Learning Objectives: Identify two main obstacles in the implementation of a 1-on-1 tobacco cessation program for women of childbearing age in a rural area and describe mechanisms to help overcome them.
Abstract: In Vermontís rural northeastern counties, North Country Hospital (NCH) serves a population with significant economic and educational challenges. The rate of tobacco use in pregnant women is also significant, about 40%, compared to the statewide rate of 21%. With support from the VT Chapter of the March of Dimes in 2001, a tobacco cessation facilitator was available 16 hours/week for 1-on-1 intervention with women who use tobacco and are patients of a local OB/GYN practice. Based on the 40% tobacco use rate in the 200 women per year who give birth at NCH, a goal was set of reaching 33% (27) of these 80 women. By the end of the project year, 45 (56%) women had received intervention; 19 of these (42%) set quit dates, and 13 (29%) were still smoke free. Support was provided regularly with evaluation intervals established at 6 weeks, 3 months, 6 months and 1 year post quit date. Relapse was tracked. Currently, 22% (10) have been smoke free for 3 to 6 months with evaluation ongoing. Despite extensive facilitator availability, the greatest obstacles were recruiting women to speak with her and maintaining communication. Most women did not keep scheduled appointments and were difficult to reach by phone. In addition to provider advice and appointment scheduling, recruitment methods included press releases, newspaper advertising, brochure distribution, and mailings. Project replication is feasible with the knowledge that recruitment requires sound planning and a healthy dose of persistence.
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