Why SMART Moms? - Middle Tennessee State University

S.M.A.R.T. Moms
Smart Mothers are Resisting
April, 2014
Welcome and Introductions
Please Note!
While this training program was developed specifically for
Tennessee, it may also be used by other states interested in
implementing a similar prenatal smoking cessation model.
The S.M.A.R.T. Moms project staff welcome questions and
inquiries from other states!
This training program is available online – with details provided
later in this presentation on accessing the online materials - and
may also be modified to be carried out as a live training.
Planning a Live Training?
Plan on FOUR HOURS to cover the agenda as outlined in this
Welcome and Introductions
Review of Training Objectives
Why S.M.A.R.T. Moms?
Overview of S.M.A.R.T. Moms
Key Concepts in Smoking Cessation for Pregnant Women:
Risks of Smoking in Pregnancy
5 A’s and 5 R’s of Tobacco Cessation
Motivational Interviewing
• Implementation of S.M.A.R.T. Moms
• Questions and wrap-up
Training Objectives
To have a better understanding of the S.M.A.R.T. Moms program
To recall the 5 A’s of the tobacco practice guidelines for counseling a
patient who is ready to quit smoking
To recall the 5 R’s of the tobacco practice guidelines for counseling a
patient who does not want to quit smoking and to be able to
effectively address roadblocks such as stress and weight gain
To identify three techniques of motivational interviewing for
counseling patients
State the risk of smoking during pregnancy to the fetus
State the risk of smoking during pregnancy on the infant/child postdelivery
Understand the clinical trial data on pharmacotherapy for smoking
cessation during pregnancy
Verbalize process for counseling pregnant patients about using
pharmacotherapy to aid in smoking cessation
Be able to identify steps required to fully implement the S.M.A.R.T.
Moms program with patients
Why S.M.A.R.T. Moms?
In 2012, 22.7% of all women in Tennessee smoked (BRFS)
17.1% of women in Tennessee smoked throughout pregnancy (CDC,
In 2011, 13,486 babies were born to women who smoked (TDH,
As many as 29% of pregnant WIC patients smoke in some regions of
Tennessee (TDH, Neonatal Summary Report , 2012)
According to the Office of the Surgeon General, smoking is THE most
important modifiable cause of poor health for women, noting
specifically poor pregnancy outcomes and poor reproductive health.
Why S.M.A.R.T. Moms?
Providers Can Make a Difference!
As a health care provider, you can make a tremendous impact
on your patients’ health.
“A brief cessation counseling session of 5-15 minutes, when
delivered by a trained provider with the provision of
pregnancy specific, self help materials significantly increases
rates of cessation among pregnant smokers.”
(Tobacco Control 2000; Vol. 9,Suppl 3:iii80-iii84,September 2000, BMJ
Publishing Group Ltd.)
Overview of S.M.A.R.T. Moms
Originally implemented in Tennessee from 2002 to 2006 as part of a
grant from the March of Dimes, and administered through MTSU’s
Center for Health and Human Services, with the TN Dept. of Health
(TDH) as a project partner
Primarily implemented in WIC clinics, though also with private
The grant became self-sustaining and continues to date, most
recently in 2013 being cited by TDH as a “Rising Star” Effective
Practices program for Tennessee counties receiving Tobacco
Settlement dollars.
During the initial grant period, the S.M.A.R.T. Moms project trained
providers in best practices smoking-cessation techniques for
pregnant women, allowing them to counsel over 13,000 women
between 2002 and 2006 when the project was fully funded.
Overview of S.M.A.R.T. Moms
A toolkit has been developed to assist other states and organizations
in developing similar programs and to orient providers in TN new
to the program with how it may be implemented.
S.M.A.R.T. Moms is based on the “5 A’s” approach to smoking
cessation—Asking, Assessing, Advising, Assisting, and Arranging—
which is an evidence-based method that is used in many programs.
The 5 A’s described in the kit and included in the training are taken
from “Treating Tobacco Use and Dependence: A Clinical Practice
Guideline,” produced by the U.S. Public Health Service.
Overview of S.M.A.R.T. Moms
Key components of the program are:
Tool Kit
Tobacco Consultation Record
Patient Self-Help Guide
Tennessee Tobacco Quitline Resources
Overview of S.M.A.R.T. Moms
• At the end of the funded grant period for the pilot project, over
13,000 pregnant women had been counseled by trained providers
using “best practices,” 5 A’s-based counseling since the
inception of the project in 2002.
