Proposal to decrease Smoking Prenatal among teenage and low
income groups
By Aysha
Siddiqui
Changing
Health Behavior
Abstract
This essay describes a program that is designed to reduce
the trend of prenatal smoking i.e. smoking by women during pregnancy among
pregnant teenagers who belong to a low income group. This program would also
aim to help the pregnant population that is not in the teenage group, and in
varying age groups and have shown unhealthy behavior of antenatal smoking due
to depression, stress caused by financial and emotional factors.
The essay includes statistics that show the increasing
number of antenatal smoking cases among some groups and decreasing numbers
among a different group. We examine the reasons for the varying number of cases
to find ways to deter this health behavior. The proposal may face some
challenges, and these challenges are discussed in this essay as well.
Prenatal smoking is the behavior of
smoking by pregnant women during the time before the birth of their child while
they are pregnant. According to the CDC and the 2008 Pregnancy Risk Assessment and
Monitoring System (PRAMS) data from 29 states shows that 13% of women reported
smoking during the last three months of pregnancy. PRAMS is the surveillance
branch of CDC that collects data on maternal behavior before, during and after
pregnancy. For our proposal the data collected from PRAMS is substantial. While
collecting data on smoking during pregnancy, PRAMS used two ways of reporting.
First includes self reporting by the expectant mothers and second through a
questionnaire filled out during birth certificate information. In 2005 the data
collected from these two sources showed that the percentage of women who did
prenatal smoking was much higher than estimated by PRAMS. Data was collected
from 31 sites all over the USA. Andreka et al (2010) did a study on 4,667
mothers to understand the behavior of pregnant women with smoking during
pregnancy and the risk assessments of this behavior. Their results showed that
43.7% of the women continued to smoke during pregnancy and low birth weight and
preterm delivery cases were the highest among this group of the population
selected.
Prenatal smoking is linked to many
pregnancy complications like placenta previa (when placenta covers the cervix
and severe bleeding can occur), low birth weight, placental rupture, restricted
fetal growth, spontaneous abortion and preterm delivery (baby is born before
the natural due date and completion of nine months). PRAMS reports that during
2000-2004 an estimated 776 infants died annually due to maternal smoking during
pregnancy. CDC reports that ‘during 2002, 5%–7%
of preterm-related deaths were attributable to prenatal smoking in the United
States’.
Smoking during pregnancy is the single most
important conditions that can modified, improved to prevent poor birth
outcomes, yet it prevails among many groups, especially among the low income
group of pregnant women. Holtrop et al (2010) report that both stress and
depression are prevalent among low income groups in which women who smoked
during pregnancy. They studied a total of 2,203 women who were qualified for
Medicaid and found that 26% of women continued to smoke during pregnancy. Among
those more than half had a high mental stress score and other than mental
health history, demographics had a high relation with the attitude towards
smoking. Their study concluded that prenatal smoking is the single most
important factor among reduced birth results that can be controlled.
The target
population for this program proposal is the low income pregnant women, mostly
who are in their teenage. The rate for unintended pregnancies is highest among
women who are aged 18-24 years, unmarried, low income, black or Hispanic
(Henshaw, 1998). Teenage is a time where risk taking in behavior is very common,
and an unexpected pregnancy can cause more stress. Since stress is a major
cause in cases where prenatal smoking occurs, teenagers are most at risk to
smoke during pregnancy. According to American Lung Association, daily almost
3,900 children under the age of 18 years try their first cigarette and more
than 950 will make this a habit and become regular smokers. Teenpregnancystatistics.com
reports that about 17 percent of pregnant teens smoke and one major reason is
because they are usually in the company of other teenagers or young kids who
also smoke. Low income teenagers who are pregnant is the main population to be
targeted. Prenatal smoking is a health behavior found most commonly among low income
groups. Low birth weight is common among low income groups of pregnant women
and so is teenage pregnancy. Cigarette smoking emerged as an important factor
in low birth weight, so there is a connection between the two. This was also
studied and concluded by McCormick et al (1990) when they looked at a sample of
458 central Harlem women.
Like any
other program, this program may face some challenges as well. The first
challenge would be to find the pregnant women company that is not in the favor
of prenatal smoking. They will need to be put into a support system where they
can be encouraged to quit smoking at all times with the awareness of the
dangers prenatal smoking bring to their unborn babies.
If you are
targeting a low income population, then finding such support maybe a challenge.
Education
is of vital importance and being aware of the potential dangers of smoking to
the baby as well the importance of prenatal care. It is usually the trend for
unexpected teenage pregnant women to either drop out of school after they get
pregnant, or may have dropped out prior to the pregnancy. Lack of education
among low income groups will be a very challenging combination.
Hormonal changes happen
during pregnancy which can cause pregnant women to be very sensitive to even
smallest of challenges. This can create a difficult challenge for our program
proposal as well.
Anderka, M.,
Romitti, P. A., Sun, L., Druschel, C., Carmichael, S., & Shaw, G. (2010).
Patterns of tobacco exposure before and during pregnancy. Acta obstetricia et gynecologica
Scandinavica, 89(4),
505-514.
Henshaw, S. K.
(1998). Unintended pregnancy in the United States. Family planning perspectives,
24-46.
Holtrop, J.
S., Meghea, C., Raffo, J. E., Biery, L., Chartkoff, S. B., & Roman, L.
(2010). Smoking among pregnant women with Medicaid insurance: are mental health
factors related?. Maternal and
child health journal, 14(6),
971-977.
McCormick, M.
C., Brooks-Gunn, J., Shorter, T., Holmes, J. H., Wallace, C. Y., &
Heagarty, M. C. (1990). Factors associated with smoking in low-income pregnant
women: relationship to birth weight, stressful life events, social support,
health behaviors and mental distress. Journal
of Clinical Epidemiology,43(5), 441-448.
Jones, J. R.,
Dietz, P. M., D’Angelo, D., & Bombard, J. M. (2009). Trends in Smoking Before, During,
and After Pregnancy: Pregnancy Risk Assessment Monitoring System (PRAMS),
United States, 31 Sites, 2000-2005. Department of Health and Human
Services, Centers for Disease Control and Prevention.
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