Final Capstone project
Precious14
Capstonepaperdraft.docxRunning Head: The Study of Effects of Smoking in Pregnant Women 1
The Study of Effects of Smoking in Pregnant Women 21
The Study of Effects of Smoking in Pregnant Women
Background
The following section will discuss the background of the topic. Smoking during pregnancy exposes the mother and unborn child to great risks. Prenatal exposure to maternal cigarette smoking (PEMCS) is linked, therefore, with many different obstetric complications. According to Bauld (2017), the complications could range from an augmented danger of ectopic pregnancy, fetal development limitation, placental previa and abruption, preterm premature rip apart of the membranes, preterm delivery, unexpected newborn death syndrome, and oral facial clefts. Anblagan et al., (2013) includes more risks such as the development of respiratory diseases, gestational bleeding, obesity and obesity associated disorders like cardiovascular as well as diabetes results that start when the child reaches puberty. However, intrauterine growth restriction is the most common of them all. Considering all these risks and the fact that women who smoke carry on with this habit during pregnancy, there is a great need to develop policies and interventions that would address this matter. As such, there is need to discover what can be given to these women to help in cessation.
General Problem Statement
The general problem is that there are limited researches that detail about smoking patterns in pregnant women. A research by Eiden et al., (2013) indicates a shifting trajectory in pregnant smokers and major changes in due course within each trajectory. This element is important as it has the prospective to notify timing of smoking cessation intervention.
Specific Problem Statement
The specific problem is that there is little information about the stability of cessation efforts on the elements that distinguish women who effectively minimize smoking during their pregnancy in comparison to the persistent smokers who stop later in pregnancy. For example, little is known about low-income expectant smokers’ demographic factors such as monetary challenges, psychological symptoms like anger and depression, as well as increased supposed stress levels (Goodwin et al., 2017). However, the study by Eiden et al., (2013) demonstrated that financially able pregnant smokers demonstrated a change in trajectory with light moderate smokers showing a considerable decline in smoking during pregnancy. There is also no information regarding age in pregnant smokers.
Purpose Statement
The purpose of this research is to determine the relationship that exists between low-income pregnant smokers and financially stable pregnant smokers as well as the correlation between different ages in pregnant smokers. As such, it should determine if they demonstrate similar trajectories between heavy smokers and light smokers during the course of pregnancy.
Research Questions
The research addressed the following research questions.
RQ1: Do low-income pregnant smokers demonstrate similar trajectories as middle-income pregnant smokers?
RQ2: How does geographic location relate to the trajectory of pregnant smokers?
RQ3: How does socioeconomic status relate to the trajectory of pregnant smokers?
Hypotheses
The following null and alternative hypotheses served as the foundation for the study:
H10: There is no correlation between low-income pregnant smokers and middle-income pregnant smokers.
H1A: There is a correlation between low-income smokers and middle-income smokers.
H20: There is no correlation between 18-35years old pregnant smokers and 35-45 years old pregnant smokers.
H2o: There is correlation between 18-35years old pregnant smokers and 35-45 years old pregnant smokers.
References
Anblagan, D. et al. (July 3, 2013). Maternal Smoking during pregnancy and Fetal Organ Growth: A Magnetic Resonance Imaging Study. Plos One. Retrieved from https://doi.org/10.1371/journal.pone.0067223
Bauld, L., & Oncken, C. (May 1, 2017). Nicotine & Tobacco Research. Oxford University Press, 19(5), 495-496. Retrieved from https://doi.org/10.1093/ntr/ntx034
Eiden, R. D., Homish, G. G., Colder, C. R., Schuetze, P., Gray, T. R., & Huestis, M. A. (2013). Changes in Smoking Patterns During Pregnancy. Substance Use & Misuse, 48(7), 513–522. Retrieved from http://doi.org/10.3109/10826084.2013.787091
Goodwin, R. et al. (April 11, 2017). Serious psychological distress and smoking during pregnancy in the United States. Nicotine Tob, 19(5), 605-614. Retrieved from https://doi.org/10.1093/ntr/ntw288
Wehby, G. L., Prater, K., McCarthy, A. M., Castilla, E. E., & Murray, J. C. (2011). The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. Journal of Human Capital, 5(2), 207–254. Retrieved from http://doi.org/10.1086/660885
The Effects of Smoking in Pregnant Women
Background
The following section highlights some historical and reviewed information or material on smoking during pregnancy, and some of the effects the practice has not only on the unborn children but also on the mothers. Most people associate smoking with heart disease, cancer and major health conditions that have been documented in different scholarly materials. Smoking during the period of pregnancy is attributed to additional health challenges most of which are connected with the well-being of the unborn child (Banderali et al., 2015). It has been documented that smoking cigarettes is the leading cause of preventable deaths in several parts of the country and the rest of the world. Estimated figures of smoking prevalence during pregnancy are most of the time derived from self-reported data and information.
