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Practice

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Charlotte Jackson

on 15 October 2012

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Transcript of Practice

Smoking in pregnancy Communication
Opportunistic advice
Assessment - commitment to quitting, how many aday.
Approach Screenings and interventions. Women may be reluctant to admit to smoking due to stigma, shame or feel that pressure to quit will be intense. Advise to stop not cut down. cognitive behavioral therapy
structured self help and support
NHS stop smoking service. Carbon monoxide (CO) testing The Results The number of quit dates set by pregnant women was 31.3% higher during the period after the campaign launched, than it was during the same period in the previous year. The number of successful quits at 4 weeks was also up on last year’s figures by 34%.

Recognition of the campaign overall, was strong. The posters achieved the highest, followed by radio and adverts, then online.

Significant increase at the post-campaign stage of partners trying to stop smoking from 28% pre-campaign to 45% post.

The campaign had a positive impact on claimed behaviour – 2/3 said they were more likely to stop smoking as a result of the advertising, and 2/5 said they had taken some action as a result. The campaign has been very successful according to media peers 2010 Winner of Chartered Institute of Public Relations (CIPR) Excellence awards, Health category
2010 Grand Prix, Data Strategy Awards, Department of Health
2010 Winner, Data Strategy Awards, Client Brand of the Year, Department of Health Health Promotion and the Media Public Health promotion activities, reaching the hard to reach and using mass media to maximum effect requires : 2009 NHS Smokefree Campaign The object of this campaign was to make the consequences of smoking during pregnancy feel immediate, motivating pregnant women to quit - the underlying theory being that of Prime Theory. The campaign also effectively explained how every cigarette can be harmful to the foetus, in a manner that is easy to understand and re-iterated in various forms.

Midwives were also a key audience and given a free toolkit of support materials, designed to enable them to easily explain the risks of smoking in pregnancy and increase referrals to NHS support services. The Results The number of quit dates set by pregnant women was 31.3% higher during the period after the campaign launched, than it was during the same period in the previous year. The number of successful quits at 4 weeks was also up on last year’s Q1 figures by 34%.
Searches related to smoking in pregnancy during the campaign increased by 21%
Recognition of the campaign executions overall was strong. The posters achieved the highest cut-through followed by radio and advertorials, then online.
Significant increase at the post-campaign stage of partners trying to stop smoking from 28% pre-campaign to 45% post.
The campaign had a positive impact on claimed behaviour – 2/3 said they were more likely to stop smoking as a result of the advertising, and 2/5 said they had taken some action as a result 2009 NHS Smokefree Campaign The object of this campaign was to make the consequences of smoking during pregnancy feel immediate, motivating pregnant women to quit. The campaign effectively explained how every cigarette restricts oxygen supply to the baby, causing their heart to pump harder1. Midwives were also a key audience and given a free toolkit of support materials, designed to enable them to easily explain the risks of smoking in pregnancy and increase referrals to NHS support services. It’s won awards so it must be true 2010 Winner of Chartered Institute of Public Relations (CIPR) Excellence awards, Health category
2010 Grand Prix, Data Strategy Awards, Department of Health
2010 Winner, Data Strategy Awards, Client Brand of the Year, Department of Health Health Promotion and the Media One single campaign can be attributable to decreasing the numbers of women smoking during pregnancy.

True

False Care Delivery Policies for smoking in pregnancy.


Smoking in pregnancy has been happening for hundreds of years, policies have been brought in along with guidelines to try and encourage and prevent mothers from smoking during and after pregnancy.
The need for guidance
It has been reported (British Market Research Bureau, 2007) that nearly a third of mothers in England are smokers before pregnancy. This study found that 49% gave up at some stage before the birth; however 7% continued to smoke throughout their pregnancy. Other studies suggest that these figures may be an estimate (Nice.2008).
When researching policies in pregnancy I found that there was a large amount of policies on smoking and only small amounts on the pacific topic of smoking in/during pregnancy. As a group we took it upon our self’s to get in touch with a variety of different health professionals to find out as much information as possible and who uses which policies.






