Field Experience Log #1
Title of Event / Sponsors: Rutland County Maternal-Child Health Coalition Tobacco Cessation in Pregnancy Meeting / Vermont Department of Health and the Rutland County Maternal-Child Health Coalition
Preparation Steps Taken: Prior meeting minutes provided by Bethany Yon, Nutritionist at the Vermont Department of Health were reviewed. Pregnancy Risk Assessment Monitoring System (PRAMS) Data from the CDC at https://www.cdc.gov/prams/tobaccoandprams.htm was also reviewed.
Place / Date / Time / Length: Rutland Area Visiting Nurses and Hospice (RAVNAH) in Rutland, Vermont / May 19, 2017 / 9:30 / 2 hours
Topic Under Discussion: Pilot project for smoking cessation program for pregnant women. Names of Participants and Their Titles: Joanne Calvi (District Director / Nursing Supervisor Vermont Department of Health), Jill Hamilton (Registered Dietician / WIC Supervisor, Vermont Department of Health), Bethany Yon (Nutritionist, Vermont Department of Health), Kathleen Romano ( RN supervisor at Rutland Women’s Health Care), Sarah Cosgrove (Respiratory Therapist, Asthma Educator, Community Health Team at Rutland Regional Medical Center), Marjanna Barber-Dubois (QI Facilitator, Community Health Improvement at Rutland Regional Medical Center), Rhonda Williams (Chronic Disease Prevention Chief, Vermont Department of Health), Allison Kurti (University of Vermont Behavioral Health), Marissa Wells (University of Vermont Behavioral Health)
Brief Description of the Testimony / Meeting / Event: Rutland Regional Medical Center’s Women’s Health Clinic is partnering with the Vermont Department of Health to focus on decreasing the rate of smoking in pregnancy. Collaboratively, they are working with area partners to complete a pilot project for an incentive based smoking cessation program, modeled off an University of Vermont based incentive program. This meeting was a review of progress to date, the plans for initial roll out of the pilot project, and the plan for provider education.
Description and Analysis of the Health Policy Issue and Its Implications for Health Care:
Many behaviors and lifestyle choices that individuals choose to take part in significantly impact their health. One such health determinant, the behavior choice to smoke, is the leading cause of preventable disease and death in the United States (Shi & Singh, 2015). Smoking is one of the 3 health behaviors that contributes to four chronic diseases, leading to 50% of deaths in Vermont (Vermont Department of Health, 2017). For women who smoke during pregnancy, there are many additional health concerns related to the impact of smoking on the pregnancy and fetus as well. Some examples of these health concerns are an increased risk for miscarriage, certain birth defects, premature births, low birth weights, and SIDS (Centers for Disease Control and Prevention, 2016).
With the continued high rate of smoking in pregnancy in Vermont, the Maternal Child Health Division of the Vermont Department of Health is focused on addressing this public health concern. Rutland Regional Medical Center was selected as a site for the smoking cessation pilot project for two reasons. First, the Rutland Women’s Health clinic has been working to create smoking cessation programs for pregnant women. Second, the smoking rate during pregnancy is the highest in the state at 29.3%, and has the third lowest smoking cessation rate during pregnancy of 11.2% (Personal Communication, Sarah Cosgrove, May 19, 2017). The grant funded pilot project is looking to provide a financial incentive to women that take part in the smoking cessation program, which includes individual and group counseling, along with urinalysis to confirm compliance with smoking cessation.
Smoking during pregnancy has many implications on health and health care. As noted above, smoking leads to many preventable health conditions. This leads to significant health care costs to treat these medical issues. Between 2000 and 2012, it has been estimated that $133 billion has been spent in health care costs associated to treating tobacco-related illnesses (American Cancer Society, 2016). Melvin, Adams, Ayadi, and Rivera (2004) reported that in 1996, $366 million was spent on neonatal healthcare costs associated to maternal smoking during pregnancy.
The public health program being implemented in this community looks to provide a multidisciplinary team of providers with the education and training they need to educate, support and empower women to make the needed behavior modifications to successfully quit smoking. In addition, they will be utilizing an incentive based program targeted to this specific, high-risk patient population. Shi & Singh (2015) identified such methods as being avenues to motivate behavioral changes in health promotion and disease prevention.
From the public health perspective, it is not the treating of the disease caused by smoking that needs the attention. It is addressing the cause of these conditions, the behavior of smoking, that needs to be the focus to achieve improvements (Harvard University School of Public Health, 2014). Shifting the focus from one of disease treatment to health promotion through primary prevention interventions is key to improving population and public health. Such primary prevention strategies include therapeutic community efforts, such as the program described above, to assists people with smoking cessation to prevent the health conditions that can result from smoking. Hopefully in the future, there will be an increase focus and implementation of such primary prevention programs to improve the health of populations and decrease the costs of healthcare across the United States.
American Cancer Society. (2016). Tobacco: The true cost of smoking. Retrieved from https://www.cancer.org/research/infographics-gallery/tobacco-related-healthcare-costs.html
Centers for Disease Control and Prevention. (2016). Tobacco use and pregnancy. Retrieved from https://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/inde x.htm
Harvard University School of Public Health. (2014). United States health policy. Retrieved from https://courses.edx.org/dashboard
Melvin, C. L., Adams, E. K., Ayadi, M. F., & Rivera, C. C. (2004). State estimates of neonatal-healthcare costs associated with maternal smoking: United States 1996. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5339a2.htm
Shi, L., & Singh, D. A. (2015). Delivering health care in America: A systems approach (6th ed.).
Burlington, MA: Jones & Bartlett Learning
Vermont Department of Health. (2017). 3-4-50: Prevent Chronic Disease. Retrieved from http://www.healthvermont.gov/3-4-50