The
World Health Organisation defines second-hand smoking as the air that fills
enclosed spaces when people burn tobacco products. There’s no safe level to
second-hand smoke that’s why in adults the causes of second hand smoke includes
serious cardiovascular and respiratory diseases. In infants, it causes sudden
death and in pregnant women, low birth weight and more than 890,000 premature
deaths per year. Almost half of the children breathe air regularly polluted by
tobacco smoke in public places. In 2004, children were accounted for the 28% of
the deaths attributed to second hand smoking. Children with a parent who smokes
are three times more likely to smoke. It is estimated that each year at least
23,000 young people in England and Wales start smoking by the age of 15 as a
result of exposure to smoking at home (RCP, 2010). This is the reason why a new
legislation in England and Wales made it illegal to smoke in a vehicle carrying
someone under the age of 18 and the fine for the offence is £50. This law is to
protect children and young people from the damaging effects of second-hand
smoke, which can put them at risk of serious health implications (Public Health
of England).

 

Smoking worsens poverty in adults with mental
conditions in the UK. Analysis from the Health Survey for England and the Adult
Psychiatric Morbidity Survey reports that the number of adults in the UK with mental
health problems and who currently smoke are considered as living in poverty if
their expenditure on tobacco is being taken from their household income. The analysis
found that smoking prevalence is very high with adults in poverty who have a
mental problem with an estimated 900,000 to 1.2 million people with a common
mental disorder living in poverty who are currently smokers. 10% of the
estimated 1.3 million poor smokers with a common mental health problems would
be lifted from poverty if they were to quit smoking because the average annual
expenditure of a poor smoker with a mental disorder is about £1220. Therefore smoking
creates a very significant financial burden to an individual in a deprived group
(Social Care Institute for Excellence- Mental health, smoking and poverty in
the UK, 2016.)

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NICE
has produced guidance on how pregnant smokers can be helped to quit. Smoking can
have devastating consequences for a pregnant woman and their child because smoking
during pregnancy can increase the risk of stillbirth and babies born to mothers
who smoke are likely to be underdeveloped and in poor health. Smoking
during pregnancy is also a major health inequality, with prevalence varying
significantly across communities and social groups. Women under the age of 20
and those in more disadvantaged groups have a higher smoking prevalence because
mothers in manual occupations are five times for likely to have smoked
throughout their pregnancy compared to women in managerial roles and
professional occupations. This implies that those women from a lower
socio-economic group are more likely to become smokers themselves further hence
continuing the cycle of inequality and affecting their life chances.

NICE has
set an ambitious goal of reducing smoking amongst pregnant women to 6% by 2022.
This important to ensure that children have the best start of their lives. Smoking
in pregnant women varies hugely from 2.3% in the West London to 28.1% in
Blackpool. So to reach their goal to everyone, they must focus particular attention
on disadvantaged groups and localities where the prevalence of smoking remains
much higher. Achieving this goal requires action from both a national and local
level that’s why NICE Guidance on smoking amongst pregnant women contains
evidence-based recommendations for local policies. The examples include using
Carbon Monoxide (CO) monitors to assess whether the pregnant women were smoking
or not and getting plenty of help for pregnant women to stop smoking. When using
the CO monitors to identify pregnant women who smoke, its best to use a low cut
point
to avoid missing someone who may need help to quit because CO quickly disappears
from expired breath which means the level can fall by 50% in less than 4 hours,
and as a result, low levels of smoking may go undetected.

It
is required that the midwives take action by assessing the woman’s exposure to
smoking through discussion and use of a CO test and explaining that it will
allow her to see a physical measure of smoking and exposure to other people
that are smoking (passive smoking). And to help interpret the CO reading correctly,
the midwife must ask the pregnant woman if she knows anyone in the household
that smokes. Then the midwife must provide information about the risks of
smoking to the unborn child and the effects of passive smoking.

All the
pregnant women that have been referred for help must be provided with ongoing
support throughout pregnancy and beyond this includes regular monitoring. Local
initiatives and on-going support have been provided by the NHS stop smoking
services which discuss the risks and benefits of Nicotine Replacement Therapy
(NRT) with pregnant women who are regular smokers. NHS stop smoking services
have not only helped pregnant women but also other regular smokers by providing
expert advice, support and encouragement to help the individuals to stop
smoking for good by offering one to one support along with stop smoking
medicines (NHS Smoke free).