Blog 8: Key Determinants

Problem definition:

Smoking increased the rate of preterm birth in pregnant women

Facts about Smoking during Pregnancy

http://americanpregnancy.org/pregnancyhealth/smoking.html  

1)   Direct smoking: when you smoke your baby smokes as well.

a.     When a mother smokes, inhale poisons such as nicotine, lead, arsenic. And carbon monoxide. They get into the placenta, a tissue that connects to your baby and sends oxygen and nutrients and eliminates waste.

2)   Second hand smoke

a.     According to the American Lung Association, new studies have shown that if a woman is around second hand smoke during pregnancy they are added risks. Greater chance of having a baby that weight too little and may have health problems.

3)   Nicotine replacement therapy such as patch can still affect your baby

a.     Discuss it with a health care provider

Key determinants: http://www.gov.ns.ca/hpp/publications/TC/Loppie_Presentation.pdf

1)   Biological determinant: http://www.nice.org.uk/nicemedia/documents/smoking_and_health_inequalities.pdf

a.     Children from lower socio-economic households are more likely to be exposed to tobacco smoke in the home (54%) compared with those from professional households (18%).

b.     Migration and low education daily consumption

2)   Socioeconomic determinant: http://www.biomedcentral.com/content/pdf/1471-2458-10-325.pdf

a.     The most preventable risk factor for an unsuccessful pregnancy outcome

b.     Marginal and unemployed smokes the most

c.      Posttraumatic tress disorder (PTSD)

                                               i.     Higher odds of smoking and nicotine dependence and lower rates for quitting

                                              ii.     Depression

3)   Educational level

a.     Younger women prone to smoke more during pregnancy

b.     Due to lack of education

c.      Unaware of health related consequences

d.     Age à intermediate factor serving as a media for the causes of the causes

e.     Common: cope with stress, less favorable social networks and poorer economic conditions

4)   Environment determinant

a.     Partner’s smoking

b.     Urban smoke more than in rural

5)   Attending prenatal care: 61.6% of smokers compared with 85.6% of non-smokers during pregnancy attended the classes meaning, those who attended the prenatal class were less likely to smoke.  This is considered a behavioral determinant specifically because it depends on the Mother’s behavior (action) of consistently attending class. ( http://www.iomedcentral.com/content/pdf/1471-2393-10-24.pdf)

6)    Occupation is another behavioral determinant of smoking in general. Direct statistics could only be found from a study performed in Canada, where the highest percentage (55.5 %) of workers in the fishing/foresting/mining profession smoked. The second and third highest rates of smoking by occupation were transportation and construction workers where 46.1 and 44.6% of the workers smoked respectively.

More of these numbers can be found in http://www.google.com/imgres?imgurl=http://www.hc-sc.gc.ca/hc-ps/images/pubs/tobac-tabac/1996-work-travail/fig2-eng.gif&imgrefurl=http://www.hc-sc.gc.ca/hl-vs/pubs/tobac-tabac/1996-work-travail/part1_smoking_prev_e.html&usg=__MPRlqYbr4_iRCNWE8mOd1BVGJwc=&h=401&w=452&sz=16&hl=en&start=0&zoom=1&tbnid=GTuWFrqE9MLAaM:&tbnh=171&tbnw=189&prev=/images%3Fq%3Dsmoking%2Brates%2Bby%2Boccupation%26um%3D1%26hl%3Den%26sa%3DN%26rlz%3D1C1SNNS_enUS383US383%26biw%3D1366%26bih%3D643%26tbs%3Disch:1&um=1&itbs=1&iact=hc&vpx=146&vpy=87&dur=1496&hovh=211&hovw=238&tx=112&ty=50&ei=QenxTILNI8OblgelurySCg&oei=QenxTILNI8OblgelurySCg&esq=1&page=1&ndsp=17&ved=1t:429,r:0,s:0 (Reference is this link it’s a graph)

Interesting fact: Researchers found that almost 22 percent of pregnant white women aged 15 to 44 smoked cigarettes, compared with just over 14 percent of pregnant African American women and 6.5 percent of Hispanic women in the same age range.  The study was done by the Substance Abuse and Mental Health Services Administration.

