Mecosta County, Michigan

Created by: Lindsey Koch, Carrie Smith,Jennifer Ames, Elizabeth Berkemeier, Catherine Buckel

Total Population: 43,318 Race and Ethnicity: 93.5% white High School Graduates: 89.4% Jobless Rate: 9.3% Median Income: $38,332 Persons Below Poverty: 22.9% English as a Primary Language: 95.7%

Source: US Census Bureau, 2008-2012 American Community Survey 5-year Estimates,

MECOSTA COUNTYCOMMUNITY ASSESSMENT

POVERTY IN MECOSTA COUNTY

ACCESS TO HEALTH CARE

BIRTHS IN MECOSTA COUNTY

Birth Related Trends

COMMUNITY ANALYSIS

Smoking during Pregnancy◦ Mecosta County: 31.6%◦ State of Michigan: 19.5%

Healthy People 2020 Goal: 1.4% Potential Risks of Smoking during

Pregnancy:◦ Higher risk of miscarriage and pregnancy loss◦ Prematurity and low birth weight in neonates◦ Higher risk of SIDS ◦ Smoking will reduce breast milk supply◦ Higher risks of allergies, asthma, and ear

infections in infants

AREA OF CONCERN

Planned Parenthood Catholic Charities of West Michigan Mecosta County Health Department

◦ MI Child◦ Healthy Kids◦ Maternity Outpatient Medical Services◦ Group 2 Pregnant Women◦ Maternal Infant and Support Services

WIC Mecosta County Community Team Hope House Free Medical Clinic Early Head Start (Mid Michigan Community Action Agency) Early Success Right from the Start (MOISD school district)

AREA OF CONCERN

There appears to be adequate resources available in the community, but a lack of utilization. Evidence shows Mecosta County is almost double the state rate and 30x the Healthy People 2020 goal.

The ideal plan would be to engage physicians, community health nurses, health department employees, existing community organizations, healthcare students at Ferris State University, and the general public in addressing this issue.

HOW DO WE ADDRESSSMOKING IN PREGNANCY?

The “Keystone” of Community Health Nursing

Essential precursor to Community Health Intervention

Uses the community assessment to clearly describe and address the problem & etiology

Completes the Diagnostic process

Muecke, M.A. (1984). Community health diagnosis in nursing. Public Health Nursing, 1(1), 23-25.

COMMUNITY NURSING DIAGNOSIS

Risk of pregnancy complications due to smoking during pregnancy among Mecosta County women related to:◦ Lack of access to healthcare

Inadequate education on risks of smoking to fetus

◦ Poverty on the rise Stressors at home may lead to difficulty quitting

As demonstrated in higher percentages of pregnant women who smoke (31.4%)

Infant mortality rate of 9.1 Low birth weight of 6.2%

COMMUNITY HEALTH DIAGNOSIS

PROBLEM STATEMENT

To reduce women smoking during pregnancy in Mecosta County to below the 2012 state average of 19.3%.◦ Through more healthcare coverage/prenatal care

for pregnant women◦ More education by providers on dangers of smoking• Use of Maternal Infant Health Program through

Michigan Medicaid• Provides transportation, education & support

◦ Reduce low birth weight percentages◦ Reduce infant mortality

Michigan Department of Community Health (2014). Pregnant women. Retrieved from: http://www.michigan.gov/mdch/0,4612,7-132-2943_4672-106183--,00.html

GOALS & OBJECTIVES

Increased risk of placenta previa, preterm rupture of membranes, and preterm birth

Low birth weight Cognitive deficits Sudden Infant Death Syndrome (SIDS)

RISKS OF PRENATAL SMOKING

Counseling Pharmacological interventions such as

nicotine replacement therapy Psychosocial interventions, such as The Five

A’s

INTERVENTION

Ask, Advise, Assess, Assist, Arrange◦ Determine if prenatal smoking is a risk◦ Provide information about risks of prenatal

smoking◦ Interview to determine if smoking is an existing

habit, how many cigarettes are smoked daily, how long the patient has been a smoker, etc.