Validation of these data and information using biochemical markers like cotinine has most of the time shown that women who are pregnant may hide their smoking especially when they understand the kind of reactions they could be exposed to. As a result, the self-reported smoking prevalence data and information during pregnancy is underestimated (Banderali et al., 2015). Since negative attitudes towards maternal smoking have been on the increasing trend over the recent past, the validity and credibility of self-reported smoking data and information may be of special attention (Banderali et al., 2015).
This literature perspective brings forth an understanding on the consequences of smoking during pregnancy from the perspective of brain functioning and how the developing fetus is likely to be affected by the common practice. Banderali et al. (2015) stress that mothers often want healthy babies full of life and with a high brain capacity. However, smoking has been illustrated to have an immediate impact on how the fetus is developed and how the capacity of the brain is affected. Environmental factors can massively modulate genetically programmed development of the brain during the fetal life, and maternal smoking is a harmful factor (Banderali et al., 2015). It is saddening that while pregnant mothers and other people in the society have widespread and detailed knowledge and information on the consequences of smoking on the development of the fetus, statistics still show that more than 20 percent of women in this category continue with the practice in several parts of the world, Europe and United States not left behind (Ekblad, Korkeila & Lehtonen, 2015).
Statistics speculate that women and first-time mothers especially those coming from low-income families are worst hit by the effects of smoking during pregnancy, as compared to the older women who have had more than one baby (Ekblad, Korkeila & Lehtonen, 2015).The authors argue that in the case of teenage pregnancies, the depression and pressure from the families can drive the young girls into smoking as a way of relieving the stress and “becoming normal.” While another percentage of the teenagers smoke because it is considered “cool.”
The highest rates of smoking, according to Banderali et al. (2015) during pregnancy is often seen in teenage women, with more than 50 percent of them following the smoking bandwagon. In the recent past, we have had breakthroughs of increased knowledge of the potential negative consequences that smoking may have on the later psychological development of the child, which has the possibility of extending into adulthood as demonstrated in the available literature (Banderali et al., 2015). In their study, Hollams, De Klerk, Holt and Sly (2014), elaborate that compared to children born to non-smokers, infants who are born to smoking mothers are three times likely to be exposed to the risk of developing attention-deficit hyperactivity disorder.
References
Banderali et al. (2015). Short and long term health effects of parental tobacco smoking during
pregnancy and lactation: a descriptive review. Journal of translational medicine, 13(1), 327.
Ekblad, M., Korkeila, J., & Lehtonen, L. (2015). Smoking during pregnancy affects foetal
brain development. Acta paediatrica, 104(1), 12-18.
Hollams, E. M., De Klerk, N. H., Holt, P. G., & Sly, P. D. (2014). Persistent effects of
Maternal smoking during pregnancy on lung function and asthma in adolescents.
American Journal of respiratory and critical care medicine, 189(4), 401-407.
Literature Review
Introduction
This section is the literature review. It includes an overview of trajectories between middle and low income pregnant women smokers, an overview of geographic location in relation to the trajectory of pregnant smokers, an overview of the socioeconomic status in relation to the trajectory of pregnant smokers. The section gives a highlight of the recurring themes and some of the recommended practices which result from this literature review.
Overview of trajectories between middle and low income pregnant women smokers
Despite the efforts to warn pregnant women about the dangers of smoking, they still continue to smoke. Today, approximately 11% of pregnant women smoke during the first four months of pregnancy although to some, this often provides a unique motivation for them to quit smoking due to concerns for their personal health and that of the baby. Ideally the financial status of the pregnant women has so much effect when it comes to smoking prior to pregnancy and abstinence during pregnancy. Prior studies have identified that more than 44% of pregnant women quit smoking during pregnancy but unfortunately, 50% of these women resume smoking by six months of postpartum from 50% to 91% in duration of one year. There exist trajectories when it comes to both middle income and low income women smokers during pregnancy (Anblagan, D. et al, 2013).
Low-income women are prone to be smokers prior to their pregnancy and less likely to abstain from the same. According to Bauld & Oncken (2017) there is an increase in the rate of smoking among low-income pregnant women in most rural areas as compared to most of their counterparts in urban areas. Eiden & Huestis (2013) examined some of the factors that best assist low-income pregnant women to achieve abstinence whereby they found out that most of these women quit smoking because of an aversion of smell and taste while regrettably, 74% went back to smoking when in the postpartum period. In another study of smoking in low-income pregnant women in the postpartum period conducted by Wehby & Murray, (2011), Murray found that only 14% of the women were smoke free at 17 months and therefore social support was found to be an essential aspect when it came to quitting among low-income pregnant women. Therefore, there are various reasons for low-income pregnant women to cut back or quit smoking during or prior to the pregnancy period including the motivation to stop smoking, potential harmful effects of smoking on their breast milk. According to Goodwin, R. et al (2017) motivational intervention among low-income pregnant mothers led to continuous abstinence of 22% at 25 weeks postpartum spontaneous quitters, at a duration of 2 months only 40% achieved cessation and 43% reduced their smoking rate by 67%. Findings examined by McEvoy & Spindel (2017) indicated that 37% of low-income women smoked during the pregnancy period and this rate was four times higher than the current rate of 11% for all the pregnant women across the globe. The mean age of the women from this study was between the ages of 19 and 25.
