1. S MOKING D URING P REGNANCY M ECOSTA C OUNTY Abby Fish, Sam Fries, Josh Gibson, Kathryn Kaufman, Jacqueline Mulder (DeBoer), Corrin Simon, Sara Staffen, Jenna Winters

2. M ECOSTA C OUNTY Population of 43,300 Demographic breakdown: 93% White 3.1% Black 1.9% Hispanic 1.6% Asian or Native American Median Household Income is $37,677 ($48,669 statewide) 9.1% Unemployed 23.6% below poverty 88.7% graduated high school 21.6% have a Bachelor’s degree

3. S TRENGTHS & W EAKNESSES The Good: Large healthcare facility complex Plenty of open space Lower than state average regarding some issues The Not-So-Good High poverty rate Large number of uninsured Large number of jobless individuals Relatively low level of education Limited transportation High rates of other morbidities

4. Nearly one-third of women smoked during pregnancy Statewide rate is 19% Many factors predispose the women of Mecosta Poverty Level of education Occupational status 23.3% uninsured S MOKING FOR T WO …

5. P ROBLEMS I DENTIFIED Risk for delayed growth and development 6.2% infants have low birth weight 9.1 infant mortality rate 7.3 statewide Risk-prone health behaviors Risk for ineffective respiratory function related to second-hand smoke

6. G OALS AND O BJECTIVES The rate of pregnant smokers living in Mecosta County will decrease from 31.4% to 25% after a 5 year period through educational teaching regarding fetal and maternal risks of tobacco use The rates of respiratory infections and chronic respiratory disease in children born to smoking mothers will be reduced by 10% by 2020 as a result of a reduction in second-hand smoke exposure

7. I NTERVENTIONS The first intervention is to provide specialized counseling along with support Provided by certified personnel who specialize in addictions Provides understanding through the Transtheoretical Model & its stages of change Hosted at the local Health Department Available to women at any stage in pregnancy Attendance requirements

8. I NTERVENTIONS The second intervention for women who smoke while pregnant involves the barriers to access, health, and wellness. The client’s definitions of health and wellness and major barriers to health and wellness related to smoking while pregnant will be assessed, and physical therapy will be used to aid in tobacco cessation.

9. E VALUATION All members involved will meet to evaluate the program and the mothers who participated Goal: advertise program and refer smoking mothers The program’s popularity will be tracked and the attendance measured to determine if the goal was met.

10. Goal: patient teaching regarding the effects of smoking on the fetus Efficacy will be measured by annually tracking the number of low birth weight infants born to mothers who use tobacco If our numbers are not reached but our program seemed successful, we will determine what other barriers are standing in the way of the community E VALUATION

11. If the percentage of women who smoke drop from 31.4% to 25%, then the goal will be achieved If the goal is only partially met, then other barriers will be considered and the intervention altered If the rates of respiratory infections and chronic respiratory disease in children born to smoking mothers are reduced by no less than 10% by 2020, then the educational intervention was a success E VALUATION

12. R EFERENCES Alexandria, VA. (2003). Guide to Physical Therapist Practice. 2nd ed. American Physical Therapy Association. Chen, R., Clifford, A., Lang, L., & Anstey, K. (2013). Is exposure to secondhand smoke associated with cognitive parameters of children and adolescents? A systematic literature review. Annals of Epidemiology, 23(10), 652-661. Cunningham, Matt. (2011). 10 reasons people start smoking. Discovery Health. Discovery. Retrieved Sept 18, 2013 from http://health.howstuffworks.com/ District Health Department #10. (2012). Mecosta county health summary profile: 2012. DHD. Retrieved Sept, 20,2013 from http://dhd10.org/ Fahy, K. (2007). Why do women continue to smoke in pregnancy? Women Birth. 20(4):161-8. Retrieved Sept,18, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/ Haustein, K. (2006). Smoking and poverty. Eur J Cardiovasc Prev Rehabilitation. 13(3):312-8. Retrieved Sept 18, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/16926658 Ladwig, G.B., & Ackley, B.J. (2011). Mosby’s Guide to Nursing Diagnosis. Maryland Heights, MO: Mosby Inc. & Elsevier Inc. McGowan, A., Hamilton, S., Barnett, D., Nsofor, M., Proudfoot, J., & Tappin, D. (2010). 'Breathe': the stop smoking service for pregnant women in Glasgow. Midwifery, 26(3), 1-13.doi:10.1016/j.midw.2008.05.005. Retrieved from CINAHL.

13. R EFERENCES Michigan Department of Community Health. 2012. Health Profile Chart Book Mecosta County. Retrieved from http://dhd10.org/images/Mecosta_Chartbook_2012_April_2_2013.pdf Oral Cancer Foundation. (2010). Demographics of tobacco use. Retrieved Sept 18, 2013 fromhttp://oralcancerfoundation.org/tobacco/ demographics_tobacco.htm The National Partnership to help Pregnant Smokers Quit. (2013). Retrieved Sept 18, 2013 from http://www.helppregnantsmokersquit.org/ Nursing Theories. (2012). Health Belief Model. Retrieved Sept 18, 2013 from http://currentnursing.com/nursing_theory/ health_belief_model.html Röske, K., Thyrian, J. R., & Hapke, U. (2010, December 24). An intervention to support postpartum women to quit smoking or remain smoke-free. Journal of Midwifery & Women's Health, 51(1), 45-50. doi:10.1016/j.jmwh.2005.07.002. Retrieved from CINAHL. Yu, S. M., Park, C. H., & Schwalberg, R. H. (2002, June). Factors associated with smoking cessation among U.S. pregnant women. Maternal and Child Health Journal, 6(2), 89-97. Retrieved September 10, 2013, from CINAHL.

14. …T HANKS FOR L ISTENING !