Central New York Perinatal and Postpartum Tobacco Needs Assessment

Transcription

1 Central New York Perinatal and Postpartum Tobacco Needs Assessment Report created by the Central New York Regional Center for Tobacco Health Systems at St. Joseph s Hospital Health Center

2 Central New York Perinatal and Postpartum Tobacco Needs Assessment (June 2016) NEEDS ASSESSMENT TABLE OF CONTENTS Introduction 2 Background 2 Methods 6 Key Findings 6 Conclusions and Recommendations 7 Appendix 10 1

3 INTRODUCTION: The Central New York (CNY) Regional Center for Tobacco Health Systems at St. Joseph's Hospital Health Center (SJHHC) launched a special needs assessment in vember 2015 that focused on tobacco cessation efforts for perinatal and postpartum tobacco users in the 14 county Central Region of New York. As a result of the alarming rate of tobacco use among pregnant woman in CNY, the average rate of use is 23.6 percent, and the importance of reducing these rates among CNY County Health Departments this needs assessment was developed. This was the initial step of the project, to determine what types of needs these organizations have when treating tobacco use among this specific population. The information is invaluable to develop a better understanding of individuals working with this population and their specific needs, as well as their organizational needs. BACKGROUND: Ten percent of women smoke three months prior to pregnancy. Of those which smoke prior to pregnancy, only about one quarter quit before they become pregnant. When examined in context across the country this represents exposing 300,000 babies to tobacco smoke in utero each year. 1 Exposure to tobacco smoke and chemicals can have a dangerous impact on the development of the fetus. As seen in the graphs from the CDC, there are many health risks that could occur from tobacco exposure in utero and postpartum from secondhand and thirdhand smoke exposure. 2

4 There appears to be a strong desire to address tobacco use during pregnancy as highlighted by the fact women who continued to smoke at the onset of pregnancy, 21 percent were able to quit by the third trimester. The unfortunate part is a high relapse rate is documented following the delivery. 2 All across the United States, including New York State, local Health Departments and Healthcare Organizations are taking strides to reduce tobacco use among perinatal and postpartum woman. Many of these organizations have made this a priority area in their Community Health Improvement Plans (CHIP) and Community Health Assessments (CHA), especially in the Central Region of New York State. According to the New York City Department of Health and Mental Hygiene the recommendations for treating pregnant and postpartum tobacco users are as followed: 1. Obstetricians, Pediatricians, Gynecologists, Family Physicians, and other providers should discuss tobacco use before, during, and after pregnancy o Discuss smoking and smoke exposure with all women of reproductive age o Discuss smoking and smoke exposure during every prenatal visit and child health visit o Provide supportive and practical counseling o Take advantage of free resources: Help your Pregnant and Postpartum Patients Quit Smoking: A Coaching Guide 3 Smoking Cessation for Pregnancy and Beyond - A Virtual Clinic 4 o Refer patients to the New York State Smokers Quitline available online, by fax, or by the Opt to Quit program 2. Those who quit smoking during pregnancy are at high risk of relapse. Providers should discuss relapse and relapse prevention strategies during pregnancy, at hospital discharge, and at every follow-up visit Provide counseling and medication (if appropriate) to those who have relapsed after delivery. See Section seven of Help Your Pregnant and Postpartum Patients Quit Smoking: A Coaching Guide 3 While there are beneficial recommendations for healthcare providers on treating this specific population, nicotine addiction is very potent and there are many obstacles in the treatment of perinatal and postpartum tobacco users. The Center for Disease Control reports that: Approximately 10 percent of women reported smoking during the last three months of pregnancy; 3