I spoke to my local midwifes and health visitors ( The knoll surgery Frodsham). Who follow the NICE guidelines , http://www.nice.org.uk/nicemedia/live/13023/49345/49345.pdf.

This is backed by the NHS policy on smoking in pregnancy;
http://www.eastcheshire.nhs.uk/About-The-Trust/policies/M/Maternity%20stop%20smoking%20in%20pregnancy%201621.pdf. Examples of reasons why policies and guildlines have been brought in;

* The cost of a complicated delivery by a pregnant smoker is eastimated to be 66% higher than a non smoker (Nice.2008).

* Healthy lives, Healthy people (2011) A tabacco control plan for england- national ambition to reduce the percentage of women who smoke during pregnancy from 14% to 11% by 2015.

* Smoking kills (1998)- to reduce the percentage of women who smoke during pregnancy from 23% to 15% by 2010, this target was reached.

*Priorities and planning framework (2002)- deliver a 1% reduction per year. National scale There are many more Policies, Guildines ans acts which are alvailbe online at; www.dh.gov.uk, some that are availble and useful for our topic are;

* Every Child Matters (HM Government,2004).,

*Maternity matters: choice, access and continuity of care in a safe service (Dh,2007a).

*The Cancer Reform Strategy (DH,2007b).,

* Smoking Kills (Dh,1998).,

* Health inequalities: Pregress and next steps (DH 2008) and

* THe implementation plan for reducing health inequalities in infant mortality: good practice guide (DH, 2007c). Studies have been taken out all over the world to find out what countries have policies in place and which countries have reduced there smoking in and around pregnancy targets. England, New zealand and Ireland have proven to have a high air quality in builds and in door public places as they have all brought in policies and laws to stop people smoking in public places. this has reduced their complications in pregnancy from second hand smoking ( World Health Organization 2007). on the first of July 2007 England brought in there stop smoking in public place law. The policy we chose to look at world wide is, Protection from exposure to second hand tobacco smoke. When researching smoking during pregnancy world wide, there was a number of policies which where very similar to the east Cheshire policy and the healthy child.
I chose to look at a policy which broadens our subject.
The policy protection from exposure to second hand tobacco smoke.
This policy gives information and the effects second hand smoke has on an unborn child.
Partners and families to the newborn child are given information- including leaflets, website and helplines to give them ways of protecting an unborn child.
This policy gives information, facts and figures on the effects of second hand smoking has on babies, children and everybody around them. Smoking is a hard habit to break, but ultimately smoking is a choice and it is your responsibility to choose whether or not you will continue to smoke during pregnancy! What are the political, social and cultural factors that may effect on the health and well-being of expectant mothers and their child? UK National Smoking Cessation conference The Department of Health strategy for tobacco control is called “Healthy Lives, Healthy People: A Tobacco Control Plan for England, it has 3 key ambitions

1. To reduce smoking amongst adults
2. To reduce smoking amongst young people
3. To reduce smoking in pregnancy (to reduce rates of smoking in pregnancy to 11% or less, from 14%, by the end of 2015

This Tobacco Control Plan sets out the key actions under each strand that the Government will take in order to support efforts to reduce tobacco use over the next five years, within the context of the new public health system.

Healthy Lives, Healthy People: Our strategy for public health in England (HM government) White paper and associated documents: http://www.dh.gov.uk/en/publichealth/healthyliveshealthypeople Political – campaigns, law/policy/paternalism Dahlgren G & Whitehead M (1991) Policies and strategies to promote social equity in health. Institute for Future Studies, Stockholm (Mimeo) The health and well-being of individuals and populations across all age groups is influenced by a range of factors both within and outside the individual's control. One model, which captures the relationships between these factors, is the Dahlgren and Whitehead (1991) 'Policy Rainbow', which describes the layers of influence on an individual's potential for health. Social – Population, class, lifestyle, community Women also look to family, friends and partners for advice and have identified positive and negative influences associated with having smoking and non-smoking partners/family.

