Pregnets: A Tool on Quitting Smoking and Pregnancy Thursday, February 19, 2015
+ Presenters Nadia Minian, PhD Dr. Minian is a Knowledge Translation and Evaluation Scientist at the Nicotine Dependence Services (NDS) at CAMH. Her work ensures that the NDS is continually striving toward delivering the highest quality and most efficient services possible so that the best outcomes can be achieved for Ontario smokers. She uses a utilization-focused and participatory approach to evaluation, to build the capacity for sustainable evaluation and knowledge translation activities. She likes to work in collaboration with communities, researchers and policy makers to promote health equity and improve the health system. Jessica Penner, MA Jessica is a Knowledge Translation Coordinator at the Nicotine Dependence Service at the Centre for Addiction and Mental Health in Toronto. In this role she works in knowledge translation research, evaluation and program design/implementation. She also has experience in systems planning, education and community engagement and in the fields of addiction and mental health, food security/agriculture and community economic development Katherine Wallace, RN, RM Katherine is a Registered Nurse and a Registered Midwife with a strong clinical background in perinatal care. She holds a Masters in Health Studies and undergraduate degrees in nursing and midwifery. Currently she is a Program Manager at the Registered Nurses' Association of Ontario (RNAO) and leading a program on smoking cessation and pregnant and postpartum women and their families. This program's objectives include capacity building and awareness raising and is a component of RNAO's provincial Smoking Cessation Initiative. Key deliverables include the creation on new resources, a workshop series, a new elearn module, and webinars.
+ Learning Objectives 1. Understand the effects of smoking during pregnancy for women, fetus, and babies. 2. Describe the population-based trends of tobacco use among Ontario pregnant smokers. 3. Explore how Pregnets can be used by health care providers and by pregnant women. 4. Mobilize practitioners to talk to their pregnant patients about smoking, and if needed utilize Pregnets and refer their clients.
Tobacco addiction kills 37,000 Canadians per year (1, 2)
Pregnancy (3) New Born (3) Children (3, 4) Adults (5) 1. Placenta Previa 2. Still Birth 3. Spontaneous abortion 4. Pre term low weight baby 1. Sudden Infant Death Syndrome 2. Difficulty feeding 3. Cleft lips 4. Bronchitis and pneumonia 1. Asthma and allergies 2. middle ear infections 3. hearing loss 4. ADHD 1. Increased risk of diabetes mellitus among adult daughters
Pre term babies Babies (6) Mothers (6) Costs (6) five times more likely to die within the first year of life depression and anxiety costs for a late preterm infant s care 5 X cost of care for a full term neonate. (6)
Benefits of Quitting- Smoker (7)
Benefits of Quitting - Fetus (3) more oxygen Healthy Baby Quit Smoking Lungs work better Born due date
In 2011 2012 in Ontario, 9.0% of women reported smoking during pregnancy ONTARIO DATA
BORN Data (9) Health Region Smoking (N) Smoking (%) Central East 9,142 8.9 Central West 8,607 14.7 Eastern 6,638 15.3 North East 3,633 28.7 North West 1,859 33.6 South West 7,925 17.8 Toronto 3,858 5.2
Mean and Median age of Pregnant Women: Those that Smoke and Those that Don t (9,10)
Pregnancy and Smoking: BORN Data (10) Pregnant women who smoke are: 1. Less likely to have formal education than pregnant women who do not smoke (p<.0001) 2. More likely to have asthma (p<.0001) 3. More likely to use illicit substances (opiodes, narcotics, cocaine, marijuana) (p<.0001) 4. More likely to have alcohol dependence syndrome (p<.0001)
Pregnancy and Smoking: BORN Data (10) Pregnant women who smoke are more likely to have: 1. Asthma 2. Alcohol Dependence 3. A history of depression 4. Have depression during pregnancy 5. Have a history of anxiety 6. Have anxiety during pregnancy 7. Have other mental illnesses
Pregnancy and Smoking: BORN Data (10) Pregnant women who smoke are more likely to: 1. Have a baby <1500 grams (very low birth weight) than those born from nonsmokers. 2. Have a baby 1500-2499 grams (low birth weight) than those born from nonsmokers.
