· Web viewDESCRIPTION OF THE FIRST BREATH PROGRAM. Background. In 2000, the Wisconsin Women’s Health Foundation (WWHF), in partnership with the …

I. DESCRIPTION OF THE FIRST BREATH PROGRAM

BackgroundIn 2000, the Wisconsin Women’s Health Foundation (WWHF), in partnership with the State of Wisconsin Division of Public Health (DPH), Bureau of Family and Community Health (BFCH), and APS Healthcare, developed the First Breath pilot program. This program was developed with four objectives:

To increase the number of pregnant women who quit smoking To reduce smoking among pregnant women who are not able to quit To improve the health of newborns To decrease the rate of relapse among mothers after they deliver

The First Breath pilot program was exclusively available to women with low-income through their Women, Infants, and Children (WIC) and Prenatal Care Coordination (PNCC) providers or at their tribal health center. The program operated through the public health system to reach women at 15 sites in 11 of Wisconsin’s 72 counties.

The Wisconsin Tobacco Control Board (WTCB) funded the First Breath pilot program in 2001 and 2002. The First Breath pilot program ended on December 31, 2002, and at that time, First Breath expanded into a statewide program. Changes were made, especially in the data collection processes, as part of the transition from pilot project to statewide program, but the four objectives remained the same.

On January 1, 2003, the First Breath program expanded statewide, allowing all private and public prenatal care providers throughout Wisconsin to participate in the program. The program now focuses on all pregnant women who smoke, with low-income women remaining a priority population. Funding was shifted to the Department of Health, of the Department of Health and Family Services (DHFS) after the WTCB was disbanded and its tobacco control programs were absorbed by DPH.

Program DescriptionFirst Breath uses a best-practice, counseling-based approach to aid pregnant smokers in their quit attempt. Prenatal care providers are trained in the program's protocols and logistics, the 5As intervention (ask, advise, assess, assist, and arrange), and motivational interviewing techniques. First Breath providers are given pregnancy-specific tools and materials to use with their clients. The First Breath approach includes meeting pregnant women where they regularly receive services and providing non-judgmental support and encouragement. First Breath is available to all pregnant women in Wisconsin - regardless of age, income, race, ethnicity or insurance status, and enrollment in the program can occur at any time during pregnancy. Additionally, First Breath encourages women who have recently quit smoking to participate in the program to help prevent relapse.Women who participate in the First Breath program receive:

Personal smoking cessation support Intensive smoking cessation counseling Educational and self-help materials Educational materials for their friends and family Free incentives for participation A gift at delivery Wisconsin Tobacco Quit Line materials, information and access

First Breath sites and providers are offered a number of support services and opportunities for communication between one another and with Wisconsin Women’s Health Foundation First Breath staff including:

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Training and technical assistance to sites through site visits, regional sharing sessions, statewide meetings and monthly email updates.

Annual evaluation report of the program and site specific reports.

First Breath sites are also provided with all the materials needed to administer the program at their site. These materials are shipped to the First Breath site upon request; at no cost to the provider, site or client. This includes:

All client materials- client workbooks, data forms, program brochures, posters and client incentives.

Participating sites agree to provide smoking cessation counseling to pregnant clients using Treating Tobacco Use and Dependence, Federal Clinical Practice Guideline: 2008 Update and to participate fully in the data collection process and communicate with WWHF First Breath staff.

FundingOver the years the First Breath program has been funded with a combination of grants:

State of Wisconsin DPH – funded the statewide expansion in 2003 for $200,000; funding for the period January 2004 – June 2005 was $300,000; July 2005 – June 2006 was $225,000; July 2006 – June 2007 was $250,000; July 07-June 08 was $300,000; and for the Healthy Birth Outcomes expansion start up, for the period July 2007-December 2007 funding was $50,000; January 2008-June 2008 was $150,000; July 2008-December was $150,000.

WTCB – funded the pilot program in 2001 and 2002 in the amount of $422,888. American Legacy Foundation – in 2004, awarded First Breath a one-year grant in the amount of

$48,000. State of Wisconsin Tobacco Prevention and Control Program – funded the First Breath program in

2009, for the period January 2009 – December 2009; in the amount of $300,000. Wisconsin Partnership Fund for a Healthy Future – The UW-School of Medicine and Public

Health’s Wisconsin Partnership Fund awarded First Breath and UW-CTRI a grant of $150,000 per year for three years which began on March 1, 2005. This grant was for the statewide project “First Breath: Enhancing Services to Healthcare Providers and Clients”, which concluded February 28, 2008.

Center for Disease Control and Prevention (CDC) and University of Wisconsin Center for Tobacco Research and Intervention (UW-CTRI), awarded First Breath $40,700.00 in 2008 for the grant period of September 30, 2008 – September 29, 2009.

HRSA Tobacco Collaborative: Tobacco Dependence Treatment for Young Women of Low Socioeconomic Status, Wisconsin Primary Health Care Association (fiscal agent for grant), awarded First Breath $7,500.00 in 2009 for the period of August 31, 2009 – February 28, 2011.

In addition to funds, many organizations have supplied in-kind support. These have included Kimberly-Clark Corporation, Girl Neighborhood Power, UW-Madison nursing students, and community volunteers.

Program Cost SavingsAn important benchmark for the First Breath program is to determine the cost savings of this program to the health care system. Medicaid is the one area in which we have reliable data to estimate cost savings due to a cost analysis done on the pilot phase of the First Breath program. It was calculated that the First Breath program on average saves the Medicaid program $1,274 per First Breath enrollee who has quit smoking (based on the mother's delivery charges, the baby's delivery charges and the infant's first six months of life). Since the statewide program began in 2003, an average of 78% of the women in the program each year have been Medicaid eligible. That number is derived from averaging the percentage of women who were Medicaid eligible from 2005 through 2010, and then estimating that that percentage is representative of the 2003 and 2004 enrollees as well since that data was not collected in 2003 and 2004.

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Overall, 2,814 women have quit smoking, with an estimated 2,200 women who are Medicaid eligible, which generates a cost savings of $2,796,328 to the Medicaid program. For more details on the cost savings analysis, refer to Cost Savings Associated with Smoking Cessation for Low-Income Pregnant Women, published in the 2004 Wisconsin Medical Journal Volume 103, No. 5.

II. FIRST BREATH ACCOMPLISHMENTS IN 2008

Client Enrollment and Site InformationIn 2008, 1,524 women were enrolled at 102 sites in 62 of Wisconsin’s 72 counties. A major highlight of 2008 was the difference in client demographics from previous years. There was a 48% increase in clients identifying their race/ethnicity as African American.

Site VisitsA total of 55 site visits were conducted by First Breath staff in 2008. These visits enable staff to provide technical assistance and support to First Breath sites and providers.

Regional Sharing SessionsIn 2008, 7 RSS were scheduled, however due to factors such as low registration and inclement weather, only 2 RSS were held in Madison and Milwaukee. A teleconference RSS was conducted on June 19, 2008 to give providers from the state’s northern, western and northeastern regions an opportunity to participate. Twenty (20) participants represented 17 First Breath sites at the RSS in 2008.

Statewide MeetingThe fourth annual First Breath Providers Statewide Meeting (SWM) was held on October 24, 2008 in Wisconsin Dells. Forty two providers attended the SWM, representing 33 First Breath sites.

Program MaterialsIn 2008, WWHF staff took on the challenge of updating First Breath program materials. When asked about program materials, such as, A Workbook for Pregnant Women Who Want to Quit Smoking and Smoke Free After Delivery- a workbook to help you stay quit, providers reported that content was good, but that the over-all look could use an update. WWHF staff edited each program piece to ensure cultural appropriateness of content and of photos. Program posters and brochures were also edited. New materials were sent to providers in the spring of 2009.

Presentations, Poster Presentations, ConferencesFirst Breath staff displayed and presented First Breath program materials and the display board at seven different locations in 2008 and attended and exhibited at five conferences.

First Breath General Mini-Grants and Disparities Mini-Grants Mini-grants totaling $9,326 were awarded to 6 First Breath sites in 2008.

