Helping Low Income Pregnant Women Quit Smoking: Improving the First Breath Program.

BACKGROUND: Maternal smoking during pregnancy can have dire consequences for both baby and mother. In 2000, the Wisconsin Women's Health Foundation developed the First Breath program to address this challenge, particularly among low-income women. While this prenatal smoking cessation program was successful, 2 factors necessitated changes in the program: changes in the health care reimbursement environnment and a high postpartum relapse rate. METHODS: The First Breath program was revised using the concepts of implementation science and included focus groups of First Breath clients, a randomized control trial to test new postpartum services, and an implementation project to test the new method of delivering First Breath. RESULTS: A year after implementing the new First Breath program, results are encouraging. First Breath expanded its reach by 34% over 2017. Eighty-eight new First Breath sites (to a total of 235 sites) have been added, resulting in increased diversity. While there was significant relapse within the new program from prenatal abstinence to 1-month postpartum abstinence (from 13.6% to 7.3% abstinence, biochemically verified, intent-to-treat) there was not additional relapse through 6 months postpartum. CONCLUSION: Sustaining a valuable community-based tobacco dependence intervention program serving a vulnerable population requires continuous improvement built on measured outcomes and response to changes in the health care delivery system. First Breath may serve as a model program to aid underserved pregnant women who smoke.

Addressing Postpartum Smoking Relapse Among Low-Income Women: A Randomized Control Trial.

PURPOSE: Smoking during pregnancy can have dire consequences for both the baby and mother. Low-income pregnant women smoke at particularly high rates. Among women who quit during pregnancy, postpartum relapse is high. This randomized control trial tested the effect of adding postpartum assistance to an existing smoking cessation program (First Breath) designed for low-income women. METHODS: Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. First Breath consisted of evidence-based smoking cessation counseling provided at every prenatal visit. The enhanced program included all First Breath services plus 4 in-home counseling visits (3 postpartum), 3 postpartum counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at 6 months postpartum. RESULTS: Among the 98 women who completed the study, the abstinence rate among the intervention participants (n=41) was significantly greater than among the control participants (n=57) (36.6% vs 12.3%, respectively; P<0.01). Analyzed on an intent-to-treat basis, with those lost to follow-up assumed to be smoking, the abstinence rate among intervention subjects (n=91) was 16.5% vs 7.4% among control participants (n=94); P=0.07. CONCLUSIONS: Extending smoking cessation interventions into the postpartum period may help address postpartum relapse.

A randomized controlled trial of financial incentives to low income pregnant women to engage in smoking cessation treatment: Effects on post-birth abstinence.

OBJECTIVE: Evaluate the effectiveness of monetary incentives for increasing engagement in smoking cessation treatment and improving 6-month abstinence in low-income pregnant smokers. METHOD: Two-group randomized clinical trial recruiting low-income (Medicaid-registered) pregnant smokers receiving assistance through a perinatal support program. Participants were randomized to either an incentive (n = 505) or control condition (n = 509). All participants were offered identical smoking cessation counseling at contacts. Incentive condition participants received incentives for attending pre- and postbirth treatment contacts: $25 for each of 6 prebirth provider visits, $25-40 for each of 4 postbirth home visits at Weeks 1, 2, 4, and 6 (total = $130), $20 for each of 5 postbirth counseling calls and $40 for biochemically verified abstinence at the Week 1 and 6-month visits. Control condition participants received only $40 for attendance at the Week 1 and 6-month postbirth visits ($40 each). MAIN OUTCOMES: Primary outcome was biochemically confirmed 7-day point-prevalence abstinence at 6-month postbirth follow-up. Secondary outcomes included number of home visits and phone calls taken over the first 6 months postbirth; biochemically confirmed abstinence at postbirth Week 1 visit; and self-reported smoking status at 2- and 4-month visits. RESULTS: Incentive condition participants had a higher biochemically confirmed abstinence rate at 6-month postbirth than controls (14.7% vs. 9.2%, respectively: p < .01). This effect was mediated by incentive condition participants' greater acceptance of postbirth home visits and counseling calls. CONCLUSIONS: Moderate incentive payments for smoking treatment engagement (a mean of ≈$214 paid) increased low-income pregnant smokers' engagement and success in smoking cessation treatment. (PsycINFO Database Record

Badger Heart Program: health screenings targeted to increase cardiovascular awareness in women at four northern sites in Wisconsin.

PURPOSE: This study reports the results of initial statewide health screenings of the Badger Heart Program (BHP), which aims to increase the cardiovascular health awareness and health status of women living in Wisconsin. METHODS: In May 2004, the BHP provided cardiovascular disease risk screenings to women in 4 geographic areas throughout Wisconsin. Screening participants were informed of their results and counseled on issues concerning diet, exercise, smoking cessation, medications, and/or visiting their primary health care professional. Data collected included total cholesterol, high-density lipoproteins, low-density lipoproteins (LDL), triglycerides, blood pressure (BP), blood glucose measurements, height and weight, along with a brief survey of medical history, family history, smoking status, and current medication use. After the screening, participants were asked to volunteer for an opt-in 6-month educational program. RESULTS: A total of 318 women participated. The majority screened were Caucasian (95.9%) with an average age of 58 years (standard deviation [SD] = 13.2). Participants' blood pressure and LDL goals were determined from the risk profile assessment. According to national guidelines, an optimal blood pressure goal of < 140/90 was recommended for the majority of the participants (294 [92.5%]), while an optimal blood pressure goal of < 120/80 was recommended for only 24 (7.5%) participants. An optimal LDL value <100 was recommended for 48 (15.4%) participants, an LDL goal of <130 was recommended for 106 (33.3%), and an LDL goal of less than <160 was recommended for 157 (50.5%) participants. Of screened participants, 35% were not at BP goal, 32.4% were not at LDL goal, and 53.5% were not at both goals. CONCLUSION: While the number of participants who were at BP and/or LDL goal is higher than what is generally reported in the literature, there is still opportunity for significant improvement. A follow-up analysis including re-screening of individuals aimed at measuring the improvements in CVD profile post educational interventions will occur in November.

Cost savings associated with smoking cessation for low-income pregnant women.

Despite the many health risks associated with smoking during pregnancy, it remains a chief public health concern with a high prevalence evident at the local level. In Wisconsin, the First Breath program was developed to help pregnant smokers quit and served 424 women during its pilot phase in 2001 and 2002. This cost savings analysis included claims associated with First Breath enrollees who were identified within the Wisconsin Medicaid data warehouse. This analysis allowed for a comparison of medical claims for women who quit smoking through the First Breath program versus those who continued to smoke. Three billing categories were included in this analysis: mother's maternity admissions (maternal DRG), inpatient neonatal care (neonate DRG), and infant's medical costs for the first 6 months of life. Average Medicaid savings per First Breath enrollee who quit smoking was 1274 dollars. Applying this savings to the actual number of women who quit smoking during the pilot study gives a total savings of 137,592 dollars for the Medicaid program. Considering the maximum Medicaid cost of providing cessation services to all First Breath participants, the return on investment associated with the First Breath program is 9 to 1.

Smoking cessation and prevention in women of reproductive age: resources and partnerships for physicians.

The importance of smoking cessation and prevention as a women's issue is clear--physicians who interact with women of reproductive age are in an excellent position to influence women's decisions to quit smoking. This paper provides information on community resources physicians can offer to their patients to help support their cessation attempts and describes a new partnership opportunity that physicians can become involved with.