5 Of women who smoked three months before pregnancy, 55 percent quit during pregnancy; and Among women who quit smoking during pregnancy, 40 percent relapsed within six months after delivery. 3 Relapse is a very high concern among this population. Various statistics are available on relapse; the highest is that 65 to 80 percent of post partum women will relapse within one year of delivery. National statistics show, at two to three months postpartum 45 percent, at six months 60 to 70 percent and at one year as much as 80 percent of postpartum tobacco users relapse, respectively. The reasons being: Cessation during pregnancy may really be a temporary abstinence from smoking rather than permanent behavior change actual shift in identity may have occurred Relapse is often viewed as a reward after pregnancy Return of triggers (caffeine, alcohol) Smoking spouse, family and friends Sleep deprivation, increased stress Weight concerns Less social pressure to stay quit 6,7 In addition, another barrier in relapse is the pharmacotherapy recommendations for perinatal and postpartum, breastfeeding women. As stated previously, the primary recommendation for cessation is through psychosocial interventions. Due to insufficient evidence to determine the effectiveness and safeness of pharmacotherapy on this specific population, the World Health Organization and the Clinical Practice Guideline for Treating Tobacco Use and Dependence do not recommend use of pharmacotherapy products among perinatal and postpartum, breastfeeding women. This could have a significant impact on continued abstinence due to the addictive nature of nicotine. 4 The characteristics of pregnant tobacco users also may hinder their ability to remain abstinent from tobacco. The typical pregnant smoker usually has the following characteristics: Age: Younger mothers (<25 years) Education Level: Less than High School Low Socioeconomic Status: Living in a household at or below the low income cut-off Employment Status: Unemployed Marital Status: Single Mothers ne/little Support During Pregnancy 6

6 The United State Department of Health and Human Services Healthy People 2020 goal for increasing abstinence from cigarette smoking among pregnant women is to be less than 1.4 percent. Current tobacco use rates during pregnancy in CNY are significantly higher than the United States and New York State rate of 10 percent and eight percent, respectively. 35 Central NY County Preliminary Rates Data reported for the following years: 2015 (preliminary) Broome, Chenango, Cortland, Jefferson, Lewis, St. Lawrence, Tioga, Tompkins; 2014 Cayuga, Madison, Onondaga, Oswego; 2013 New York State, Herkimer; 2011 United States; Oneida There are two concerns present with this specific population in terms of reporting. Under reporting is a concern in regards to the stigma of using tobacco while pregnant and the use of electronic nicotine delivery systems (ENDS), also known as electronic-cigarettes. For decades we have known about the dangers of using tobacco, especially during pregnancy. Many women, whether pregnant or not, do not report using tobacco to their physician because of feeling ashamed, embarrassed and/or judged due to the stigma attached. They also may be using tobacco as a method to promote weight loss. The past decade we have seen a rise in the use of ENDS. Usage rates among perinatal and postpartum woman are not currently available in New York State. Concern arises over the use rates and lack of knowledge about the dangers of these products. There is a common feeling that many perinatal and postpartum women are using these products in place of traditional tobacco products. ENDS are currently 5

7 not regulated (FDA regulation takes effect August 2016) and have not been shown to be a safe or effective cessation aide. In addition, the health effects of using ENDS before, during or after pregnancy have not been adequately studied. METHODS: The needs assessment was sent to healthcare organizations, community organizations, County Health Departments and many private organizations in our CNY catchment area. The CNY Catchment area includes the following counties: Broome, Cayuga, Chenango, Cortland, Hamilton, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga and Tompkins. The needs assessment was sent electronically via , e-newsletter and fax. All sectors that work with perinatal and postpartum tobacco users were evaluated whether it was through direct services/care, referral based and/or research based. Participation was voluntary. Certain questions on the assessment were required. Outside of these required questions participants could decline to answer any questions. There were 68 questions total on the needs assessment, however broken down by sector the following questions were applicable: Direct Services/Care 47 questions total Referral Based 38 questions total Research Based 31 questions A total of 74 needs assessments were completed. The majority of assessments were completed by not for profit organizations and County Health Departments (39.1% and 33.7%, respectively All three sectors). The needs assessment collection period opened on vember 19, 2015 and closed on January 31, KEY FINDINGS: 1. Tobacco cessation is a high priority area for those working in the field with the perinatal and postpartum population (Very much a priority 73.1% and Somewhat of a priority 26.8%) 6 2. Ask, Advise, Assess, Assist and Arrange (The 5A s) are lower than optimal in Direct Services/Care (Ask 89.7%, Advise 55.2%, Assess 75.9%, Assist/Arrange ranges from 24.1% to 55.2%)