III. PROGRAM STATUS: JANUARY 1, 2009 – DECEMBER 31, 2009

Technical Assistance and Support

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As part of the First Breath program’s ongoing goal to enhance technical assistance and support to sites, providers are able to access assistance in a variety of ways. Following is a detailed description of the various types of assistance that First Breath offers:

Site Visits and Trainings: In 2009, First Breath staff was able to conduct 31 site visits and/or site trainings, many of which UW-CTRI Regional Outreach Specialists (ROS) joined. First Breath staff updates providers with program information and materials. New providers are trained in program protocol and logistics. Site notes are taken by First Breath staff and are kept on record. Eight new sites were established in 2009.

Regional Sharing Sessions: Regional Sharing Sessions (RSS) continue to be a valuable offering in the First Breath program. Providers are able to meet one another, to discuss their site’s successes and barriers and are able to hear updates from ROS and First Breath staff on a variety of topics, such as motivational interviewing, the clinical practice guidelines and program news and updates. In 2009, there were 5 RSS held in Burnett County, Grant County, Green Bay, Madison, and Milwaukee. Forty participants represented 23 sites at the RSS in 2009. 76% of participants strongly agreed that the RSS was helpful to them as providers.

Statewide Meeting: The Annual First Breath Statewide Meeting was originally scheduled for November 2009; due to the H1N1 influenza epidemic, many First Breath providers were unable to attend a November meeting. As a result, the Annual First Breath Statewide Meeting was rescheduled for January 22, 2010 in Stevens Point, Wisconsin. 36 First Breath providers, representing 27 sites, attended the Statewide Meeting. 67% strongly agreed that the presentations met their expectations.

Web-based Trainings: Web-based trainings have been a part of the First Breath program since 2005 and continue to be a useful tool. Providers can access these trainings any time- 24 hours a day, 7 days a week. In 2008, links to each of the online training modules were made more easily accessible on the First Breath website http://www.wwhf.org/pg_Firstbreath.asp. Providers can simply click on each link to watch the training session. Provider use of these training modules will no longer be tracked.

Mini-Grants: Mini-grants totaling $12,116.15 were awarded to 8 First Breath sites in 2009. Some of the mini-grant initiatives included: increasing community awareness of the program through use of media and attendance of community events, creating a support group for First Breath clients and their support people, implementing text messaging into the client’s prenatal care and smoking cessation counseling, and providing additional incentives for quitting and attendance of appointments.

Email Updates and Newsletter: Providers receive monthly email updates from the First Breath Program Manager that include the enrollment report, program news and updates, information about upcoming events and resources pertinent to First Breath providers and the work they do with clients. First Breath news is also included the Wisconsin Women’s Health Foundation’s newsletter.

Presentations, Exhibits and ConferencesIn 2009, First Breath staff attended and exhibited at several conferences in Wisconsin and throughout the country. Conferences are an excellent opportunity to learn new tobacco cessation strategies, network with other tobacco control organizations and agencies and to share First Breath program information and progress. The following events and conferences were attended by First Breath staff in 2009:

Attended and exhibited at Wisconsin Tobacco Prevention & Control conference in Madison, Wisconsin.

Attended DPH/DCF/AIAA Conference “Healing Our Communities” in Wisconsin Dells, Wisconsin. Presented a poster entitled “Collaborative Relationships to Decrease Disparities” to health care

professionals at the National Conference on Tobacco or Health in Phoenix, Arizona.

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http://www.wwhf.org/pg_firstbreath.asp

Presented to University of Wisconsin School of Medicine and Public Health residents about the First Breath program and the importance of addressing smoking during pregnancy.

Wisconsin Tobacco Quit Line and Fax to QuitIn 2010, pregnant women represented 1% of callers to the Wisconsin Tobacco Quit Line (unpublished Wisconsin Tobacco Quit Line data, 2010). Despite aggressive promotion of the Quit Line at more than 100 First Breath sites, only 5.5% of the women enrolled in that program reported that they contacted the Quit Line in 2010. Clearly, barriers exist to widescale quitline utilization by pregnant smokers.

In 2010, 23 First Breath sites referred one or more women to the Quit Line’s Fax to Quit Program. Thirty-three women were referred to the First Breath Fax to Quit program during the year; 42% of which accepted Quit Line services. Fax to Quit links the services of the Wisconsin Tobacco Quit Line directly to those wanting to quit smoking. Upon receiving a faxed consent form, a quit coach will call the client at a previously specified time. Health care providers also receive a faxed report about the contact between the Quit Line and the client.

Healthy Birth OutcomesFirst Breath continues to contribute to the efforts going on throughout the state, particularly in southeast Wisconsin, to eliminate racial and ethnic disparities in birth outcomes. In 2009, one new First Breath site was added in the priority region of Southeast Wisconsin, contributing to a total of 30 sites in the region. Between those 30 sites, 509 women were enrolled in the First Breath program.

First Breath has also been involved in the “Lifecourse Initiative for Healthy Families” program that seeks to identify the needs of African-American women and their families, and pursue opportunities to address those needs. First Breath staff has been in attendance at committee meetings and has distributed program materials to interested sites. First Breath will likely continue to be a key partner in this initiative.

IV. CHALLENGES

Challenges in the First Breath program remain, these include:

Sustaining provider energy and enthusiasm within the First Breath program. First Breath providers have limited time with each client. During visits, providers address various health-related topics and may not have sufficient time to discuss their client’s smoking. Filling out paper work related and unrelated to First Breath also take up time. Because of these time restraints, First Breath can often get set aside.In efforts to keep energy and enthusiasm up, we have provided various training and educational opportunities that have garnered a positive response from First Breath providers. Increased site visits have also helped in sustaining energy. Incentives for providers, such as gift cards have also been successful in this effort.

Staff Turnover. It is likely that this issue will always be a challenge within the First Breath program and for the agencies we work with. A new First Breath Program Manager and Outreach Specialist were hired in July and August of 2008. In 2009 an additional Outreach Specialist and a Clerical Assistant were hired. Staff turnover at First Breath sites can make communication with those sites hard; training and site visits are offered.

Addressing post-delivery relapse among program participants. Although program data will show low relapse rates, there are some significant limitations to this information. Clients are often “lost to follow-up” after their baby is born, thus their smoking status cannot be measured. For clients whose post-partum

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smoking status we have collected, it should be noted that data was often collected very shortly after delivery and that all responses are self-reported by the client. It will continue to be a goal of the First Breath program to encourage providers to provide smoking cessation counseling and support to clients as long after delivery as possible.

First Breath staff has worked to increase client participation in the program after delivery by encouraging providers to tell clients about the diaper coupon (good for one free pack of Huggies® diapers) they will receive after their post-partum smoking information form is collected. Clients can also earn a $10.00 gift card for sharing their First Breath story. Women are also able to enroll in First Breath up to six months after delivery.

The need for sustained funding. It is likely that this issue will always be a challenge within the First Breath program and for the agencies we work with. In 2009, we saw a drastic cut in the Wisconsin Tobacco Prevention and Control Program budget; 55% of the WI TPCP’s budget was cut, decimating many of our partner programs in Tobacco Control. Although First Breath was not directly affected by this dramatic cut in funding, we continue to pursue other avenues of funding and will continue to focus on collaboration.

V. FUTURE PLANS

Program Goals- January 1, 2010 – December 31, 2010:The goals of the statewide First Breath program in 2009 include:

1. By December 31, 2010 1,500 pregnant/postpartum women who smoke will enroll in the First Breath program.

2. By December 31, 2010, First Breath sites will be provided with at least five options to access program technical assistance, support offerings and communication tools.

3. From January 1, 2010 to December 31, 2010 First Breath will maintain and support the 30 sites in Milwaukee, Racine, Dane, Kenosha and Rock counties that serve low-income women of color, focusing efforts on increasing enrollment.

4. By December 31, 2010, First Breath will maintain and support the existing eleven Native American First Breath sites that serve Wisconsin Native Americans at tribal clinics, focusing efforts on increasing enrollment of Native American women.

5. By December 31, 2010, 30% of First Breath clients will report not smoking at the last data point before delivery, and reduce smoking among an additional 35% of women who are unable to quit.

6. By December 31, 2010, 25% of First Breath clients will report not smoking at postpartum data point and reduce smoking among an additional 30% of women who are unable to quit.