Nearly four to five pregnant women smokers come from lower-income communities and this explains the reason as to why the tobacco industry strategizes to appeal lower income smokers. Low-income pregnant women spend their expenditure of 15% on tobacco prior to the pregnancy period affecting the health of their unborn children, in other households; low-income women suffer direct health effects by inhalation of secondhand smoke. This is because the smoke contains approximately over 3000 chemicals which cause cancer and other health effects including lead and cyanide. Mothers who smoke allow the toxic chemicals to enter the blood vessels obstructing the source of oxygen and nutrients for the fetus. Harmful compounds like carbon monoxide and cyanide lead to smoking related complications during pregnancy. Nicotine for instance chokes off oxygen hence narrowing the blood vessels of the body and umbilical cord. Smoking in pregnant women affects lactation leading to less milk production (Houghton & Terry, 2018).
According to a research carried out by Rayfield & Plugge (2016) in Southern Europe, smoking patterns among middle-income pregnant women was more prevalent than the low-incomes. Among middle-income pregnant women in the United Kingdom for example, only 10% are smokers. Pregnant women who earned a middle-income were found to be the major economic providers for households and therefore increased their likelihood to smoke. This is because they had freedom with their personal economy to use their own money to purchase the cigarettes. Ultimately, they did this because they associated smoking with modernity and independence. It was also noted in another study that the proportion of smoking among middle income women decreased prior to the pregnancy (Gilmour & Shibuya, 2015). Availability of tobacco among the families of middle income pregnant women was another cause to smoke. In most middle-income pregnant women, second hand smoke is a major issue due to the addiction properties of family members. This has adverse effects first off, the weight and size of the baby are affected greatly whereby daily smoking reduces a gram from the original baby’s birth weight. Secondly, this affects the baby’s body and lungs whereby babies who are undersize also have bodies that are underdeveloped. Smoking also leads to baby’s heart related defects that obstruct blood flow. Smoking also affects the brain function of the baby leading to low IQs, learning disorders and behavioral problems
Finally, there are trajectories when it comes to both middle income and low income women smokers during pregnancy whereby low-income women are prominent to smoke during pregnancy than middle-income pregnant women due to lack of adequate policies and resources. On the other hand middle-income pregnant women smoke prior to the pregnancy period but abstain due to motivation of the health effects on the baby and themselves (Herba & Rondon, 2016).
Overview of geographic location in relation to the trajectory of pregnant smokers
Smoking among pregnant women varies by geographic location across the world. Pregnant women that live in different regions and communities suffer from poor health due to cigarette smoking. Vanker & Zar (2017) examined that prevalence is highest in the U.S. among smoking pregnant women living in the Midwest which was 26% and the South 25% and the lowest regions were the West which was 19% and the Northeast 20%. Pregnant women living in the South and the Midwest tended to use a variety of tobacco products including smokeless tobacco and cigarettes. In addition, trajectories indicate that pregnant smokers who live in most rural areas smoke approximately 16 or more cigarettes each day than those who live in urban areas and most of them began earlier in life which makes it difficult to abstain during the pregnancy period. In general, geographic location relates to the trajectory of pregnant smokers in various ways (Lian & Heath, 2016).
Disparities in the geographical access to health care have adverse effects on the trajectory of smoking among pregnant women. It is a fact that the number, quality and locations of health care providers is different from one place to another with unavailability of services in regions where there are large numbers of pregnant women. The access to most of the healthcare facilities is affected by various factors including social and cultural norms, networks of transportation and socioeconomic status. For instance, Szatkowski & Leonardi-Bee (2015) examined access to government health services in South Africa and found out that a model that focused solely on distance did not provide much better indicators of access to health care than a transportation model that was adjusted for completion and actual use patterns between health facilities. This example shows that a clear understanding of the location circumstances which create inequalities in access to health care is vital to the larger health picture when it comes to helping smoking pregnant mothers. In another study, Gould & Bonevski, (2017) developed the index of spatial accessibility as a method of analyzing the local supply of primary health services as it relates to local demand. Their technique analyzed spatial access to primary care in Illinois and its relationship to smoking pregnant women and they found out that in Illinois most rural areas are characterized by levels of spatial access to primary care that are low as compared to urban areas. Social factors like peer pressure in urban areas also contribute a large part in pregnant smoking mothers. Globalization and migration are factors that play a big influence, and due to this reasons, you may find locations where smoking pregnant women who are married to smokers finding it very difficult to quit smoking during smoking. Pregnant women who live in cold areas are likely to smoke due to harsh weather conditions than those who live in good weather geo-locations (Lewis & Doherty, 2016).