Read more: http://www.abc2news.com/dpp/news/health/many-women-still-smoke-while-pregnant#ixzz2PSMSUJiC

Blog 7: Final Paper Preview

Hello again! Throughout the research that I’ve done, I’ve decided to move away from the vaccines, and focus on another topic: Smoking in pregnant woman, or tobacco usage while pregnant. Approximately 13% of women reported smoking during the last three moths of pregnancy. Also women who smoked three months before the pregnancy, 45% quit during, and among other women who quit, 50% relapsed within six months.  The problem definition that I will focus on is:

Tobacco usage while pregnant is prone to a more likely preterm birth, Sudden Infant Death Syndrome (SIDS).

Questions that arise from this problem definition: why are they at risk? Why is tobacco so dangerous? Why is the vulnerable child unhealthy? What are the consequences? And so forth. These questions and the problem definition lead to surveillance, its determinants, and the magnitude of the problem.

Surveillance:

Is the monitoring of the behavior, activities, or other changing information of a suspected activity. In the world of public health, there are two types: passive and active. Passive surveillance is the issue brought up to gather data from all reporting health care workers, such as communicable disease. On the other hand, active surveillance provides a stimulus to health care workers in the form of individual feedback or other incentives and they actually go find cases requiring more time and resources.

Before smoking can be eradicated or not, health concerns must be listed and analyzed. The main surveillance that is used for smoking while pregnant is surveying. Major surveillance systems in the division included Pregnancy Risk Assessment Monitoring System (PRAMS), National ART Surveillance System (NASS) and the Pregnancy Mortality Surveillance (PMSS). PRAMS is a surveillance project from the CDC and state health departments that collect state specific, population based data on maternal attitudes and experience before, during and after pregnancy.

Example of study that was done with passive surveillance, between the years of 2000-2008 has shown that there’s a prevalence estimate and 95% confidence intervals were calculate for smoking during the three months prior to pregnancy. Focusing on the United States area, , the highest women between the ages of 20 and 24 had a 19.3% and less than 12 years of education 22.5% or were on Medicaid insured during prenatal care 22.1%.  (Reference: http://www.cdc.gov/prams/TobaccoandPrams.htm).

An example of a survey that was done in 2008:

Percentage of mothers that smokes in three months before pregnant.

Percentage of mothers that smoked in the last three months during pregnant.

The studies above:

(Reference: http://healthland.time.com/2011/07/12/why-its-bad-to-smoke-while-pregnant/ )

Based on the statistics, Sudden Infant Death Syndrome, or SIDS, is defined as the sudden death of an infant less than one year of age that cannot be explained after a thorough investigation is conducted such as autopsy, examination of death scene and a review of clinical history. IT IS THE LEADING CAYSE AMONG INFANTS AGED between 1 – 12 months, and third leading cause in overall infant mortality. Even though, there’s a reduce risk of 50%, it is still a priority.

States: Arizona, Colorado, Connecticut, Louisiana, Michigan, Minnesota, New Jersey, New Mexico New Hampshire, Wisconsin.

Reference: http://www.cdc.gov/sids/CaseRegistry.htm

SUID Case Registry State Grantees, 2012

The figure above, it is a state based surveillance system that supplements current vital statistics based surveillance methods. It builds upon the National Center for Child Death Review (NCCDR) system.

Once the surveillance is done, it is shown that surveying is not a great way to ask pregnant women if they smoke, because it has shown that some lie that they don’t because they feel embarrassed.

Once the magnitude of the SIDS is clarified and the surveillance of smoking while pregnant is taken into account, key determinants, such as indirect indicator and direct indicators. In public health a determinant in general is an influencing element or factor in a problem. Related to my problem definition, determinant would relate to an increase or decrease in the likelihood of smoking while pregnant.

The problem from these statistics is may have taken a long time to review the case and data entry. Also Improve Data Quality by implementing efforts to reduce missing or unknown information.

Key determinants: References (http://www.ncbi.nlm.nih.gov/pubmed/11733454 )

1)   Educational level (12 years only)

2)   Low social class, socioeconomic; environment

3)   Single mothers

4)   Smoking parents

These key determinants below are referred as indirect or direct.

