STARSS

1. STARSS Start Thinking About Reducing Secondhand Smoke: A harm reduction support strategy for low-income mothers who smoke Developed by AWARE: Action on Women’s Addictions – Research and Education info@aware.on.cawww.aware.on.ca

2. Objectives for Webinar 3 • Understand and support women who smoke, in particular those with young children • Reframe: you don’t have to “do” STARSS, you “are” a STAR! • Become familiar with the STARSS resources and ways to use them in a variety of ways • Hear from other programs about STARSS implementation successes and challenges

3. Recap – Women & Smoking • The STARSS message • Who STARSS is for • How to Talk Like a STAR! • STARSS scenarios for difficult life situations

4. Who Benefits from STARSS STARSS was designed to meet the needs of women who: • Live on a low-income • Are single parents (which may mean they have a part time partner) and have children under age 6 • Receive support from service providers who don’t necessarily have experience with tobacco strategies • Are not ready to quit smoking (i.e., precontemplators and contemplators)

5. Precontemplation /Contemplation Our role with pre/contemplators is to: • Develop rapport • Raise consciousness of risks but avoid scare tactics • Show interest and curiosity • Avoid action statements—focus on listening • Avoid commands (even action statements can seem like accusations)

6. Finding Your Voice Things to consider: • Be sensitive to the stresses in her life and the role tobacco plays • Think of motivational ways to begin the discussion • You don’t have to “fix” the problem • Plant a seed • I believe in you • Small steps are steps forward

7. Difficult Life Situations Moms might have difficulty engaging in STARSS (or any smoking intervention) due to: • Lack of support from family and friends • Difficult life situations • Shame, guilt, embarrassment • Strategies feel overwhelming

8. Difficult Life Situations For the service provider: • Convey hope and optimism • Start all over again or think of smaller steps • Use the time to discuss other pressing issues; begin the STARSS discussion later when she’s ready • Focuson her strengths and successes with STARSS so far • Remind her (and yourself) change is a gradual process and setbacks happen

9. Coping With Guilt Frances’ daughter, Jane, has just finished her first day in grade 2. Frances was cleaning up around the house when Jane got off of the bus. While Frances was emptying the ashtrays, Jane said to her “Mommy, you shouldn’t smoke. It’s bad for me and you’re going to die.” Frances feels terrible but isn’t ready to quit smoking. • What can Francis say to her daughter to reassure her that she cares? • What small steps can Frances take to protect her daughter from second hand smoke?

10. Strategies Feel Overwhelming Barb was confident about her STARSS goals, especially when all three children are home. But between fixing meals, homework and bedtime routines, she struggles not to smoke until the kids are in bed at 7:30. Now, her bills are piling up and phone calls start at 5:00 from people wanting money. Barb feels her anxiety go up with each threatening phone call about hydro or phone being cut off. By 6:00, Barb feels like screaming at everyone and definitely wants to smoke. • How can Barb use the DEEDS strategy to her advantage? • What forms of substitution for smoking could Barb consider to help her cope with her anxiety and stress?

11. STARSS Resources • The Guide to STARSS Strategies(a guidebook for service providers) • The I’m A STAR! Journal(a workbook for moms) • How To Be a STAR!: The STARSS Train-the-Trainer Guidebook (for trainers/service providers) • Series of posters • Magnets, window clings, stress “squeezies” • Newsletters and other resources from the website

12. The Guide to STARSS Strategies The Guide to STARSS Strategies has 6 sections that include: • Welcome (issues) • How to use STARSS • STARSS sessions (the 7 individual sessions to use with moms one-on-one) • Worksheets • Handouts • Appendix

13. Keystone Family Services • Quit pack items and how they are useful • Benefits of journal writing and record keeping • Developing a plan to avoid triggers and change patterns/environment • Self care/stress reduction • Individualized rewards that can replace cigarettes

14. Keystone Family Services • Discussion about cigarettes as a friend • Issues with group dynamics and unique issues that revolve around smoking • Examples of literature and posters that contradict the STARSS message

15. Healthy Beginnings (Owen Sound) • Offer a $5 gift card/baby item to those who choose not to leave for a smoke break during groups (learn delay and distract strategies) • Intake forms ask not only number of cigs they smoke, but also how many they’ve reduced • Small steps approach seems to really work as many participants have quit smoking over time

16. Healthy Beginnings (Owen Sound) • Being aware that some women continue to smoke because it may be too risky to quit…many of these women have reported that they use cigarettes to de-escalate partners during a confrontation • Use Lunch and Learns to discuss with partners the importance of support when trying to make a change in smoking patterns

17. CAPC/CPNP(Simcoe County) • Tobacco Public Health Nurse, Program Manager, and CAPC program facilitator were promoting smoke-free practice with all CAPC/CPNP programs in Simcoe County • Conducted surveys with participants to get feedback on going smoke-free February 27th • After completing the survey at a MotherCare Program, a participant said: “If someone tells me I can't smoke, then it makes me want to have one even more. But when (program staff) said ‘To help have a smoke-free place for all of our participants and their children, I appreciate it if you didn't go out for a smoke while at program’ then I respected that. It was a lot nicer than telling me I can't smoke."

18. CAPC/CPNP(Simcoe County) • Another participant said: "I'm stressed out about all this talk about smoking. I want to go outside right now to have one! You can't stop me, it's not February 27th yet. I'm getting a smoke from my friend." • Together, we tried some “Distraction” strategies which helped our participant long enough to get through the program without leaving to have a cigarette.  • We used what we call the 4 Ds: Deep breathe, Drink water, Do something with your hands, and Delay your cigarette. We have a yellow basket in our programs at all of our sites that are filled with distraction objects. The participants may use them to do something with their hands to remain smoke-free during program.

19. Steps to Implementation (York Region) • Attended TEACH specialty course (Helping Pregnant Smokers Stop Smoking) • Obtained manager approval • Conducted a literature search - developed background document, operational plan and researched resources • Reviewed OPHS for Child and Family Health • Obtained buy-in of Child Family Health team-Manager/Director • Established a partnership with Reproductive Health • Attended RNAO Champion workshop-funding • Provided training to both CPNP and Public Health Unit staff • Developed a sustainability plan and evaluation

20. Challenges(York Region) Tobacco use not seen as a priority Reluctant to take on another project Reluctant to introduce smoking with clients Rethinking the approach fetus focus v/s women centered H1N1 resulted in staff reallocation Many staff changes

21. Opportunities (York Region) STARSS philosophy similar to CPNP Networking with TCAN and other groups who had implemented STARSS Tobacco manager was previously a manager in the CFHD STARSS was easily incorporated into the CPNP “All Babies Count” program Champion on Reproductive Health team was TEACH trained

22. Take a Walk Through … … the STARSS section of the website • Go to www.aware.on.ca/starss • www.aware.on.ca/starss/starss-resources • www.aware.on.ca/starss/starss-newsletter • www.aware.on.ca/starss/starss-mom-newsletter • www.aware.on.ca/starss/starss-showcase • www.aware.on.ca/starss/starss-action • www.aware.on.ca/starss/starss-presents • www.aware.on.ca/starss/starss-training