8 3. Re-assessment of tobacco quit attempts/abstinence in Direct Services/Care is low (54.5%) 4. Follow-up about tobacco use/cessation is low across all types of organizations represented (60.0% follow up upon discharge Direct Services/Care) 5. Education about second/thirdhand smoke is high among Direct Services/Care and Referral Based (80.0% ask about secondhand smoke exposure and 58.6% ask about thirdhand smoke exposure - Direct Services/Care; 50.0% ask about secondhand and thirdhand smoke exposure - Referral Based) 6. Less than half of all organizations have a tobacco reduction related outcome (47.2% All three sectors) 7. There were notable inconsistencies of reporting systems to track tobacco users: o Various types: Paper/Electronic (31.0% Electronic, 34.5% Paper, 34.5% Both Electronic/Paper Direct Services/Care) o Various brands (11 various types of Electronic Health Records Direct Services/Care) o Lack of quality assurance reporting (46.0% reporting system; 22.2% t sure of a reporting system All three sectors) 8. Staff training needs are high (only 19.5% feel adequately trained to counsel) and many are interested in a community based perinatal/postpartum tobacco cessation program (84.2% would be interested in more information) 9. The majority of organizations are interested in having regular regional meetings (56.1% Interested) 10. Lack of tobacco free grounds policies in a quarter of the organizations (22% policy or not sure of a policy) 11. Organizations feel that there is a lack of support at the state level to address smoking cessation (only 22.5% feel the state supports cessation efforts) CONCLUSIONS AND RECOMMENDATIONS: Based on the needs assessment findings the following recommendations with the recommended responsible parties in parentheses are as follows: 7

9 1. Develop a Perinatal/Postpartum Tobacco Health Systems plan to facilitate collaboration and embed tobacco treatment policies. (Health Systems for a Tobacco-Free New York with support from the Center of Excellence for Health Systems Improvement) 2. Increase educational opportunities for healthcare providers about local resources, dangers of ENDS, tobacco screening and counseling for perinatal and postpartum populations. In addition, cessation support for significant others/partners of the perinatal and postpartum users may be beneficial in creating a supportive, tobacco-free environment. (CNY Regional Center for Tobacco Health Systems at St. Joseph s Hospital Health Center) 3. Targeted staff training is a necessary component for anyone working with this population. Partner with the Center of Excellence for Tobacco Health Systems and other national entities to create and promote short, online modules for counseling perinatal and postpartum women. (The Center of Excellence for Health Systems Improvement) 4. Resources available through the State Quitline for perinatal/postpartum tobacco users should be developed and marketed. For example, the Pennsylvania Free Quitline and the Ohio Tobacco Quitline offer incentives for pregnant women to assist them in quitting. For participating in counseling calls, a gift card is provided. Additionally, if the patient receives a prescription from a physician Nicotine Replacement Therapy can be provided. (New York State Smokers Quitline) 5. Explore quarterly regional networking opportunities for those working with the perinatal and postpartum population: in-person, conference calls, and webinars. (CNY Regional Center for Tobacco Health Systems at St. Joseph s Hospital Health Center) 8 6. While this specific initiative is a priority, it appears a lack of support exists for funding resources targeted to decrease the use among this population. Research beneficial ways to increase local cessation programs specific to the perinatal and postpartum populations as part of the regional networking meetings (ie. Tobacco-Free Baby and Me: Identify costs, barriers to implement, collaborations and partnership with other organizations and/or counties, strategize to overcome barriers, sustainability of programs). (Health Systems for a Tobacco-Free New York with support from the Center of Excellence for Health Systems Improvement)

10 7. Assist organizations in implementing comprehensive tobacco-free grounds policies to help foster the tobacco-free norm. (Advancing Tobacco-Free Communities Grant Contractors) 8. Additional Support at the State level is critical in order to coordinate a cohesive, comprehensive effort statewide for provision of resources, screening tools and training. (New York State DOH and Maternal Child Health) Sources: 1. Center for Disease Control (CDC) National Vital Statistics Reports, February New York City Pregnancy Risk Assessment Monitoring System Help your Pregnant and Postpartum Patients Quit Smoking: A Coaching Guide (www1.nyc.gov/html/doh/downloads/pdf/smoke/postpartumpatients-coaching-guide.pdf) 4. Smoking Cessation for Pregnancy and Beyond - A Virtual Clinic ( 5. Center for Disease Control 2011 Pregnancy Risk Assessment and Monitoring System 6. A. Ordean; Smoking Cessation During Pregnancy and Lactation; Ottawa Conference; Jan E. McClain; You Quit, Two Quit: Evidence Based Strategies to Address Tobacco Dependence During the Perinatal Period; BreatheEasy NC Conference; Mar

