I've been asked to help put together an educational program to encourage smoking cessation among pregnant teens and new mothers. I would appreciate receiving some help and insight into the influences at work in teenagers who continue to smoke despite the barrage of information available about the dangers of secondhand smoke and the harmfulness of smoking during pregnancy. Is this a continuation of the teenage rebelliousness that may have played a role in their getting pregnant in the first place? Is it an extreme case of denial because of an acute addiction to nicotine? Or is it another manifestation of the desire to appear all grown up?
With birth control and abortion readily available it seems likely that most of these are "wanted" pregnancies - if only on a subconscious level. So why do these young mothers persist in endangering their infants (or fetuses) when many would not dream of deliberately inflicting other forms of physical harm.
The other curious fact is that many pregnant teens quit smoking during the pregnancy but resume after the baby is born when the infant is often exposed to smoking fathers and grandparents as well.
Any suggestions on how to approach this educational program (printed materials and a video are being considered) would be most appreciated).
Answered by Paul Hunter, M.D. (xx119@ofcn.org)
Teens who take risks often do not consider the consequences. Pregnancy, AIDS, gunshot wounds, car crashes, etc all happen to "other people". I see about one pregnant teen a day for routine prenatal visits who continues to smoke. I patiently explain how she is three times more likely to have a small, early baby that might be on a ventilator. The typical response is that an acquaintance had a baby six weeks early that did fine.
I also see many women who test positive for cocaine and marijuana during their pregnancy. Although I expect this at my clinic, a community health center for poor people, researchers (Ira Chasnoff) say that in every social group about 16% of women will test positive for some substance during their pregnancy.
Everyday I also try to convince two or three people to stop smoking. The free nicotine patch program at our clinic provides a gimic to get people interested in quiting. The patch can't be used with pregnancy, but could but can be given to family members and to women who don't breastfeed their babies. The patch does not help with the habit of lighting up after eating, when getting into a car, or because of other triggers. It does help with the fatigue and irritibility from nicotine withdrawal.
In encouraging smoking cessation I follow the four A's suggested by the US Public Health Service and many other organizations: ASK whether they smoke and whether they are interested in quitting. ASSIST people who want to stop with programs like yours, the patch, and especially with follow up visits or phone calls 2 weeks and 2 months after a quit date. ADVISE people to quit even if they are not interested. A #4. I forgot what this was. Please e-mail me if you find it.
You ask for insight into why anyone continues to smoke despite barrage of information. My view is that data does not influence behavior. Emotions (especially pleasure and pain) seem to influence behavior. Any drug of addiction relies on pleasure of use and pain of withdrawal for continued use. Presenting data, no matter how graphic, does not necessary create pleasure or pain in the audience. Role playing and participatory small groups may create many more emotions, but be time-consuming and difficult to control. After the session, the participants return to their former emotion environment which reinforces their behavior.
I must disagree with framing substance abuse in pregnancy in terms of "wanted pregnancies" and "delibrately harming the infant". I had to struggle with this issue personally two years ago when I started at my clinic. My one year old son had just died of SIDS a few months before. The first two or three deliveries I attended on call were to women who had abused cocaine. In order to not hate my patients, I felt I needed to talk to a woman as a fellow human and see where she was coming from. I went out into a housing project with a social worker and spent an afternoon hearing the life story of a woman in recovery. I discovered she was a person with hope and despair.
Since then, I have attempted to remain non-judgemental, even-tempered, and open to pregnant women who choose to show up for their prenatal appointments, whether or not they smoke. I see too often how such patients bounce between clinics or simply don't come to appointments and attribute this to dissatisfaction with how they are treated. The studies show that lack of prenatal care is very strongly associated with bad outcomes of pregnancy.
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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