13%), combining exercise with quitting program (13%), Social media program (8.7%), Individual counselling (4.3%), Prescription medication (4.3%), NOT INTERESTED in quitting (17.4%)
Summary of survey data
Best ways to help young parents quit smoking
: One-to-one counselling (69.6%), no-cost NRT (69.6%), Group support sessions (65.2%), Quit buddy (47.8%), Contest or rewards program (34.8%), Group support sessions that include exercise (30.4%), On-line group support (21.7%), Hotline (21.7%)
Best way to let people know about program:
Facebook (73.9%),Posters (65.2%), PSA (34.8%), Websites (34.8%), Social media (34.8%), Texting (26.1%), also mentioned Dr.'s office, prenatal groups
How can we get people interested?
Gift certificates (91.3%), Free meal or snacks (82.6%), Bus tickets (69.6%) also mentioned contest prizes & Free child minding
Program offered:
vast majority said once/week
Who will deliver the program?
PHN, Smoking cessation specialist
Angela's place, Grace Haven or Community Centre
What they want to talk about:
How to quit, effects of smoking, coping strategies, why they started and how to stop, facts about smoking & cues, dealing w. cravings & withdrawal, reasons to quit, community supports
What the group would look like:
interactive sessions, fun lessons, discussions, one-on-one support, circle group, talk and exercise, different activities, field trip to see what smoking does to you
What would the group do?
group learning & discussions, games, fun activities, watch videos, team building activities, go for walks, exercise, quizzes
Best Practice guidelines
KTA Cycle
By: Jamie Dawdy, M.Sc.N
March 25th, 2014

A qualitative study exploring the personal and contextual factors that influence pregnant and parenting young women's decision making regarding their smoking behaviour
Knowledge to action
What influences young women's smoking behaviour in pregnancy & postpartum?

To understand young mothers attitudes towards and experiences with smoking cessation programs

To hear the first hand accounts of the struggles that pregnant & parenting young women face in trying to access community supports

To gain a better sense of how these young women can be supported within the community
We are inviting you to consider a potential collaboration in this study by promoting the study to young women at Angela's Place, Grace Haven & St. Martin's Manor
Posters & study brochures available for distribution

Eligibility criteria:
pregnant or parenting mother (up to 2 years postpartum) between the ages of 16-24 years who smoke currently or smoked prior to
becoming pregnant

Participants will:
be asked to complete an interview in-person or over the phone, as per their personal preference. The interviews will last roughly 30-45 minutes. Participants may also be contacted and asked to do a shorter interview to help us verify themes emerging from the data.

Participants will receive:
Participants will receive a $15 grocery, Walmart or Shopper’s Drug Mart gift card, as per their preferences. If the participant consents to a second contact, they will receive an additional $5 added to their gift card value and will therefore have received a total of $20 in gift cards!

we need your help!
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