Blog 11

Blog 11: Intervention Implementation and Evaluation

As a policy maker for health issues, an implementation that I will address

Screening to all pregnant women for tobacco use and all receive best practice cessation counseling

This is a policy that should be implemented to all those pregnant women’s or every woman in their communities should be reinforced to go. Tobacco usage in general is already bad and screening could prevent it to these women and to orient them. Also if a woman doesn’t smoke and she has high levels of cotinine it is highly due to second hand smoking. This could be caused by one of the determinants, environmental, such as her workplace or even a member in the household which could be even prevented and leading to another implementing program which is:

Education programs for women/partners as well as health and social services providers.

As well as prenatal care services will be held, a short term outcome of the program will be that since these workers know the sighs and symptoms of preterm labors an the appropriate response they can share the guidelines and labor assessment if the screening doesn’t look good before the 22 weeks pregnancy.

The effectiveness of this implementation is considered secondary and tertiary since they are directed to each person individually as well as a solution for the aftermath. To show and prove its effectiveness is the amount of pregnant women who come to get screened. If a group number of pregnant women are recorded per community per week, it can be seen if it is effectiveness based on their appointments and if they come. Also based on their screening and their cotinine level if values of 10ng/mL or less is considered no smoking, 10 ng/mL to 100 ng/mL are associated with light smoking or moderate passive exposure, and levels above 300 ng/mL are seen in heavy smokers - more than 20 cigarettes a day. In urine, values between 11 ng/mL and 30 ng/mL may be associated with light smoking or passive exposure, and levels in active smokers typically reach 500 ng/mL or more. Based on this data you can divide the women into groups and based on their data you can know what statistics or measurements you have to take.

For this to be implemented, I will like it to be a policy in their community that for every woman pregnant, they should have a screening for cotinine levels. During the 18 to 22 weeks. The barriers that will be encountered is the social factor. Some women would not like to go to screening or they will not go just because they don’t feel like it. To overcome this issue, free screening could be offered or a minimal cost that they could afford or create medias for it, and not sell it as a smoking propaganda. The advertisement will be more for a check up and it could be free. Another barrier is transportation. Some women due to economical issues, they can’t go to a prenatal care; however, for this to be overcome, prenatal care services could be placed into those communities for screening, prenatal care services and educational programs that will follow up with the program. Another barrier that could be encountered is the infrastructure (what is mentioned above) and also the issue with the money. The money can be donated from potential action groups that could make fundraisers or even get grants for this public health issue, as well governmental support.

Once I have the barriers, the stakeholders that I will communicate the information too will be:

-       The pregnant mothers

-       Physician: Neonatologist and Obstetricians and Gynecologists

-       Prenatal Care Staff

-       National Institute for Health and Clinical Excellence

The pregnant mothers will be the first one to talk to. Once they are convinced, then we are able to talk to the other stakeholders for money, services and more. My strategy for these pregnant women is to tell them that the screening will be a way to check on their health and their baby. There could also be educated forums that these women can go to. Another way of doing it is these women have Medicaid meaning that their primary physicians for the screening view should contact them. These will make them go, and with that we can count the number of women who came and who didn’t for other extra measures to take such as to see if they had trouble to come to the prenatal care services or to educate them as to why screening is such an important thing to do. Once that is done, we can contact the National Institute for Health and Clinical Excellence for grants or any other action groups, and once money is secured, prenatal care staff as well as physicians.

The evaluation for this effectiveness for my intervention will be the total number of women in a community, and based on that the number of pregnant women who go to these screenings based on their appointment records and if they come. Based on that we can tell if it is working or not and to see the other measures to take. Identify one partner to coordinate the data collection and collate the data from the various sources for the evaluation.

Blog 10

Problem definition: There's a higher prevalence of preterm births in the USA among pregnant women who smoke.

Implementations and Interventions: Tobacco usage while pregnant and reducing preterm birth.

The purpose of implementing programs or policies is to execute a model for those pregnant women or mothers with the issue of tobacco usage as well as other stakeholders such as prenatal care services and any member in the community. For these implementations to work, it should be focused into those key determinants that were looked into and to the stakeholders as well.

Our main stakeholder is the pregnant woman with the issue of their behavior and the services that are provided:

·      Screening to all pregnant women for tobacco use and all receive best practice cessation counseling

This is a policy that should be implemented to all those pregnant women’s or every woman in their communities should be reinforced to go. Tobacco usage in general is already bad and screening could prevent it to these women and to orient them. Also if a women doesn’t smoke and she has high levels of cotinine it is highly due to second hand smoking. This could be caused by one of the determinants, environmental, such as her workplace or even a member in the household which could be even prevented and leading to another implementing program which is:

·      Education programs for women/partners as well as health and social services providers.

As well as prenatal care services will be held, a short term outcome of the program will be that since these workers know the sighs and symptoms of preterm labors an the appropriate response they can share the guidelines and labor assessment if the screening doesn’t look good before the 22 weeks pregnancy.

The Strategy of these two programs combined:

·      Once the screening is done between the 18 and 22 prenatal weeks, due to their results of the cotinine levels prenatal class instructions and as well education through community groups for pregnant women such as Canada Prenatal Nutrition Program (CPNP), which is already implemented, and it is already taken place.

·      Another strategy that is used for these women to be aware off.  CDC also helps states and other groups estimate the costs associated with maternal smoking through its development and promotion of Maternal and Child Health Smoking Attributable Mortality, Morbidity and Economic Costs (MCH SAMMEC) software. MCH SAMMEC is an online application that allows the user to estimate the number of smoking- attributable deaths and years of potential life lost for infants in the United States, as well as neonatal medical expenditures for certain user-defined populations.

o   These results will impact these women how the medical cost is so big and the death poll.