11 APPENDIX: NEED ASSESSMENT QUESTIONS Disclaimer - Other responses/comments provided have been simplified for the purpose of this document. QUESTION: WHAT COUNTIES DO YOU SERVE? 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Other Response: Otsego (3), Wayne (3), Seneca (2), Delaware (1) QUESTION: HOW WOULD YOU DEFINE YOUR ORGANIZATION? 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 10 Other Responses: FQHC (4), Community Action Agency (1), Government Youth Planning and Granting (1), Integrated healthcare system (1), home visiting (1), Family Planning Provider (1), Head Start (1)

12 QUESTION: WHAT PERCENTAGE OF PERINATAL TOBACCO USERS DOES YOUR ORGANIZATION WORK WITH ANNUALLY? QUESTION: WHAT PERCENTAGE OF POSTPARTUM TOBACCO USERS DOES YOUR ORGANIZATION WORK WITH ANNUALLY? 8.6% 6.9% 6.9% ne 10.3% 6.9% 6.9% ne 1%-25% 1%-25% 32.8% 44.8% 26%-50% 51%-75% 36.2% 39.7% 26%-50% 51%-75% 76%-100% 76%-100% QUESTION: DOES YOUR ORGANIZATION CURRENTLY HAVE A REPORTING SYSTEM IN PLACE TO MONITOR THESE PERCENTAGES? 22.2% 31.7% t sure 46.0% Other Responses: WIC Nutritional Risk Criteria (2); Manual Data Pull By Staff or Electronic Health Record (3); Intake Self-Reported (1); Intake Staff Screening (11); Pregnancy Risk Assessment Monitoring System (1) 11

13 QUESTION: FOR YOUR SPECIFIC OUTCOMES IN REGARDS TO PERINATAL AND POSTPARTUM TOBACCO USERS, DO YOU PARTICIPATE IN OUTSIDE MEETINGS AND/OR AGENCY FUNCTIONS TO ACHIEVE YOUR OUTCOMES? (CHECK ALL THAT APPLY) 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% County CHIP Coalition Meetings DSRIP Project Meetings CHA Planning Meetings Other Other: /t Sure (4);, but not specifically for the individual completing the needs assessment (2);, through State Grant programs (1);, through local coalitions (2);, but provide report data to State Grant programs (1) QUESTION: DOES YOUR ORGANIZATION HAVE A SPECIFIC OUTCOME RELATED TO TOBACCO USE AMONG THIS POPULATION WITHIN YOUR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP), COMMUNITY HEALTH ASSESSMENT (CHA), OR ANOTHER TYPE OF PLAN ASSESSMENT? 47.2% 52.8% Comments: Increase referrals to Quitline (1); t Sure (1); Goals to reducing smoking in this specific population via CHIP, CHA, Local Collaborative and Quality Improvement plans (7) 12

14 QUESTION: DOES YOUR ORGANIZATION CURRENTLY PROVIDE A TOBACCO FREE BABY AND ME PROGRAM? 9.1% 90.9% QUESTION: IF NO TO THE PREVIOUS QUESTION, WOULD YOUR ORGANIZATION BE INTERESTED IN MORE INFORMATION REGARDING THE TOBACCO FREE BABY AND ME PROGRAM? 15.8% 84.2% QUESTION: IF YES, HOW MANY PARTICIPANTS DO YOU HAVE ANNUALLY? 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% QUESTION: WHAT IS THE ANNUAL COST TO YOUR ORGANIZATION TO OPERATE THIS PROGRAM? 1. Year one $8,000 (start up), Year two $ We buy the diaper coupons QUESTION: WAS THERE AN INITIAL STARTUP COST TO BEGIN THIS PROGRAM? (CHECK ALL THAT APPLY) 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%, Program Fees, Travel Fees, Advertising Fees startup fees Please describe any other startup costs: Training (1); Supplies (1); Tech Support (1); Incentives/Diaper Coupons (2) 13

15 QUESTION: WHAT ARE SOME OF THE REASONS YOU DECIDED TO START THE BABY AND ME PROGRAM? (CHECK ALL THAT APPLY) To provide incentives for the pregnant/post-partum mother to quit smoking To help obtain the results of healthier babies and mothers Because it is a beneficial program no matter the cost It is/was a CHIP Priority Because there is/was a high tobacco use rate in the perinatal/postpartum population 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 14

