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Goal Statement: Increase pregnant smokers’ awareness of the adverse effects of tobacco use on unborn babies and identify local resources that can be utilized to help pregnant women quit smoking and maintain a tobacco-free lifestyle.

Significant Findings: In Okaloosa County, Florida, studies have found that pregnant women who continue smoking while pregnant comprise nearly double the state average of 7.4 percent among White women (e.g. 13.1 percent), and nearly four times the 3.6 percent of Black women in Florida (McLaughlin, 2017). Given the wide range of adverse outcomes associated with tobacco use during pregnancy, the author recommends that various stakeholders and community institutions work collaboratively to devise plans, strategies, and interventions at various levels to address this problem and implement different programs (e.g., Baby & Me Tobacco Free) that aim to help pregnant smokers with their tobacco dependence and connect them with resources and treatment services that can improve health outcomes (Nyambe, Van Hal & Kampen, 2016).

Objectives/Strategies/Interventions/Next Steps

The primary goal of this Social Change Portfolio is to increase pregnant smokers’ knowledge of the adverse effects of tobacco use during pregnancy and postpartum, while the main objective is to decrease the negative health outcomes associated with tobacco use during pregnancy (i.e., decrease rates of miscarriage, premature birth, low birth weight, stillbirth, and infant mortality in Okaloosa County, Florida; Florida Department of Health, n.d; Salihu, Aliyu, Pierre-Louis & Alexander, 2003). To reach the goal and attain the objective, it is essential to assess what are the most salient risk and protective factors that contribute to the high rates of negative health outcomes in the area. In this respect, one risk factor that has been shown to contribute to higher rates of pregnant smokers in rural areas is limited educational attainment by the mother. For example, the prevalence of smoking is highest among women with a high school diploma or GED, followed by those with less than a high school diploma (Drake, Driscoll & Mathews, 2018). On the other hand, local WIC clinics represent an important community-level protective factor, as they provide pregnant smokers in rural areas with various programs, services, and resources (e.g., information, education, counseling interventions, advice, support, and smoking cessation services) aimed at curbing negative outcomes of smoking during pregnancy (Olaiya et al., 2015).

Based on these findings, the author believes that one strategy that can be used to improve health outcomes in the area involves a collaborative effort between various providers in the community (i.e, mental health providers, health care clinicians, such as primary care physicians, gynecologists, nurses, and health department personnel) to use the same approach to opening the dialogue about tobacco use during pregnancy. One such intervention is the 5As approach: ask, advise, assess, assist, and arrange, which takes only a few minutes to complete and may promote quitting among pregnant smokers, as well as improving maternal and child health outcomes in the long run (American Association for Respiratory Care, 2020; Olaiya et al., 2015). Ensuring that all providers use the same approach, as well as the same available resources in the community, would evidence to the public (i.e., pregnant smokers) not only a unified effort on their part, but also that these clinics are working towards a common goal to benefit the entire community.

To take things a step further, the author suggests that counselors in Okaloosa County, Florida collaborate with personnel from local Women, Infants, and Children (WIC) clinics to address the issue of tobacco use during pregnancy. One way to accomplish this step would be by implementing the 5As approach at all WICs locations, beginning with, if necessary, training the personnel on how to conduct the interview, and continuing with assisting and arranging treatment for tobacco dependence services by referring and connecting pregnant smokers with the resources that can help them quit for good (e.g., counseling interventions, advice, support, support groups, and smoking cessation services (Fallin-Bennet et al., 20; Olaiya et al., 2015).

Another avenue that can be employed to enhance positive health outcomes involves working with local stakeholders to advocate for the implementation of a smoking cessation program aimed directly at helping pregnant women quit using tobacco. One such program is the BABY & ME -Tobacco Free Program (BMTF), an evidence-based cessation initiative created to help pregnant women quit smoking for good and reduce the burden of tobacco use on the pregnant and postpartum population (Baby & Me-Tobacco Free Program, 2020). In addition to helping pregnant women quit smoking for good, the program also offers those who successfully quit diaper vouches for up to twelve months, provided they test tobacco-free.

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