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Baby & Me - Tobacco Free

State: NY Type: Model Practice Year: 2005

The target audience is smoking prenatal women in Chautauqua County, who quit smoking while pregnant and stay quit for at least one year after the birth of the baby. The number of the target population reached is approximately 37% of the pregnant women in Chautauqua County. The preliminary results show that 87% of the women enrolled in the program successfully quit while pregnant and stay quit for 3 months postpartum, and 85% at 6 and 9 months are still smoke free. Key elements to duplicate this program include a lead agency willing to support the program, and staff/agencies to implement the program. The goals are to reduce by 17% in Chautauqua County the number of pregnant women who quit smoking. The objective is to collaborate with local agencies currently providing services pregnant women and link the program with their existing prenatal services, which then enroll the women into the program. The goals and objectives are clearly linked to the fact that Chautauqua County has a 37% smoking prenatal rate, which is 27% higher than the nation rate of 17-20%. This causes an increased rate in Chautauqua County of premature births, low-birth weight rates, asthma and respiratory diseases, and sudden infant death syndrome. The preliminary results show that due to the Baby & Me - Tobacco Free program there is a reduced rate of smoking pregnant woman -after only two years of data. The practice intends on reducing the rate of pregnant smoking women to less than 20%, within 3 years of initiating the program. The collaborating with non-traditional partners and utilizing a unique incentive program of FREE diapers, result in the success of this duplicable program.
The Baby & Me - Tobacco Free Program addresses the need to reduce smoking in pregnant women and increase cessation duration to at least one-year afar the birth of the baby. Chautauqua County rates of prenatal smoking are 37%, a 20% higher rate of smoking than the smoking rate nationwide. The high rate of smoking in Chautauqua County among pregnant women correlates to the higher incidences of low birth weights, premature births, and increased rate of sudden infant death syndrome. The Chautauqua County Department of Health coordinates this program for Chautauqua County pregnant women along with facilitating and financing it for two bordering rural counties, Cattaraugus and Allegany. By partnering with the New York State Tobacco Control program, the Chautauqua County Coordinator has assisted in establishing this successful program in 17 other counties in New York State. The Chautauqua County Department of Health provides the certified cessation training and materials, the program curriculum and protocols, the brochures and application materials, the testing and diaper vouchers and the programmatic technical support for partnering agencies in Chautauqua, Cattaraugus and Allegany Counties. The unique incentive program was created to foster a cycle-of success that could be easily duplicated and assist in creating a long-term sustainable program. The Chautauqua County Department of Health collaborated with a non-traditional partner, Wal-Mart stores to provide the incentive to the women. After weeks of negotiating with the corporate offices in Bentonville Arkansas, Wal-Mart agreed to redeem the free diapers vouchers that the women receive as incentives for staying quit after the birth of the baby. Once Wal-Mart agreed to redeem the vouchers, two additional Western New York grocery stores agreed to participate and redeem the vouchers. This collaboration is a key relationship with health department because then the women are able to choose any size or brand of diapers. Another positive relationship is that the fiscal agent processing the redeemed vouchers facilitates the payment between the Counties participating and the stores so that a smooth transition of payment is always maintained. The county also established a relationship with Wal-Mart so that they will support this program in other areas of New York State and the US.