Ultimately, Hedderson & Xu (2016) examined two studies on the trajectory of geographic location and its effect on pregnant smoking women, the first study in California showed that living in a predominantly working class geographical location doubles the odds of pregnant smoking women while the second study in South Carolina showed that women who live in neighborhoods with higher percentage of a population that receives public assistance were likely to smoke during the pregnancy period. According to a research study by Balte & Arshad (2016) Black race and Hispanic ethnic women who live in predominantly black neighborhoods reduce their odds of smoking by 65% during pregnancy and that more ethnically, racially homogeneous counties are associated with reduced odds of smoking.
I believe that social capital and rurality are related to maternal smoking during the pregnancy period. According to findings by Ronfani & Barbone (2016) social capital is believed to be stronger in rural areas than urban areas since pregnant women in the rural areas are prone to help and trust each other despite the low population distribution. The rurality of a place where pregnant women live is closely related to the variations in smoking prevalence, research indicates that there is a higher percentage of pregnant women who smoke in rural areas than urban areas. Social capital provides intangible and tangible assistance whereby communities with higher social capital, share out the effects of smoking during pregnancy influencing decision making and pregnant women adopt this due to information diffusion. Social capital also leads to healthy behaviors and control. Geographical access to cigarette or tobacco outlets plays a big role in advancing the spatial variations in the spread of smoking among pregnant women. Geographical location also affects access to care, treatment and prevention of smoking in pregnant women.
In conclusion, Geographic location plays a fundamental aspect to the trajectory of pregnant smokers due to various geographic influences including physical circumstances, social context and the economic conditions. Trajectories differ due to differences in access to care and treatment or prevention of smoking among pregnant smokers. The geographic location helps understand the spatial variations and geographical factors affecting pregnant smokers (Sutin & Terracciano, 2016).
Overview of the socioeconomic status in relation to the trajectory of pregnant smokers
Conceptually, the socioeconomic environment of smoking pregnant women is represented as their journey from socioeconomic environments of the natal family through school to their occupation. Having gone through this trajectory, important life chances and good living standards in a rich industrialized society is acquired. Basically the level of education, income and occupation are huge indicators of pregnant women’s socioeconomic status. The magnitude and direction of socioeconomic inequality is different substantially between the rich and poor smoking pregnant women. Socioeconomic inequalities in smoking among pregnant women are affected largely by the progression of the smoking epidemic and smoking prevalence among pregnant women peaks whenever the cigarette pries become affordable among all socioeconomic groups. Therefore, the socioeconomic status affects the trajectory of pregnant smokers due to their level of education, income and type of occupation (Gavin Morris, 2017).
Collier & Lindsay (2017) conducted a research on the independent effects of income, employment status and level of education among pregnant women smokers and found out that smoking patterns were prevalent among the women who had low level of education and a low income. According to a study done by Krebs & Kazi (2017) using data from 49 pregnant women, showed that the direction and magnitude of socioeconomic inequality vary substantially. International comparisons of economic indicators like GDP and life expectancy show that lower socioeconomic pregnant women experience higher rates of cigarette smoking than affluent socioeconomic groups. There exist so many economic and health effects among the poor smoking pregnant women including reduced earnings and production, investment problems and labor. The current prevalence of patterns in pregnant women with high-incomes is associated with their socio-economic status. According to McEachan & Nieuwenhuijsen (2015), in Australia for example, there is only 11% of pregnant women that are smokers and this pattern is the same between education and smoking levels. In most countries, the magnitude and pattern of prevalence follows an upward gradient from high to low socio-economic groups and according to their employment.
Smoking among pregnant women tends to be more prevalent those who are poor than the rich in most occasions. Poverty is not a cause of smoking and the poor do not smoke more than the rich in some countries. Education is a major predictor of smoking among pregnant women because education is knowledge and the poor have less knowledge on the dangers of smoking which explain why they are prone to adapt to this practice during pregnancy. Low-income pregnant women also show greater difficulty in quitting smoking due to limited concerns on the risks related to smoking, social norms in favor of quitting that are weak and high levels of stress as compared to high-income pregnant smokers. Pregnant Women smoke due to various reasons including relieve of stress, addiction, to control their weight, to deal with depression and also due to the gender differences in the behavior to quit since women are less interested in quitting than men. Smoking may also be a replacement reward among pregnant women. Smoking among pregnant women is also taken to be self-medication and helps in regulating mood or coping with the strains of material deprivation among low-income women (Yang & Gibson, 2017).
Low socioeconomic countries that have Pregnant women with low socioeconomic status have scarce income and are therefore diverted away from important aspects like access to healthcare, education, quality of food, housing just to be able to purchase cigarettes. According to Dadvand & Nieuwenhuijsen (2017) households with pregnant women in rural China that are poor are said to spend more than 11% of their total household expenditures just on cigarettes that usually has indirect effect on the mother, family and the unborn child. Maternal pregnant smoking in most families that are poor is said to divert spending from vegetables, fruits and this leads to child malnutrition.