◦ Provide tools to assist in smoking cessation◦ Arrange for further counseling, prescriptions for

nicotine replacement therapy, follow through with additional interventions if necessary

FIVE A’S

Not all smoking during pregnancy can be eliminated through any intervention method

Comprehensive care initiated and continued in a prenatal care/clinical setting can increase the number of pregnant women who are able to quit smoking before delivery

Though not all smoking during pregnancy can be eliminated, education and intervention along with nicotine replacement therapy is the best option in assisting pregnant women to quit smoking

Ensuring continuous care and follow-through is important in having successful prenatal smoking cessation interventions

ANALYSIS

Theoretical Support forCommunity-based

Interventions

For Decreasing Percentage of

Smoking in Pregnant Women

KURT LEWIN(1890-1947)

“Father of Social Change Theories”

KURT LEWIN’S CHANGE MANAGEMENT THEORY

Lewin’s change theory is a planned change’ guide that consists of three distinct and vital stages:

Unfreezing stage

Moving to a New Level or change stage

Refreezing Stage

“The first stage involves finding a method of making it possible for people to let go of an old pattern that was counterproductive”.

“The second stage involves a process of change- in thoughts, feelings, behavior, or all three”.

The Target population or change group are convinced the new way is better than the

old

“The third and final stage consists of establishing the change as a new habit or process”. This process is done by:

Establishing supportive mechanismsSuch as policies, rewards, ongoing support

Kaminski, J. (2011, March 23). Theory applied to informatics-Lewin's Change Theory. 6(1).

KURT LEWIN’S CHANGE MANAGEMENT THEORY

THE CHANGE THEORY (ToC)

“Approach championed by realist methodologist…”

“Developed in U.S. in an effort to find ways of evaluating processes and outcomes in community-based programs…”

Defined as: “A systematic and cumulative study of the links between activities,

outcomes and contexts of the initiative”

Douglas, F. C., Gray, D. A., & Van Teijlingen, E. R. (2010). Using a realist approach to evaluate smoking cessation interventions targeting pregnant women and young people. BioMed Health Services Research, 10(49), 1-7.

“ToC will link outcomes and activities and explain how and why the desired change is expected to come about”

“Proponents of ToC often advocate the use of Logic models in the process”

“…as a means of identifying and intervention’s inputs and activities and its intended outcomes”

Douglas, F. C., Gray, D. A., & Van Teijlingen, E. R. (2010). Using a realist approach to evaluate smoking cessation interventions targeting pregnant women and young people. BioMed Health Services Research, 10(49), 1-7.

LOGIC MODEL

A SECOND THEORY:THE CAUSAL THEORY

“Dr. Faye is a psychologist, marriage and family therapist and forensic evaluator. She is the founder and clinical director of the non-profit Parenting and Relationship Counseling Foundation (PaRC) in Granada Hills, California”.

Snyder, F. (2012). The Causal Theory. Retrieved from Dr. Faye Snyder The Originator of The Causal Theory: http://www.drfayesnyder.com/the-causal-theory.html

 

“The Causal Theory is a progressive and controversial theory based upon”

“Cause and Effect”

She is the originator of The Causal Theory

“The Causal TheoryAssumes that personality and behavior

Result from childhood experiencesBeginning from birth…”

It includes: Attachment Theory

Lessons from Trauma Theory

Family Systems Theory

Some behavior and cognitive models, biopsychology and Zen

“The assumption: few genetically driven causes

For behavior For humans in generalAnd None for individual traits”

Snyder, F. (2012). The Causal Theory. Retrieved from Dr. Faye Snyder The Originator of The Causal Theory: http://www.drfayesnyder.com/the-causal-theory.html 

“THE CAUSAL MODEL IS UNIQUEIT ASSISTS IN THE CHOICE OF BEHAVIOR

CHANGE TECHNIQUES…”

“The Theory is not just practical; it is supported by research”

Causal theory is based on the concept that personality is created not born

Ansari, R. M., Dixon, J. B., & Browning, S. A. (2013). Application of causal model to maternal smoking cessation intervention in pregnancy. Open Journal of Preventive Medicine, 3(4), 347-354.

Snyder, F. (2012). The Causal Theory. Retrieved from Dr. Faye Snyder The Originator of The Causal Theory: http://www.drfayesnyder.com/the-causal-theory.html

 

Policy Implications

Borland, T., Babayan, A., Irfan, S., & Schwartz, R. (3013, May 14). Exploring the adequacy of smoking cessation support for pregnant and postpartum women. Retrieved from Bio Med Center Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658958/

Absence of a county smoking cessation program can be a major barrier.

Emphasize, “…the importance of integrating tobacco-focused policy, practice and programming into reproductive and child health fields”.

“…policy that addresses smoking during pregnancy should be, “a pillar of any maternal and child health strategy.”

