Emily's Case Study

1. Overview of Emily's Situation

Emily is a 28 year old Haida woman. She lives with her husband and two children (4 and 7 year old girls); She is pregnant with 3rd child. Emily completed high school and is currently unemployed and is a full time mom. Her husband quit smoking last year.

Emily smokes outside and in the garage. She has tried chew before but never really liked it. Currently, Emily smokes 5 cigarettes a day of "light" cigarettes. When she speaks of her smoking she emphasizes the “light.” She smoked about 15 cigarettes a day before pregnancy. She started smoking in high school at about 15 years old (13 years of being a smoker) when all her friends started smoking and doing drugs.

She is not sure that she wants to quit even though she is pregnant. She rationalizes that she smoked during her first two pregnancies and her babies are fine. “So what's the big deal?” is her comeback question when she is asked about it. 

2. Current Treatment

She is seeing a Tobacco Treatment Specialist (TTS) because her husband and her doctor encouraged her to do so. When asked about main concern about using tobacco while pregnant Emily answered, "I don't know." She also told the TTS that she had not made any changes in the type of tobacco she uses but did report that she decreased the amount she is using. She does ask for all the information the counselors can provide and is open to learning about how to quit. 

When asked about past and current health issues she responded yes to having had head injuries, and she currently has skin allergies, some shortness of breath, and coughing. She tries to walk every day to keep her weight down but has noticed that walking her same route is getting harder. Emily says she is more and more tired because she is pregnant.

When asked about mental health issues Emily said that she suffers from anxiety and is taking medications for it. She said that she worries about her husband as he is a slope worker and gone a lot. She does not have depression, but often misses her husband although her kids and friends keep her busy. Emily said that she does normally drink alcohol but she does not drink while she’s pregnant.

Emily has tried to quit four times in the past. Her longest quit attempt was for four months, when she was pregnant with her first child. She said that she relapsed because her husband smoked at the time and all her friends did as well. It was difficult for her not to smoke and still be around it. The second time she tried to quit was when her first child was 2 years old. She tried the patches and lozenges for 3 weeks but did not like the taste of the lozenges and the patches made her itch.

3. Assessment Information

Symptoms of withdrawal: Emily has was able to remember experiencing all the symptoms related to nicotine withdrawal.  

Main reason for wanting to quit: Emily talked about her husband and he said to her that he feels better and wants her to feel better as well. Emily’s father-in-law died of lung cancer recently and she knows that her husband cannot stand the thought of possibly losing her as well. Emily also thinks it would be better for her children not to see their mommy smoking as they are already imitating many things she does. 

She reported that she mainly uses tobacco when she drinks coffee in the morning, when relaxing, when bored, when she drinks alcohol and when she feels anxious. Her sister has diabetes and mom had a stroke a few years back.

Obstacle: Concerned about gaining weight.

Emily is a little stressed about the thought of giving birth again, the health of the child, and her personal appearance. Dealing with three kids alone when her husband is gone is also a challenge. Emily heard of tobacco cessation program from her OB/GYN. 

Importance level is 8/10 and 

Confidence is 7/10 because she has already tried patches and is worried it won't help.

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