Management of smoking cessation is an important aspect for both the woman and the unborn child. Pregnant smokers are categorized into continuing smokers, postpartum relapse and spontaneous quitters. Interventional recommendations include promotion of cessation among all the women who consider to bear children, reaching pregnant smokers early enough using healthcare programs for sustainable smoking cessation, using healthcare programs to maintain postpartum cessation, development of diversified interventions for continuing smokers and using healthcare programs to focus on pregnant smoking partners. Counseling and other strategies should also be used as cessation interventions (Gavin Morris, 2017).
Conclusion
In conclusion, previous studies have found that there is a close connection between the level of income, geographic location, the socioeconomic status and the trajectory of pregnant smokers. In this dissertation an attempt was made to compare the trajectories of pregnant smokers and the level of income on a macro-scale. However, few studies have used this methodology by doing the research on a micro-scale and yielded mixed findings (Bauld & Oncken, 2017). Therefore, it is vital for future investigation to closely examine the effects level of income on pregnant smoking women in order to be able to give better understanding of cessation methods in this case.
References
Anblagan, D. et al. (July 3, 2013). Maternal Smoking during pregnancy and Fetal Organ Growth: A Magnetic Resonance Imaging Study. Plos One. Retrieved from https://doi.org/10.1371/journal.pone.0067223
Bauld, L., & Oncken, C. (May 1, 2017). Nicotine & Tobacco Research. Oxford University Press, 19(5), 495-496. Retrieved from https://doi.org/10.1093/ntr/ntx034
Eiden, R. D., Homish, G. G., Colder, C. R., Schuetze, P., Gray, T. R., & Huestis, M. A. (2013). Changes in Smoking Patterns During Pregnancy. Substance Use & Misuse, 48(7), 513–522. Retrieved from http://doi.org/10.3109/10826084.2013.787091
Goodwin, R. et al. (April 11, 2017). Serious psychological distress and smoking during pregnancy in the United States. Nicotine Tob, 19(5), 605-614. Retrieved from https://doi.org/10.1093/ntr/ntw288
Wehby, G. L., Prater, K., McCarthy, A. M., Castilla, E. E., & Murray, J. C. (2011). The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. Journal of Human Capital, 5(2), 207–254. Retrieved from http://doi.org/10.1086/660885
McEvoy, C. T., & Spindel, E. R. (2017). Pulmonary effects of maternal smoking on the fetus and child: effects on lung development, respiratory morbidities, and lifelong lung health. Paediatric respiratory reviews, 21, 27-33.
Houghton, L. C., Goldberg, M., Wei, Y., Cirillo, P. M., Cohn, B. A., Michels, K. B., & Terry, M. B. (2018). Why do studies show different associations between intrauterine exposure to maternal smoking and age at menarche? Annals of epidemiology, 28(3), 197-203.
Rayfield, S., & Plugge, E. (2016). Systematic review and meta-analysis of the association between maternal smoking in pregnancy and childhood overweight and obesity. J Epidemiol Community Health, jech-2016.
Gilmour, S., Moffiet, T., d'Espaignet, E. T., Stevens, G. A., Commar, A., Tuyl, F., & Shibuya, K. (2015). Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco Control. The Lancet, 385(9972), 966-976.
Herba, C. M., Glover, V., Ramchandani, P. G., & Rondon, M. B. (2016). Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low- income and middle-income countries. The Lancet Psychiatry, 3(10), 983-992.
Vanker, A., Gie, R. P., & Zar, H. J. (2017). The association between environmental tobacco smoke exposure and childhood respiratory disease: a review. Expert review of respiratory medicine, 11(8), 661-673.
Lian, M., Madden, P. A., Lynskey, M. T., Colditz, G. A., Lessov-Schlaggar, C. N., Schootman, M., & Heath, A. C. (2016). Geographic variation in maternal smoking during pregnancy in the Missouri Adolescent Female Twin Study (MOAFTS). PloS one, 11(4), e0153930.
Szatkowski, L., Fahy, S. J., Coleman, T., Taylor, J., Twigg, L., Moon, G., & Leonardi-Bee, J. (2015). Small area synthetic estimates of smoking prevalence during pregnancy in England. Population health metrics, 13(1), 34.
Gould, G. S., Zeev, Y. B., Tywman, L., Oldmeadow, C., Chiu, S., Clarke, M., & Bonevski, B. (2017). Do Clinicians Ask Pregnant Women about Exposures to Tobacco and Cannabis Smoking, Second-Hand-Smoke and E-Cigarettes? An Australian National Cross- Sectional Survey. International journal of environmental research and public health, 14(12), 1585.
Lewis, L., Hauck, Y., Ronchi, F., Crichton, C., Allsop, S., & Doherty, D. (2016). An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth. Journal of Addiction Research and Therapy, 7(6), 1-7.
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Balte, P., Karmaus, W., Roberts, G., Kurukulaaratchy, R., Mitchell, F., & Arshad, H. (2016). Relationship between birth weight, maternal smoking during pregnancy and childhood and adolescent lung function: A path analysis. Respiratory medicine, 121, 13-20.