16 QUESTION: DO YOU FEEL THAT THERE IS ENOUGH SUPPORT AT THE STATE LEVEL TO ADDRESS THE ISSUE OF PERINATAL/POSTPARTUM SMOKING LOCALLY? 22.5% 45.0% t sure 32.5% QUESTION: WOULD YOU BE INTERESTED IN HAVING REGIONAL MEETINGS WITH ORGANIZATIONS TO BRAINSTORM NEW IDEAS IN REGARDS TO SMOKING CESSATION FOR THIS POPULATION? 29.3% 14.6% 56.1% t sure 15

17 QUESTION: DOES STAFF FROM YOUR ORGANIZATION FEEL ADEQUATELY TRAINED TO COUNSEL PERINATAL OR POSTPARTUM TOBACCO USERS? 19.5% 36.6% t sure 43.9% If no or not sure, what type of training do you think is needed? (ex. 6 hr training, 1 hr training, online training, etc.): t needed (2); t sure (1); Online/short trainings (1-2hrs) (10); In-person/short trainings (1); Any type of training (1); In- Person/All day conference (3); Training specifically on motivational interviewing for this specific population (1); Training OB staff (1); Local cessation support for this population (1) QUESTION: IN TERMS OF CONTINUING EDUCATION FOR YOUR STAFF, DO YOU PROVIDE REGULAR IN-SERVICES ON SMOKING CESSATION COUNSELING? 7.7% 10.3% 33.3% 48.7%, but we would be interested in training facilitators to provide these sessions t sure 16

18 QUESTION: DOES YOUR ORGANIZATION HAVE A TOBACCO OR SMOKE FREE GROUNDS POLICY? 4.9% 9.8% 7.3% 78.0%, but we would be interested in more information t sure 17

19 QUESTION: DO YOU FEEL THAT TOBACCO CESSATION IS A PRIORITY FOR THE PERINATAL AND POSTPARTUM POPULATION? 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% it is not a priority it is somewhat a priority it is very much a priority Please feel free to comment on your answer: Lack of resources (2); Lack of clear, consistent strategy (1); Specific population is difficult to assist with cessation (1); Lack of honest usage among population (1) QUESTION: IF OUR ORGANIZATION COULD PROVIDE ONE SERVICE THAT WOULD IMPROVE YOUR ORGANIZATIONS ABILITY TO TREAT TOBACCO USE IN THE PERINATAL/POSTPARTUM POPULATION, WHAT WOULD THAT SERVICE BE? Online Program/Education Training for Staff (5) Increased resources (education, cessation counselors, comprehensive statewide approach/support, etc) (10) Onsite/Local Cessation Programs specific for this population (text, phone, support groups) (5) t Sure (4) Collaborative/Coordination of Providers to local cessation resources (3) QUESTION: PLEASE PROVIDE ANY ADDITIONAL FEEDBACK THAT WOULD BE PERTINENT FOR THIS NEEDS ASSESSMENT. Difficult population to assist with cessation/tobacco abstinence (2) Difficult with certain locations and access to tobacco at a lower fee (ie. Native American reservations, State Borders, etc) (1) Client Follow through with referrals to outside support (2) Local cessation support is needed for this population (1) Increased training for staff (1) Stats may not be accurate (1) Address collaboration through OB/GYN/Pediatricians/Family Practices/Community organizations (1) 18

20 QUESTION: WHAT TYPE OF INVOLVEMENT DOES YOUR ORGANIZATION HAVE WITH PERINATAL OR POSTPARTUM TOBACCO USERS? We provide direct services/care to this population 37.1% 61.3% We are referral based, by directing this population to providers We are research based through studies that we conduct on this population 19

21 DIRECT SERVICES/CARE QUESTION: WHAT TYPE OF DIRECT CARE DO YOU PROVIDE? 43.8% 34.4% OB/GYN Lactation Visits 43.8% 25.0% 37.5% Pediatrics/Family Medicine Nurse Visits Other (please specify) Other Responses: Day Care/Community Programming (1); Housing (1); Tobacco Free Perinatal program (1); Family Planning (1); Child Development (2); Nutrition (2); Home Visits (3); Community Health (1) 20

22 DIRECT SERVICES/CARE QUESTION: DOES YOUR ORGANIZATION USE AN ELECTRONIC HEALTH RECORD, PAPER CHARTING OR BOTH? 34.5% 31.0% Electronic Health Record Paper Charting Both 34.5% QUESTION: IF YOU ANSWERED YES TO USING ELECTRONIC HEALTH RECORDS, PLEASE CHECK WHAT SOFTWARE SYSTEM(S) YOU USE. 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Other Responses: t sure (1); Horizon (2); CPSI; WICSIS 21

