UW-CTRI and WWHF Study Helps Babies Grow Smoke-free

Families with healthy babiesUW-CTRI and the Wisconsin Women’s Health Foundation (WWHF) are coming to the last year of another collaborative grant to help low-income pregnant, postpartum, and caregiving individuals become tobacco-free through a program called First Breath. It’s helping Wisconsin babies to grow up in smoke-free environments.

WWHF received a $1 million grant four years ago from the Wisconsin Partnership Program to significantly expand efforts to bring quit-smoking services to high-risk individuals, families and communities across Wisconsin. The group is working on sustainable systems changes in healthcare systems.

First Breath staff are collaborating with local agencies that serve pregnant and postpartum women and their families, providing statewide access to regional WWHF Quit Coaches, and developing participant-informed services.

Similar to how UW-CTRI Regional Outreach Specialists work with healthcare professionals across Wisconsin to integrate tobacco treatment into their care, so do WWHF professionals. In fact, they often collaborate on regional clinician trainings, said UW-CTRI Regional Outreach Specialist Amy Skora.

This grant has allowed WWHF to streamline the provider component of First Breath, said Krissy Alaniz, WWHF Director of Programs.

“Perinatal healthcare professionals now use the Ask-Advise-Refer model, which has reduced administrative burden on partner sites and increased access to the program,” said Alaniz. “After the launch of the streamlined model, we saw a 34-percent increase in participant reach, a 50-percent increase in number of new sites, and 13-percent increase in county coverage. We have since maintained 100 percent county coverage.”

By streamlining the provider component of First Breath, they have been able to re-allocate resources to participants themselves, offering intensive one-on-one tobacco treatment services to pregnant and postpartum people statewide.

“Intensive services allow us to address the unique needs of this population and shift our focus from short-term to long-term, sustainable change,” Alaniz said. “It has also allowed us to address the complex and root causes of tobacco dependence such as housing and food insecurity, unmet mental health needs, social isolation, and co-use of other substances.

“By meeting participants in their homes, we are able to support other family and household members and focus on reducing infant and childhood exposure to tobacco smoke in the home. Overall, we are able to engage more deeply with program participants so their voices are centered in our work and they are active decision makers in the direction of First Breath.”

First Breath Quit Coaches are Certified Tobacco Treatment Specialists who are trained on the unique challenges of the perinatal period. Regional Quit Coaches serve all regions of Wisconsin. In a participant survey of 56 First Breath patients, 98 percent rated the program “very good” or “excellent” and 100 percent would recommend the program to a friend.

The ongoing grant is one piece of a partnership between WWHF and UW-CTRI that began more than 20 years ago when WWHF Founder Sue Ann Thompson and UW-CTRI Director Dr. Michael Fiore secured free patches for smokers across Wisconsin. In 1999, they held a news conference and disseminated 19,000 health kits with 800,000 nicotine patches to women across the state. In 2002, they gave free nicotine patches to 1,000 seniors.

Dr. Michael Fiore (left) discusses how to help people quit smoking during a joint news conference with the Wisconsin Women's Health Foundation as its founder, Sue Ann Thompson (far right) observes. 
Dr. Michael Fiore (left) discusses how to help people quit smoking during a joint news conference with the Wisconsin Women’s Health Foundation as its founder, Sue Ann Thompson (far right) observes.

Dr. Michael Fiore

“My mom and Dr. Fiore had an opportunity and didn’t want it to go to waste,” said Tommi Thompson, current WWHF Director and daughter of Sue Ann Thompson and former Wisconsin Governor Tommy Thompson. “So they would offer the patches to help people quit. They saw an opportunity and made the best out of the situation, hopefully making a difference in people’s lives.”

Striving to Quit logoAfter the launch of the Wisconsin Tobacco Quit Line in 2001, the two organizations partnered to integrate the Quit Line and First Breath to help people across the state to quit tobacco.

They also began to conduct research. Wisconsin had received a five-year, $9.2 million grant from the Center for Medicare and Medicaid Services (CMS) to help Medicaid recipients quit smoking. The project, called Striving to Quit, was designed to test the effects of incentives on engagement in quit-smoking treatment and quitting behavior among adult BadgerCare (Medicaid) members who smoked.