Ronfani, L., Brumatti, L. V., Mariuz, M., Tognin, V., Bin, M., Ferluga, V., & Barbone, F. (2015). The complex interaction between home environment, socioeconomic status, maternal IQ and early child neurocognitive development: a multivariate analysis of data collected in a newborn cohort study. PLoS One, 10(5), e0127052.
Sutin, A. R., Flynn, H. A., & Terracciano, A. (2018). Maternal smoking during pregnancy and offspring personality in childhood and adulthood. Journal of personality, 86(4), 652-664.
Gavin, A. R., & Morris, J. (2017). The association between maternal early life forced sexual intercourse and offspring birth weight: the role of socioeconomic status. Journal of Women's Health, 26(5), 442-449.
Collier, A., Abraham, E. C., Armstrong, J., Godwin, J., Monteath, K., & Lindsay, R. (2017). Reported prevalence of gestational diabetes in Scotland: The relationship with obesity, age, socioeconomic status, smoking and macrosomia, and how many are we missing?. Journal of diabetes investigation, 8(2), 161-167.
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McEachan, R. R. C., Prady, S. L., Smith, G., Fairley, L., Cabieses, B., Gidlow, C., & Nieuwenhuijsen, M. J. (2015). The association between green space and depressive symptoms in pregnant women: moderating roles of socioeconomic status and physical activity. J Epidemiol Community Health, jech-2015.
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Method
Introduction
Use of tobacco products which includes smoking cigarettes, smokeless tobacco and electronic cigarettes during pregnancy is considered to be the biggest cause of harm to young infants and their mothers. Smoking is considered to be a risk factor associated with adverse outcomes including pregnancy related effects, unhealthy and physical problems, cognitive deficits, behavioral and social problems. Statistics show that up to 13% of the women in the United Kingdom smoke during pregnancy although pregnancy motivates around 49% of the women to stop smoking. Ultimately, intervention and screening for smoking during pregnancy can be imperative in achieving smoking cessation, educating women’s partners and family members on the merits of smoking cessation during pregnancy. This section is an overview of the Methodologies used in my research assignment. The section focuses on the population used, sampling frame and the analyzed data and some of the recommended practices which result from the methodologies in regard to effects of smoking in pregnant women.
Research Method and Design Appropriateness
Experts acknowledge that it is essential to know the difference between quantitative and qualitative research methods although there are misconceptions between the two. On the contrary both methods serve vastly diversified purposes. Quantitative research methods are used when it comes to quantifying the problem through generation of numerical data which is transformed into useable statistics. This method uses measureable data in formulation of facts and includes surveys, observations and reviews of records. Qualitative research method is used in gaining a clear understanding of underlying opinions, motivations and reasons. This method uses a small selected size sample and helps to develop ideas or hypotheses and gives insights into the problem. Qualitative research methods include focus groups, individual interviews, document reviews and in-depth interviews. This research study was designed to use qualitative approach in the form of in-depth interviews with women in the core group that was targeted. This method was more appropriate for my study because the fundamental goal of the research was to carry out face-to-face in-depth interviews at a well-known location. Due to the interests of including the views of a variety of women, an approach that was flexible to the actual location was adopted including local cafes, in-home, meeting rooms and in multiple special cases by telephone. This allowed the researching process many women in the client group.
Population
The study population on the effects of smoking in pregnant women involved an inclusion criterion of both white and black women pregnant smokers and pregnant non-smokers between 17 years and 36 years of age specifically in the state of Alabama United States. Alabama is considered part of the South and the numbers from the neighboring states are taken to be the same. This research paper seeks to discuss the effects of smoking in pregnant women living in Alabama who are receiving prenatal care at the moment. Alabama is considered to be the third state across the nation with a percentage of 36% whereby pregnant women are reported to smoke often and consequently suffer the effects of smoking on the infants and the mothers as health reports show.
This issue hence has become a major health concern. Women in Alabama smoke due to various reasons including relieve of stress, addiction, control of weight, in order to deal with depression and also due to the gender differences in the behavior to quit since women are less interested in quitting than men. This has become a major health catastrophe because women who smoke in Alabama allow the toxic chemicals to enter the blood vessels obstructing the source of oxygen and nutrients for the fetus. Harmful compounds like carbon monoxide and cyanide lead to smoking related complications during pregnancy. Nicotine for instance chokes off oxygen hence narrowing the blood vessels of the body and umbilical cord. Smoking in pregnant women affects lactation leading to less milk production. Second hand smoke that is exhaled by a person smoking ultimately has adverse effects on both the mother and the fetus. All these effects cripple the country’s healthcare system now that currently Alabama has a debt which amounts to $22 billion with only 10.1 billion in assets. You find that such a high magnitude of debt cuts in other areas including schools and the environment that consequently lead to lack of jobs which leads to stress within the community that brings us to smoking pregnant mothers.
