Changing Clinical Norms: Tobacco Intervention in Pediatric Care Settings

1. Changing Clinical Norms: Tobacco Intervention in Pediatric Care Settings Shann Hauck Wyoming Department of Health Substance Abuse Division 2003 National Conference on Tobacco or Health December 10-12, 2003

2. AAP Policy Statement Tobacco’s Toll: Implications for the Pediatrician (RE0041) April 2001, pp 794-798 Volume 107, Number 4

3. Johnson County, Wyoming model • 1999-2003; 5 year period working on reduction of tobacco smoke exposure and increased cessation through policy changes • 1999; working with local physicians to code tobacco use and exposure (Explanation code) • Sticker reminder system • Prenatal pack and onesie projects

4. Wyoming Pilot Projects • 2001; 4 perinatal pilot projects called Tobacco Free Families • Target; pregnant women, women of child bearing age, and their families • Training for healthcare providers on 5 A’s

5. Tobacco Free Families • Strategies • Reduce tobacco use initiation among young women of childbearing age • Eliminate exposure to secondhand smoke • Integrated system & network for health care providers to identify and treat tobacco users • Reduction of tobacco use during and after pregnancy • Public education, outreach and media

6. Integrated System Challenge • To maximize resources the project expanded to include all healthcare providers • Large state, small population, only 40 pediatricians statewide

7. All 4 county based programs… • Trained healthcare providers in 5 A’s protocol • Implemented sticker reminder system in clinical settings • Healthcare providers are beginning to refer to new Wyoming Quitline (contract with the Mayo Clinic) or to local cessation counselors

8. Challenge • Physicians and pediatricians level of involvement was dictated by their client base. One project reported, • If clients were higher educated or had insurance, it was assumed they knew about the dangers of exposure to ETS and smoking • If clients were Medicaid patients, the provider was afraid the parent would become hostile

9. How will these things happen? • Raise the priority of treating tobacco dependence and reduce exposure to ETS • State the case; what does the science say? • Know the sources • Champion the cause • Identify and implement appropriate policies and procedures • Consistent messages throughout the community

10. Lessons Learned • Sustainability = Policy focused (AAP recommendations - see list of 12 on policy statement) instead of one smokefree campaign after another • Training for healthcare providers that discusses tobacco prevention, intervention, and cessation (i.e., Mayo Clinic) including pharmacotherapy

11. Lessons Learned, Continued • Most healthcare providers have not prioritized tobacco prevention, intervention, and cessation • The AAP has set the standard; National policy support! • Prioritize policy change at the local level • Involve community health leaders in the movement (identify a local champion)

12. All healthcare providers should be working towards • Reducing exposure to secondhand tobacco smoke • Increasing tobacco cessation

13. Wyoming Chapter of the AAP • President, Barry M. Wohl, MD, FAAP • District 8 meeting, May 2003, Vancouver • Discussion-Integrating patient’s tobacco history into well and sick child visits as part of standardized protocol • Routine history forms are being used by some

14. Wyoming Chapter Conference Call Agenda • Invited to join statewide conference call to discuss • Current progress towards implementing the AAP policy statement • The implementation of a statewide policy • Needed guidance and technical assistance to support the changes and further move the policy forward

15. Future Focus Wyoming will continue to works towards having an adequately funded, comprehensive tobacco control program that prioritizes policy focused initiatives at the state and local level.