Baby Steps. Offering Pregnant Women in Jefferson County Assistance to Quit Smoking. To a Smoke-Free Pregnancy

Transcription

1 Baby Steps To a Smoke-Free Pregnancy Offering Pregnant Women in Jefferson County Assistance to Quit Smoking Sarah Bartnicki Grace Daigler Brooke Powers Rebecca Steichen 10/9/13 Dr. Gilham Generalist Practice III Some Rights Reserved to zippaparazza! Via Flickr

2 Understanding the Problem Effects of Smoking During Pregnancy One of the most preventable causes of low birth weight, preterm birth and perinatal death (Lumley, Oliver, Chamberlain, & Oakley, 2004) Increased risk for pregnancy complications with the placenta and membranes (Ohio Department of Health, 2012) Increased risk for cleft palate, cleft lip, Sudden Infant Death Syndrome (SIDS), and time in a neonatal intensive care unit (NICU) (Ohio Department of Health, 2012)

3 Understanding the Problem Human Costs In the U.S., smoking during pregnancy accounts for 5-8% of preterm births, 13-19% of low birth weight at term, 23-34% of SIDS, and 5-7% of perinatal deaths (Ohio Department of Health, 2012) Economic Costs Estimated $367 million per year in neonatal costs to the U.S. healthcare system ($700/exposed child) (Bailey, McCook, Hodge, & McGrady, 2012) Some Rights Reserved to Jim B L via Flickr

4 Understanding the Problem Some Rights Reserved to ALalto via Flickr Characteristics of Pregnant Smokers Non- Hispanic whites in late teens who have completed some high school have the highest rate (Ward, Vander Weg, Sell, Scarinci, & Read, 2006) Ohio- women on WIC almost 3 times more likely than those not on WIC to smoke during pregnancy (Ohio Deparment of Health, 2012)

5 Why Advocate for This Cause? (Ohio Department of Health, 2012) Ohio 2010 Nearly 1/3 of Ohio women who gave birth had smoked in the last 3 mo. before pregnancy More than half of these did not quit during pregnancy Change in rates in the last decade is not significant

6 Mission Statement The mission of Baby Steps: is to help pregnant women obtain assistance to quit smoking by providing an educational and support group in Jefferson County. Some Rights Reserved to justj0000lie via Flickr

7 Goals & Objectives Goal: To increase the smoking cessation and reduction rate among pregnant women in Jefferson County. Some Rights Reserved to Tulane Publications via Flickr

8 Goals & Objectives Objectives 1. Educate pregnant women on harmful side effects of cigarette smoke on mother and child through a weekly educational and support group, titled Baby Steps. 2. Provide social support for pregnant women interested in quitting smoking via Baby Steps. 3. Provide guidance from a qualified social worker at the weekly Baby Steps program. 4. Encourage progress in the program through a rewards system.

9 Why This Plan? Lots of Plans Tried Info on harmful effects Advice by professional Help manuals Group counseling Phone support Feedback on the real- time effects on their own fetus (heart rate, breathing, etc.) Nicotine replacement therapy Rewards & Social Support = Results In a review of 64 trials with over 28,000 women, a combination of rewards and social support resulted in higher smoking reduction rates than any other method (Lumley, Oliver, Chamberlain, & Oakley, 2004)

10 Action Steps 1. Obtain needed funds to operate the program, as well as material rewards/ incentives for program participants. a) Apply for a state grant to fund: 1- the salary of a new part- time social worker position to moderate the group sessions; 2- the workbook curriculum; 3- costs of advertising for the group. b) Ask local businesses and grocery stores for starter donations of diapers. c) Ask local churches and community centers for assistance in setting up diaper drop off bins. d) Collect diapers from the drop off bins on a monthly basis.

11 Action Steps 2. Acquire a space to meet for the group program that is easily accessible for those in Jefferson County, even for those with low income and no means of vehicle transport. Also acquire a space for office functions. a) Map out the Jefferson County community to determine areas with a high density of low income housing. b) Contact local community and church leaders near this area to inquire for a room to host the program and a room for office functions (Ex. phone calls, interviews).

12 Action Steps 3. Obtain leadership for the support group. a) Advertise an opening for a part- time social work position to run the group in newspapers and via electronic means. b) Interview applicants and hire a qualified and licensed social worker. 4. Publicize to promote the support group. a) Ask our identified allies to sponsor poster advertisements, banners, and commercials for educational purposes and to provide a phone number to sign up for the support group.

13 Action Steps b) Supply Jefferson County doctorsʼ offices, AIM Crisis Pregnancy, and the WIC Office with brochures to place in their waiting rooms regarding the support group. c) Place advertisements in local newspapers. d) Set up a booth/station at a Community Health Day at the Steubenville Mall advertising the program. 5. Run the support group to educate and facilitate cessation and reduction of smoking in Jefferson County pregnant mothers.