• Approximately 77 percent of women who received the self-help
guide and counseling agreed to attempt smoking cessation.
• Statewide, 24.4 percent of those who received counseling AND
the cessation guide AND for whom smoking cessation data was
available, quit smoking.
• Statewide, 21.4 percent of those who did not receive the guide
but were counseled AND who had complete data records on
smoking cessation quit smoking.
Key Concepts in Smoking Cessation for
Pregnant Women
Risks of Smoking in Pregnancy
5 A’s and 5 R’s of Tobacco Cessation
Motivational Interviewing
Online provider training for prenatal smoking
cessation provided though Joan C. Edwards School of
Medicine at Marshall University
For those who are participating in a live training
session, the session will include viewing the webbased training to address these topics.
Key Concepts in Smoking Cessation for
Pregnant Women
Online provider training:
• Features Dr. Lynne Goebel, MD, Internal Medicine,
and Dr. Brenda Mitchell, MD, OB/GYN
• Includes printable materials, certificate of
completion for providers
• Patient scenarios and interactive activities as part
of the training
• Visit Marshall University’s Website at
• http://www.musom.marshall.edu/medctr/med/tobacc
Key Concepts in Smoking Cessation for
Pregnant Women
Before completing this PowerPoint presentation, please click on the
link below or cut and paste in your browser and follow the
instructions to complete the online training.
After completing the online training, please return to this
presentation to view the remainder of this presentation.
Video Summary: Key Concepts in
Smoking Cessation for Pregnant Women
•Tobacco Cessation Guidelines:
• 5 A’s – Ask, Advise, Assess, Assist, Arrange
• 5 R’s – Relevance, Risks, Rewards, Roadblocks, Repetition
Motivational Interviewing:
Decision Analysis – “Good” or “Bad” about staying the same,
and about changing
OARS – Open-ended questions, Affirm, Reflect, Summarize
Ready, Important, Successful
Video Summary: Key Concepts in
Smoking Cessation for Pregnant Women
• Weigh risks of medication against benefit of not smoking
• No large randomized control trials to confirm safety
• More like to be necessary for heavy smokers – i.e., those
smoking more than 1 pack per day
• Behavioral Intervention “Cold-Turkey” is first line treatment
S.M.A.R.T. Moms – Online Training
Before completing this PowerPoint Presentation, please click on
the link below or cut and paste in your browser and download a
copy of the S.M.A.R.T. Moms tool kit for review.
After reviewing the toolkit, please return to this presentation to
complete the training session.
Implementing S.M.A.R.T. Moms
Easy Implementation Steps:
• Participate in training (online or live training
session) and review materials including the toolkit.
• Train other staff working with prenatal women.
• Provide multiple copies of “Tobacco Consultation
Record,” the 5 A’s-based patient self-help guide,
and other patient education materials on smoking
and tobacco to staff working directly with pregnant
• Begin counseling patients using techniques learned
through the online learning modules.
• Share patient education materials and resources,
including information on the Tennessee Tobacco
• Collect all completed Tobacco Consultation Records
and give to director who will submit to S.M.A.R.T.
Moms staff on a quarterly basis.
Implementing S.M.A.R.T. Moms
Tobacco Consultation Record Form
NOTE that EVERY pregnant smoker will have a
completed consultation form, including postpartum
ONLY women indicating a commitment to quit smoking
will receive the cessation guide, but EVERY pregnant
smoker will have the completed form with postpartum
Implementing S.M.A.R.T. Moms
More on the Tobacco Consultation Record:
• The Tobacco Consultation Record should be
completed for each patient that smokes –
regardless of her intent to quit.
• Form is kept in the patient’s records until the
postpartum visit is completed.
• Forms are collected by director and submitted to
S.M.A.R.T. Moms project staff quarterly.
• All information is kept confidential and there is no
identifying patient information.
• Study ID will be filled in if that information is
needed; if there is nothing in this line, please leave
it blank.
Implementing S.M.A.R.T. Moms:
• ALL prenatal patients that currently smoke are
eligible for this smoking cessation intervention.
Need Materials? Forms? Questions
S.M.A.R.T. Moms?
Please Contact:
Dr. Jo Edwards [email protected]
Cynthia Chafin [email protected]
Caron Petersen [email protected]
Post-Test, Evaluations, and CEUs/CMEs
• For those participating in a live training, this is the
portion of the agenda where post-tests,
evaluations, and CEUs/CMEs will be addressed.

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