Smoking during Pregnancy in the Kalkaska county Kate Galloup Misty Donley Audrey Munn

Overview Kalkaska county is a low income county with several areas for improvement. One of their highest issues is smoking during pregnancy. This issue causes many other health risks and concerns. Addressing this health concern will lead to improved life outcomes. Smoking during pregnancy (HP2020: 1.4%) (Michigan: 19.8%) (Kalkaska: 42.9%) (DHD #10,2014) Kalkaska County percentage of smoking while pregnant is higher than percentages in DHD#10 and Michigan. (DHD #10,2014) Healthy People 2020 Target: The Healthy People 2020 target is 98.6 percent of females delivering a live birth reported abstaining from smoking cigarettes during pregnancy. (DHD #10,2014)

Muecke Community Health Nursing Diagnosis Risk of adverse health outcomes among Kalkaska County Residents related to smoking during pregnancy demonstrated by statistics of:  “Cancer mortality rate: Michigan 178.1, Kalkaska (HealthyPeople (HP) 2020 Goal: 160)  Smoking: Michigan 22.7% Kalkaska 24.1%, (HP2020: 12.0%)  Smoking during pregnancy: Michigan 19.8%, Kalkaska 42.9% (HP2020: 1.4%)” (District Health Department #10, 2014).

Conditions associated with Smoking  Poverty  At or below poverty level 25.1% of women  400% above poverty level 10.1% of women  Location  Nonmetropolitan/ Micropolitan 27.5%  Large Metropolitan 13.5%  Disabilities  Any complex activity limitation 29.8%  No disabilities 13.5%  Education  No high school diploma (white only) 40.5%  GED (white only) 30%  Some college or more (white only) 14.6%  Stats did not have an all category

Goal The community RNs goal is to decrease the number of pregnant smokers in Kalkaska County by 2020 by increasing community awareness programs and offering free support to pregnant smokers to reduce the number of adverse health outcomes for both mother and child.

Community RN importance in Pregnancy Smoking Cessation “Brief advice from you significantly increases the chances that your patient will try to quit and do so successfully. Smokers cite health care professional advice to quit as an important motivator for attempting to stop smoking” (Centers for Disease Control and Prevention, 2015).

ADPIE Assessment: Kalkaska is an at risk county Diagnosis: Smoking during pregnancy does not meet HP2020 goal Planning: Increase awareness and education Implementation: Establish a health-education program Evaluation: Are the results an improvement? Is the educational program suitable for the county?

Kalkaska County suggested improvements to reduce smoking during pregnancy  Areas of Concern:  18.7% below poverty line  63.9% within Medicaid's poverty criteria  39.6% smoked while pregnant  85.9% have a high school diploma or higher  Suggested Improvements:  Increase wages  “Higher poverty levels have also been shown to decrease the overall health status of a community, thus making it less attractive to business and industry, resulting in decreased employment opportunities”(DHD)  Improve educational opportunities  Develop tobacco free policies  Educate on the benefits of non-smoking  “engage coalition partners to advocate for smoke free policies”  Groups and individuals responsible  “DHD#10, hospital partners, City and County Governments, community Health Coalitions, Great Start Collaborative”

Planning Increasing community awareness by offering free information and access to free or low-cost help for quit smoking medication in Michigan from the Department of Community Health (2015) Medicaid application and eligibility Michigan Tobacco Quitline Partnership for prescription assistance Connection to care Bridges to access Together Rx

Programs through the district health department Smoking Cessation  Freedom From Smoking Online Program  Michigan Department of Community Health Quit Kits  Quit Net  Michigan Related Quit Smoking Information  Become an Ex Smoker Program (  Quit Kit, Michigan Tobacco Kit Line Information, Resource to Look up Medicaid Quit Assistance, being pregnant and quitting  "I Can Quit" toll free telephone support line: (DHD #10,2014)

Michigan Tobacco Quitline The Michigan Tobacco Quitline (800) QUIT-NOW offers a special program designed for pregnant women decreasing the risk of preterm delivery, low-birth weight and offers a personal quit coach and plan for the mother. _Smoking_Flyer_rnd3_1_383234_7.pdf

Implementation Who: Pregnant women What: Decrease the percentage of smoking Where: The Kalkaska County When: By 2020 Why: Improve women and baby health How: Smoking cessation program “Preventative healthcare measures (i.e. smoking cessation programs) have shown to be effective in reducing the number of smoking women during pregnancy” (Meyer et al, 2010).

Implementation Continued Technology is easily accessible and free for most people to use. We will provide a free or low-cost smoking cessation program that women can obtain. We must address other lifestyle concerns that contribute to cigarette smoking including poverty, disabilities, education, and location. This program will work with the District Health Department.

Barriers Barriers to rolling out community education related to pregnancy smoking cessation is that Kalkaska county has many residents below poverty and they may have limited access to transportation, internet and quitting smoking resources as well as decreased will-power to quit smoking (Tod, 2003).

References Centers for Disease Control and Prevention. (2013). Current cigarette smoking among adults aged 18 and over, by sex, face, Hispanic origin, age, and education level: United States, average annual selected years through Retrieved from Centers for Disease Control and Prevention. (2013). Current cigarette smoking among adults aged 18 and over by sex, race, and age: United States, selected years Retrieved from Centers for Disease Control and Prevention. (2015). FAQS for health care providers. Retrieved from Centers for Disease Control and Prevention. (2014). Tobacco Use and Pregnancy. Retrieved from District Health Department #10. ( ). DHD# 10 Community Statistics: Kalkaska County. Retrieved from District Health Department #10. (2015). Kalkaska county health profile summary Retrieved from Healthy People (2014). Tobacco Use. Retrieved from: objectives/topic/tobacco-use/objectives Meyer, S., Tutdibi, E., Bucheler, M., Raisig, A., Ong, M., & Gortner, L. (2010). Smoking and smoking cessation during pregnancy. Eur J Pediatr, 169, p DOI: /s Michigan Department of Community Health. (2015). Free or low-cost help for quitting smoking medication in Michigan. Retrieved from Tod, A.M. (2003). Barriers to smoking cessation in pregnancy: a qualitative study. Retrieved from U.S. Census Bureau. (2013). Metropolitan and Micropolitan Statistical Areas of the United States and Puerto Rico. Retrieved fromhttp://