“…affordable Nicotine Replacement Therapy (NRT) …”; “…a necessity to establishing a comprehensive system…”

Policy Implications Continued

Possible recommendations to include polices beyond smoking cessation could be:

Another barrier to cessation: “…easy access to cigarettes and exposure to other smokers and secondhand smoke…”

greater taxation of tobacco products measures to reduce the availability of cheap cigarettes further development of smoke-free policies

Need For:

Further Policies Centered on Social Determinants of Health: poverty reduction, housing and education

supportBorland, T., Babayan, A., Irfan, S., & Schwartz, R. (3013, May 14). Exploring the adequacy of smoking cessation support for pregnant and postpartum women. Retrieved from Bio Med Center Public Health:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658958/

What would be the eventual desired outcome?

The desired outcome is to reduce women smoking during pregnancy by at least 30% in the next three years to put Mecosta County under the 2012 state average of 19.3%.

HP2020=Healthy People 2020 targets

Sources: Michigan Department of Community Health; US Census Bureau;

County Health Rankings; MI Department of Technology, Management

and Budget; Michigan League for Public Policy; Michigan Care

Improvement Registry.

EVALUATION

How long would you anticipate before you saw the changes?

Once the plan is put into effect, we should see a slow decrease in the number of women smoking during pregnancy. This should be decreased the most at our goal time.

EVALUATION

What interim outcomes might you track?

We would track the statistics yearly of: The number of pregnant women using the healthcare

coverage for prenatal care Number of pregnant women accepting education by

providers on the dangers of smoking Number of pregnant money using the Maternal Infant

Health Program through Michigan Medicaid Watching for a reduction in low birth weight

percentages Watching for a reduction in infant mortality Checking to see if the number of tobacco products

have decreased.

EVALUATION

Are there already available measures that would help track any of the

changes?

Yes, there is an ability to measure and track changes from year to year.

Available State and local statisticso Yearlyo Bi-yearly

EVALUATION

Ansari, R. M., Dixon, J. B., & Browning, S. A. (2013). Application of causal model to maternal smoking cessation intervention in pregnancy. Open Journal of Preventive Medicine, 3(4), 347-354.

Borland, T., Babayan, A., Irfan, S., & Schwartz, R. (3013, May 14). Exploring the adequacy of smoking cessation support for pregnant and postpartum women. Retrieved from Bio Med Center Public Health: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3658958/

Current tobacco use and secondhand smoke exposure among women of reproductive age - 14 countries, 2008-2010. (2012). MMWR: Morbidity & Mortality Weekly Report, 61877-882.

District Health Department #10 (2014). Mecosta County health profile chartbook. Retrieved from http://www.dhd10.org/images/Mecosta_Chartbook_2013__Feb_18_2014.pdf

Douglas, F. C., Gray, D. A., & Van Teijlingen, E. R. (2010). Using a realist approach to evaluate smoking cessation interventions targeting pregnant women and young people. Bio Med Health Services Research, 10(49), 1-7.

Gilman, S. E., Breslau, J., & Subramanian, S. V. (2008). Social Factors, Psychopathology, and Maternal Smoking During Pregnancy. American Journal Of Public Health, 98(3), 448-453.

Kaminski, J. (2011, March 23). Theory applied to informatics-Lewin's Change Theory. 6(1).

REFERENCES

Kim, S. Y., England, L. J., & Kendrick, J. S. (2009). The Contribution of Clinic-Based Interventions to Reduce Prenatal Smoking Prevalence Among US Women. American Journal Of Public Health, 99(5), 893-898.

Leonard, T. (2001). Ten best reasons not to smoke while you’re pregnant [Brochure]. Santa Cruz, CA: Journeyworks Publishing

Mecosta Osceola Intermediate School District (2011). Resources for Mecosta & Osceola Counties. Retrieved from http://view.officeapps.live.com/op/view.aspx?src=http%3A%2F%2Fwww.moisd.org%2Fdownloads%2Fgenedfiles%2Fresources_for_mecosta_county_and_surrounding_area_20110928_194159_5.doc

Ricketts, S., Murray, E. K., & Schwalberg, R. (2005). Reducing Low Birthweight by Resolving Risks: Results from Colorado's Prenatal Plus Program. American Journal Of Public Health, 95(11), 1952-1957.

Snyder, F. (2012). The Causal Theory. Retrieved from Dr. Faye Snyder The Originator of The Causal Theory: http://www.drfayesnyder.com/the-causal-theory.html

Summaries for patients. Preventing tobacco use and related diseases in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. (2009). Annals of Internal Medicine, 150(8), I-46.

REFERENCES