23 DIRECT SERVICES/CARE QUESTION: HOW DO YOU SCREEN FOR TOBACCO USE? (CHECK ALL THAT APPLY) GRAPH SCREENING RESPONSE KEY PERCENT 1 Ask about tobacco use by identifying and documenting tobacco use status of every 89.7% patient/client, at every visit. 2 Advise every tobacco user to quit in a clear, strong and personalized manner. 55.2% 3 Assess current tobacco user s willingness to make a quit attempt at this time. 75.9% 4 Assess ex-tobacco user, about their quit date and challenges to remaining abstinent. 5 Assist patients/clients willing to make a quit attempt by offering medication to help the patient quit. 6 Assist patients/clients willing to make a quit attempt by providing or referring for counseling or additional behavioral treatment to help the patient quit. 7 Assist patients/clients unwilling to quit at this time, by provide motivational interventions designed to increase future quit attempts. 31.0% 24.1% 48.3% 55.2% 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0%

24 DIRECT SERVICES/CARE QUESTION: IF YOU ANSWERED YES TO PROVIDING MOTIVATIONAL INTERVENTIONS IN THE PREVIOUS QUESTION, WHAT TYPES OF MOTIVATION INTERVENTIONS DO YOU USE? (CHECK ALL THAT APPLY) GRAPH MOTIVATIONAL INTERVENTIONS RESPONSE KEY PERCENT 1 Relevance: We encourage the patient/client in a personalized, relevant manner. 77.3% 2 Risks: We identify and discuss potential negative consequences of tobacco use. 86.4% 3 Rewards: We work with the tobacco user to identify benefits to quitting. 72.7% 4 Roadblocks: We identify roadblocks and barriers to quitting and assist with problemsolving. 54.5% 5 Repetition: At every visit motivational interventions are repeated. 54.5% 100.0% 80.0% 60.0% 40.0% 20.0% 0.0%

25 DIRECT SERVICES/CARE QUESTION: WHEN EVALUATING YOUR PATIENTS/CLIENTS DO YOU ASK ABOUT SECONDHAND SMOKE EXPOSURE? (IE. ARE YOU EXPOSED TO SECONDHAND SMOKE AND/OR DO YOU LIVE WITH A SMOKER?) If yes, what follow up is provided?; on the benefits and risks (;;.; Education/Materials on the dangers of SHS exposure (6), referral information to the NYS Smokers Quitline (3), Mothers and Baby Quit program (2); N/A (1) 20.0% 80.0% QUESTION: WHEN EVALUATING YOUR PATIENTS/CLIENTS DO YOU ASK ABOUT THIRDHAND SMOKE EXPOSURE? (IE. ARE YOU EXPOSED TO THIRDHAND SMOKE AND/OR DO YOU LIVE WITH A SMOKER?) If yes, what follow up is provided? Education on the risks (5); NYS Smokers Quitline (2); Recommendations (4); 41.4% 58.6% QUESTION: IF YES TO ANY OF THE ABOVE QUESTIONS DO YOU REFER TO THE NYS SMOKER'S QUITLINE AND/OR ANY OTHER SMOKING CESSATION PROGRAMS? HMHB of CNY (2); NYS Smokers Quitline (6); Mother & Babies Perinatal Network (1). 96.0% 24

26 DIRECT SERVICES/CARE QUESTION: WOULD YOU BE WILLING TO PROVIDE MORE INFORMATION ON SECONDHAND/THIRDHAND SMOKE EXPOSURE TO YOUR CLIENTS/PATIENTS? 96.9% QUESTION: WHEN EVALUATING YOUR PATIENTS/CLIENTS, DO YOU ASK ABOUT ELECTRONIC CIGARETTE USE? 28.1% 25.0% 21.9% 25.0% - every patient/client - but not everyone t Sure 25

27 DIRECT SERVICES/CARE QUESTION: DOES YOUR ORGANIZATION HAVE A POLICY IN PLACE TO FOLLOW UP WITH DISCHARGED PATIENTS? 33.3% 6.7%, we follow up (no specified time line). 60.0% follow up is conducted once a patient is discharged from our care. t sure QUESTION: IF YOU ANSWERED YES TO A DISCHARGE FOLLOW-UP, DO YOU RE-ASSESS TOBACCO USE AT THAT TIME? 12.5% 62.5% 25.0% t Sure 26