7. By December 31, 2010, data submitted for clients participating in the First Breath program in 2009 will be analyzed and compiled in the 2009 First Breath evaluation report and the site specific reports.

8. 725 or 80% of infants born to women enrolled in the First Breath program will be of a healthy weight (greater than 2,500 grams) and/or will report a healthy birth outcome.

9. Enroll client support people in First Breath Support Person Initiative.10. Sites which offer both First Breath and My Baby & Me programs will include new educational

components in their client interactions.

VI. PROGRAM RESULTS: JANUARY 1, 2009 - DECEMBER 31, 2009

Results Relative to Program Goals:

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UW-CTRI, 06/07/10,

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1. By December 31, 2009 1,440 pregnant/postpartum women who smoke will enroll in the First Breath program. 1,386 women enrolled in the First Breath program in 2009, falling just short of the program goal.

2. By December 31, 2009, First Breath sites will be provided at least 5 options to access program technical assistance and support offerings. First Breath providers are able to access assistance and support through the First Breath website, email updates, Regional Sharing Sessions, Statewide Meeting, Mini-Grant RFP, email and telephone.

3. From January 1, 2009 to December 31, 2009 First Breath will maintain and support the seven new sites added in 2008 in Milwaukee, Racine, Dane, Kenosha, and Rock counties that serve low-income women and women of color, focusing efforts on increasing enrollments. 13 site visits and/or site trainings were conducted to sites in Southeastern Wisconsin. In all, 509 women were in enrolled by the 30 sites in Southeastern Wisconsin in 2009.

4. By December 31, 2009, First Breath will expand to three additional sites that serve Wisconsin Native Americans at tribal clinics, focusing efforts on increasing the enrollment of Native American women. Two new tribal clinics were established as First Breath sites in 2009, adding to the existing nine tribal health centers. In all, 49 women were enrolled in First Breath by the tribal health centers in 2009.

5. By December 31, 2009, the First Breath team will develop new materials and edit existing materials to ensure cultural sensitivity and appropriateness. In 2009, First Breath program materials such as the program brochure, posters and client workbooks were updated to ensure cultural sensitivity and appropriateness. These materials were made available to First Breath sites in January of 2009.

6. By December 31, 2009, 25% of clients will report not smoking at the last data point before delivery, and reduce smoking among an additional 30% of women who are unable to quit. A prenatal quit rate of 36% exceeds the program goal of 25%, and 30% of the women unable to quit were successful in reducing their smoking, meeting the program goal.

7. Data submitted for clients participating in the First Breath program in 2009 will be analyzed and compiled in the 2009 First Breath Program Evaluation Report and the site specific reports. This report will be completed by June 2010.

2009 EnrollmentAt year end, the First Breath program had been established at 100 sites throughout Wisconsin. A total of 1,386 client enrollment forms were submitted in 2009, bringing the total program enrollment to 9,115 since the statewide expansion in 2003. Table 1 (see page 16) presents the First Breath site name and number of women enrolled per site.

Data Collection ProcessParticipation in the First Breath program requires the submission of information about those enrolled in the program for use in evaluating outcomes. The necessary information collection process was designed to be the least intrusive on providers as possible. Data is submitted to WWHF by one of three methods: mail, fax, or online at www.wwhf.org. Six forms make up the information collection process. Three are completed at the time of enrollment, one prenatal, one postpartum, and one completed whenever there is a client status change (e.g., address change, miscarriage). Following is a description of the forms:

Client Consent Form: The Client Consent Form is completed at the time of enrollment and is signed by the enrolled client. It ensures that the client understands the parameters of the First Breath program. The consent form includes a unique identification number for each client, which is used in all subsequent data

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collection. This is the only form which lists both the client name and identification number, as well as the only form that must be mailed to WWHF as First Breath must retain the original form.

Client Enrollment Information: The Client Enrollment Information is completed at the time of enrollment and collects basic demographic and background information about the enrolled client.

Enrollment Smoking Information: The Enrollment Smoking Information form is completed at the time of enrollment and collects self-reported smoking status information.

Prenatal Follow-up Smoking Information: The First Breath program must receive self-reported smoking status information about each participant at least once before delivery, but this survey can be completed and submitted multiple times.

Postpartum Smoking Information: The First Breath program must receive self-reported smoking status information about each client at least once after the client delivers, but this survey can be completed and submitted multiple times. This survey also collects the health information of the baby (weight, and health status).

Change of Status: The Change of Status form is completed by the provider whenever there is a client status change and is used to report any of five changes: change in client contact information, change in enrollment, change in expected delivery date, change in client’s family doctor, obstetrician, or mid-wife information, or change in child’s pediatrician.

First Breath Client Survey Results As with previous years, enrollment data for 2010 included all clients having a Client Enrollment Information form and/or an Enrollment Smoking Information form conducted in 2010. Prenatal and postpartum data analysis for 2010 included those clients having a prenatal and/or postpartum smoking information survey conducted in 2010 even though they may have been enrolled in the program in the previous year.

Client Enrollment Information: Table 2 (page 19) provides a description of First Breath enrollees by presenting selected characteristics. Of the 1,338 submitted Client Enrollment Information forms, the majority are non-Hispanic white (72%), 76% are Medicaid recipients, and 74% have a high school or less education level. The percentage of women who are not employed is 54% and the majority of women (56%) fall into the age category of 18-24. The average client age at the time of enrollment is 23, with minimum and maximum ages of 10 and 43, respectively. Compared to previous years, the client population has remained fairly consistent with one major difference: since 2006, there has been a 78% increase in the rate of African American client enrollments (9.0% in 2006; 16% in 2010).

Enrollment Smoking Information: Table 3 (page 20) presents self-reported smoking status information at the time of enrollment in the First Breath program. Note that First Breath encourages women who have already quit smoking to enroll in the program as well. This may include clients who had already quit at the time of enrollment with enrollment being at any time during pregnancy. This way, First Breath can provide needed support and encouragement to help clients remain quit throughout the pregnancy and avoid relapse after delivery.

Of the 1,224 submitted Enrollment Smoking Information forms: The majority (54%) had started smoking within the age range of 11 to 15 years.

Three months prior to getting pregnant, 37% of the women were smoking 11 to 20 cigarettes per day with:

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o 30% having their first cigarette of the day immediately (within five minutes) upon waking up.

o 23% of the women had already quit smoking at the time they were enrolled. Of these women:

56% of the Hispanic-Latina population reported not smoking 20% Caucasian population reported not smoking 28% African-American population reported not smoking 24% Native American population reported not smoking 40% Southeast Asian population reported not smoking

The majority of women (75%) at enrollment were smoking up to half a pack of cigarettes a day (1 pack = 20 cigarettes).

77% of enrollees had tried to quit smoking previously. Of the women with previous quit attempts:o 28% have had one previous quit attempto 29% have had two previous quit attemptso 21% have had three previous quit attemptso 7% have had four previous quit attemptso 4% have had five previous quit attemptso 11% have had greater than 5 previous quit attempts

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The Nicotine Patch has proven to be the most popular medicine women have used to help them quit (24%; 10% while being pregnant), followed by:

o Nicotine Gum (18%; 5% while being pregnant)o Zyban/Wellbutrin (14%; 6% while being pregnant)o Nicotine Lozenge (5%; 3% while being pregnant)o Nicotine Inhaler (3%; 2% while being pregnant)

More than half (60%) of enrollees have had a previous pregnancy. Of those, 38% reported quitting smoking during all previous pregnancies.

Changes women have made since learning that they were pregnant:o 48% have cut down a lot,o 21% have cut down a little, ando 24% have quit smoking.

When asked what they want to happen with their smoking: o 83% want to quit for good,o 8% don’t know what they want,o 4% want to only cut down, and o 5% plan on quitting only until their baby is born.

Almost half of women (47%) are somewhat confident that they can reach their goals with their

smoking, followed by 35% feeling very confident they have the needed skills.

