Running head: SMOKING WHILE PREGNANT CRAWFORD COUNTY

Smoking While Pregnant in Crawford County Gerber Gang Ferris State University

SMOKING WHILE PREGNANT CRAWFORD COUNTY Smoking While Pregnant in Crawford County The Center for Disease Control and Prevention (CDC) states that there are approximately 43.8 million Americans who consider themselves smokers (CDC, 2012). Smoking can have many damaging affects on your body, which may result in diseases including cancer, emphysema, cardiovascular disease, and gastrointestinal disease (Faucher & Carter, 2001). Healthy People 2020 marks smoking as a leading health indicator (Healthy People 2020, 2013). Women who smoke while pregnant have higher risks associated with their pregnancies when compared to women who abstain

from smoking while they are pregnant (March of Dimes, 2010). These risks include low birth rate, fetal addiction to tobacco, miscarriage, and other serious fetal health complications (March of Dimes, 2010). Smoking while pregnant is considered the number one most preventable risk factor for an unsuccessful pregnancy (Cnattingius, Lindmark, & Meirik, 1992). In a study done by Amasha and Jaradeh, they found that 15.6% of active smoking mothers experienced abortions more than three times more than mothers who do not smoke (2012). Some of the factors that contribute to women continuing to smoke while pregnant include socioeconomic status, education level, stress, and addiction level (Cnattingius, Lindmark, & Meirik, 1992). Crawford County is located in Northern Michigan with Grayling being the county seat for the area. This area is mainly rural, with few densely populated areas. In 2010, the population of the county was approximately 14,000 with about 20% of the population under 18 years of age (District Health Department #10, 2012). Crawford County had numbers better than state average in levels of cardiovascular disease, chlamydia prevalence, and childhood immunizations

SMOKING WHILE PREGNANT CRAWFORD COUNTY (District Health Department #10, 2012). This region scored poorly in areas concerning smoking while pregnant, teen pregnancy, low birth weights, and people being overweight (District Health Department #10, 2012). They also have lower than average education levels in the area with only 15% of the population possessing a college degree and with 17% of the population living below poverty (District Health Department #10, 2012). These areas of deficiency are possible

barriers for the population in this county. These barriers may contribute to some of the problems that these communities are facing regarding smoking during pregnancy. The rate of smoking while pregnant in Michigan in 2012 was 19.3% while Crawford County had the second highest rates in the state coming in at 47.4% (District Health Department #10, 2012). Healthy People 2020 strive for a goal of 1.4% in this category (District Health Department #10, 2012). It is evident by these numbers that Crawford County needs to take drastic measures to decrease the incidence of smoking while pregnant. The high prevalence of teenage pregnancy, binge drinking, and poverty in this county may contribute to the identified difference in the state and county averages. With a teenage pregnancy rate of 61 pregnancies out of 1000 teenagers in this area, adolescent girls may be a significant portion of women who are smoking while pregnant. According to a study by Faucher and Carter, adolescent girls are more likely to begin smoking due to peer pressure, poor academic performance, and a lack of parental supervision (2001). The Health Belief and Transtheorectical Models can be used to describe why women make certain behavioral choices and changes involving their health while

SMOKING WHILE PREGNANT CRAWFORD COUNTY pregnant. The Health Belief Model is a model based on behavioral changes that relates their desire to change with their perceived risks and challenges associated

with making the change (Harkness & DeMarco, 2012). In this situation the pregnant women may not decide to quit smoking if they do not believe smoking will affect the health of the fetus or themselves. This may be due to a lack of education about the risks associated with smoking while pregnant, lack of resources in the area, and the culture of the society. This is shown to be a societal norm as evidenced by almost 48% of the pregnant population engaging in smoking. The Transtheoretical Model breaks down the change into various stages related to the readiness of the patient. The stages include pre-contemplation, contemplation, preparation, action, and maintenance (Harkness & DeMarco, 2012). For a pregnant woman the precontemplation phase would involve her not taking any action toward smoking cessation. The contemplation stage would start when the woman plans to take part in a cessation program, but has yet to schedule the appointment. The preparation stage would be when the woman has made the appointment and begins to prepare mentally and physically for the change. The action phase would be when the woman has quit smoking and intends to continue this behavior. Lastly, the maintenance phase describes the woman continuing her cessation throughout her pregnancy and post postpartum period. Many programs already exist in the state of Michigan and nationally regarding smoking cessation. There are also many programs that specifically discuss the importance of not smoking while pregnant. First, the Maternal Infant Health Program (MIHP) is designed for mothers and babies with Medicaid. It