Pregnancy and Smoking Pregnant women in Ontario are highly motivated to quit (8) 75% tried to quit smoking (CCHS, 2007-2008) (8)
Best Practices for Smoking Cessation for Pregnant and Postpartum Women Expecting to Quit
Approaches to Smoking Cessation Interventions During and After Pregnancy (10) Tailoring Women-centered care Reducing stigma Relapse prevention
Approaches to Smoking Cessation Interventions During and After Pregnancy (10) Harm reduction Partner/social support Social issues integration
Lots still to know NRT and women in general NRT and pregnant women
A Tool on Quitting Smoking and Pregnancy
Pregnets Prevention of Gestational and Neonatal Exposure to Tobacco Smoke Provides evidence based-strategies and information in a user friendly approach Provides resources for: Health care providers Pregnant/post partum smokers
Pregnets: Resources for HCPs Complete literature review Academic articles Clinical Practice Guidelines Info sheets Tool kit Desk reference guide Patient resource card
Example of Information Available
Discussion Board
Quit Meter
History of Pregnets 2008 Website launched 2012 Re-launched with new site design, updated information and data 2013 Evaluation 2013 Informal survey for dissemination 2014/2015 Project expansion and website updating
Pregnets Evaluation Completed by OTRU Key findings: A useful site for both women and HCPs 75% of women and 60% of HCPs reported learning new info A non-judgmental, safe venue to obtain relevant knowledge
Pregnets Evaluation Recommendations Discussion board is good but increasing opportunities for peer support would be useful Information is good but expected literacy level is high More information would be helpful Graphics lack cultural diversity Need for adaptability on Smartphones Website colours seem medical Pregnets could help raise awareness Internet might not be the best way to reach this population
Informal Survey Maternal Newborn Child Health Promotion Network listserv 66 respondents 21 had not heard of Pregnets 57 wanted to learn more 55 would be interested in attending a webinar on the subject or receiving more information by email
Partnership
Successful Grants
Current and Upcoming Grant Activities Promotion of the site Updating Pregnets utilizing the recommendations of the evaluation
Current and Upcoming Grant Activities Promotion of the site Social media Webinars
Current and Upcoming Grant Activities Promotion of the site Printing, design, distribution of promotional material Pamphlet Poster Desk reference guide Patient resource card Email Pregnets@camh.ca to let us know you d like to be contacted when the materials are ready
Current and Upcoming Grant Activities Updating Pregnets Creation of lower- literacy text of the Moms and Moms-to-be sections Current section on latest research, for HCPs A blog www.pregnetsblog.com
6 Women posting since Sept 43 blog posts to date Over 3000 views Pregnets Blog
Pregnets Blog Views: Canada 2100 US 560 Brazil 135 India 48 UK 41 Italy 38
Pregnets Blog Blog post topics that have been covered Strategies for quitting Smoking triggers Dealing with the stigma of smoking during pregnancy The effects of smoking on the woman and baby E-cigarettes as NRT Husband/partner support
RNAO Smoking Cessation Initiative Pre and Postnatal Women and Their Families Program Resources New Pre- and Postnatal Resources Wallet cards Fact sheets for care providers Posters Pamphlets Tobacco Free RNAO Website Upcoming events
RNAO has multiple new resources for health-care providers working with pregnant and postpartum women who use tobacco Two new wallet cards with evidence-based content developed in collaboration with Motherisk and Smokers Helpline. These are geared to health-care providers and their pregnant and postpartum clients. Content for I am a NEW MOTHER wallet card includes impact of smoking on breast feeding, NRT and cessation medications and breast feeding, general quit tips, impact of second and third hand smoke for infants and children as well as tips for partners who smoke. Content for I am PREGNANT wallet card includes effects of smoking on pregnancy, benefits of quitting, discussion of safety of NRT and cessation medications during pregnancy, tips for making a quit plan, impact of second and third hand smoke on pregnancy as well as contact numbers for provincial resources. These new wallet cards are available at no cost (excluding shipping) through the RNAO Online Store at https://shop.rnao.ca/. For further information please contact Julie Burris, Best Practice Guidelines Sales Coordinator at (416) 907-7965 or by e-mail at jburris@rnao.ca.