Prenatal Follow-up Smoking Information. Table 4 (page 25) presents smoking status information at the last data point before delivery. Of the 763 submitted Prenatal Follow-up Smoking forms in 2010:

When women were asked how they would describe their current cigarette smoking, 33% reported not smoking at their last prenatal visit.

o 39% of the Hispanic-Latina population reported not smoking,o 33% of the Caucasian population reported not smoking,o 42% of the African-American population reported not smoking,o 25% of the Native-American population reported not smoking, ando 33% of the Southeast Asian population reported not smoking

Current smoking reported by the remaining women:o 29% were smoking one to five cigarettes per day,o 15% were smoking six to 10 cigarettes per day, o 14% were smoking as little as one puff and up to a few cigarettes on some, but not every

day,o 5% were smoking 11 to 20 cigarettes per day,o 0.8% were smoking 21 to 30 cigarettes per day, o 0.1% were smoking 31 to 40 cigarettes per day, and o 0% were smoking more than 40 cigarettes per day.

The women are surveyed on how their smoking has changed during their pregnancy, whereby the woman indicates the number of cigarettes smoked during each trimester. Data was analyzed on a total of 718

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women that provided this information for all trimesters. The data results show that there were large changes from the first to third trimester in terms of increasing women reporting not smoking and increasing women reporting giving up high levels of cigarette use. See Figure 2 (page 33).

When asked what they want to happen with their smoking after their baby is born:o 39% want to remain quit,o 31% want to quit, o 19% want to do better than now (want to quit or smoke less),o 6% don’t know what they want to happen with their smoking,o 4% want to stay where they are at, ando 0.8% are looking forward to smoking again.

The majority of women are confident that they can reach their goals with their smoking; 42% are very confident and 43% are somewhat confident they have the needed skills (an increase in confidence compared to the time of enrollment).

This table also presents data on the providers, specifically how much time they have spent on helping the client quit smoking and how many prenatal contacts they have had with the client. Most providers spend one-half to one hour (38%) or less than a half hour (37%) providing smoking cessation assistance to each client. The average number of prenatal contacts (contacts can be an office appointment, home visit, or phone call) a provider has had with a First Breath client is five contacts.

Postpartum Smoking Information. Table 5 (page 28) presents self-reported postpartum smoking status at the last postpartum data point. Postpartum data was submitted on 745 women in 2010.

When the women were asked how they would describe their current cigarette smoking 39% reported not smoking at their last postpartum visit (see Figure 3– page 34).

o 61% of the Hispanic-Latina population reported not smoking,o 38% of the Caucasian population reported not smoking,o 35% of the African-American population reported not smoking,o 36% of the Native-American population reported not smoking, ando 57% of the Southeast Asian population reported not smoking.

Current smoking reported by the remaining women:o 25% were smoking one to five cigarettes per day,o 18% were smoking six to 10 cigarettes per day, o 13% were smoking as little as one puff and up to a few cigarettes on some, but not every

day,o 5% were smoking 11 to 20 cigarettes per day,o 0.9% were smoking 21 to 30 cigarettes per day, o 0.1% were smoking 31 to 40 cigarettes per day, ando 0% were smoking more than 40 cigarettes per day.

Now that the baby is born, 41% of women want to remain quit followed by 24% who are not yet quit, but want to. The percentage of women who are very confident and know that they have the skills to achieve their goals with their smoking is 55%, followed by 32% who feel somewhat confident. There are 45% of

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women who feel their doctor (non-First Breath provider) has been helpful and supportive in working with them on their smoking.

Related to secondhand smoke, the majority of women responded that their baby is not regularly exposed to cigarette smoke in the home (94%) or in the car (94%). The majority of women (84%) also responded that other people never smoke around their baby.

Forty women (6%) recall using the Wisconsin Tobacco Quit Line. The average number of postnatal visits providers have had with their First Breath clients is two visits.

VII. OUTCOMES

The ultimate objective of the program is smoking cessation. However, First Breath has also adopted a harm reduction perspective and recognizes that complete cessation only during pregnancy or even reduction, is beneficial, although not as beneficial as permanent cessation. Collected data can be used to explore both cessation and smoking reduction.

It should be noted that all references to quit rates are self-reported and have not been biologically verified. In addition, the stated quit rate or cessation rate describes the percent of First Breath clients who reported at a given data point that they have not smoked in the past week. This may include clients who had already quit at the time of enrollment, with enrollment being at any time during pregnancy. In this case, it was the goal of First Breath to provide support and encouragement to help the client stay quit throughout the pregnancy and avoid relapse after delivery.

Measures of Abstinence and Smoking ReductionFigure 4 (see page 35) presents the smoking cessation rate across the data collection points. Three months prior to getting pregnant, 0.6% of the women reported they were not smoking, 23% had already quit by the time of First Breath enrollment, 33% were not smoking prior to giving birth and 38% were not smoking postpartum. This 33% prenatal quit rate is just short of the program goal of 25%.

Data was also analyzed on a total of 747 women who had both enrollment and prenatal smoking measurements taken focusing on the last data point before delivery. There were 173 women (23%) who reported not smoking at enrollment. Of these, 150 women (87%) were still not smoking before delivery and 23 women (13%) relapsed before delivery.

Of the remaining 574 women who reported they were smoking at enrollment, 104 women (18%) did quit smoking by their last prenatal visit. Additionally, 168 women (29%) who were unable to quit were successful at reducing their smoking during pregnancy. This is just short of the program goal of a 30% reduction in smoking.

Success with Their Smoking PlansAnalysis was done on how successful women have been with their plans for their smoking. For this analysis, data was used from the Enrollment Survey Question 12 (see page 24) ‘When pregnant, some women quit smoking for good; some quit only until the baby is born; some don’t quit but do cut down. What do you want to happen for you?’ and compared to the smoking status reported at the last prenatal smoking measurement before delivery. Data was collected on a total of 747 women for this analysis, (see Figure 5, page 36). This includes women who were enrolled in 2009, but had prenatal smoking measurements taken in 2010. Results to the question responses are as follows:

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I want to quit for good. Of the 622 women who chose this response, 36% (224 women) were not smoking at their last prenatal measurement, and 21% (128 women) had reduced their smoking.

I want to quit only until the baby is born. Of the 29 women who chose this response, 41% (12 women) were not smoking at their last prenatal measurement, and 34% (10 women) had reduced their smoking.

I want to only cut down. Of the 28 women who chose this response, 11% (3 women) were not smoking at their last prenatal measurement and 46% (13 women) reported cutting back on their smoking from enrollment.

I don’t know what I want. Of the 68 women who chose this response, 22% (15 women) were not smoking at their last prenatal measurement, and 25% (17 women) had reduced their smoking.

Harm ReductionIt is important to analyze harm reduction because it may be a more sensitive outcome than a simple cessation rate. The harm reduction impact of the First Breath program can be investigated by comparing self-reported smoking levels across the four time periods (three months before pregnancy, at enrollment, at third trimester, and at postpartum). When there were multiple measurements for a given time period (such as two third trimester records), which is encouraged but not required, the latest measurement was used in this analysis. For the harm reduction analysis, responses to the amount of smoking over the past week were coded in the following manner:

SCOREI have not smoked at all, not even a puff 8As little as one puff, up to a few cigarettes on some days, but not every day 71-5 cigarettes per day 66-10 cigarettes per day 511-20 cigarettes per day 421-30 cigarettes per day 331-40 cigarettes per day 2Greater than 40 cigarettes (or greater than 2 packs) per day 1

Therefore, the higher the harm reduction score, the lower the harm from smoking. Rising scores over time indicate harm reduction, while falling scores indicate increases in harm.

The following parametric analyses treat this data as interval even though it is best considered ordinal. While doing so is not uncommon, the following analyses could be questioned on statistical grounds.

The results from this question were analyzed in a repeated measures analysis of variance (ANOVA). The results are based on those 589 clients who had measures at all four points in time. Results are graphed on Figure 6 (see page 37). The overall F ratio was significant (p<.001) indicating that harm reduction increased across time. Each possible trend test (linear, quadratic, and cubic) was also significant (p<.001). This suggests that harm reduction grew across time (linear trend), but also leveled off (less increase) at the later points in time.

Relapse Rate

13

Of the 500 women for which there was pre- and post-delivery smoking status information, 178 (36%) had quit prior to giving birth. Of those, 144 (81%) reported not smoking post-delivery. Thus, the relapse rate is 19%. This is quite low, but should be viewed in the context that smoking status was measured fairly soon after delivery. Relapse rates will typically increase over time.

