PlanningGrant Example 2(1)

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“Bun in the Oven? Put Out the Smoke!”: Eliminating Maternal Smoking in Humboldt Park Submitted to: The Handler Community Trust Date: December 5, 2017

“Bun in the Oven? Put Out the Smoke!”: Eliminating Maternal Smoking in Humboldt Park Community Introduction and Background The Humboldt Park community has been home to a multitude of diverse immigrant populations in Chicago for the past two centuries and the ever-changing demographic population of Humboldt park over time has given way to certain community needs (Doe, 2017). The community was officially annexed to Chicago in 1869 and was originally home to Scandinavian immigrants (Doe, 2017). Since then, the community has served as a home to German, Danish, Norwegian, Polish, Roman Jew, and Puerto Rican immigrants. Humboldt Park is Chicago’s 23rd community district and currently is home to a majority Hispanic and Latin(x) population, with residents of Puerto Rican decent making up around a quarter of the population. It is the only officially recognized Puerto Rican neighborhood in the nation, outside of Puerto Rico (Doe, 2017). The community has a current population that is 52% Hispanic or Latin(x) [ CITATION Hum172 \l 1033 ] and 51.5% Female, and about half of the female identifying population are in their childbearing years [ CITATION Hum172 \l 1033 ]. The Humboldt Park Healthy Moms coalition is made up of families and residents that live in the Humboldt Park community area, local businesspersons and church leaders, representatives from community organizations, and graduate students from the University of Illinois at Chicago. Statement of Need The Humboldt Park Healthy Moms coalition seeks to address the issue of maternal smoking amongst women who are pregnant in the community. According to community data from the Chicago Health Atlas, the rate for smoking while pregnant in Humboldt Park is 4.3% [ CITATION Hum172 \l 1033 ], twice the rate for the city of Chicago. As stated in the previous section, about 46.4% of women (female identifying individuals) are in their childbearing years. Though data on the number of families or percentage of women pregnant in Humboldt Park is unavailable to us at this time, we recognize the impact that smoking, secondhand smoke, and thirdhand smoke, has on women, fetuses, and children and our coalition hopes to bring further education and intervention to the community to address this issue. While we understand that smoking in itself is a health behavior that is detrimental to everyone, the coalition will focus its program efforts on women who are currently pregnant and smoking in Humboldt Park.

Studies show that 12-20% of pregnant women in America smoke [ CITATION Smo17 \l 1033 ] and approximately 10% of women reported smoking during the last 3 months of their pregnancy [ CITATION Tob17 \l 1033 ]. 2.3% of women in Chicago admitted to smoking while pregnant and 4.3% of women in Humboldt Park admitted to smoking while pregnant [ CITATION Hum172 \l 1033 ]. When a mother smokes during her pregnancy it increases her likelihood to have preterm labor, or severe complications such as vaginal bleeding, ectopic pregnancy (which is when a fertilized egg implants itself somewhere other than the uterus), placental abruption (a condition in which the placenta separates from the walls of the uterus), and placental previa (a condition where the placenta forms lower in the uterus, covering part of or the entire cervix) [ CITATION Smo15 \l 1033 ] compared to nonsmoking mothers. Smoking during pregnancy is a significant health issue because not only is the mother harming her own body, but she is also harming her unborn fetus ’ . When a mother smokes, nicotine, carbon monoxide, and tar – all addictive and toxin elements found in cigarettes and cigarette smoke – pass through the placenta and umbilical cord into the baby’s bloodstream [ CITATION Smo15 \l 1033 ]. This can result in birth defects, a miscarriage or still birth (depending how late the mother is in her pregnancy) and contribute to sudden infant death syndrome (SIDS) [ CITATION Smo15 \l 1033 ]. Other effects of maternal smoking are equally devastating. According to the American Pregnancy Association, smoking while pregnant is estimated to account for approximately 14% of preterm deliveries, 20-30% of low birth weight babies, and approximately 10% of all infant deaths [ CITATION Smo17 \l 1033 ]. In Humboldt Park, the rates for these maternal and child health indicators match or are higher than those of Chicago’s. 11.2% of births in Humboldt Park are preterm (similar to 10.5% in Chicago), 10.9% of babies are born with a low birthweight (similar to 9.3% in Chicago), and 9.7 per 1000 infants die before their first birthday (compared to 7.1 per 1000 in Chicago) [ CITATION Hum172 \l 1033 ]. This information is astounding, and the issue of maternal smoking can become more severe if the mother has other children. Second and thirdhand smoke can affect both male and female fertility [ CITATION May15 \l 1033 ], as well as contribute to the incidence of childhood asthma and adult asthma – the rate of which is 16.1% in Humboldt Park [ CITATION Hum172 \l 1033 ] – bronchitis, and other respiratory complications. This data shows the significance of maternal smoking and our aim to address this issue in Humboldt Park has the potential to affect a plethora of other negative health outcomes for women, children, and families in our community. Program Description The aim of our program is to decrease the rate of maternal smoking in Humboldt Park. We feel that the most effective way to implement this program for behavior change is by establishing an intervention that utilizes the framework and approach of both the social cognitive theory (SCT) and social network theory (SNT) while simultaneously addressing the constructs from both the Health Belief Model (HBM) and the Transtheoretical Model (TTM). Behavior change is a complex issue to address because there are multiple facets that can influence decision making. The behavior of smoking itself can be influenced by stress, habit, and