Stigma and Trauma-Informed Care Fact Sheets DESCRIPTION: Discusses three steps to help address care providers bias including being sensitive to the stigmas of tobacco use, mitigating the tendency to blame smokers and building up empathy. DESCRIPTION: This four-page fold out describes five trauma-informed care values to incorporate into your interventions. These new brochures are available at no cost (excluding shipping) through the RNAO Online Store at https://shop.rnao.ca/. For further information please contact Julie Burris, Best Practice Guidelines Sales Coordinator at (416) 907-7965 or by e-mail at jburris@rnao.ca.
New RNAO resources for health-care providers working with pregnant and postpartum women who use tobacco 8 Tips for Pregnant Women and New Moms Trying to Quit Smoking A brochure for client that offers general tips and suggestions for quitting smoking for pregnant and new moms. Will I Start Smoking Again After My Baby s Birth? A brochure for client offering tips for coping with cravings and relapses in the first year after the baby has been born. These new brochures are available at no cost (excluding shipping) through the RNAO Online Store at https://shop.rnao.ca/. For further information please contact Julie Burris, Best Practice Guidelines Sales Coordinator at (416) 907-7965 or by e-mail at jburris@rnao.ca.
A new poster series from RNAO for health-care providers working with pregnant and postpartum women who use tobacco These new posters are available at no cost (excluding shipping) through the RNAO Online Store at https://shop.rnao.ca/. For further information please contact Julie Burris, Best Practice Guidelines Sales Coordinator at (416) 907-7965 or by e-mail at jburris@rnao.ca.
New RNAO Resources are now available at www.tobaccofreernao.ca
Upcoming Pre- and Postnatal Workshops and Webinars Best Practices for Smoke-free Pregnancies Workshops Series: The Ontario Public Health Convention March 25 th 2015. RNAO will be presenting Supporting tobacco cessation from pre-conception to postpartum with women and their families in collaboration with the EOHU, KFL+A Health Unit, and Best Start. Upcoming Webinars: All held from 12 pm 1 pm EST Webinar Pharmacology and Smoking Cessation- A webinar for NP's and other health professionals March 3, 2015 Webinar Harm Reduction in Tobacco for Pregnant and Postpartum Women and their Families March 24, 2015 For further information please contact Sara Da Silva, Smoking Cessation Project Coordinator, at (416) 408-5637 or by e-mail at sdasilva@rnao.org.
References 1. Canadian Centre for Substance Abuse (2006), The Costs of Substance Abuse in Canada 2002. 2. Image retrieved from: www.betabacofree.org [accessed 2014 Aug 11]. 3. Pregnets Literature Review. http://www.pregnets.org/dl/lit%20review%20final.pdf [accessed 2014 Aug 11]. 4. Lain SJ et al Trends in New South Wales infant hospital readmission rates in the first year of life: A populationbased study. Med J Aust 2014; 201 (1): 40-43. 5. Merrill MA et al The impact of prenatal parental tobacco smoking on risk of diabetes mellitus in middle-aged women. Journal of Developmental Origins of Health and Disease 2015; doi:10.1017/s2040174415000045 6. Final Report (2010) of the PCMCH Late Preterm Birth Work Group 7. https://www.lung.ca/protect-protegez/tobacco-tabagisme/quitting-cesser/benefits-bienfaits_e.php [accessed 2014 Aug 11]. 8. Schwartz R, O Connor S, Minian N, Borland T, Babayan A, Ferrence R, Cohen J, Dubray J. Evidence to Inform Smoking Cessation Policymaking in Ontario: A Special Report by the Ontario Tobacco Research Unit. Toronto, Canada. : Ontario Tobacco Research Unit:, 2010 9. The Better Outcomes Registry & Network (BORN) Ontario, 2008 (available at: http://www.bornontario.ca/reports/public-health-unit-reports) 10. Echo: Improving Women s Health in Ontario. May 2011. Smoking Cessation Best Practices for Pregnant Women: Adapting to Local Needs. Echo Advance. Toronto, Ontario. 11. Greaves, L., Cormier, R., Devries, K., Bottorff, J., Johnson, J., Kirkland, S. & D. Aboussafy. A best practices review of smoking cessation interventions for pregnant and postpartum girls and women. Vancouver : British Columbia Centre of Excellence for Women s Health, 2003.
49 Questions?
Thank you! For more information or follow-up, contact: Pregnets@camh.ca