Delivery OutcomesThere were 731 postpartum forms submitted with delivery outcome information for 2010 (see Table 6, page 37). Of those women:

95% reported delivering healthy babies (5 of which were multiple births). 5% reported delivering babies with abnormalities, including premature birth, low birth weight,

cardiac anomaly, cystic fibrosis, cleft lip and palate, spina bifida, etc. 0% reported infant death.

Birth weights in the First Breath Program ranged from 567 grams to 4,955 grams and averaged 3,199 grams; 717 postpartum forms included birthweight information. Eleven percent of First Breath babies born were considered low birth weight, weighing 2,500 grams or less. Low birth weight babies tend to have impaired immune function and increased risk of disease. They are likely to remain undernourished, with reduced muscle strength, throughout their lives, and to suffer a higher incidence of diabetes and heart disease.

Withdrawal from ProgramThere were 169 Change of Status forms submitted in 2010 that indicated a client’s withdrawal from the First Breath program, (see Table 7, page 31). Of those women:

68% of clients were no longer receiving care at their First Breath site. A client may no longer receive care at a site because they moved from the area or were lost to follow-up. It does not include clients who have delivered their babies or were discharged from care.

21% reported no longer participating in First Breath. Reported reasons that clients choose to no longer participate in First Breath include: not interested any longer, wants to quit on own, doesn’t want to change smoking behavior, unable to reach.

12% reported a pregnancy loss/miscarriage.

14

VIII. FIRST BREATH AND MY BABY & ME CLIENTS

My Baby & Me is a fetal alcohol spectrum disorders (FASD) prevention program of the Wisconsin Women’s Health Foundation. My Baby & Me mirrors the First Breath program and adapts the same approach and practices to address alcohol cessation during pregnancy. My Baby & Me providers are trained in program protocols and evidence based practices for counseling such as: the 5 A’s counseling strategies (Ask, Advise, Assess, Assist and Arrange) and motivational interviewing. Providers support women through non-judgmental and client-centered counseling.

Alcohol use during pregnancy is a leading cause of preventable birth defects and developmental disabilities. Fetal alcohol spectrum disorders (FASDs) is the umbrella term used to describe the range of lifelong effects that can occur due to prenatal alcohol exposure including physical, cognitive, behavioral, and/or social deficits.

Since the inception of the My Baby & Me program in April 2006, it has been integrated into 10 First Breath sites. Given that women who smoke during pregnancy are also likely to drink alcohol, it is opportune that pregnant women have access to both tobacco and alcohol cessation treatment at the same time. The need is evident in the fact that 56% (145/261) of My Baby & Me clients have been concurrently enrolled in the First Breath program since 2006. In 2010, 51% (21/41) clients were enrolled in both programs simultaneously.

In 2009 Wisconsin Women’s Health Foundation staff members Hillary Whitehorse and Molly Zemke, completed the University of Wisconsin – Madison, Continuing Studies, Fetal Alcohol Spectrum Disorders (FASD) Train the Trainer program. This training is sponsored by the Great Lakes FASD Regional Training Center. Hillary and Molly are trained to provide and evaluate FASD-related education.

15

TABLESTABLE 1: First Breath Sites & Number of Women Enrolled per Site in 2009 and Total Enrollment

SITE NAME 2009TOTAL

ENROLLEESABRI HEALTH PLAN 0 7ADAMS COUNTY PUBLIC HEALTH 1 12APPLETON CITY HEALTH DEPARTMENT 3 48ASHLAND COUNTY HEALTH & HUMAN SERVICES 2 28AURORA HEALTH CENTER - DTWN MILWAUKEE 7 16BAD RIVER TRIBAL HEALTH CENTER 1 20BARRON COUNTY DHHS 14 74BUFFALO COUNTY DHHS 0 0BURNETT COUNTY DHHS 4 71CALUMET COUNTY HEALTH DEPARTMENT 1 18CATHOLIC CHARITIES- GREEN BAY DIOCESE 3 5CHAK-HA-CHI, HO CHUNK HEALTH 0 9CHILDREN'S COMMUNITY HEALTH PLAN 5 20CHIPPEWA COUNTY DEPT. OF PUBLIC HEALTH 27 225CLARK COUNTY HEALTH DEPARTMENT 20 50COLUMBIA COUNTY DHHS 13 115CRAWFORD COUNTY HEALTH DEPARTMENT 0 3DEAN HEALTH SYSTEM 67 290DODGE COUNTY HUMAN SERVICES & HEALTH DEPT. 18 122DOOR COUNTY PUBLIC HEALTH DEPARTMENT 14 105DUNN COUNTY HEALTH DEPARTMENT 4 46EAU CLAIRE CITY CO. HEALTH DEPARTMENT 26 90EAU CLAIRE FAMILY MEDICINE 6 18FAMILY HEALTH/LA CLINICA 1FAMILY RESOURCE CENTER OF CRAWFORD COUNTY 0 0FAMILY RESOURCE CENTER OF SHEBOYGAN COUNTY 0 0FAMILY SERVICES OF NEW 28 70FLORENCE COUNTY HEALTH DEPARTMENT 1 21FOREST COUNTY HEALTH DEPARTMENT 3 35FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER 8 13FRANCISCAN SKEMP - SPARTA 3 58GERALD L. IGNACE INDIAN HEALTH CENTER 0 0GRANT COUNTY HEALTH DEPARTMENT 7 51GREEN COUNTY HEALTH DEPARTMENT 1 34GREEN LAKE COUNTY PUBLIC HEALTH DEPT. 5 38GUNDERSEN LUTHERAN 37 203

16

SITE NAME 2009TOTAL

ENROLLEESHEALTH AND NUTRITION SERVICES OF RACINE 257 1159IOWA COUNTY HEALTH DEPARTMENT 5 33JEFFERSON COUNTY HEALTH DEPARTMENT 2 19JUNEAU COUNTY HEALTH DEPARTMENT 11 97KENOSHA AREA FAMILY AND AGING SERVICES 5 44KENOSHA COUNTY HEALTH DEPARTMENT 11 33KROHN CLINIC 13 114LA CAUSA FAMILY RESOURCE CENTER 0 0LA CROSSE COUNTY HEALTH DEPARTMENT 42 115LAC COURTE OREILLES COMMUNITY HEALTH CENTER 5 13LAC DU FLAMBEAU HEALTH AND WELLNESS CENTER 0 41LADY PITTS SCHOOL AGE PARENT CENTER 0 6LANGLADE COUNTY HEALTH DEPARTMENT 1 28LINCOLN COUNTY HEALTH DEPARTMENT 6 12LUTHER MIDELFORT NORTHLAND MAYO HEALTH SYSTEM 8 16MANAGED HEALTH SERVICES 48 183MANITOWOC COUNTY HEALTH DEPARTMENT 2 48MARATHON COUNTY HEALTH DEPARTMENT 23 206MARINETTE COUNTY HEALTH & HUMAN SERVICES 0 25MARQUETTE COUNTY HEALTH DEPARTMENT 2 27MARSHFIELD CLINIC - MARSHFIELD 56 226MENOMINEE TRIBAL CLINIC 28 83MERITER CENTER FOR PERINATAL CARE 49 72MERITER HOSPITAL PNCC 1 9MIDELFORT CLINIC LUTHER 8 288MILWAUKEE HEALTH DEPARTMENT 9 90MILWAUKEE HEALTH SERVICES 7 60MINISTRY MEDICAL GROUP - RICE 93 436MONROE COUNTY HEALTH DEPARTMENT 5 21MORELAND OB/GYN ASSOCIATES 9 179NORTHWEST WISCONSIN COMMUNITY SERVICE AGENCY 3 112ONEIDA COUNTY HEALTH DEPARTMENT 7 110OUTAGAMIE COUNTY HEALTH & HUMAN SERVICES 10 149OZAUKEE COUNTY PUBLIC HEALTH DEPARTMENT 6 18PEPIN COUNTY HEALTH DEPARTMENT 6 46PIERCE COUNTY HEALTH DEPARTMENT 12 85POLK COUNTY HEALTH DEPARTMENT 43 453SITE NAME 2009 TOTAL