Sampling frame
Clinical research will be carried out using the recruited 31 pregnant smokers and 35 pregnant non-smokers who are between 17 years and 36 years of age. The clinical research will be done in Montgomery the most populated city of Alabama. Using Montgomery will be the best option since it fits and has both white and black women from all walks of life that smoke and others who do not smoke. Participants who delivered term infants will be considered for clear evaluation of the effects of smoking exposure on the growth of the baby; this will help analyze the effects on preterm delivery. In addition to this, participants were also supposed to have two sets of measures that corresponded to smoking including their urine cotinine concentration and self-reported smoking separated by a minimum of 8 weeks. The purpose of doing this is to exclude the pregnant smokers whose changes in smoking were not sufficient to have impact on their infant’s birth weight.
Data collection
Data will be collected by use of qualitative approach. The participants will be brought in to the chosen location of the Montgomery medical research facility then they will be told that their results will be made publicized but then their identities will be protected from the public. The primary approach of collecting data will be through conducting face-to-face in-depth interviews at the medical research facility. Birth weights will be obtained from maternal interview during the postpartum visit. All the participants will be told the objective of the study which is to find out the effects of smoking in pregnant women.
After that, a standardized questionnaire will be filled; smoking and pregnancy data will be collected. A COex measurement will also be performed and a sample of participant’s urine will be collected in order to measure the levels of cotinine. Upon delivery, the participants will be contacted for data collection about their newborn a month after their delivery. The cotinine concentration will be measured using a high performance liquid chromatography technique.
Data analysis
The entire process of data analysis will be quite complex. The participants will be categorized in four parts depending on the COex levels and as per the levels of urinary cotinine. The percentile will also be used for data that is categorical and ANOVA will also be used in comparison of the means and several regressions. Adjustments will be made in the gestational age, age of participants, number of pregnancies, amniotic fluid and the degree of placenta. The level of significance that will be assigned will be 0.05 and the data will be processed using SPSS version 22. The percentiles will be used in comparison of the resistance indices and the birth weights of the fetus as per the age of gestation for each participant and a Hadlock table will be used for the weight.
References
Alabama. (2018). Statedatalab.org. Retrieved 27 Sep 2018, from https://www.statedatalab.org/state_data_and_comparisons/detail/alabama
Alabama State Smoking Data, Rates and Trends - The State of Obesity. (2018). Stateofobesity.org. Retrieved 27 Sep 2018, from: https://www.alabamapublichealth.gov/gal/substances.html
Alabama’s crackdown on pregnant marijuana users (2018). HuffPost. Retrieved 29 April 2018, from https://www.al.com/news/birmingham/index.ssf/2017/03/alabamas_crack_down_on_pregnan.html
Michael, (2018) Smoking while pregnant in Alabama, Retrieved from: https://www.marchofdimes.org/peristats/ViewTopic.aspx?reg=01&top=9&lev=0&slev=4
Leah C. T & Gregg L., (2018) Tobacco control in Alabama Retrieved from: http://boards.cannabis.com/threads/smoking-while-pregnant-in-alabama.193576/
Discussion
Use of tobacco products which includes smoking cigarettes, smokeless tobacco and electronic cigarettes during pregnancy is considered to be the biggest cause of harm to young infants and their mothers (Anblagan, 2013). This section will discuss the limitations, use and applications of findings and the recommendations in regard to effects of smoking in pregnant women.
Findings
The study evaluated some of the major effects of smoking in pregnant women in the state of Alabama United States. The women involved an inclusion criterion of both white and black women pregnant smokers and pregnant non-smokers between 17 years and 36 years of age. Data was collected through qualitative approach (Anblagan, 2013). It was estimated that approximately 6% to 10% of women in Alabama smoke. However, it was found out that smoking in pregnant women was 26% more severe than what they admitted to the health providers. The data on the same was justified from the answers given during the interview and the cotinine measurement in the blood. In addition, it was found out that heavier smokers during pregnancy took 11 to 40 cigarettes each day, light smokers took 1 to 5 cigarettes and medium smokers took 6 to 10 cigarettes (Leah C. T & Gregg, 2018).
Limitations
Some of the limitations of this study include the study population consisting of women with low income and who often go to public clinics which limits this research since they may report their use which is unique in this group making the research study inaccurate. This means that most of the data given of the participants was inaccurate or incomplete leading to biasness. Although the experiment took about 9 weeks it is also not clear when the last exposure could have taken place in all women taken to be reducers. In addition, since the study was retrospective this could mean that we could be interacting to women who were answering questions in a different way. Basing on this weakness, the information was gathered from the medical records and maternity documents (Goodwin, 2017).
Use and application of Findings
The use and application of these findings may contribute to curb against addition of pregnant women smokers by introduction of nicotine therapy sessions. The use and application of these findings may also contribute to minimization of the effects which are negative on mothers and their newborn baby’s weight by reduction on the number of cigarettes smoked per day. The use and application of these findings may contribute to cessation of smoking among pregnant women smokers by recognizing the reasons why pregnant women smoke in the first place and why they continue to smoke hence this helps formulate appropriate strategies for cessation.
