Oregon’s health care overhaul has given health organizations permission to try things that might be a little unusual.
A Coordinated Care Organization in Eugene is taking the state at its word — it’s going to pay pregnant women cold, hard cash to stop smoking.
Heidi Zauner is an administrative assistant in the Mollalla River School District. When she was 28, she became pregnant. She was smoking about 10 cigarettes a day.
“I didn’t give myself a choice. I just knew I had to quit for the health of my child,” she said.
She says her folks didn’t know she smoked — so quitting in front of them wasn’t an issue. But she worked at a fabric store where several other people smoked.
Zauner explained, “You just don’t go out on the deck. You just have to change your habits and say, okay, I’m going to eat my lunch inside and I’m not going to go out on the patio and smoke.”
Zauner says the real problem was driving home — when nobody could see her spark-up in the car.
So, how long did it really take to stop?
She said, “Probably for I would say three or four more days, after I knew I was pregnant and going to work. And then I would try to cut out the morning and then I would try and cut out the night of going home. She’s 17 now, so it’s a while ago.”
In these days of smoking bans in offices and bars, it’s tempting to think smoking isn’t as much of a problem. Dr. Holly Jo Hodges of the Trillium Community Health Plan in Eugene says that’s true — but it still surprising how many people still smoke.
She explained, “In Lane County, a recent chart review at one of our clinics showed that up to 40 percent of women of child bearing age on the Oregon Health Plan smoked cigarettes and that 32 percent of them continued to smoke while they were pregnant.”
And just to be clear she says, smoking can cause real problems.
She said, “It results in 5 percent of fetal deaths, up to 10 percent of pre-term deliveries and up to 30 percent of low birth-weight babies.”
There is even evidence she says, that having a mother smoke during pregnancy can result in life-long medical complications for the child — like asthma and ear infections. Quite apart from the health effects of smoking, there’s a financial cost, too. A study by the Lane County Public Health District found that for the 1400 babies born each year at Trillium, up to $1 million dollars is spent on neonatal care because of smoking. Currently, the doctors at Trillium send smoking mothers for counseling and acupuncture. But Hodges says pregnancy is a tough time to quit.
Hodges said, “It’s hard to use pharmacological interventions that you might be able to more readily use in people who aren’t pregnant. Things like nicotine replacement products, there’s also Chantix and Zyban that are pills to take that help people to quit smoking. But we don’t use Chantix or Zyban at all in pregnancy.”
In an effort to find a better solution, Trillium asked a panel of community volunteers for ideas. One of those volunteers, Tara Davee says she’s motivated by incentives, and she put herself in a pregnant mother’s shoes.
Davee said, “So a lot of these people I think want to quit, they just need that little extra wrap-around service and extra boost. So we thought, hey, how about gift cards.”
Davee says with a department store gift card, the women couldn’t buy tobacco, alcohol or firearms, but baby clothes, groceries or other household supplies would be fair game.
Here’s how it would work:
A woman arrives at Trillium and is pregnant. She gets a breathalyzer or a urine test to see if she’s a smoker.
If she agrees to the program, she picks a quit date and signs up for counseling.
Then, she returns for her 16 week pregnancy appointment and urine test.
Hodges said, “They’re looking for sugar, they’re looking for protein, things that are bad when you’re pregnant. Well now, we’re also looking for nicotine. So if you’re negative for nicotine, you get a $20 gift certificate. Then the second time, which is somewhere around 28 weeks if you’re still negative for nicotine, you get a $30 gift card.”
At 36 weeks, they get $50 and then if they come back six weeks after the birth, they can get a $100 certificate. So a total of $200 to quit.
“If at any point in time somebody falls off the wagon, they had a stressful day, something happened and they go back to smoking and they test positive at any point along the way, they just don’t get the gift certificate that time. But they’re still eligible to get the certificate the next time.”
Hodges says about 500 women a year deliver children at Trillium, who are on the Oregon Health Plan.
She said, “And so our goal is to get 33 percent, a third of those women, to quit smoking with this program. That’s our goal. Right now, we know that 18 percent or less are actually successful.”
Hollea Puzio is 22 and looks after her four-year-old at home. She’s near her due-date and says she smokes about four cigarettes a day — at home — where nobody can see her.
Puzio said, “I’ve tried to give up smoking. It’s really hard. A four year old, trying to find a place to move to. Just the stress of being pregnant, too.”
So, what does she think of the idea of getting cash to stop?
She said, “I don’t know if it would work. I would say I would try.”
Puzio says she feels guilty about smoking and she continues trying to quit.
Meanwhile, Trillium is training 20 tobacco cessation specialists to be ready by July 1, when they’ll be assigned to the agency’s various clinics.
A scientific study will track the program to see just how successful it is.