17

ENROLLEESPRICE COUNTY HEALTH DEPARTMENT 7 48PUBLIC HEALTH - MADISON & DANE COUNTY 29 172RED CLIFF COMMUNITY HEALTH CENTER 1 25RENEWAL UNLIMTED, INC 1 1ROCK COUNTY HEALTH DEPARTMENT 31 140ROCK RIVER CHARTER SCHOOL 2 41ROSALIE MANOR 0 19RUSK COUNTY HEALTH & HUMAN SERVICES 6 60SAUK COUNTY HEALTH DEPARTMENT 12 60SHEBOYGAN COUNTY HEALTH DEPARTMENT 20 243SOKAOGON CHIPPEWA COMMUNITY HEALTH CENTER 2 2ST. CROIX COUNTY DHHS 23 166ST. FRANCIS HOSPITAL PRENATAL ASSESSMENT CENTER 0 19ST. JOSEPH WOMEN'S OUTPATIENT CENTER 32 43STOCKBRIDGE MUNSEE HEALTH & WELLNESS CENTER 2 11TREMPEALEAU COUNTY HEALTH DEPARTMENT 0 21UNITY HEALTH INSURANCE 2 2UW HEALTH 20 S. PARK OB/GYN 0 2UW HEALTH EAST CLINIC 2 4UW HEALTH SUN PRAIRIE 2 3UW HEALTH WEST CLINIC 0 3UWHP CENTER FOR WOMEN'S HEALTH 7 39WALWORTH COUNTY HEALTH DEPARTMENT 10 36WATERTOWN DEPT. OF PUBLIC HEALTH 2 21WAUPACA COUNTY TOBACCO FREE COALITION 3 28WAUSHARA COUNTY HEALTH DEPARTMENT 7 89WEE CARE WIC CAPITOL 20 23WEE CARE WIC NORTH 5 19WEE CARE WIC TEUTONIA 11 19WEST ALLIS HEALTH DEPARTMENT 0 41WESTSIDE HEALTHCARE ASSOCIATION 5 5WOOD COUNTY HEALTH DEPARTMENT 3 139DISCONTINUED SITES 5 1769

TOTAL 1374 9100

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TABLE 2: Client Enrollment Information

Client Age at Enrollment

Age (Years)

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

Women13-17 66 4.4 65 4.7 112 8.418-24 823 54.6 747 53.9 752 56.225-30 406 26.9 375 27.1 336 25.131-35 160 10.6 139 10.0 109 8.136-40 42 2.8 54 3.9 22 1.641 and older 10 0.7 4 0.3 7 0.5Unknown/Not Answered 0 0.0 2 0.1 0 0.0

Total 1,507 100.00% 1,386 100.00% 1,338 100.00%

Question 1: How many years of school did this client complete?

Education Level

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

Women

A. Less than eighth grade 9 0.6 11 0.8 11 0.8B. Some high school 457 30.3 440 31.7 382 28.6C. High school graduate 645 42.8 572 41.3 567 42.4D. Some college or 2-year degree 334 22.2 325 23.4 338 25.3E. College graduate 32 2.1 27 1.9 22 1.6F. Post-college education 6 0.4 5 0.4 6 0.4Unknown/Not Answered 24 1.6 6 0.4 12 0.9

Total 1,507 100.00% 1,386 100.00% 1,338 100.00%

Question 2: What is this client’s ethnicity/race?

Ethnicity/Race

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. Hispanic/Latina 59 3.9 49 3.5 34 2.5B. Caucasian, Non-Hispanic/Latina 1,116 74.1 991 71.5 961 71.8C. African American or Black 200 13.3 213 15.4 219 16.4D. Native American 66 4.4 58 4.2 70 5.2E. Southeast Asian 16 1.1 13 0.9 5 0.4F. Other (Multi-Group, Black White Biracial, Japanese, Pacific Islands)

40 2.7 47 3.4 40 3.0

Unknown/Not Answered 10 0.7 15 1.1 9 0.7Total 1,507 100.00% 1,386 100.00% 1,338 100.00%

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Question 3: What is this client’s main language?

Language

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenEnglish 1,482 98.3 1,367 98.6 1,325 99.0Spanish 12 0.8 8 0.6 8 0.6Hmong 4 0.3 5 0.4 1 0.1Russian 1 0.1 0 0.0 0 0.0Other (English, Ojibwe, Spanish, German)

2 0.1 3 0.2 0 0.0


Question 4: Is this client employed?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenYes 736 48.8 593 42.8 559 41.8No 745 49.4 738 53.2 724 54.1Unknown/Not Answered 26 1.7 55 4.0 55 4.1

Total 1,507 100.00% 1,386 100.00% 1,338 100.00%

Question 5: Is this client eligible for any of the following? (check all that apply)

Response

2008 (1,507 Women) 2009 (1,386 Women) 2010 (1,338 Women)# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenPrenatal Care Coordination

950 63.0% 842 60.8% 836 60.3%

Medicaid or BadgerCare

1,175 78.0% 1,052 75.9% 1,057 76.3%

WIC 1,276 84.7% 1,191 85.9% 1,186 85.6%None of the above

144 9.6% 0 0.0% 0 0.0%

TABLE 3: Enrollment Smoking InformationQuestion 1: How old were you when you started smoking?

Age (Years)

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

Women5 to 10 74 4.9 78 5.7 51 4.111 to 15 798 53.3 736 53.5 673 54.116 to 20 557 37.2 487 35.4 462 37.121 or older 46 3.1 52 3.8 44 3.5Unknown/Not Answered 23 1.5 23 1.7 14 1.1

Total 1,498 100.00% 1,376 100.00% 1,244 100.00%

20

Question 2: How many cigarettes per day were you smoking three months before you got pregnant?

# of Cigarettes

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I was not smoking, not even an occasional puff. 9 0.6 7 0.5 8 0.6B. A few cigarettes on some days, but not every day. 45 3.0 42 3.1 51 4.1C. 1 to 5 cigarettes per day 203 13.6 167 12.1 181 14.5D. 6 to 10 cigarettes per day 385 25.7 401 29.1 362 29.1E. 11 to 20 cigarettes (up to 1 pack) per day 591 39.5 513 37.3 457 36.7F. 21 to 30 cigarettes per day 178 11.9 187 13.6 130 10.5G. 31 to 40 cigarettes (up to 2 packs) per day 74 4.9 43 3.1 41 3.3H. Greater than 40 cigarettes (or greater than 2 packs) per day

10 0.7 12 0.9 11 0.9


Question 3: Before you were pregnant, which of the following statements best describes how soon after you woke up that you had your first cigarette?

Amount of Time

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. Immediately when I woke up – within 5 minutes

415 27.7 425 30.9 372 29.9

B. 5 to 10 minutes after I woke up 259 17.3 240 17.4 226 18.2C. 10 to 30 minutes after I woke up 269 18.0 240 17.4 220 17.7D. 30 minutes to 1 hour after I woke up 208 13.9 197 14.3 167 13.4E. Over 1 hour after I woke up 308 20.6 245 17.8 233 18.7Unknown/Not Answered 39 2.6 29 2.1 26 2.1

Total 1,498 100.00% 1,376 100.00% 1,244 100.00%

Question 4: Have you ever tried to quit smoking before?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenYes 1,177 77.8 1,068 77.6 949 76.3No 335 22.1 306 22.2 280 22.5Unknown/Not Answered 1 0.1 2 0.1 15 1.2

Total 1,513 100.00% 1,376 100.00% 1,244 100.00%

21

Question 5: How many times have you tried to quit smoking?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. Once 312 26.5 333 31.2 268 27.8B. Two times 336 28.5 309 28.9 277 28.7C. Three times 225 19.1 177 16.6 203 21.1D. Four times 89 7.6 79 7.4 67 7.0E. Five times 55 4.7 47 4.4 42 4.4F. Greater than five times 148 12.6 117 11.0 102 10.6Unknown/Not Answered 12 1.0 6 0.6 5 0.5

Total 1,177 100.00% 1,068 100.00% 964 100.00%

Question 6: Have you ever used any of the following medicines to help you quit smoking?

