SMOKE FREE MOMS Dr. Lorenzo Spizzichino Prevention Department Ministry of Health Rome, Italy Ministero della Salute
AcknowledgementI am presenting this work on behalf ofdr Luca Sbrogiò,dr.ssa Alessandra Schiavinatoand their collaborators
Epidemiological data• Newborns in Italy are 550,000 every year• Mean age at delivery is around 30 years old• the number of young female smokers is around 23%;• the same percentage is smoking at the beginning of pregnancy;• 71% of female smokers quit smoking during pregnancy;• from 70 to 80% relapse after delivery ;• one child over two has at least one parent who smokes.
Smoke free moms: History-2003 Pilot projectconducted in VenetoRegion- 2007 Ministry of Health– CCM programme
Smoke free moms: aimsThe objective of theProgramme is to favour astandardized intervention ofmidwives to help pregnantwomen to quit smoking andto follow-up these womenand their families, in thepuerperal period
Smoke free moms: aimsSpecific objectives:• reduce the number ofwomen who smoke duringpregnancy (<5%)•avoid relapse afterdelivery (<50%)
Smoke free moms: Strategy• Production of formative materials• training midwives in counselling to quit smoking, increasing deeper scientific knowledge on women and tobacco issue, specially during pregnancy• Link with special issue dealt by midwives (e.g. breastfeeding)• monitoring and evaluation of the efficacy of the intervention
SFM: MATERIALS- Counselling guide- Educational materials for tutors/teachers- Forms and data entry for the monitoring/evaluation- Educational materials for families (leaflet, reminder, bib, flyers and posters) in 8 different languages- Website www.mammeliberedalfumo.org
TRAINING• 3 days course address to tutors/1-3 days to others• Counselling techniques (theory and practice - role playing)• Tobacco prevention and therapy information• Target: midwives and other health workers (primary health care, paediatricians, gynaecology and obstetrics units, etc.)
Evaluation of the pilot project in Veneto Region A follow-up at two years after delivery conducted on 600 women in 2005-2007 in Veneto Region showed that women and partners who received anti-smoking counselling have better percentage of abstinence compared to a control group.Dr. Luca Sbrogiò - Dipartimento di Prevenzione Az. ULSS19 - Adria
Effectiveness evaluation: follow up 1 year after delivery Sbrogiò, Michieletto, Tagliapietra 2008% of non smokers women at the end of pre-deliverycourse still abstinent one year after delivery 80% 75% 75% 70% 65% 65% 60% Counselling Control90% 87%85%80%75%70% 65%65%60% Counselling (>=3 contacts) Control
Diffusion of the programmeVeneto full participation Participation with cancer league Participation with midwives society Veneto Regione Cohordinator No participation (mateiials)
Results of the National Programme• 20/21 Italian Regions formally adopted the programme• 4 national courses forming 100 tutors who have already trained more 1,500 midwives• The SFM programme is now part of the National Cancer Plan 2010-2012
Critical aspects• organizational (making permanent the innovation)• scientific: – How to make the natural cessation rate permanent, – When to refer parents to a second level of assistance (clinical); – Is pharmacological treatment appropriate and safe during pregnancy and breastfeeding? – Beyond tobacco: towards a global healthy lifestyle.
ConclusionsThe programme “Smoke free Moms” is stillongoing, is well accepted by midwives andparents, is feasible and sustainable.brief counselling by midwives is possible inall settings, especially in out-hospitalpremises.