1)   The number of years of education of a mother is also a determinant as to whether she will smoke during pregnancy. Those women twenty or older with a college degree are more likely to not smoke during pregnancy. However as it was read above, if they had less than 12 years of education, 23.7% of women will smoke during pregnancy, having the highest rate and prone for their children to develop SIDS syndrome, correlating to ages between these women 15 to 19 years old.

Reference:  http://www.hpb.gov.sg/news/article.aspx?id=6028

2)   Low social class, or socioeconomic. Based on a multivariate analysis, it was shown that smoking was greatly related to this socio economic status. Women in the lowest family income had the highest rates of cigarette use before, during, and after the pregnancy.  References:  http://www.childtrendsdatabank.org/pdf/11_PDF.pdf

3)   Single mothers as well are more prone to cigarettes due to stress in the environment and attending prenatal classes. It is an indirect determinant, meaning that 61.6% of smokers compared with 85.6% of non -smokers during pregnancy attend the classes. This means that the mother’s behavior or action is shown here. References:  http://www.biomedcentral.com/content/pdf/1471-2393-10-24.pdf

4)   These mothers, that had a consistency in their family with smoking, are more likely to smoke. A Student Health Survey in 2006 was conducted by the Health promotion Board, showing that a significantly higher percentage of youth smokers (59%) had at least one parent who smoked, as compared to nonsmokers (34%).

References:  http://www.hpb.gov.sg/news/article.aspx?id=6028

INTERESTING Statistics: SIDS

1)   2,226 à the number of infants between the ages of one month to one year that passed away because of SIDS. It has an amazing strength since it was vital statistics shown by the National Center for Health Statistics.

2)   Babies of mothers who smoke during pregnancy have a 3 times greater risk for SIDS. Babies whom breath secondhand smoke have2.5 times greater risk of SIDS.

3)   40 à the number of time of greater risk of SIDS a baby has if he/she sleeps in an adult bed

4)   African American Babies have twice a greater risk

5)   Studies show that for infants who received any breast milk for any duration, the likelihood of SIDS was 60% lower.

(reference: http://www.cjsids.org/resource-center/sids-statistics.html)

Also interesting fact: worldwide, 250 million women use tobacco daily, and according from the 14^th World Conference on Tobacco or Health held in 2009 in Mumbai. (Reference: http://healthland.time.com/2011/07/12/why-its-bad-to-smoke-while-pregnant/)

Vaccine, mandatory or not mandatory?

Parents are refusing their children to get vaccines.

The issues that the United States is having are that in small little towns, there’s a strong belief in NO vaccines. States in American allow exemptions from vaccines due to religious, moral, or philosophical beliefs, meaning that vaccines are not mandatory. However failing to vaccinate is a failure to protect the interests of those who are most vulnerable. Immunizing a sufficient proportion of the population creates a herd immunity, which imparts protection to those that are unvaccinated. In the Michigan Law Review it clearly highlights rules that pose a problem of aggregation using tort’s law which states that the if an individual’s rights infringe on the rights of another, this law provides a way to redress the harm caused. The numbers are rising rapidly increasing the likelihood of an infectious outbreak.

Vaccines are an important public health issue because it has been raising increasingly the amount of children that are not vaccinated. Influenza has given too much of a risk in the States, and the stakes are high. This is a socially relevant issue because it was reach the epidemic level here in the States. Vaccines are a protection against those viruses that will infect the entire population. If we don’t have a number of people of protect, where does the herd immunity will go and what will happen to those communities around the states.

MMR defined by the Medline Plus is one of the recommended childhood immunizations that protect you from measles, mumps or rubella. The second shot is recommended to cover people who may not have gotten full protection from the first MMR shot. However this shot has caused parents to refuse vaccinations because it appeals to give autism since 1998 a paper written by Andrew Wakefield on the Lancet, causing twenty percent of the population of the USA thinks that MMR causes autism. However this vaccine is given at a very early age where autism can also be detective, ages from four to six.

However, many studies and epidemiologist studied and analyzed the MMR vaccine, which has proven that it doesn’t cause vaccine. However these presents have led an upraise against vaccines also due to mercury and other ingredients that are found in the vaccine that can cause autism from what they know. However it has proven false.