The Wisconsin Department of Health Services partnered with UW-CTRI and WWHF on the project. In 2012, as part of Striving to Quit, First Breath developed a new model in which women received intensive counseling from a tobacco treatment specialist.

All participants received payment for completing a baseline assessment and a six-month smoking test to confirm they had quit. Researchers found that participants fared better if they received the higher incentives—for taking counseling calls ($20 per call) and for biochemically-verified abstinence from smoking at the six-month visit ($40).

Striving to Quit results showed that modest financial incentives to engage in treatment to quit smoking increased new mothers’ attendance at post-birth appointments and increased their smoking abstinence at six months after birth.

A group of Medicaid smokers in Striving to Quit, who received up to $190 to adhere to treatments and abstain from smoking, quit at a rate of 22 percent, while those who didn’t receive that level of monetary incentive quit at a rate of 14 percent. Researchers published these results in the American Journal of Preventive Medicine.

Because significantly more people quit in the incentive group, researchers found that the cost per patient who quit smoking was $660 less than the cost per quitter in the control group.

Chenequa quit smoking with the help of the Striving to Quit project.
Chenequa quit smoking with the help of the Striving to Quit project.

“This study demonstrates that fairly moderate levels of incentive payments increased very low-income smokers’ engagement and success in smoking-cessation treatment,” said Dave Fraser, a co-author of the paper and now a retired UW-CTRI researcher.

In 2016, First Breath and academic partner UW-CTRI received funding from the Institute for Clinical and Translational Research (UW ICTR) to conduct a randomized controlled trial to test the effectiveness of a new model.

Of 185 study participants, 94 women were randomly assigned to the standard First Breath program (control) and 91 to an enhanced program. In standard First Breath, women received counseling as part of existing prenatal care. In the enhanced program, women also received one-on-one in-home counseling visits, counseling calls, support to others in the home, and incentives (gift cards) totaling $100. The primary outcome was biochemically verified abstinence at six months postpartum.

The researchers found that, among the 98 women who completed the study, the abstinence rate among the 41 intervention participants was significantly greater (34.1% quit) than among the 57 control participants (12.5% quit). So extending smoking cessation interventions into the postpartum period may help address postpartum relapse.

Treatment results

“Our joint projects have benefited both organizations greatly,” said UW-CTRI Distinguished Researcher Dr. Bruce Christiansen. “More importantly, they have resulted in a far larger capacity to provide evidence-based tobacco dependence treatment to low-income pregnant women across the state.”

“We know there is a lot of stress for women who are pregnant or postpartum,” said Tommi Thompson. “Our health educators meet with women pre- and post-birth to help with aspects like mental health resources, financial resources, breast feeding. It’s important to listen and hear what a mom is needing and try to help them with a holistic approach,” she said. Focus groups have helped First Breath fine-tune services.

The partnership between UW-CTRI and WWHF goes beyond research and outreach. When Tommy Thompson served as US Secretary of Health & Human Services from 2001-2005, he and Fiore realized that each state had different phone numbers for their tobacco quitlines and services varied greatly from state to state. So, they worked together to create one national tobacco quit line available by calling 800-QUIT-NOW in 2004.

Tommi Thompson said the blend of the academic, nonprofit, and policy expertise of UW-CTRI, WWHF, and her father has made the collaboration through the years ideal. Through their efforts, they’ve reached millions through the national quitline, more than 20,000 through First Breath, and hundreds more through research.

“I think when my parents look back at all they’ve accomplished, it’s one of the things they’re most proud of,” Tommi Thompson said. “First Breath and the Quit Line would rise to the top.”

“Among the many collaborations that UW-CTRI has participated in over the last three decades, our work with the WWHF stands among the most important in terms of impact,” said Fiore. “The privilege of partnering with everyone at the WWHF during this time period has also been a personal honor for me. Sue Ann Thompson, Tommi Thompson, and Governor Thompson represent the best of public health—they bring science, passion, and generosity together. And, they are great fun. They are both professional partners and dear friends—I appreciate them very much.”

Pregnant mom with her daughters