Agency Community RolesThe Chautauqua County Department of Health coordinates this program for Chautauqua County pregnant women along with facilitating and financing it for two bordering rural counties, Cattaraugus and Allegany. By partnering with the New York State Tobacco Control program, the Chautauqua County Coordinator has assisted in establishing this successful program in 17 other counties in New York State. The Chautauqua County Department of Health provides the certified cessation training and materials, the program curriculum and protocols, the brochures and application materials, the testing and diaper vouchers and the programmatic technical support for partnering agencies in Chautauqua, Cattaraugus and Allegany Counties. The partnering agencies provide the staff support and implementation of the program by offering the cessation program to the women applicants and after the birth of the baby; they provide the testing and incentive. They provide the outreach and support to pregnant smoking woman and encouraging them to look at the benefits for the whole family when mothers quit. By having partners facilitate this program throughout the counties, the program is can reach a maximum amount of women and partner with agencies where they are receiving pre-natal, young child health care services. The unique incentive program was created to foster a cycle-of success that could be easily duplicated and assist in creating a long-term sustainable program. The Chautauqua County Department of Health collaborated with a non-traditional partner, Wal-Mart stores to provide the incentive to the women. After weeks of negotiating with the corporate offices in Bentonville Arkansas, Wal-Mart agreed to redeem the free diapers vouchers that the women receive as incentives for staying quit after the birth of the baby. Once Wal-Mart agreed to redeem the vouchers, two additional Western New York grocery stores agreed to participate and redeem the vouchers. This collaboration is a key relationship with health department because then the women are able to choose any size or brand of diapers. Another positive relationship is that the fiscal agent processing the redeemed vouchers facilitates the payment between the Counties participating and the stores so that a smooth transition of payment is always maintained. The county also established a relationship with Wal-Mart so that they will support this program in other areas of New York State and the US. Costs and ExpendituresThe cost of the program is approximately $340. per participant. The Chautauqua County tobacco control program has invested $17,000 per year for the past two years, including print materials, CO2 monitors and supplies, and enrolling 130 women. In-kind contributions include the partnering agencies and the tobacco control coordinator. The staff time from the agencies facilitating the program is approximately 5-10 hours per week. The funding source is provided by the New York State Tobacco Control program. Chautauqua County Department of Health receives the funds as the lead agency for the Tri-County Tobacco Control Program, for Chautauqua, Cattaraugus and Allegany Counties. ImplementationThe objective of the Baby & Me - Tobacco Free program is to reduce the use of tobacco while pregnant and stay quit after the birth of the baby. The following specific tasks achieve this objective: Women enroll in the program by completing the program application form and send it into the health department. The health department notifies the closest participating agency of the name and contact information of the women and then they call and set up the first appointment for the pregnant woman. The pregnant woman returns at least three times to receive certified cessation counseling and support. She is tested for smoke free status by a CO2 Smoke Check monitor. After the birth of the baby the women returns to the agency to continue her CO2 testing. If she remains smoke free she receives a $20.00 voucher for free diapers at participating stores. The participating store redeems the voucher for any brand or size of diapers and then submits the voucher to the fiscal agency for reimbursement of the value of the voucher. The fiscal agency pays the stores and submits a monthly cost/tracking number to the participating county for reimbursement of the cost of the voucher. The county receives a total number of vouchers redeemed and the number of women enrolled for the evaluation component of the program. The timeline for carrying out these tasks is for each participating woman, enrolling her during her first trimester, keeping her enrolled and smoke free during the entire pregnancy, and providing her the free diapers for at least one year after the birth of the baby. The timeline for the evaluation of the program is to reduce the amount of pregnant smoking woman to less than 20% within three years of initiation of the program. The data for the program is currently at the two-year mark and is showing an early reduction rate from 37% to 27%.
The evaluation methodology was based on the data before the program began. Based on the county statistics for prenatal smoking, Chautauqua County in 2001 showed was 37%. After two years of implementing the program in Chautauqua County, the data collected through monthly reporting to the Chautauqua County Department of Health by the participating agencies is a reduce rate of pregnant smoking woman of 27%. Monthly reporting from participating agencies included the number of women enrolled, the number of women smoke free during their nine months, and the number still quit after 3,6,9, and 12 months of giving birth.  
The funds are currently being applied for through a Promise Practices grant proposal from the New York State Tobacco Control Program. If awarded the program could generate additional funds per year and continue through 2008. The long-term goal of the program is to have agencies continue providing the cessation and support for the pregnant women, while funds for the incentive to be transferred to local/state agencies that support health women and children.