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Treating Tobacco Use During Pregnancy and Beyond

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Introduction to individual counseling techniques to use with pregnant smokers (5A's) ... I stopped smoking before I found out I was pregnant and am not smoking now. ... – PowerPoint PPT presentation

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Title: Treating Tobacco Use During Pregnancy and Beyond


1
Treating Tobacco Use During Pregnancy and Beyond
  • Dr. Monica Scheibmeir
  • Associate Professor School of Nursing
  • University of Kansas Medical Center

2
Treating Tobacco Use During Pregnancy and Beyond
  • Overview of Information
  • Maternal smoking
  • Introduction to individual counseling techniques
    to use with pregnant smokers (5As)
  • Pharmacological aids for smoking cessation
  • Office-Based reminder systems

3
Preaching to the Choir
  • Why do we care if women smoke during their
    pregnancy?
  • Risks to infant
  • prematurity, low birth weight, sudden infant
    death syndrome, cognitive delays in toddler
    years, increased risk of becoming a smoker

4
Preaching to the Choir
  • Why do we care if women smoke during their
    pregnancy?
  • Risks to infant
  • Risks to mother
  • increased risk of spontaneous abortion
    prior to 28 weeks, placenta previa, and abruptio
    placenta

5
Preaching to the Choir
  • Why do we care if women smoke during their
    pregnancy?
  • Risks to infant
  • Risks to mother
  • Economic costs to state/nation

6
Cost of Complicated Births
Complications include hemorrhage from placenta
previa, maternal infection, fetal distress,
malposition of the fetus CDC. MMWR
19974610481050
7
Neonatal Health Care Costs Related to Smoking
During Pregnancy
8
Cigarette Smoking During Pregnancy
9
Percentage of women age 15-19 who reported
smoking during pregnancy
10
Percentage of women and girls who smoke while
pregnant according to race (1999)
11
Percentage of women and girls who smoke while
pregnant according to age (1999)
12
2004 Birth Statistics Women Who Reported Smoking
During Their Pregnancy (N4,906)
13
Theoretical Basis for the 5As
  • Major assumption When a person wants to
    change a behavior, he/she goes through stages
    or a serious of changes before reaching his/her
    final destination.
  • Five stages are precontemplation,
    contemplation, preparation, action, and
    maintenance

14
Theoretical Basis for the 5As
  • The 5 Stages of Change
  • The first 3 stages are indicative of readiness to
    change.
  • Patients will use specific behaviors with certain
    stages.
  • Last 2 stages represent action (i.e. quitting,
    abstaining, drying out, cold turkey)

15
Applying the TTM Model to Tobacco Addiction
  • 5 As of tobacco cessation treatment
  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange

16
5 As Ask
  • Ask about smoking…some questions are better than
    others.
  • Do you smoke now? is okay but social
    desirability is an issue with prenatal smokers
  • Robert Wood Johnsons Smoke Free Families
    initiative suggest the following

17
5 As Ask
  • Which of the following statements best describes
    your cigarette smoking?
  • I have never smoked or have smoked fewer than 100
    cigarettes in my life.
  • I stopped smoking before I found out I was
    pregnant and am not smoking now.
  • I stopped smoking after I found out I was
    pregnant and I am not smoking now.
  • I smoke some now but have cut down since I found
    out I was pregnant.
  • I smoke about the same amount now as I did before
    I found out I was pregnant.

18
5 As Advise
  • Be clear, Be strong, and make it personal
  • Clear Its important that you quit smoking as
    soon as possible.
  • Strong Quitting smoking is the most important
    thing you can do to protect your health.
  • Personal I know that quitting smoking is hard.
    I am here to help you. When you are ready, I
    will work with you to be successful.

19
5 As Assess
  • Assessing a persons readiness to quit smoking
  • The decision to quit lies in the hands of each
    patient.
  • Patients differ in their readiness to commit to
    quitting.
  • Your actions will be based upon the patients
    readiness to make a change.

20
Is the Patient Ready to Quit?
  • Does the patient now use tobacco?
  • Yes No
  • Is the patient now Did the patient
  • ready to quit? once use
    tobacco?
  • No Yes Yes
    No
  • Promote provide prevent Encourage
  • motivation treatment relapse abstinence

21
Patient Not Thinking About Quitting
  • Do
  • Strongly advise to quit
  • Raise awareness of health concerns
  • Demonstrate empathy, foster communication
  • Leave decision to patient
  • Donts
  • Persuade
  • Cheerlead
  • Tell patients how bad smoking is an a judgmental
    manner

22
5As Advise
  • Many pregnant women are tempted to cut down
    the number of cigarettes they smoke instead of
    quitting.
  • Cutting down to less than 5 cigarettes a day
    can reduce risk, but quitting is the best thing
    you can do for you and your baby.

