Evaluation of 5 A’s tobacco treatment in Ohio’s WIC Program
State: OH

Skill Area: Program Evaluation

Internship summary
The intern will be housed in the State Epidemiology Office (SEO) at the Ohio Department of Health (ODH). The SEO was established in 2008 and its mission is to “guide epidemiologic priorities and activities for the state, operate in coordination and collaboration with local, state and federal partners, building epidemiologic capacity for the state, and assist with the translation and reporting of epidemiologic findings to public health programs and policies in Ohio.“ It is staffed by the Senior State Epidemiologist, State Infectious Disease Epidemiologist, State Chronic Disease Epidemiologist, State Environmental Health Epidemiologist (vacant) and State Maternal and Child Health Epidemiologist. An EIS officer and a CSTE fellow are also are housed in this office and supervised either solely by the State Epidemiologists, who have no other direct reports. The SEO works closely with and is physically integrated with the Center for Public Health Statistics and Informatics (CPHSI), which houses epidemiologists and researchers who support areas including maternal and child health, vital statistics, and chronic disease.

The Division of Family and Community Health Services (DFCHS) administers programs and oversees data systems fundamental to maternal and child health (MCH). DFCHS houses six program bureaus, representing the spectrum of MCH and other populations. The secondary supervisor works within DFCHS and the intern will have opportunities to work with relevant bureaus within DFCHS. The state MCH epidemiologist primarily supports programs and activities of the DFCHS.

Purpose
Cigarette smoking during pregnancy has been identified as one of the most significant factors contributing to poor pregnancy outcomes. However, in 2006 almost 20% of pregnant women in Ohio smoked, far more than the 2% goal set in Healthy People 2010, and smoking during pregnancy increased in Ohio between 2000 and 2005. In December of 2006 through May 2007, Ohio Women, Infants and Children (WIC) program staff in 4 high-risk counties implemented a 5 A’s smoking cessation program, which was released by the Agency for Healthcare Research & Quality (AHRQ). The 5 A’s program focuses on implementing five steps (Ask, Advise, Assess, Assist and Arrange), through which health care providers can systematically identify women who smoke, advise them to quit, assess their willingness to make a quit attempt and assist them with ways to quit. The program in Ohio aimed to reduce smoking in the prenatal period and was part of a larger Birth Outcomes Improvement Initiative sponsored by the DFCHS.

A process evaluation was completed during the planning and implementation periods of the pilot phase (January 2006-June 2007) to determine the feasibility of delivering evidence-based tobacco treatment services to WIC clients and included measurement of the ability to 1) reach at-risk Women; 2) increase provider efficacy in counseling about tobacco use; 3) address barriers to implementation. The process evaluation confirmed that core systems changes were successfully put into place and pilot sites were able to partially incorporate the 5 A’s into their daily routine.

Since the pilot, WIC projects in the four initial counties have continued to provide the program, WIC projects in 12 additional counties have begun the program, and more counties could be added in the future.

The purpose of the internship is to evaluate the effectiveness of the program in reducing last trimester smoking rates among Ohio WIC participants.

Goals
The goals are to provide more detailed information on 1) the epidemiology of prenatal smoking behaviors among Ohio WIC participants, 2) changes in prenatal smoking behaviors among Ohio WIC participants, and 3) the effect of the prenatal smoking cessation program on those behaviors. The goals will be accomplished using 2005-2008 Ohio data from Center for Disease Control and Prevention (CDC) Pregnancy Nutrition Surveillance System (PNSS).

Objectives
The objectives are to 1) develop an analysis plan informed by a literature review of the topic, 2) conduct appropriate and valid analyses given the data sources and research questions outlined in the plan, 3) summarize and interpret results of the analyses, and 4) draft a brief report and present an oral presentation to ODH staff.

Data or analytic tasks and activities involved
The project will require development of research questions; a literature review; writing of an analysis plan; identification of variables of interest (outcome variables, primary variables of interest, potential confounders and effect modifiers) within the PNSS database or other program data which can be merged with the PNSS data; recoding of variables as necessary; application of appropriate analysis methods, and interpretation of results, summarizing results in a brief written report; and preparation and presentation of an oral presentation.

Required data or analytic skills
The internship position requires basic SAS data and analytic skills, familiarity with multivariate regression techniques, and writing and communication skills. Familiarity with the fundamentals of program evaluation is preferred.

Begin date
05/01/2010

Housing assistance available?
Yes, staff will be able to assist the student in locating and securing housing during the internship period. The Ohio Department of Health is located in downtown Columbus, Ohio, with excellent access to public transportation. Apartments, sublets and other housing available for short term lease exist nearby.

Public transportation available?
Several bus lines pass directly in front of the Ohio Department of Health building.