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Smoking is one of the major behavioral health problems faced by pregnant women. It has been widely documented that smoking negatively affects pregnant women and their babies. In this paper a behavioral health prevention program is proposed with the goal of reducing the scope of smoking among pregnant and postpartum women and preventing health complications in the newborns. The mission and vision of the program are discussed. Stakeholder responsibilities and functions are discussed. The paper includes a brief discussion of barriers to smoking cessation and provides recommendations to improve health behaviors in pregnant women.
Behavioral Health Prevention Program
Smoking remains one of the major behavior and health problems faced by women during and after pregnancy. The seriousness of smoking effects on pregnant women and their babies have been abundantly established. The number of women-smokers in the United States steadily decreases, but smoking during pregnancy is still one of the main objects of public concern in America and the rest of the world (Cnattinguis, 2004). The number of pregnant women-smokers decreases not because more women quit smoking during pregnancy, but because more women do not smoke at all or quit smoking long before they become pregnant (Cnattinguis, 2004). Therefore, the issue of smoking cessation during pregnancy and postpartum continues to be a source of considerable health controversies. No less serious are the effects of maternal smoking on babies’ health: women who smoke during pregnancy increase the risks of physician-diagnosed asthma and wheezing in their babies (Gilliland, Li & Peters, 2000). Unfortunately, many women are unaware of the risks of smoking during pregnancy; others lack access to educational and learning materials due to social and cultural barriers. All these facts justify the feasibility of a broad behavioral health intervention program for pregnant smokers in a public health maternity clinic.
Program Mission and Vision
The goal (mission) of the proposed behavioral health program is to prevent the development of health complications in newborns, by reducing the number of pregnant and postpartum smokers and facilitating pregnant women’s transition to a new, non-smoking life. The vision is that all women deserve to live healthy lives and give birth to healthy children; this being said, all women have the right to learn about the risks of smoking and ways to improve their health behaviors long-term. It should be noted, that the proposed program builds on the principles and constructs of the Health Belief Model (HBM); the latter was developed at the beginning of the 1950s, in an attempt to explain reasons why individuals failed to change their behaviors and prevent disease (Champion & Skinner, 2008). The model helps to explain why people do or do not take action to control their health, manage their health behaviors, and minimize the risks of illness (Champion & Skinner, 2008). According to HBM, whether or not individuals act to reduce the risks of disease depends on perceived susceptibility to these risks, perceived severity of the risks and consequences, perceived benefits from behavior changes, and perceived barriers to change (Champion & Skinner, 2008). This is an individual model of health promotion, which helps to raise individual awareness on the existing health risks, identify and reduce the perceived barriers to behavior change, and sustain the positive effects of change in the long run.
The principal program stakeholders include pregnant women attending a public health maternity clinic, nurses, health organizations and medical care providers, psychologists and counselors, interpreters, partners, families and the entire community. Here, partner involvement is particularly important: having a partner who smokes is one of the most salient factors of smoking and return to smoking among pregnant and postpartum women (DiClemente, Dollan-Mullen & Windsor, 2000). “Partner smoking appears to make a critical contribution both to the woman’s continuing smoking during pregnancy as well as in the return to smoking postpartum for spontaneous quitters” (DiClemente et al., 2000, p.iii19). Therefore, partner involvement is crucial to the success of the proposed program. In this program each party and stakeholder will need to fulfill a predetermined set of functions. Pregnant women who cannot quit smoking without the professional help will become the focus of the behavioral health prevention program.
Patients/ pregnant women: women are empowered to take control over their lives and initiate a positive change in behaviors to improve their and their babies’ health. In this program, women provide information about the barriers they face and the benefits they would like to have from changes in their health behaviors. Women who quit smoking and improve their health will also serve an effective motivational force (or cue to action) for other women in the treatment group.
Nurses: professional nurses provide education, learning and knowledge to raise women’s awareness of the major health risks and help them to improve their health behaviors. Nurses develop and implement culturally-sensitive strategies and monitor women’s progress towards positive changes in health behaviors.
Health care organizations and medical care providers: these stakeholders identify pregnant women-smokers and refer them to the proposed health promotion program. These stakeholders also provide physical (meeting space) and learning (booklets and newsletters) resources to pregnant women-smokers. Organizations and providers are responsible for training their nursing and clinical personnel to provide anti-smoking advice to pregnant women and monitor changes in babies’ health (Young & Ward, 2001).
Psychologists and counselors provide psychological support and counseling, to facilitate women’s transition to a life without smoking. Together with nurses, psychologists and counselors are responsible for patient’s follow up after the program and during the postpartum period.
Interpreters make possible the participation of the pregnant minority of women in the program, guarantee that these women receive the fullest information about the program, and realize the benefits of their participation in it.
Partners, families, and the community provide physical and emotional support to pregnant women struggling with their smoking habits. Partners and families are encouraged to participate in the program, since they cause profound effects on pregnant women and newborns’ health (DiClemente et al., 2000).
Behavioral and Psychological Barriers Impeding Behavior Modification
Pregnant women face a number of psychological and structural barriers that impede positive changes in their health behaviors. More often than not, patients simply have no motivation to quit smoking (Young & Ward, 2001). They do not feel that quitting smoking should be a matter of their immediate concern or do not realize why it is so important to quit (Young & Ward, 2001). Many patients, including pregnant women, either forget anti-smoking recommendations or do not listen to them (Young & Ward, 2001). They may lack time to deal with smoking or do not perceive the benefits of cessation as tangible and meaningful (Young & Ward, 2001). Eventually, women may lack power and self-efficacy to implement the desired change, and this is one of the main reasons why the Health Belief Model discussed earlier can support pregnant women in their way to a healthier life.
The main recommendations to help pregnant women quit smoking include education, counseling, as well as postpartum nurse and counselor follow up. Education is believed to be the most efficacious and method of positive behavior change in pregnant smokers (Windsor et al., 1986, Windsor et al., 1993). Newsletters, guides, and counseling create a unique combination of behavior change techniques that improve perceived self-efficacy in pregnant women, empower them to take control over their health, teach them about the importance of smoking cessation before, during, and after pregnancy, and monitor their progress. Pregnant women need a greater support and motivation to quit smoking than their non-pregnant counterparts; they also need to sustain changes in smoking behaviors during the postpartum period (Windsor et al., 1986; Windsor et al., 1993). That is why counseling and follow up are extremely important for pregnant women involved in the proposed program. At all stages of the program implementation, partners and family members are encouraged to 1) participate; 2) quit smoking; 3) support pregnant women through smoking cessation towards ultimate quitting (DiClemente et al., 2000). In the meantime, health care and medical organizations are recommended to provide training and support, to guarantee that nurses, clinicians, and psychologists do not forget to provide anti-smoking advice and refer women-smokers to the proposed behavioral health program in timely fashion.
Thousands of women continue smoking during pregnancy, thus subjecting their babies to unreasonable health risks. The goal of the proposed program is to prevent the development of asthma and wheezing in newborns, by reducing the scope of smoking among pregnant and postpartum women. The proposed program relies on the principles of the Health Belief Model, and its principal stakeholders include pregnant women, nurses, health organizations and medical care providers, psychologists and counselors, interpreters, partners, families and the entire community. Pregnant women face a number of barriers in their way to healthy life, but education, counseling, and nurse follow up can create a unique combination of instruments to enhance women’s self-efficacy and empower them to produce a sustained positive change in their health behaviors. This is how women can prevent the development of various health complications in their babies.