Oceana County Community Needs Created by: Vivian Liverance Marcos Vergez Renee Welch

County Demographics West Central Michigan Second largest fruit acreage in the state Tourism Population 26,211 Rural Caucasian 80% own home 6 public beaches Numerous hunting and fishing resources. www.factbook.org Oceana county is located in West Central Michigan, it is on the coast of Lake Michigan and was formed in 1831. This area grew and prospered during the lumber era. However, when the lumber boom died orchards became the primary industry. Today, Oceana county has the Second largest fruit acreage in the state and is also known as the asparagus capital of the world. Tourism is vital part of the area’s economy. In 2014 the estimated Population was 26,211 Which by definition is a Rural area The residents of this county are primarily Caucasian And more than 80% own their own homes The tourism industry is supported by 6 public beaches There are also Numerous hunting and fishing resources including a number of lakes.   County Demographics Sources: United States Census bureau

Community Health Indicators Community Strengths Lower cardiovascular disease rates Lower cancer mortality rates Comparable overall mortality rates As in every community, Oceana county has both positive and negative health indicators. Specifically, Cardiovascular disease mortality rates that are lower than the state average. Mortality from Cancer diseases are also lower than then the state of Michigan However, Overall mortality rates are comparable to State averages. Community Health Indicators Community Strengths Sources: Michigan Department of Community Health, 2014

Community Health Indicators Community Weakness Lower household income 21.8% of community in poverty Higher incidence of teen pregnancy High percentage of pregnant smokers Higher rate of Medicaid paid births Unfortunately, there are many negative health indicators prevalent in Oceana. On average the household income is lower than the state along with a high rate of poverty. This community also has a higher incidence of teen pregnancy. The percentage of women who smoked while pregnant was 5% higher than the state average. And finally, Oceana has a higher rate of Medicaid paid births in the county than the state average. Community Health Indicators Community Weakness Sources: Michigan Department of Community Health, 2014

Problem Statement Risk of: Pregnancy complications Among: Pregnant women and teens Related to: Prenatal smoking As demonstrated by: 25.4% prenatal smoking rates of smoking in Oceana County An appropriate nursing problem statement for the existing prenatal smoking issues in Oceana County is Risk of pregnancy complications Among pregnant women and teens Related to prenatal smoking As demonstrated by the 25.3% prenatal smoking rates in Oceana County compared to the 17% rates for the state of Michigan. Problem Statement

Analysis Increased teen pregnancy Increased poverty Lower education rates Young unmarried Live in poverty Stressed Undereducated Heavy smokers Multiparous In analysis of Oceana county it was noted that there was a high rate of teen pregnancy, high incidence of poverty and lower education have contributed greatly to the high incidences of prenatal smoking. Research has shown that “Women who smoke while pregnant tend to be young, unmarried, poor, stressed, undereducated multiparous and heavy smokers” Research also supports that some women use cigarettes to "organize" their social interactions to build and bond relationships. Furthermore, Smoking also has a mental component beyond addiction such as a comforter, supporter and as a means of self-definition. Analysis Source: Chomitz, Cheung & Lieberman, 1995

Maternal Infant Health Program There are numerous programs existing both nationally and locally that address smoking cessation. However, programs that address prenatal smoking cessation specifically also exist. More specifically is the maternal infant health program or MIHP. MIHP is a program developed for all pregnant Michigan women with Medicaid Health Insurance. Also for all infants up to one year of age with Medicaid. MIHP provides support, education and nursing visits to help promote healthy pregnancies, good birth outcomes and healthy infants. (MIHP) Resources Source: Michigan Department of Health and Human Services, 2016

“Expecting” To Be Smoke Free. Quitline Resources Within MIHP in Oceana county is a smoking cessation program called   “Expecting” To Be Smoke Free. This is a 6 week in home program offered by MIHP staff. Another program available to pregnant women is the Michigan quit line. Through this program telephone support is given to pregnant women in addition a gift card is given to the prospective mother after every phone call. Resources Source: District Health Department #10, 2015

Health Belief Model Health Belief model Here is an example of the health belief model. The health belief model for nurses addresses a persons perception of health related behaviors based on four areas: the severity of the illness, patient’s perception of susceptibility of the illness, benefits of preventative action, and barriers to taking action. Health Belief Model http://currentnursing.com/nursing_theory/health_belief_model.html Source: Nursing Theories a Companion to nursing theories and models, 2013

Expectant mother needs to be educated about the risks of smoking during pregnancy. Fetal growth restriction, preterm birth, still birth, & infant mortality There is increased risk of unborn child smoking as an adult Later-in life risks of cardiovascular and metabolic disease are increased. The Health Belief Model is a model based on behavioral changes that relates a person’s desire to change with their perceived risks and challenges associated with making the change. Knowledge about risks is important to teach expectant mothers so that they can make informed decisions. They need to know that there is a higher risk of fetal growth restriction, preterm birth, still birth and infant mortality if they smoke. There also are future risks of their child smoking as an adult or having cardiovascular and metabolic diseases. Health Belief Model Source: Centers for Disease Control and Prevention, 2016

Smoking is the leading preventable cause of poor pregnancy outcomes in the U.S. Barriers Unaware of the dangers Past failed attempts Social pressures Smoking is the leading preventable causes of poor pregnancy outcomes in the U.S. Young mothers may not know that smoking may cause harm to their unborn child. They may have tried to stop smoking previously and found it hard to do. There may be social pressures they are facing from friends or family to keep smoking. These are some of the barriers they may face when trying to quit smoking during their pregnancy. Health Belief Model Source: Centers for Disease Control and Prevention, 2016