28 DIRECT SERVICES/CARE QUESTION: DO YOU CURRENTLY OFFER INDIVIDUAL TOBACCO CESSATION COUNSELING? QUESTION: ON AVERAGE THE TYPICAL COUNSELING SESSION TAKES US % 59.3% 29.6% t sure 60.0% 20.0% 20.0% Less than three minutes 3-10 minutes 10+ minutes QUESTION: FOR CESSATION COUNSELING ON SITE, DO YOU BILL SPECIFICALLY FOR THE COUNSELING OR DO YOU INCLUDE IT IN THE VISIT? 0.0% We bill separately for cessation counseling. 50.0% 50.0% We include the counseling in the overall visit and do not bill separately. QUESTION: WHEN COUNSELING WHAT TYPES OF EDUCATIONAL TOOLS/TOPICS ARE USED? (CHECK ALL THAT APPLY) 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Triggers Dealing with Cravings Cost of Using/Savings NY Quitline Information Other tools/topics Other tools/topics: Generic information (1); N/A (1); refer to counseling department (1); Motivational Interviewing techniques (1) & educational materials provided (1). 27

29 DIRECT SERVICES/CARE QUESTION: DO YOU PROVIDE ANY INFORMATION ON SMOKE-FREE LIVING? 28.6% 42.9% 28.6%, but I would be interested in providing this information QUESTION: DO YOU CURRENTLY OFFER A MONTHLY SUPPORT GROUP OR CESSATION CLASS? 0.0% 100.0% 28

30 DIRECT SERVICES/CARE QUESTION: DOES YOUR ORGANIZATION CONDUCT ANY RESEARCH WITHIN THE PERINATAL/POSTPARTUM POPULATION? 71.9% 28.1% QUESTION: WHAT TYPE OF RESEARCH ARE YOU CONDUCTING WITHIN THE PERINATAL/POSTPARTUM POPULATION? 1. Healthy Families NY (2) 2. Rate of smoking at first visit (1) 3. HCPs and SUNY faculty (1) QUESTION: HOW IS YOUR RESEARCH BEING FUNDED? 1. t sure 2. OSBG QUESTION: PLEASE LIST ANY ORGANIZATIONS YOU ARE CURRENTLY WORKING WITH TO CONDUCT YOUR RESEARCH. 1. t sure 2. Healthy Families and OSBG QUESTION: DO YOU HAVE ANY CNY RESEARCH DATA THAT WOULD BE BENEFICIAL TO THIS NEEDS ASSESSMENT? If yes please describe: t sure (1); small sample size(1) % 50.0 % 29

31 REFERRAL BASED QUESTION: DO YOU ASK IF YOUR CLIENTS USE TOBACCO? 5.0% 25.0% 70.0% all clients but not every client t Sure QUESTION: IF YOU HAVE A TOBACCO USING CLIENT, DO YOU PROVIDE THEM WITH ANY SMOKING CESSATION INFORMATION? (CHECK ALL THAT APPLY) 15.0%, to the NYS Smokers' Quitline 90.0% 55.0% 75.0%, to local cessation support groups, educational brochures on tobacco use Other Other: Asthma (1); Early Head Start Programs (1);Healthcare providers (1). QUESTION: DO YOU ASK ABOUT ELECTRONIC CIGARETTE USE? 10.5% % 42.1% 21.1% - every client - but not everyone t Sure

32 REFERRAL BASED QUESTION: DO YOU ASK YOUR CLIENTS IF THERE IS EXPOSURE TO SECONDHAND OR THIRDHAND SMOKE? (IE. ARE YOU EXPOSED TO SECONDHAND OR THIRDHAND SMOKE AND/OR DO YOU LIVE WITH A SMOKER?) 20.0% 15.0% 50.0%, both Only Secondhand smoke exposure Neither 15.0% t Sure QUESTION: IF YES, WHAT TYPE OF FOLLOW UP DO YOU PROVIDE TO YOUR CLIENTS IN REGARDS TO SECONDHAND OR THIRDHAND SMOKE EXPOSURE? 1. Offer smoking cessation to all family members; education (8) 2. Goals/plans (4) 3. ne (1) 4. Referral to NYS Smokers Quitline (1) 5. Growing Great Kids Curriculum (1). QUESTION: IF NO, WOULD YOU BE WILLING TO PROVIDE INFORMATION TO YOUR CLIENTS REGARDING SECONDHAND AND THIRDHAND SMOKE EXPOSURE? 0.0% 100.0% 31