Medicine

2008 2009 2010

# of Women

with quit attempts

% of 1,177

Women with quit attempts

# of Women

with quit attempts

% of 1,068

Women with quit attempts

# of Women

with quit attempts

% of 964 Women

with quit attempts

Nicotine Gum 166 14.1 176 16.5 169 17.5Nicotine Patch 247 21.0 237 22.2 228 23.7Nicotine Inhaler 25 2.1 35 3.3 33 3.4Nicotine Nose Spray 1 0.1 2 0.2 2 0.2Nicotine Lozenge 39 3.3 35 3.3 48 5.0Zyban/Wellbutrin 146 12.4 137 12.8 132 13.7None 772 65.6 678 63.5 595 61.7

Question 7: Have you ever used any of these medicines to help you quit smoking while you were pregnant (either this time or a previous pregnancy)?

Medicine

2008 2009 2010

# of Women

who used medicines

% of 405 Women

who used medicines

# of Women

who used medicines

% of 390 Women

who used medicines

# of Women

who used medicines

% of 369 Women

who used medicines

Nicotine Gum 20 4.9 21 5.4 18 4.9Nicotine Patch 40 9.9 42 10.8 35 9.5Nicotine Inhaler 3 0.7 3 0.8 6 1.6Nicotine Nose Spray 2 0.5 1 0.3 0 0.0Nicotine Lozenge 4 1.0 5 1.3 3 0.8Zyban/Wellbutrin 17 4.2 18 4.6 21 5.7None 335 82.7 320 82.1 304 82.4

22

Question 8: Have you had any previous pregnancies?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenYes 736 58.7 717 61.0 645 60.2No 491 39.2 448 38.1 416 38.8Unknown/Not Answered 27 2.2 10 0.9 10 0.9

Total 1,254 100.00% 1,175 100.00% 1,071 100.00%

Question 9: Did you quit smoking during previous pregnancies?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. Yes, all of them 284 37.0 275 37.8 250 38.3B. No, none of them 338 44.1 333 45.8 283 43.3C. Some of them 101 13.2 70 9.6 84 12.9D. I had not yet started smoking when I was pregnant before

18 2.3 31 4.3 27 4.1

Unknown/Not Answered 26 3.4 18 2.5 9 1.4Total 767 100.00% 727 100.00% 653 100.00%

CURRENT SMOKINGQuestion 10: Which of the following statements best describes how much you have smoked over the past week?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I have not smoked, not even an occasional puff 318 21.2 287 20.9 280 22.5B. As little as one puff and up to a few cigarettes on some days, but not every day

175 11.7 139 10.1 127 10.2

C. 1 to 5 cigarettes per day 459 30.6 476 34.6 416 33.4

D. 6 to 10 cigarettes per day 358 23.9 323 23.5 284 22.8E. 11 to 20 cigarettes (up to 1 pack) per day 151 10.1 116 8.4 108 8.7F. 21 to 30 cigarettes per day 17 1.1 14 1.0 12 1.0G. 31 to 40 cigarettes (up to 2 packs) per day 7 0.5 9 0.7 8 0.6H. Greater than 40 cigarettes (or greater than 2 packs) per day

9 0.6 7 0.5 6 0.5

Unknown/Not Answered 4 0.3 5 0.4 3 0.2

Total 1,498 100.00% 1,376 100.00% 1,244 100.00%

23

Question 11: What changes have you made in your smoking since learning you were pregnant?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I smoke more now than before finding out I was pregnant.

19 1.3 16 1.2 17 1.4

B. I smoke the same or about the same as before finding out I was pregnant.

81 5.4 83 6.0 77 6.2

C. I’ve cut down a little since finding out I was pregnant.

345 23.0 272 19.8 257 20.7

D. I’ve cut down a lot since finding out I was pregnant.

721 48.1 711 51.7 597 48.0

E. I’ve quit smoking since finding out I was pregnant.

321 21.4 287 20.9 292 23.5


Question 12: When pregnant, some women quit smoking for good; some quit only until the baby is born; some don’t quit, but do cut down. What do you want to happen for you?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I want to quit for good 1,226 81.8 1,149 83.5 1,030 82.8B. I want to quit only until the baby is born

64 4.3 55 4.0 61 4.9

C. I want to only cut down 68 4.5 59 4.3 45 3.6D. I don’t know what I want 133 8.9 104 7.6 104 8.4Unknown/Not Answered 7 0.5 9 0.7 4 0.3

Total 1,498 100.00% 1,376 100.00% 1,244 100.00%

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Question 13: Do you think you now have the ability and skills to reach the goal you indicated in question #12? How confident are you that you will reach your goal?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I know I have the skills; I’m very confident

484 32.3 464 33.7 437 35.1

B. I think I have most of the skills; I’m somewhat confident

735 49.1 633 46.0 584 46.9

C. I’m not sure I have the skills I need; I’m not very confident

201 13.4 222 16.1 167 13.4

D. I don’t think I have the skills I need; I’m not confident at all

55 3.7 37 2.7 40 3.2


TABLE 4: Prenatal Follow-up Smoking InformationQuestion 1: Which of the following statements best describes how much you have smoked over the past week?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I have not smoked at all, not even a puff. 320 34.0 373 36.4 255 33.4B. As little as 1 puff and up to a few cigarettes on some days, but not every day

115 12.2 139 13.6 110 14.4

C. 1 to 5 cigarettes per day 296 31.5 288 28.1 222 29.1D. 6 to 10 cigarettes per day 145 15.4 144 14.0 115 15.1E. 11 to 20 cigarettes (up to 1 pack) per day 47 5.0 50 4.9 40 5.2F. 21 to 30 cigarettes per day 9 1.0 2 0.2 6 0.8G. 31 to 40 cigarettes (up to 2 packs) per day 1 0.1 2 0.2 1 0.1H. Greater than 40 cigarettes (or greater than 2 packs) per day

0 0.0 1 0.1 0 0.0


25

Question 2: How has your smoking changed during your pregnancy? (Check the box for the number of cigarettes you smoked during each trimester)

Response

20101st Trimester 2nd Trimester 3rd Trimester

# of Women

% of Women

# of Women

% of Women

# of Women

% of Women

A. None, not even a puff. 67 9.3 179 24.9 184 25.6B. A few cigarettes, but not every day 67 9.3 94 13.1 82 11.4C. 1 to 5 per day 178 24.8 206 28.7 152 21.2D. 6 to 10 per day 171 23.8 130 18.1 77 10.7E. 11 to 20 per day 142 19.8 56 7.8 25 3.5F. 21 to 30 per day 30 4.2 2 0.3 1 0.1G. 31 to 40 per day 6 0.8 3 0.4 2 0.3H. Over 40 per day 1 0.1 0 0.0 0 0.0Unknown/Not Answered 56 7.8 48 6.7 195 27.2

Total 718 100.00% 718 100.00% 718 100.00%

Question 3: What do you want to happen with your smoking after your baby is born?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I want to remain quit 358 38.1 437 42.6 298 39.1B. I want to quit 271 28.8 274 26.7 236 30.9C. I want to do better than I am now (I want to quit or smoke less)

193 20.5 203 19.8 143 18.7

D. I want to stay where I am at now

45 4.8 39 3.8 32 4.2

E. I’m looking forward to smoking again

7 0.7 8 0.8 6 0.8

F. I don’t know what I want to happen with my smoking

52 5.5 51 5.0 45 5.9


26


Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I know I have the skills I need; I’m very confident.

411 43.7 438 42.7 320 41.9

B. I think I have most of the skills I need; I’m somewhat confident.

398 42.3 435 42.4 327 42.9

C. I’m not sure I have the skills I need; I’m not very confident.

85 9.0 109 10.6 87 11.4

D. I don’t think I have the skills I need; I’m not at all confident.

21 2.2 17 1.7 19 2.5


PROVIDER RESPONSES ONLYQuestion 5: Considering all of these types of help, how much time have you spent so far helping this client quit smoking/remain abstinent?

