Smoking During Pregnancy

1. Smoking During Pregnancy Nicki Croel, Suad Ali, Vaughn Lovell, Tyler Baerwolf, Dan Herbert, Erin White, Nikki McDonald

2. Community AssessmentMecosta County • Population: 43,000 • Median HH income: $37,677 • Persons below poverty: 23.6% • Ethnicity: 93.2% non-Hispanic white • Education: 88.7% high school grads, 21.6% bachelors degree

3. Pregnant Women • 31.4% of women in Mecosta County smoked while pregnant • 19.3% of women in Michigan smoked while pregnant • Healthy People 2020 goal is to decrease smoking while pregnant to 1.4% as a nation.

4. Healthy People 2020 - Tobacco Use and Environmental Health are both topics of Healthy People 2020 • Tobacco Use • $193 billion in health care costs related to tobacco use each year. “Tobacco use is the single most preventable cause of death and disease in the United States.”

5. Analysis of Findings Strengths • Rate of low birth weight is 6.2% vs. MI at 8.4% • Teen pregnancy rate at 28.7% vs. MI at 48.3% • High school grad rate is at parity with MI Weakness • Poverty level high at 23.6% vs. MI at 15.7% • Medicaid pays for 54.9% of births in Mecosta County • Food desert • Limited access to healthcare

6. Resources Available • Michigan Tobacco Quit Line • Michigan Department of Community Health- Smoke Free for Baby and Me • Options Pregnancy Resource Center • Mid Michigan Community Action Agency • District Health Department #10 • Maternal Infant Health Program – Smoking Cessation • Supplemental Nutrition Program for Women, Infants, and Children (WIC) • Spectrum Health – Big Rapids Hospital & affiliated practices

7. Nursing Diagnosis Risk of: Poor infant outcomes Among: Pregnant women in Mecosta County Related to: Smoking while pregnant As demonstrated by: elevated infant mortality rates in Mecosta County linked to maternal smoking while pregnant.

8. Problem Statement • Mecosta County has a higher than average maternal smoking while pregnant rate at 31.4% vs. the State of Michigan at 19.3%

9. Goals & SMART Objectives: • 2-3yrs- Implement a prevention and smoking cessation program within Mecosta county aimed at women who smoke while pregnant. • 5yrs- 5% decrease of smoking while pregnant • 10yrs- At parity with the state of Michigan with smoking while pregnant • SMART- The rate of smoking while pregnant will decrease by 5% after implementation of smoking cessation programs for pregnant women in Mecosta county in 5yrs.

10. Evidence Based Secondary Prevention • SCRIPT Method • Evidence based program cited by the Agency for Healthcare Research and Quality’s Smoking Cessation Clinical Practice Guidelines • 4 Components • Pregnant Woman’s Guide to Quit Smoking • Commit to quit smoking during and after pregnancy • Comprehensive Counseling • Counseling and encouragement to establish a non-smoking home

11. Evidence Based Secondary Prevention Continued • Telephone Smoking Cessation Quit-line • American Cancer Society- analysis of telephone quit-line data • Three Options- Selected by pregnant woman • Self-Help Materials only • Self-Help Materials with Phone Counseling • Phone Counseling only

12. Evidence Based Secondary Prevention Continued • The Five A’s Counseling program • Recommended by the National Cancer Institute, American College of Obstetricians and Gynecologists, and U.S. Public Health Services • Effective in a variety of settings • We decided to implement the 5 A’s Smoking Cessation Program

13. Geopolitical Community • Research • Study looked at 16 smoking cessation programs already in place • The State of Tennessee implemented the program statewide in their WIC clinics, permanently • Wide variety of participants, locations, demographic enrolled • Our population • Studies looked at participants in WIC clinics, Private and University Clinics, Public Clinics, and Health Departments across the nation

14. Stakeholders & Partners • WIC • Maternal Infant Health Program (MIHP) • Spectrum Hospital Big Rapids • Local Ob/Gyn and Primary Care offices • Great Start Collaborative • Mid-Michigan Community Action Agency • Options Pregnancy Resource Center

15. Plan Overview • Grant Funding • Develop materials • Training • Launch Five A’s Counseling Program

16. Budget

17. Five A’s Counseling Steps • Ask • Determine a women’s smoking status • Advise • Urge smokers to quit using a clear, strong, and personalized messages • Assess • Willingness to quit smoking in the next 30 days • If unwilling, reinforce at subsequent visits

18. Steps Continued • Assist • Provide materials and social support • Arrange • Continue follow up and reinforcement

19. Local Resources • Work space • Needed • Trained counselors • Promotional & Educational Materials • Community Interests • WIC & MIHP

20. Evaluation • Short-term • Number of referrals from stakeholders • Number of participants enrolled in counseling • Progress of participants each quarter • Long-term • Compare data from each year to the baseline rates in 2013 • 5% decrease in 5 years • On par with the State of Michigan in 10 years

21. Conclusion • Mecosta county has a high rate of smoking while pregnant due to many factors • Lack of prenatal care • High poverty levels • Lack of an effective smoking cessation program available to them • By implementing the 5 A’s smoking cessation program and utilizing the resources already available we will be able to reduce this number significantly • Within 5 years there should be a rate reduction of 5% among pregnant smokers and by 10 years Mecosta County should be on par with the state of Michigan’s rate of smoking while pregnant

22. References Centers for Disease Control and Prevention. (2012, September 24). A look inside food deserts. In CDC Features. Retrieved October 2, 2013, from http://www.cdc.gov/features/fooddeserts/ Centers for Disease Control and Prevention. (2009, October 29). PedNSS health indicators. In Pediatric and Pregnancy Nutrition Surveillance System. Retrieved October 2, 2013, from http://www.cdc.gov/pednss/what_is/pednss_health_indicators.htm District Health Department 10, (2012). Health profile chartbook 2012: Mecosta county. Retrieved from website: http://dhd10.org/images/Mecosta_Chartbook_Dec_14_2011-1.pdf East Tennessee State University. (n.d.). 5 A's guide. In Tennessee Intervention for Pregnant Smokers. Retrieved October 2, 2013, from https://www.etsu.edu/tips/participating/intervention.aspx Melvin, C., Dolan-Mullen, P., Windsor, R., Whiteside, H. P., & Goldenberg, R. (2000). Recommended cessation counselling for pregnant women who smoke: A review of the evidence. Tobacco Control, 9, Retrieved from www.tobaccocontrol

23. References Continued Muecke, M. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1), 23-35. Retrieved from https://fsulearn.ferris.edu/bbcswebdav/pid-349635-dt-content-rid-1923521_1/xid-1923521_1 National Center on Addiction and Substance Abuse. No place to hide: Substance abuse in mid-size cities and rural America . Commissioned by the United States Conference of Mayors. Funded by the Drug Enforcement Administration with support from the National Institute on Drug Abuse, 2000 Society for Public Health Education. (n.d.). The smoking cessation and reduction in pregnancy treatment (SCRIPT) program. InSOPHE. Retrieved October 2, 2013, from http://www.sophe.org/SCRIPT.cfm Snattingius, S. (2004). The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine & Tobacco Research, 6(2), S125-S140. doi: 10.1080114622200410001669187 U.S. Department of Health and Human Services. (2013, August 28). Family planning. In Healthypeople.gov. Retrieved October 2, 2013, from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=13