TheWorld Health Organisation defines second-hand smoking as the air that fillsenclosed spaces when people burn tobacco products.
There’s no safe level tosecond-hand smoke that’s why in adults the causes of second hand smoke includesserious cardiovascular and respiratory diseases. In infants, it causes suddendeath and in pregnant women, low birth weight and more than 890,000 prematuredeaths per year. Almost half of the children breathe air regularly polluted bytobacco smoke in public places. In 2004, children were accounted for the 28% ofthe deaths attributed to second hand smoking. Children with a parent who smokesare three times more likely to smoke. It is estimated that each year at least23,000 young people in England and Wales start smoking by the age of 15 as aresult of exposure to smoking at home (RCP, 2010).
This is the reason why a newlegislation in England and Wales made it illegal to smoke in a vehicle carryingsomeone under the age of 18 and the fine for the offence is £50. This law is toprotect children and young people from the damaging effects of second-handsmoke, which can put them at risk of serious health implications (Public Healthof England). Smoking worsens poverty in adults with mentalconditions in the UK. Analysis from the Health Survey for England and the AdultPsychiatric Morbidity Survey reports that the number of adults in the UK with mentalhealth problems and who currently smoke are considered as living in poverty iftheir expenditure on tobacco is being taken from their household income. The analysisfound that smoking prevalence is very high with adults in poverty who have amental problem with an estimated 900,000 to 1.2 million people with a commonmental disorder living in poverty who are currently smokers. 10% of theestimated 1.
3 million poor smokers with a common mental health problems wouldbe lifted from poverty if they were to quit smoking because the average annualexpenditure of a poor smoker with a mental disorder is about £1220. Therefore smokingcreates a very significant financial burden to an individual in a deprived group(Social Care Institute for Excellence- Mental health, smoking and poverty inthe UK, 2016.) NICEhas produced guidance on how pregnant smokers can be helped to quit. Smoking canhave devastating consequences for a pregnant woman and their child because smokingduring pregnancy can increase the risk of stillbirth and babies born to motherswho smoke are likely to be underdeveloped and in poor health. Smokingduring pregnancy is also a major health inequality, with prevalence varyingsignificantly across communities and social groups. Women under the age of 20and those in more disadvantaged groups have a higher smoking prevalence becausemothers in manual occupations are five times for likely to have smokedthroughout their pregnancy compared to women in managerial roles andprofessional occupations. This implies that those women from a lowersocio-economic group are more likely to become smokers themselves further hencecontinuing the cycle of inequality and affecting their life chances.
NICE hasset 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. Smokingin pregnant women varies hugely from 2.3% in the West London to 28.1% inBlackpool.
So to reach their goal to everyone, they must focus particular attentionon disadvantaged groups and localities where the prevalence of smoking remainsmuch higher. Achieving this goal requires action from both a national and locallevel that’s why NICE Guidance on smoking amongst pregnant women containsevidence-based recommendations for local policies. The examples include usingCarbon Monoxide (CO) monitors to assess whether the pregnant women were smokingor not and getting plenty of help for pregnant women to stop smoking.
When usingthe CO monitors to identify pregnant women who smoke, its best to use a low cutpointto avoid missing someone who may need help to quit because CO quickly disappearsfrom 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. Itis required that the midwives take action by assessing the woman’s exposure tosmoking through discussion and use of a CO test and explaining that it willallow her to see a physical measure of smoking and exposure to other peoplethat 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 householdthat smokes. Then the midwife must provide information about the risks ofsmoking to the unborn child and the effects of passive smoking.
All thepregnant women that have been referred for help must be provided with ongoingsupport throughout pregnancy and beyond this includes regular monitoring. Localinitiatives and on-going support have been provided by the NHS stop smokingservices which discuss the risks and benefits of Nicotine Replacement Therapy(NRT) with pregnant women who are regular smokers. NHS stop smoking serviceshave not only helped pregnant women but also other regular smokers by providingexpert advice, support and encouragement to help the individuals to stopsmoking for good by offering one to one support along with stop smokingmedicines (NHS Smoke free).