·      A group called National Partnership to Help Pregnant Smokers Quit aims to improve the understanding of how to intervene the best practice and postpartum smokers; develop and evaluate more powerful interventions and strengthen the nation and state based surveillance programs.

o   They’ve also provided a data book to be used for each state:

§  Prevalence of smoking during pregnancy by the mother’s ethnicity, age, and education, and the infant’s birth weight;

§   Smoking-attributable infant deaths due to SIDS;

§  Neonatal illness and health care costs attributable to smoking.

§  Summary birth statistics; • Medicaid programs for pregnant women;

§  Federal/state grant programs to reduce smoking-related adverse outcomes during pregnancy;

§  State cigarette tax and regulatory policies;

§  Maternal and Child Health smoking-cessation programs.

Another intervention:

Preterm Action group, which will include individuals and organizations.

·      Choose priority areas for action and objectives.

·      Get resources and funding and while the plan is in action collect data.

This action group will provide advice and endorsement and to implement the initiative. It is a great place to network with other women who are also going through the same path as they are. This intervention will definitely go towards those that have low income and they have a lack of education such as handling preterm births or even avoiding. This is a great way to bring a Guest Speakers and women who have gone through it or even prenatal care workers that could help those in need.

Based on these interventions we can classify them as which are the ones that it should be tackled first, meaning which is primary (low) secondary (medium) and tertiary (high):

1)    The first intervention or a primary intervention will be posting billboards, media or flyers that will show the communities that involve women who are smokers pregnant or not pregnant to stop smoking. 

2)   The screening should be a secondary prevention. Due to the data collected based on these screenings you can definitely tell what are the progress or the steps that should be taken to make this better or to prevent any risks. As well as to see what are the risks that they are involved as well as avoiding some before having the baby. 

3)    Our tertiary intervention are the educational programs for those smokers/partners that need help and be educated on the second hand smoking (environment determinant) and how to reach to prenatal care services that are available. Preterm Action group is as well a tertiary intervention meaning that is medium. To be able to prevent or reduce the amount of preterm births, with the results of the screening and the education that will be given to those pregnant women between the 18 and 22 weeks, it could definitely help these women be prepared for the worst. Also low income women will have accessibility to it since it will be help around the communities that these women live in and will have guest speakers that could help them understand and let them know that help is always around. Also prenatal care services will be held for their preterm action group. Also another way is for those women that already had a preterm birth should be reached out by the prenatal care services and avoid any future problem.

Blog 9: Stakeholders

Problem definition:There’s a higher prevalence of preterm births in the USA associated with smoking.

·        National Institute for Health and Clinical Excellence

o   National Institute for Health and Clinical Excellence

§  Produce public health guidance on interventions aimed at topping smoking in pregnancy following childbirth

§  Indirect and direct role

§  Working in: local authorities, education and wider public, private, voluntary and community sectors

§  Recommendations on the basis of reviews of evidence, economic modeling, expert advice and stakeholder comments

o   The Public Health Interventions Advisory Committee (PHIAC)

§  Set up by the NICE committee

o   Benefit from the intervention

§  are planning a pregnancy

§  are already pregnant

§  have an infant aged under 12 months.

o   How do they determine and recommend these interventions to those:

§  Carbon Monoxide content: Some suggest a CO level as low as 3 parts per million (ppm), others use a cut-off point of 6–10 ppm.

§  Take action: midwives

·      CO test and explain its physical measure or her smoking and her exposure

·      Provide information about the risk to the unborn child of smoking while pregnant

·      Health benefits of stopping

·      Normal practice to refer all women who smoke for help to quit

·      Refer to all women who smoke or have stopped smoking within the last two weeks, to NHS Stop Smoking Services

·      Help the partner’s that live in the household and second hand smoking

·      If women declines referral, leave the offer to help still

§  Take action: action for others in the public, community and voluntary sectors

·      Target:

o   GPs, practice nurses, health visitors and family nurses.

o   Obstetricians, pediatricians, sonographers and other members of the maternity team (apart from midwives).

o   Those working in youth and teenage pregnancy services, children's centers and social services.

o   Those working in fertility clinics, dental practices, community pharmacies and voluntary and community organizations.

o   Follow up interventions are effective in helping women who are pregnant to quit smoking

§  Cognitive behavior therapy

§  Motivational interviewing

§  Structured self help and support from NHS Stop Smoking Services

·      Prenatal care staff

o   Ensure services are delivered in n impartial, client centered manner

o   Sensitive to their circumstances.

o   Involve thee women in planning and development of services

o   Ensure flexible and coordinated services and take place in locations and times that are easy to access and be tailored to meet individual needs

o   Collaborate with the family nurse partnership and outreach schemes to identify additional support

o   Work in partnership with agencies that support women who have complex social and emotional needs.

·      Partners and other in the household who smoke

o   Clear advice about the danger that other people’s tobacco smoke poses t the pregnant women and babe before and after

o   Not smoking around pregnant woman, mother or baby

o   Multi component interventions that

§  Contra-indications and the potential for adverse effects from pharmacotherapies such as NRT

§  The likelihood that they will follow the course of treatment

§  Their previous experience of smoking cessation aids.

·      The Tobacco Companies

o   Tobacco/cigarretes taxes to increase

o   Might lose business

o   They don’t take advantage of this at all, they will lose customers and promotions as well

o   The issue of second hand smoking that can also affect pregnant women is an issue

·      The pharmaceutical companies

o   The use of NRT and other pharmacological supply = BAD

o   The use of this

o   Advise pregnant women who are using nicotine patches to remove them before going to bed

o   Neither vareniciline or bupropion should be offered to pregnant or breastfeeding women

Work Cited:

http://www.nice.org.uk/nicemedia/live/13023/49345/49345.pdf