Addressing Substance Abuse in Pregnancy: Opportunity for Change

1. Addressing Substance Abuse in Pregnancy:Opportunity for Change Jeanne Mahoney Director, Provider’s Partnership American College of Obstetricians and Gynecologists 2005

2. Overview • Why group tobacco and substance use together? • Epidemiology / costs • Interventions that work • Involving health care providers

3. Tobacco and Substance Use • Women unable to give up smoking during pregnancy are at great risk to use/abuse alcohol and other drugs • Tobacco is an addictive substance. Intervention for tobacco use similar to alcohol and drugs • Both issues best addressed in preconception period – distinct effects early in fetal development and through entire pregnancy

4. Smoking is the single most important modifiable cause of poor pregnancy outcomes in the United States(Orleans , 2000)

5. Prevalence of prenatal tobacco use • Varies by state • Highly dependent on tobacco taxes and regulations. • Varies by race/ethnicity • American and Alaskan natives greatest use • Varies by age • Teen rate highest rate in early pregnancy • Women over 35 highest rate of continued smoking

6. Public Health Results of Perinatal Tobacco Use • Annual smoking-attributable health care costs at delivery for problems caused by smoking during pregnancy - $366 million in 1996 • 2/3 of these babies were born to mothers on Medicaid • About $704 per maternal smoker CDC, 2003

7. National Perinatal Tobacco Initiatives • Partnership to Help Pregnant Smokers Quit • Great Start Quitline • March of Dimes • Partnerships • ACOG Training Programs

8. Partnership to Help Pregnant Smokers Quit • Developed by SmokeFree Families and supported by RWJF • 60 national organizations involved • 6 work groups • Products: • Medicaid tool kit • Worksite tool kit • Legislative attention • Campaigns for Native American smokers

9. Great Start Quitline • Supported by American Legacy Foundation • Tied into state and (soon) national quitlines. • Does proactive and responsive counseling • Developing a postpartum relapse prevention program

10. March of Dimes • All chapters involved in perinatal tobacco initiatives • Most include hospital grand rounds, provider and OB staff training and public health fairs • Have developed medical briefs on perinatal smoking

11. Tobacco Partnership Initiatives AMCHP, PPFA and ACOG state partnership teams – 10 • Funded by CDC and WTPN • Involve team development and planning • Have succeed in state policy changes, provider training, resource identification and collaboration.

12. ACOG Tobacco Provider Partnership - Nevada Example – Nevada Smoke Free Babies Who - Public health and ACOG previous collaboration Why – High rate of perinatal smoking Catalyst - New Quit-line – Pending legislation Result – Statewide diverse team, passed tax legislation, received grant funding for perinatal demonstration project

13. ACOG Materials • Tool kit for clinicians to counsel on perinatal smoking • Lecture guide/CD ROM to teach counseling • Chart stickers • Patient workbook • Pregnancy and Beyond – virtual clinic tutorial CD ROM (Dartmouth University)

14. Perinatal Substance Abuse Fetal alcohol syndrome (FAS) is the most common preventable cause of mental retardation. It is 100% preventable. Women rarely abuse single substances, those who abuse illicit substances frequently use alcohol and or tobacco.

15. FASD Prevention • Surgeon General’s Report • CDC’s stronger messages • Initiatives involving Women’s Health Care providers

16. Involving OB/GYNs in Tobacco and SA Initiatives Why • Direct access to patients • Strong legislative voice for policy change • It takes a physician to reach a physician How • Schedule meetings early in AM, lunch time, evening • Patch in clinician on conference call • Tighten up process • Use clinician as an advisor

17. Contact information Jeanne Mahoney Director, Provider’s Partnership ACOG 409 12th Street, SW Washington, DC 20024 202-314-2352 FAX 202-484-3917 Jmahoney@acog.org