14 Allies Local doctorsʼ offices WIC office AIM Crisis Pregnancy Trinity Hospital 4 th Street Health Clinic American Lung Association (Wheeling) Ohio Department of Health Center for Disease Control QUIT- NOW Local Churches Students for Life of Franciscan University Pro- Life groups such as 40 Days for Life Local politicians

15 Resources/Assets Communications Resources Place advertisements in gas stations, Wal- Mart, SVRTA bus stops Facebook ads targeted at women in the Jefferson County area Billboards, Radio and TV commercials, PSA Listed Allies Advertise Donate diapers, set up drop off bins Provide space for group Refer women who cannot attend sessions to QUIT- NOW Politicians can voice support, endorse grant proposals

16 Opponents Some Rights Reserved to CeeKay's Pix via Flickr Cigarette companies Gas stations and drug stores Gumbyʼ s Cigarette and Beer World Some Rights Reserved to Elvert Barnes via Flickr

17 Targets of Change Some Rights Reserved to Boobook48 via Flickr Pregnant Smokers Target: Women of Low SES Eligibility: 1. Must be pregnant 2. Must report having smoked regularly for at least one month prior 3. Must be willing to work towards program goals 4. Must be willing to participate in all program intake and evaluation interviews

18 Targets of Change Support Systems for Pregnant Women Family members or other support systems are encouraged to attend group sessions Allies We will persuade our allies to advertise, get the word out, assist with diaper drives, and provide meeting space Some Rights Reserved to EJP Photo via Flickr

19 Agents of Change Some Rights Reserved to Texas Governor Rick Perry via Flickr Media Facebook, commercials, newspaper, posters Allies Politicians persuasion Local community allies provide space and set up diaper drives Support Group Help pregnant women quit and reduce smoking and reduce health problems

20 Strategies and Tactics Persuading People to Join Our Efforts 1. Attention grabbing poster campaign Butts, Not Butts 2. Providing current, relevant information on the problem within the community and how less than half of smoking women in Ohio quit while pregnant Increasing Smoking Cessation/Reduction 1. Combination of social support and rewards/incentives 2. Using a workbook program that has been shown to be effective 3. Provision of professional intervention by a qualified social worker

21 Strategies and Tactics Rewards System 1. After every two sessions, women will receive a free bag of diapers, because we believe participation is valuable despite success or fallback. Social Support 1. Having a support group of women working towards a common goal and desiring to quit is expected to increase the success rate. 2. Encouragement of family members or other support systems to attend is expected to bring support for the lifestyle change of quitting into the home environment.

22 Evaluation 1. Did Participants Meet their Goals? After educational and support group aspects of the program, the social worker will walk participants through the goal- making process and assist them in choosing achievable goals. At each session the group will discuss successes and failures in meeting goals. The social worker and participants will identify new approaches to adjust for the participantsʼ changing needs. 2. Did Women Verifiably Quit? Breathalyzer test once per month to verify non- smoking status

23 Evaluation 3. Are Cessation/Reduction Rates Higher? After a year of the program we will compare smoking cessation and reduction rates within our program to the state rates and determine whether our program is an effective use of resources. 4. Are Fetal Health Problem Rates Lower? We will record birth weight, any preterm births, and any health problems determined at birth. After a year of the program we will compare preterm and low birth weight rates within our program to state rates and note any significant decreases in other health problems.

24 Defining Success Smoking Reduction/Cessation We aim for 2/3 of women enrolled to attend at least twice a month for the remainder of their pregnancy Increase smoking reduction 47% of Ohio smoking women quit during pregnancy. We strive for at least 80% of the women in our program to have some kind of smoking reduction, and 70% of women in our program to have quit after three months in the program Some Rights Reserved to Trostle via Flickr

25 Defining Success Decreasing Fetal Health Problems We strive for at least 20% reduction of health related problems such as low birth weight and preterm birth as compared to the state rates. Some Rights Reserved to fui via Flickr

26 References Bailey, B., McCook, J., Hodge, A., & McGrady, L. (2012). Infant birth outcomes among substance using women: Why quitting smoking during pregnancy is just as important as quitting illicit drug use. Maternal & Child Health Journal, 16(2), /s y Gadomski, A., Adams, L., Tallman, N., Krupa, N., & Jenkins, P. (2011). Effectiveness of a combined prenatal and postpartum smoking cessation program. Maternal & Child Health Journal, 15(2), Lumley, J., Oliver, S. S., Chamberlain, C., & Oakley, L. (2004). Interventions for promoting smoking cessation during pregnancy (Review). Cochrane Database of Systemic Reviews, (4). dx.doi.org/ / cd pub2.

27 References Ohio Department of Health. (2012). Perinatal cigarette smoking. Retrieved from /media/healthyohio/ ASSETS/Files/tobacco%202%20of%202/ PerinatalSmoking_ FINAL2012.ashx Ward, K. D., Vander Weg, M. W., Sell, M. A., Scarinci, I. C., & Read, M. C. (2006). Characteristics and correlates of quitting among black and white low- income pregnant smokers. American Journal of Health Behavior, 30(6), Retrieved from Academic Search Complete database. (Accession No )