Medical Student as Peer for Maternal Smoking Cessation

During pregnancy, maternal smoking is causally linked to risks of premature pregnancy, stillbirth, a baby with low birth weight, and placental abruption. In Japan, the prevalence of prenatal smokers was stated to be 7.8 percent, which was much greater than the global estimated prevalence. A representative sample of 75,234 American women was reported in the Pregnancy Risk Assessment Monitoring System survey. A 1.6-fold more significant risk of postpartum disorder was associated with prenatal smoking (Cui et al., 2020).

The 2008 US Guideline reported that in pregnant smokers, “person-to-person psychosocial interventions” (typically involving “intensive counseling”) raised abstinence rates to 13.3 percent, compared to 7.6 percent in standard treatment (Baker, 2008).

Due to the coronavirus pandemic, telehealth users are increasing, including for maternal healthcare. Also, the community intervention to smoking cessation on pregnant women and postpartum with peer-to-peer approach can adapt style and system of telehealth or telemedicine. Medical students will act as peers who will virtually approach pregnant/postpartum women for smoking cessation intervention (by phone, meeting apps, etc.).

Persons who smoke in Indonesia thought it was helpful to receive a possible smoking cessation

intervention through mobile phones. Perceived usefulness was correlated with the ability of smokers to stop smoking and the previous usage of mobile phones for communication related to health (Wibowo et al., 2019).

21 Days Design Intervention 

The 2000 Agency for Health Care Policy and Research (AHCPR; now the Agency for Healthcare Research and Quality) guidelines on clinical care on the treatment of tobacco use dependence advises physicians to regard uses as a chronic disease (AAFP, 2006).

• ASK (Day 1)

Include concerns about the use of tobacco when determining the vital signs of the patient. It may also be helpful to position tobacco-usage status stickers on patient charts, notice the use of tobacco in electronic medical records, or use computer notification systems.

• ADVISE (Day 1)

Effective: “As your peer, I ought to tell you that one of the most important decisions you can make for your health and your keen-witted child is smoking cessation.”

Personalized: Assess with patients how their well-being, children, and other family members have been harmed by smoking, the socioeconomic costs of smoking, and the intention of the patient to quit.

• ASSESS (Day 2-19, twice a day)

Appraise the motivation of the patient to quit by asking, “On a scale from 0 to 10, with 0 not encouraged at all and ten incredibly motivated, how motivated are you to quit smoking?”

1. Willing

Addressed promptly and tools for self-help

1. Unwilling

Explore what she likes and dislikes about smoking and the possible benefits and drawbacks of quitting. Identify the core values of patients (e.g., child, role model, health) and how these values are influenced by smoking. 

Appraise how many cigarette sticks they use every day. 

• ASSIST (once a week)

Help them make a quit plan and change their social life behavior, including providing essential basic information and identifying their alternative coping strategies.

• ARRANGE (Day 21)

With the help of a psychologist or any professionals for follow-up.

CALL TO COLLABORATE-ACTION

• Medical or health professional to offer medication and advise pregnant smokers

• Maternal health enthusiast to collaborate to make smoking prevention and cessation campaign toolkit

1. Government organization to:
   1. Inform the harm of smoking by publication and promotion collaborate with public relation of their region.
   2. Escalate smoke-free area on quality and quantity
   3. Confine and restrict cigarettes and smoking products on advertisement and billboard
   4. Insert ‘spooky picture’ such as congenital malformation, impotent, and lung cancer on smoking products’ ads

Written by: Aufa Fathya – CIMSA UGM Batch 2019

REFERENCES

CR, Baker TB (2008). Clinical practice guideline: treating tobacco use and dependence: 2008 update (PDF). Rockville, MD: U.S. Department of Health and Human Services, Public Health Service. Archived from the original on 2016-03-27. Retrieved 2016-07-06.

Cui M, Kimura T, Ikehara S, Dong JY, Ueda K, Kawanishi Y, Kimura T, Iso H; Japan Environment and Children’s Study Group. Prenatal tobacco smoking is associated with postpartum depression in Japanese pregnant women: The japan environment and children’s study. J Affect Disord. 2020 Mar 1;264:76-81. DOI: 10.1016/j.jad.2019.11.145. Epub 2019 Nov 30. PMID: 31846904.

Okuyemi KS, Nollen NL, Ahluwalia JS. Interventions to facilitate smoking cessation. Am Fam Physician. 2006 Jul 15;74(2):262-71. PMID: 16883923.

Wibowo, M.F., Kumar, A.A., Sumarsono, S. and Rodrigues, R., 2019. Perceived usefulness of receiving a potential smoking cessation intervention via mobile phones among smokers in Indonesia. Wellcome Open Research, 4(94), p.94.