1. SMOKE FREE MOMS
Dr. Lorenzo Spizzichino
Prevention Department
Ministry of Health
Rome, Italy
Ministero della Salute
2. Acknowledgement
I am presenting this work on
behalf of
dr Luca Sbrogiò,
dr.ssa Alessandra Schiavinato
and their collaborators
3. 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.
6. Smoke free
moms: History
-2003 Pilot project
conducted in Veneto
Region
- 2007 Ministry of Health
– CCM programme
7. Smoke free moms: aims
The objective of the
Programme is to favour a
standardized intervention of
midwives to help pregnant
women to quit smoking and
to follow-up these women
and their families, in the
puerperal period
8. Smoke free moms: aims
Specific objectives:
• reduce the number of
women who smoke during
pregnancy (<5%)
•avoid relapse after
delivery (<50%)
9. 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
10. 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
11. 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.)
12. 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
13. Effectiveness evaluation:
follow up 1 year after delivery
Sbrogiò, Michieletto, Tagliapietra 2008
% of non smokers women at the end of pre-delivery
course still abstinent one year after delivery
80%
75%
75%
70%
65%
65%
60%
Counselling Control
90% 87%
85%
80%
75%
70%
65%
65%
60%
Counselling (>=3 contacts) Control
14. Diffusion of the programme
Veneto
full participation
Participation with cancer league
Participation with midwives society
Veneto Regione Cohordinator
No participation (mateiials)
15. 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
16. 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.
17. Conclusions
The programme “Smoke free Moms” is still
ongoing, is well accepted by midwives and
parents, is feasible and sustainable.
brief counselling by midwives is possible in
all settings, especially in out-hospital
premises.