SMOKING WHILE PREGNANT CRAWFORD COUNTY provides support through referrals to social workers and nurses, along with help with domestic violence, mental health, and substance abuse (MDCH, 2013). This program can also help with childbirth preparation, parenting classes or transportation needs (MDCH, 2013). Secondly, there is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which provides nutrition education, health care referrals, and food supplementation to low-income women (USDA, 2013). In addition to meeting the income requirements, in order to qualify for this program the woman has to be pregnant, breastfeeding or nonbreastfeeding postpartum (USDA, 2013). This supplemental aid is also available for infants and children up to five years of age (USDA, 2013). Healthy Kids of Michigan is another supplemental program for low-income pregnant women and their infants. The women are covered during their whole pregnancy, in addition to the

first two months postpartum (MDCH, 2013). This program assists mothers with any care that they need during their pregnancy. Children are also eligible up to one year of age, with most all medically necessary needs being covered (MDCH, 2013). For residents of Michigan in need of help with smoking cessation, the Michigan Tobacco Quit line is available. This helpline provides emotional support to help the tobacco users gain confidence and motivation to quit smoking (Michigan Health and Wellness, 2013). Although these programs are beneficial to the population of Crawford County, they are proving not to be adequate. These programs related to pregnancy and smoking cessation are designed on a national level and are not made specifically for Crawford County. If there were programs that were more individualized for the

SMOKING WHILE PREGNANT CRAWFORD COUNTY population of this county that focused on their areas of need, they may be more effective. Key members of the community to have involved in the education and awareness of the dangers of smoking while pregnant are parents and educators. Parents are the backbone of the society as they are raising the next generation and kids often mirror their parents behavior. Teachers also play an important part for

influencing behaviors, which could include abstinence from smoking and education about smoking while pregnant. These people are particularly important when dealing with pregnant teenage girls as they can be easily influenced at this age. Smoking, especially during pregnancy, has shown to be a problem in Crawford County, making it appropriate for community nursing intervention. The large amount of smokers in this area affects the health of the whole community, not just those who are smoking. In addition, these pregnant womens actions are not only affecting their health, but are also affecting the health of the unborn babies they are carrying. Besides community health, many other health care disciplines can be involved in the care of this vulnerable population. Social workers may get involved if clinicians feel the woman may be causing harm to their child, even if its unintentional due to lack of knowledge regarding prenatal care. Social workers can work with agencies to provide mothers with resources to enable them to quit smoking to ensure the health of the baby. Other disciplines may be involved depending on the health problems the baby is experiencing as a result of the mother smoking while pregnant.

SMOKING WHILE PREGNANT CRAWFORD COUNTY Since smoking is the number one preventable risk factor leading to complications during pregnancy, it is important that populations take this issue seriously (Cnattingius, Lindmark, & Meirik, 1992). A problem statement that was

determined through research of the data available from Crawford County is a higher risk of complications during pregnancy among women in Crawford county r/t smoking while pregnant as determined by 47.4% of women smoke while pregnant compared to 1.4% goal per Healthy People 2020 (District Health Department #10, 2012). Using this as a determinant as an area for improvement in this county, certain goals have been established to lower the rate of pregnancy women smoking, which can lead to more complications during their pregnancies. The goals focus on lowering the rate of women who continue to smoke while pregnant and also focus on increasing compliance of prenatal care. This is done by multiple interventions including providing smoking cessation support groups, hiring prenatal nursing educators, and implementing incentive programs for compliance. This goal can only be met if the population recognizes the severity of this problem and provides support and encouragement to the struggling pregnant mothers.

SMOKING WHILE PREGNANT CRAWFORD COUNTY References Amasha, H. A., & Jaradeh, M. S. (2012, April). Effect of Active and Passive smoking during pregnancy on its outcomes. Health Science Journal, 6(2), 335-352. Centers for Disease Control and Prevention, (2012). Current cigarette smoking among

adults-United States, 2011. Morbidity and Mortality Weekly Report 2012, 61(44): 889-894. Cnattingius, S., Lindmark, G., & Meirik, O., (1992). Who continues to smoke while pregnant?. Journal Of Epidemiology & Community Health, 46(3). 218-221. District Health Department #10, (2012). Crawford county health profile summary 2012. Retrieved from http://dhd10.org/images/Summary%20Crawford%20Chartbook%20April%2030 %202013.pdf Faucher, M., & Carter, S., (2001). Why girls smoke. a proposed community-based prevention program. Journal of Obstrestic, Gynecologic, & Neonatal Nursing, 30(5), 463-470. March of Dimes Foundation, (2010). Smoking, alcohol and drugs. Retrieved from http://www.marchofdimes.com/pregnancy/smoking-during-pregnancy.aspx Michigan Department of Community Health, (2013). Healthy kids. Retrieved from http://www.michigan.gov/mdch/0,1607,7-132-2943_4845-17752--,00.html Michigan Department of Community Health, (2013). Maternal infant health program. Retrieved from http://www.michigan.gov/mdch/0,4612,7-132-2943_4672106183--,00.html

SMOKING WHILE PREGNANT CRAWFORD COUNTY Michigan Health & Wellness, (2013). Michigan tobacco quit line. Retrieved from

http://www.michigan.gov/healthymichigan/0,4675,7-216-33084_33091_33302--,00.html