Oregon Smoke-Free Mothers and Babies
Office of Family Health Services
Oregon Department of Human Services, Health Services
Principal Investigator: Donalda Dodson, RN
Funding period: 1/1/02-12/31/04
Background
Throughout Oregon, 14.5 percent of women who had a baby in 1999 reported that they smoked during their pregnancy, slightly more than the national average of 12.6 percent, according to the National Center for Health Statistics. But among Medicaid enrollees with less educational and economic resources, approximately 28 percent smoked during pregnancy.
The Oregon Smoke-Free Mothers and Babies Project is located in ten counties in Oregon, and targets pregnant women insured by Medicaid through Oregon's Maternity Case Management Program. The Smoke-Free Families grant is being used to implement a scientifically proven five-step smoking cessation counseling method for pregnant women, the "5 A's", which has been shown to increase smoking cessation rates among pregnant women by 30 to 70 percent. The 5 A's are endorsed by the American College of Obstetricians and Gynecologists.
Target Population of Providers
The project works with Maternity Case Managers (public health nurses in county health departments) and prenatal care providers who see pregnant women enrolled in the Oregon Health Plan, Oregon's expanded Medicaid program. Smoke-Free Mothers and Babies focuses on incorporating the "5 A's" into cessation counseling offered to pregnant patients by these maternity case managers, prenatal care providers and subsequent "assist" referrals to quit line telephone counseling service. This three-year intervention is occurring in Columbia, Coos, Deschutes, Douglas, Hood River, Jackson, Jefferson, Lincoln, and Yamhill Counties. Providence Health Systems' Beginnings Program in Multnomah County is also a participant.
Intervention Model
The intervention is a coordination system of tobacco treatment by case managers, prenatal care providers, and a quitline. The case manager works with the prenatal care provider to share information on their clients, ensure that the “"5 A's"” are followed at every prenatal and case management visit, and proactively refer clients to the quitline. From each of the participating counties, one maternity case manager is selected to participate on an Implementation Team. This team has quarterly meetings to address smoking cessation counseling, data collection, and office system strategies. The Leadership Team is composed of project staff from the state health department, and they are responsible for technical assistance and training, monitoring the intervention, and conducting the process and outcome evaluation. The Steering Committee is composed of MCH and tobacco control representatives from the Department of Human Services, community-based organizations, non-profits, and advocacy groups.
Evaluation Model
Baseline needs assessments are conducted with maternity case managers and prenatal care providers (both intervention and comparison providers) to determine the current level of tobacco treatment services. Follow-up surveys are provided to assess improvements in delivering the “"5 A's" , and patient satisfaction surveys are also used to gauge the effectiveness of the intervention. Tracking of client caseloads and referrals to the Quitline are part of the process evaluation, as well as a modified version of the Assessing Chronic Illness Care tool to measure changes in health care systems supports at the county and state level.
Contact:
Lesa Dixon-Gray, MSW
Prenatal Smoking Cessation Coordinator
Oregon Department of Human Services
Office of Family Health Services
800 NE Oregon Street, Suite 825
Portland, Oregon 97232
Phone: (503) 731-8606
Email: Lesa.Dixon-GRAY@state.or.us