Stress, W.Va. culture big factors in high rate of pregnant smokers

CHARLESTON, W.Va. — Rosa Lara remembers a doctor advising her not to quit smoking during her pregnancy because her baby was used to it.

Lara had been living in California at the time. Most of her sisters had smoked and did not seem to have issues with it, and no one had told her about the health risks associated with smoking while pregnant.

“My doctor never really explained to me what can be the consequences for my daughter,” Lara said. “They said, ‘Just try to slow down.’ They didn’t even ask me to really quit. . .One doctor told me I shouldn’t quit because my daughter was used to the smoke.”

Sometime after moving to West Virginia last year, Lara became pregnant again.

In March, she was referred to the state’s Right From The Start program to learn more about how to have a healthy pregnancy.

The program connected her with care coordinator Janeen Masker, who visited Lara at her home in Charleston and talked with her about the health risks of smoking and how to quit.

A smoker since about age 14, Lara – now 34 – said recently she has not had a cigarette since March.

“Here in West Virginia they really take charge,” Lara said. “It was just a big difference.”

But West Virginia also has a culture more accepting of marlboro cigarettes sale, health officials here say. That combined with overall stress from poverty, domestic violence or drug abuse are among reasons health officials give for why women smoke, including while pregnant.

“The cigarette is like an old friend,” Masker, a registered nurse, said. “They’ve used it to help pull them up, feel a little bit better.”

West Virginia’s Right From The Start program provides in-home services to Medicaid-eligible pregnant women. The 20-year-old state program also helps women up to 60 days after they give birth and their infants up to 1 year.

Tobacco cessation is an important part of the program, as about 26.7 percent of West Virginia women reported smoking while pregnant. That 2007 figure from a recent state vital statistics report is more than double the 2005 national rate of 10.7 percent.

Smoking seems to be “almost entrenched in the culture,” said Beverly Kitchen, a regional care coordinator for Right From The Start. It also can be a stress reliever for women in the program, she said.

“They’re low-income,” Kitchen said. “They don’t have as many choices as a lot of other women do in West Virginia. . .a lot of them have had very hard lives.”

Right From The Start provides home visits, a benefit that sets it apart from similar programs in clinical settings, said Jeannie Clark, director of perinatal programs for the West Virginia Office of Maternal, Child and Family Health.

“Since they go to the home they actually become the woman’s friend,” Clark said. “They gain their trust.’ ”

Lara credited her care coordinator, Masker, as the main reason she quit smoking.

“As soon as she walked into my house, she makes me feel that she’s a part of the family, that she really cares,” Lara said. “She’s always there when I need her.”

Trained registered nurses or licensed social workers serve as designated care coordinators for the program, Clark said. They are assigned to clients based on specific needs, and they live and work in the same community and know what local resources are available, she said.

For example, if a woman has medical problems, like gestational diabetes or depression, she likely would work with a nurse, Clark said, and if she is facing more social problems, like needing shelter, food or clothing, a social worker would help her.

“You don’t have to come to us; we come to you,” Clark said. “You don’t have to spend your gas money going to an appointment. We say this program is to help you stay healthy during pregnancy.”

About 3,300 pregnant women qualify and participate in Right From The Start in West Virginia over a year, Clark said.

More could qualify because about 50 percent to 60 percent of babies born in West Virginia are Medicaid-eligible, she said.

The National Institutes of Health’s National Cancer Institute and George Washington University are in the middle of a four-year study of Right From The Start’s Smoking Cessation and Reduction In Pregnancy Treatment program, or SCRIPT.

“Since this is such a large problem with smoking in pregnancy, we were looked at by the National Institutes of Health to see what we’re doing with the program so that all Medicaid smokers that enroll in Right From The Start could have the opportunity to participate in this smoking cessation program,” Clark said.

SCRIPT is an evidenced-based smoking cessation program recommended for pregnant women, Clark said.


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