33 REFERRAL BASED QUESTION: WHAT ORGANIZATIONS DO YOU TYPICALLY REFER THE POSTPARTUM/PERINATAL POPULATION TO, WHETHER THEY ARE A TOBACCO USER OR NOT? (PLEASE LIST ALL THAT APPLY) Child Find(1); PACT; Healthy Neighborhood Program: NY State Smokers Quitline (5), Mothers and Babies Perinatal Network (3) ; WIC (3); Lead Testing Program; Cayuga Counseling; SNAP (2); Maternal Child Health Program; Nurse Family Partnership Program; American Lung Assoc.; Child Health Plus; Forever Free Program; American Cancer Assoc.; MOMs program; County Health Departments (3); Carseat Program; Breastfeeding peer counselor; Bridges (2); HCPs (2); Planned Parenthood; DSS (2);NCPPC; CareNet; CHHA, CSHCN; QUESTION: WHEN THE REFERRAL OCCURS DO YOU PROVIDE A HISTORY OF TOBACCO USE TO THE AGENCY THAT IS RECEIVING THE REFERRAL? 11.8% 0.0% 88.2% t Sure QUESTION: DOES YOUR ORGANIZATION PROVIDE DIRECT REFERRAL TO THE NYS SMOKERS' QUITLINE AND/OR OTHER SMOKING CESSATION PROGRAMS? 38.9% 61.1% 32

34 REFERRAL BASED QUESTION: DOES YOUR ORGANIZATION ALSO CONDUCT RESEARCH WITHIN THE PERINATAL/POSTPARTUM POPULATION? 10.0% 90.0% QUESTION: WHAT TYPE OF RESEARCH DOES YOUR ORGANIZATION CONDUCT WITHIN THIS POPULATION? 1. Early Head Start 2. Healthy Families American (NY). QUESTION: HOW IS YOUR RESEARCH FUNDED? 1. Federal Head Start grants QUESTION: PLEASE LIST ANY OUTSIDE ORGANIZATIONS THAT YOU ARE CURRENTLY WORKING WITH TO CONDUCT THIS RESEARCH. response QUESTION: DO YOU HAVE ANY LOCAL CNY DATA FROM COMPLETED RESEARCH PROJECTS THAT WOULD BE BENEFICIAL TO THIS NEEDS ASSESSMENT? response 33

35 RESEARCH BASED QUESTION: WHAT TYPES OF RESEARCH ARE YOU CONDUCTING? 1. A survey for perinatal and postpartum smokers. QUESTION: HOW IS YOUR RESEARCH FUNDED? 1. A grant from a local college. QUESTION: PLEASE LIST ANY OUTSIDE ORGANIZATIONS YOU ARE CURRENTLY WORKING WITH TO CONDUCT YOUR RESEARCH? 1. County Health Department (Maternal Child Health/MOMS Program) QUESTION: DO YOU HAVE ANY LOCAL CNY DATA FROM COMPLETED RESEARCH PROJECTS THAT WOULD BE BENEFICIAL TO THIS NEEDS ASSESSMENT? 1., not completed 34

36 The Central New York (CNY) Regional Center for Tobacco Health Systems at St. Joseph's Hospital Health Center (SJHHC) is a grant funded program through the New York State Department of Health Bureau of Tobacco Control. The CNY Regional Center works with health care systems to improve the reach and delivery of evidence-based tobacco dependence treatment with a focus on agencies and organizations that serve people with low education, low income or serious mental illness. The CNY Regional Center provides support to Health Care Systems in the following counties: Broome, Cayuga, Chenango, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St Lawrence, Tioga and Tompkins. For more information on the CNY Regional Center for Tobacco Health Systems at SJHHC contact us: Central New York Regional Center for Tobacco Health Systems at St. Joseph s Hospital Health Center 7246 Janus Park Drive Liverpool, NY Christopher Owens, MS, C.A.S HSMP Director of CNY Regional Center or Christopher.Owens@sjhsyr.org Julie Seaman, RRT Coordinator of Cayuga, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego and St. Lawrence Counties or Julie.Seaman@sjhsyr.org 35 Deborah Mendzef, MS, ATC Coordinator of Broome, Chenango, Cortland, Tioga and Tompkins Counties or Deborah.Mendzef@sjhsyr.org