To reduce the rate of smoking in pregnant women in Oceana county to 1 To reduce the rate of smoking in pregnant women in Oceana county to 1.4% by March 2017 A reduction of the rate of women smoking while pregnant in Oceana county of 1.4% in a year would be a reasonable goal. Smart Goal

Traditional Interventions Nicotine Replacement Therapy (NRT): Gum, Patch, Inhalers, Intranasal sprays, and Sublingual tablets. Non-Pharmacological Treatments: Self-Help, Individual & Group Therapy, Aversion Therapy. Other Medications Therapies: Antidepressants (Bupropion and notriptyline), Clonidine, Naltrexone. “Nicotine Replacement Therapy (NRT) is available in a range of methods of administration, including gum, patch, inhalers, intranasal sprays, and sublingual tablets. The evidence, clearly shows NRT in any form is significantly more effective than either placebo or no NRT at increasing rates of smoking cessation” (Robertson-Malt…, 2008). Non-Pharmacological treatments may be considered as solo or adjunctive therapies. Self-help strategies have been shown to have a positive, however small affect on smoking cessation. Individual and group therapy have proven to be effective, especially when used in combination with NRT. Aversion therapy has shown no positive affect for smoking cessation. Other medications therapies including use of antidepressants, anti-hypertensives and opioid antagonist for smoking cessation have demonstrated variable results. (Robertson Malt…, 2008). Traditional Interventions Source: Robertson-Malt, Roberts, & Kent 2008

Non Traditional Intervention Preventative Medicine Journal use of financial incentives Research trials showed success when combined with more traditional approaches. 32% success rate compared to 9% in control group 21% success rate compared to 6% in control group In an article in the preventative medicine journal they looked at using a financial incentive to motivate pregnant women and post partum women to stop smoking. This is a common approach used in substance abuse disorders. The women gained vouchers when they were biochemically-verified to abstinent from recent smoking. They then turned the vouchers in for retail items. Preventative medicine journal review “Financial incentive for smoking cessation among pregnant and newly postpartum women” (December 27, 2011) Non Traditional Intervention Source: Higgens, Washio, Heil, Solomon, Gaalema, Higgins, & Berstein, 2012

Michigan Quitline prenatal smoking cessation program Several trials were conducted to see if the voucher system would lower smoking rates among pregnant women. The success rates were highest when the voucher program was combined with other resources to help women quit smoking. Women at the end of pregnancy had a 32% success rate compared to a 9% rate in the control group. The Women who were 2- months pot partum had a 21% success rate compared to 6% in the control group. This would be another tool that could be used as an incentive to help with healthier pregnancy rates. Intervention https://michigan.quitlogix.org/ Source: Tobacco Reduction and Prevention Program, 2015

Evaluation Decrease in prenatal smoking by 1.4% Using education, resources, traditional and nontraditional methods Increase fetal weights and decrease poor pregnancy outcomes. An increase in smoking cessation should be seen in pregnant mothers with proper education and incentives. A combination of education, resources, traditional methods of care, and more innovative programs like the voucher system should result in a decrease of women smoking while pregnant. Reducing the number of pregnant women that are smoking by over one percent in twelve months will increase fetal weights and a decrease poor pregnancy outcomes in Oceana County. Evaluation

References Centers for Disease Control and Prevention. (2016). Tobacco use and pregnancy. Retrieved from http://www.cdc.gov/reproductivehealth/MaternalInfantHealth/TobaccoUsePregnancy/i ndex.htm Chomitz, V. R., Cheung, L. W. Y., & Lieberman, E. (1995). The role of lifestyle in preventing low birth weight. The Future of Children, 5(1). Retrieved from http://futureofchildren.org/publications/journals/article/index.xml?journalid=60&articlei d=376&sectionid=2528 District Health Department #10. (2015). Maternal infant health program. Retrieved from http://dhd10.org/index.php/maternal-infant-health-program Higgens S.T., Washio Y., Heil S.H., Solomon L.J., Gaalema D.E., Higgins T.M., & Berstein I.M., (2012). Financial incentives for smoking cessation among pregnant and newly postpartum women. Preventative Medicine, 55, 533-540. doi:10.1016/j.ypmed2011.12.016

Michigan Department of Community Health. (2014) Michigan Department of Community Health. (2014). Health profile chartbook, Oceana county. Retrieved from http://dhd.10.0rg Michigan Department of Health and Human Services. (2016). Maternal infant health program. Retrieved from http://www.michigan.gov/mihp/0,5421,7-311- 66377_66381_66383---,00.html Nursing Theories a companion to nursing theories and models. (2013). Retrieved from http://currentnursing.com/nursing_theory/ health_belief_model.html Roberston-Malt, S., Roberts, M., & Kent, B. (2008). Smoking cessation interventions and strategies [Abstract]. Best Practice, 12(8), 1-4. Retrieved from http://connect.jbiconnectplus.org/viewsourcefile.aspx?0=464 Tobacco reduction and prevention. (2015). Retrieved from https://michigan.quitlogix.org/default.aspx United States Census Bureau, Quick facts Oceana County, Michigan. Retrieved from http://www.census.gov/quickfacts/table/SEX255214/26127