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addiction [ CITATION Rea17 \l 1033 ]. These influences are significant because they impact behavior on in increasingly profound manner. Psychological trauma and patterns can be difficult to address and improve solely on an individual level, so our coalition’s program design would want to create an environment that focuses on and reflects the values of relationship with others and those relationship’s impact on community. Residents of Humboldt Park are firm in their culture and value the importance of meaningful relationship. This acts as a major strength for our program because we can utilize the empowering and supportive structure of the SNT to effectively show mothers that the behavior changes they are trying to make are as important to themselves as they are to their community. We can also use the SCT’s construct of “expectation” to reinforce the overall good that their behavioral decision would make (for the mother individually, to their unborn baby, and to their community as a whole). Just as much as community and community support are important, so is the mother’s understanding of the health issue and her willingness to change. This is where the individual focus of the HBM and TTM come into play. Education about the harmful effects of maternal smoking can potentially help redirect the mother’s perception of smoking while she is pregnant, and the program’s efficacy building activities can empower her to begin to see a life where she can smoke less or not at all. The TTM allows us to also design our intervention with the understanding that individuals will need support and “grace periods” as they work towards a behavioral change. Setting up our intervention this way will allow us to enhance the community effect of networking and support. This focus, within the structure of the SNT and the SCT, can create a healthy balance for progressive community-supported behavioral change. The utilization of these frameworks also allows us to collect both qualitative and quantitative data, that we can then analyze to observe the social and structural barriers pregnant women in the community face when dealing with this health behavior. We would then use this data to see what the disparities in Humboldt Park are compared to those present or absent in other Chicago communities. Implementation : One of our coalition partners is Association House of Chicago. Located in Humboldt Park, Association House has served as a community resource for a little over a century[ CITATION Our17 \l 1033 ]. We believe that Association House would be an ideal conduit for our program, seeing that it is directly connected to and trusted by the community. Our partnership with this organization allows the coalition access to the community and the utilization of well-established resources. In this past fiscal year, Association house impacted 17,233 individuals, and of these who received their services, 52% we female, 54% were Latin(x), 32% were Spanish speaking, 38% had no income, 34% were unemployed, 36% did not have health insurance, and 95% reported satisfaction with their services and quality of care [ CITATION Our172 \l 1033 ]. This is very beneficial to the utilization and sustainability of our program. Not only does Association House’s reputation confirm that our program will be supported and utilized, but it also increases the program’s ability to get information to individuals who might be unreachable if our services are distributed by other means, like in doctor’s offices or by employers. Also, 44% of Association House’s participants in this last year heard about the organization by “word of mouth” [ CITATION Our172 \l 1033 ]. We believe this is both a testament to the credibility of our intervention site as well as to the dynamic of the community.

Conclusion As mentioned above, maternal smoking is an incredibly important maternal and child health issue with potentially devastating effects, and we are seeing its presence and impact in Humboldt Park. The coalition believes that addressing maternal smoking in our community gives us the opportunity to increase the quality of life for both the current and future generation, while simultaneously addressing other maternal and child health issues in the community like preterm labor and birth, low birthweight, birth defects, infant mortality, and childhood asthma. The Trust’s funding will not only be beneficial in addressing these issues, but it will also allow us the opportunity to observe the structural and societal disparities and influences on broader aspects of health that impact smoking behavior among pregnant women in Humboldt Park. We appreciate the Handler Community Trust taking an interest in helping the Humboldt Park Healthy Moms coalition implement a program that will help mothers, babies, and families in the Humboldt Park community live healthier lives! Please feel free to contact me at jdoe@uic.edu if you require any further information. Respectfully submitted, Jane Doe MPH Student Reviewer Feedback: Overall, very nice! You have a really good tone, and you describe the community and problem well. My primary critique is that unless I was already familiar with the theories that you cited, I wouldn't know enough about them to understand how you were using them - this is better than only describing the theories and not how you would use them, but just a very brief sentence that summarizes each would be helpful.

References Doe J. (2017). Humboldt Park: Community Health Equity Profile. Chicago. Humboldt Park . (2017, October 29). Retrieved from Chicago Health Atlas: https://www.chicagohealthatlas.org/indicators/community-areas/humboldt-park Our History . (2017, October 27). Retrieved from Association House of Chicago: https://www.associationhouse.org/home/about-us/our-history/ Our Imapct (FY 2016) . (2017, December 9). Retrieved from Association House: https://www.associationhouse.org/impact/ Our Menu . (2017, December 9). Retrieved from Association House of Chicago: https://www.associationhouse.org/home/about-us/our-history/ Reasons People Smoke . (2017, December 9). Retrieved from Smoke Free: https://smokefree.gov/veterans/nicotine-addiction/reasons-people-smoke Smoking During Pregnancy . (2015, December). Retrieved from March of Dimes: https://www.marchofdimes.org/pregnancy/smoking-during-pregnancy.aspx Smoking During Pregnancy . (2017, December 9). Retrieved from American Pregnancy Association: http://americanpregnancy.org/pregnancy-health/smoking-during-pregnancy/ Staff, M. C. (2015, March 19). Smoking and Pregnancy: Understanding the Risks . Retrieved from Mayo Clinic: https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by- week/in-depth/smoking-and-pregnancy/art-20047021 Tobacco Use and Pregnancy . (2017, September 29). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/tobaccousepregnancy/index .htm

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