23
5As Advise
  • Its never too late to quit smoking during
    your pregnancy. After just one day of not
    smoking, your baby will get more oxygen.
  • Each day that you dont smoke, you are
    helping your baby grow.

24
5As Advise
  • Weight gain during pregnancy is normal. If you
    are worried about gaining weight when you quit
    smoking, now is an ideal time to quit.
  • The weight you gain is far less harmful than
    the risk you take by smoking.

25
5 As Assist
  • Suggest and encourage the use of problem-solving
    methods and skills for tobacco cessation.
  • Provide social support as part of the treatment.
  • Arrange social support in the smokers
    environment.
  • Provide pregnancy-specific self-help smoking
    cessation materials.

26
5 As Assist
  • Know your reasons for quitting.
  • Change your daily habits.
  • Keep your hands and mouth busy.
  • Deal with negative emotions.
  • Cope with withdrawal.
  • Handle others smoking around you.
  • Find support for your quitting.

27
5 As Assist
  • If you smoke when you feel
  • Stressed or nervous...
  • Bored or lonely...
  • Angry or upset...
  • Try doing this
  • Go for a walk take a hard candy break remind
    yourself what you do well
  • Talk to a friend plan a baby project do
    something you enjoy listen to music
  • Write down your feelings take a walk talk to a
    friend

28
5 As Assist
  • Ask the friend or family member to quit with
    you.
  • Ask others not to smoke around you, now that
    youre pregnant.
  • Make your home and car non-smoking areas.
  • Leave the room when others light a cigarette.
  • Plan ways to distract yourself when someone else
    is smoking. Keep your hands and mouth busy.

29
5 As Arrange
  • Follow up to monitor her progress with smoking
    cessation
  • Provide and identify support
  • Identify any high risk situations
  • Counsel the patient about potential relapse
  • Talk about her success

30
5 As Arrange
31
5 As Arrange
  • Options will vary according to what patient is
    interested in
  • Referral Sources
  • KDHE and Kansas Tobacco Use Prevention Program
  • Kansas Quitline (1-866-KAN-STOP)
  • (1-866-526-7867)

32
When You Are Stuck!
  • The 5 Rs
  • Relevance
  • Risks
  • Rewards
  • Roadblocks
  • Repetition

33
5 Rs Relevance
  • Has the patient smoked before in previous
    pregnancies?
  • Does she have friends/family members who smoked
    in their pregnancies?
  • What does her family think about her not smoking?
  • Does she believe in the harm caused by smoking to
    her baby?

34
5 Rs Risks
  • Previous miscarriage
  • Infertility problems
  • Potential harm to infant with continued smoking
  • Potential harm to the patient during pregnancy

35
5 Rs Rewards
  • Better health for the baby
  • Home, clothes, hair, car all smell better
  • Save money by not smoking
  • Over time you will have more energy

36
5 Rs Roadblocks
  • Being around other smokers
  • Handling negative moods during pregnancy
  • Dealing with temptations, cravings, and
    withdrawal during pregnancy
  • What does she see as the biggest problem to her
    quitting smoking

37
5 Rs Repetition
  • Use each prenatal visit to inquire about
    patients smoking status
  • All providers should be consistent with their not
    smoking message no mixed messages

38
Case Studies
  • Mary is a 18 year old G1 P0 patient at your
    prenatal clinic. Her LMP would suggest she is
    12 weeks along in her pregnancy. She is
    currently single, applying for Medicaid coverage
    of her pregnancy, and is employed part-time at
    the local grocery store.

39
Case Studies
  • Bobbie is a 22 year old female who presents
    to the family planning clinic with signs/symptoms
    of pregnancy. A urine B HCG test confirms her
    suspicions. You can smell tobacco smoke on her
    breath and on her clothes.

40
Case Studies
  • Susie is a 33 year old G3 P2 female who
    presents to the prenatal clinic at 22 weeks
    gestation. When asked if she smokes she answers
    yes and goes on to say I smoked in my first 2
    pregnancies and the babies turned out fine.

41
Break Time!!
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