Recommendation: reduction on the number of cigarettes
One recommendation regarding those pregnant women that find it very difficult to stop smoking, they should use less than five cigarettes every single day for minimization of the effects which are negative on themselves and their newborn baby’s weight. This ought to be accompanied with studies that further evaluate the effects of reduced cigarette smoking on the weight of the baby including prematurity, infant death syndrome that is sudden and stillbirth. This research study also shows that smoking cigarette in pregnant women is associated with low socioeconomic status and this result to health differences between low and high incomes individuals. These individuals were prone to smoke before pregnancy which also led to risk behaviors including pregnancies that are unplanned, using alcohol during pregnancy. Women who found it difficult to quit during the pregnancy period, were found to have health literacy that the low.
There was no difference shown on the analysis of premature infants between pregnant smoking and non-smoking women. However, analysis of full-term infants clearly showed negative low effect of smoking on the weight of the new born babies. The new born who were born in medium smoking pregnant women showed 321g lower than those new born babies of non-smoking pregnant women and 436g lower in high smoking women across all races. There was a similar effect that was observed after correction of different factors including the age of the women, whether the partner was present, the delivery intervals, parity, emotional issues during pregnancy, number of prenatal medical visits, hyperemesis, age of gestation, illegal drug use, high blood pressure, infection during pregnancy and anemia (Bauld & Oncken, 2017). An interesting factor was that there was no statistical data that occurred in light smokers. An essential consideration during the research study was that the number of smoked cigarettes each day by pregnant women could also limit how valid the findings emerge. During pregnancy, it is a fact that the smoked cigarettes could vary every single day and this was not considered but instead, it relied on self-reporting during the entire time of delivery or medical records. In addition, it was not recorded that women who had just quit smoking prior to the gestation period were also nonsmokers and also the passive effect of the smoke was not taken into account and this led to underestimating the effect that this could have on the birth weight of the infants although an effect that was negative was seen (Bauld & Oncken, 2017).
Recommendation: Identifying reasons for smoking in pregnant women for cessation
According to Eiden & Huestis (2013), there is need for recognizing the vital role that make pregnant women to smoke in the first place and why they continue to smoke. Some of the reasons as to why they do this are due to stress, to take off the age hard relationship and maintain the social habits or trends. Since the study also involved low socioeconomic pregnant women, inferences were not allowed on the effective because tobacco was self-reported and this meant misclassification of the smoking status. Since Montgomery is a high populated region, a quarter of the women could miss reporting on their own. In addition to that, in most low class income regions, smoking cigarette was associated with effects like metabolic problems and obesity therefore using this by pregnant meant worsening the situation and this could slow down the millennial objectives (Wehby & Murray, 2017). A fundamental strength of this research study is that collection of data was done uniformly across all women from all cultures. Using the same questionnaire on a cross cultural level made it possible for inter cultural comparison of the smoking prevalence, continuation of smoking during pregnancy and the extent of smoking in pregnant women.
Recommendation: Curbing addiction through Nicotine therapy sessions
Nicotine therapy sessions have also been launched to help curb against addiction of pregnant women smokers hence reducing the effects of smoking although there have questions on some of the effects that are long term and how safe using nicotine therapy is during pregnancy and also during the postpartum period.
References
Anblagan, D. et al. (July 3, 2013). Maternal Smoking during pregnancy and Fetal Organ Growth: A Magnetic Resonance Imaging Study. Plos One. Retrieved from https://doi.org/10.1371/journal.pone.0067223
Bauld, L., & Oncken, C. (May 1, 2017). Nicotine & Tobacco Research. Oxford University Press, 19(5), 495-496. Retrieved from https://doi.org/10.1093/ntr/ntx034
Eiden, R. D., Homish, G. G., Colder, C. R., Schuetze, P., Gray, T. R., & Huestis, M. A. (2013). Changes in Smoking Patterns During Pregnancy. Substance Use & Misuse, 48(7), 513–522. Retrieved from http://doi.org/10.3109/10826084.2013.787091
Goodwin, R. et al. (April 11, 2017). Serious psychological distress and smoking during pregnancy in the United States. Nicotine Tob, 19(5), 605-614. Retrieved from https://doi.org/10.1093/ntr/ntw288
Wehby, G. L., Prater, K., McCarthy, A. M., Castilla, E. E., & Murray, J. C. (2011). The Impact of Maternal Smoking during Pregnancy on Early Child Neurodevelopment. Journal of Human Capital, 5(2), 207–254. Retrieved from http://doi.org/10.1086/660885
Michael, (2018). Smoking while pregnant in Alabama. Retrieved from https://www.marchof
dimes.org/paristats/ViewTopic.aspx?reg=01&top=9&lev=0&slev=4
Leah, C. T & Gregg, L., (2018). Tobacco control in Alabama. Retrieved from http://boards.cann
Abis.com/threads/smoking-while-pregnant-in-alabama.193576/