Amount of Time

2008 2009 2010# of Time Segments Provided

% of Time

Segments Provided

# of Time Segments Provided

% of Time

Segments Provided

# of Time Segments Provided

% of Time

Segments Provided

A. Less than ½ hour 324 34.5 369 36.0 285 37.4B. ½ to 1 hour 340 36.2 368 35.9 286 37.5C. 1 to 2 hours 152 16.2 165 16.1 126 16.5D. 2 to 3 hours 33 3.5 41 4.0 31 4.1E. 3 to 4 hours 7 0.7 11 1.1 5 0.7F. More than 4 hours 4 0.4 1 0.1 5 0.7Unknown/Not Answered 80 8.5 70 6.8 25 3.3

Total 940 100.00% 1025 100.00% 763 100.00%

27

TABLE 5: Postpartum Smoking InformationQuestion 1: Which of the following statements best describes how much you have smoked over the past week?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I have not smoked at all, not even a puff. 321 34.1 326 34.6 287 38.5B. As little as 1 puff and up to a few cigarettes on some days, but not every day

114 12.1 122 13.0 93 12.5

C. 1 to 5 cigarettes per day 210 22.3 242 25.7 183 24.6D. 6 to 10 cigarettes per day 206 21.9 172 18.3 134 18.0E. 11 to 20 cigarettes (up to 1 pack) per day 62 6.6 63 6.7 38 5.1F. 21 to 30 cigarettes per day 7 0.7 5 0.5 7 0.9G. 31 to 40 cigarettes (up to 2 packs) per day 1 0.1 2 0.2 1 0.1H. Greater than 40 cigarettes (or greater than 2 packs) per day

1 0.1 1 0.1 0 0.0


Question 2: What do you want to happen with your smoking now that your baby is born?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I want to remain quit 336 35.7 337 36.0 303 40.7B. I want to quit 238 25.3 250 26.7 177 23.8C. I want to do better than I am now (I want to quit or smoke less)

231 24.5 200 21.4 142 19.1

D. I want to stay where I am at now 77 8.2 97 10.4 82 11.0E. I’m looking forward to smoking again 5 0.5 1 0.1 4 0.5F. I don’t know what I want to happen with my smoking

34 3.6 41 4.4 34 4.6


28


Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. I know I have the skills I need; I’m very confident. 439 46.7 480 51.0 408 54.8B. I think I have most of the skills I need; I’m somewhat confident.

370 39.3 344 36.6 236 31.7

C. I’m not sure I have the skills I need; I’m not very confident.

84 8.9 89 9.5 22 3.0

D. I don’t think I have the skills I need; I’m not at all confident.

20 2.1 14 1.5 66 8.9


Question 4: How helpful and supportive has your doctor been as you have worked on your smoking?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. Very helpful and supportive 429 45.6 461 49.0 334 44.8B. Somewhat helpful and supportive 271 28.8 258 27.4 213 28.6C. Not at all helpful or supportive 99 10.5 100 10.6 106 14.2D. My doctor discouraged me 7 0.7 2 0.2 3 0.4E. I don't know 105 11.2 105 11.2 82 11.0Unknown/Not Answered 30 3.2 15 1.6 7 0.9

Total 941 100.00% 941 100.00% 745 100.00%

Question 5: Whether or not you smoke, is your baby regularly or often exposed to cigarette smoke:

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. In the home where your baby spends most of the time? Yes 63 6.7 71 7.5 34 4.6 No 846 89.9 848 90.1 699 93.8 Unknown/Not Answered 32 3.4 22 2.3 12 1.6

Total 941 100.00%

941 100.00%

745 100.00%

B. In the car your baby usually rides in when going some place? Yes 61 6.3 64 6.8 37 5.0 No 848 87.4 851 90.4 697 93.6

Unknown/Not Answered 61 6.3 26 2.8 11 1.5Total 970 100.00

%941 100.00

%745 100.00%

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Question 6: Do other people smoke when they are around your baby?

Response

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. Never 710 75.5 753 80.0 622 83.5B. Usually not 130 13.8 110 11.7 77 10.3C. Sometimes 54 5.7 51 5.4 27 3.6D. Most or all of the time 8 0.9 8 0.9 7 0.9Unknown/Not Answered 39 4.1 19 2.0 12 1.6

Total 941 100.00% 941 100.00% 745 100.00%

Question 7: How many telephone contacts have you had with the statewide toll-free Wisconsin Tobacco Quit Line?

# of Contacts

2008 2009 2010# of

Women% of

Women# of

Women% of

Women# of

Women% of

WomenA. 0 781 83.0 829 82.3 671 90.1B. 1 45 4.8 38 3.8 25 3.4C. 2 14 1.5 13 1.3 8 1.1D. 3 4 0.4 12 1.2 3 0.4E. 4 3 0.3 4 0.4 2 0.3F. 5 or more 7 0.7 3 0.3 2 0.3G. I don’t know 21 2.2 42 4.2 9 1.2


Following Question Answered by Providers Only:Question 8: How many prenatal contacts (office appointments, home visits, or phone calls) did you have with this First Breath client?

# of Prenatal Contacts

2008 2009 2010# of

Contacts Provided

% of Contacts Provided

# of Contacts Provided


# of Contacts Provided


A. 1 93 9.9 91 9.7 69 9.3B. 2 190 20.2 181 19.2 140 18.8C. 3 127 13.5 150 15.9 121 16.2D. 4 82 8.7 111 11.8 87 11.7E. 5 70 7.4 65 6.9 52 7.0F. 6 84 8.9 70 7.4 56 7.5G. 7 61 6.5 43 4.6 45 6.0H. 8 34 3.6 55 5.8 35 4.7I. 9 27 2.9 28 3.0 14 1.9J. 10 or more 131 13.9 115 12.2 101 13.6K. None 18 1.9 12 1.3 6 0.8Unknown/Not Answered 24 2.6 20 2.1 19 2.6

Total 941 100.00% 941 100.00% 745 100.00%

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Question 9: How many visits (either in the office, by phone, or a home visit) did you have with this First Breath client after she gave birth?

# of Postpartum Visits

2008 2009 2010# of

Visits Provided

% of Visits

Provided

# of Visits

Provided

% of Visits

Provided

# of Visits

Provided

% of Visits

ProvidedA. 1 visit 498 52.9 535 56.9 424 56.9B. 2 visits 256 27.2 248 26.4 202 27.1C. 3 visits 100 10.6 76 8.1 51 6.8D. 4 visits 28 3.0 30 3.2 32 4.3E. 5 visits 8 0.9 3 0.3 7 0.9F. 6 visits 6 0.6 6 0.6 4 0.5G. 7 visits 8 0.9 1 0.1 1 0.1H. 8 visits 8 0.9 6 0.6 3 0.4I. 9 visits 3 0.3 2 0.2 0 0.0J. 10 or more visits 4 0.4 2 0.2 3 0.4K. I don’t know 22 2.3 32 3.4 18 2.4

Total 941 100.00% 941 100.00% 745 100.00%

TABLE 6: Delivery OutcomesDelivery Outcomes 2008 2009 2010

Healthy Babies 907 95.4 889 96.6 697 95.3 Multiple Births 16 6 5Babies with Abnormalities 37 3.9 28 3.0 34 4.7Infant Deaths (Stillborns, SIDS) 7 0.7 3 0.3 0 0.0

951 100.00% 920 100.00% 731 100.00%

TABLE 7: Withdrawal from ProgramReason for Withdrawal 2008 2009 2010

Client no longer receives care at this site 163 70.6 158 71.2 114 67.5Client no longer participating in First Breath 30 13.0 27 12.2 35 20.7Client experienced a pregnancy loss/miscarriage 38 16.5 37 16.7 20 11.8

TOTAL231

100.00% 222

100.00% 169 100.00%

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FIGURES

FIGURE 1: First Breath Quit Rate at Last Prenatal Contact (2003-2010)

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FIGURE 2: Reported Smoking Changes During Pregnancy – 2010

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FIGURE 3: First Breath Quit Rate at Postpartum Visit (2003-2010)

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FIGURE 4: First Breath Quit Rates Across All Points in Time (2003-2010)

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FIGURE 5: Success with Their Quit Smoking Plans for Calendar Year 2010*

Client Answer at Enrollment to “What do you want to happen with your smoking?”

* Last Prenatal smoking status data measurement compared to Enrollment smoking status data measurement.

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FIGURE 6: Harm Reduction Across Four Smoking Status Measurements – 2010

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Documents

· Web viewDESCRIPTION OF THE FIRST BREATH PROGRAM. Background. In 2000, the Wisconsin Women’s Health Foundation (WWHF), in partnership with the …