Negative

Smoking family members offered a negative influence in terms of providing temptation and a reminder of the pleasure in smoking as social activity.

Non-smoking family members were more likely to be perceived to use pressure and ‘nagging’ as a means of influence. This kind of pressure resulted in cases of both quitter and non-quitter women smoking in secret to avoid negative reactions.

Positive

Smoking family members were attempting to either quit alongside the women or were not smoking in their presence.

Smoking family members were encouraging and non-judgemental. Cultural – Peer pressure, beliefs and norms There are many laws and policy that provide influential factors to the way people preceive smoking in pregnancy. Below are but just a few examples. Rise in tobacco tax - good for health, good for the economy
Wednesday 21 March 2012


The 5% real term rise in tobacco duty has been warmly welcomed by health campaigners, who had lobbied for this level of increase to help smokers quit and dissuade children from taking up the habit.

ASH is particularly pleased that the Chancellor acknowledges that raising tobacco duty is an effective way of reducing smoking and a key component of a comprehensive tobacco control strategy.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124917 The above celebrities have all been snapped smoking while pregnant and there are many more. The issue of young mothers who smoke while pregnant has been in the media spotlight for a long time, with young celebrity mothers continuing to smoke during pregnancy. Is this setting an example to the young mothers that this is exceptable behaiour in a celebrity culture world that we live in today. MAIN POLICIES
• Increasing the unit price for cigarettes.
• Mass media campaigns.
• Health promotion and behavioral support
• Counseling and self-help strategies

Messages should be relevant and appropriate to
their circumstances. Socioeconomic factors are thought to play a key role in determining whether women will continue to smoke during pregnancy or quit. According to ASH, which is a public health charity, aiming to reduce the harm caused by tobacco women who have routine and manual jobs are almost three times more likely to smoke as women in managerial and professional jobs. Research by Professor Hilary Graham of York University's department of health sciences has found, Education, Low income, Lone expectants and Young mothers are all linked to a greater incidence of smoking during pregnancy. It has been argued that government policy on smoking has led to a disadvantaged for this group of women, and as a result the current government strategy of promoting lifestyles more commonly found in middle-class communities is unlikely to target these particular women. Research shows that the health behaviours of those around us – be that smoking or quitting – make a bigger difference to our own behaviours than we realise. It is estimated that a smoker only inhales
15% of the smoke from a cigarette and the other 85% is left in the air for bystanders to inhale. It has been proven that second hand smoke is the third leading preventable cause of disability and early death to the unborn child.

http://www1.umn.edu/perio/tobacco/secondhandsmoke.html.

The protection of exposure to second hand smoke is available at www.who.int/en.

Studies have been taken out all over the world to find out what countries have put their policies in place and which countries has reduced there smoking in and around pregnancy targets. English, New Zealand and Ireland have proven to have high air quality in buildings as they have brought in laws to stop people smoking in public places. This has reduces their factors on pregnant women (World Health Organization 2007). The smoking ban was introduced on the 1st of July 2007.


Alexander, M. F., Fawcett, J. N., & Runciman, P. J. (2006). Nursing Practice Hospital and Home: Promoting Psychological and Social Adjustment. (3rd Ed.) London: Elsevier Limited.

Childs, L. L., Coles, L., & Marjoram, B. (2009). Essential skills clusters for nurses. Oxford: Blackwell publications Ltd.




Department of Health. (2009). Creditability: awareness of reasonability. Retrieved from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_094239

Division of peridonotology: second hand smoking facts, (2003) .sourced from;
http://www1.umn.edu/perio/tobacco/secondhandsmoke.html.


East Cheshire policy, (2008). sourced from;
http://www.eastcheshire.nhs.uk/About-TheTrust/policies/M/Maternity% 20stop%20smoking%20in%20pregnancy%201621.pdf.

Healthy child policy, Department of health, (2012). sourced from ; www.dh.gov.uk.

http://www.instituteofhealthequity.org/projects/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report

http://www.lho.org.uk/LHO_Topics/Analytic_Tools/Tobaccocontrolprofiles.aspx

Luther King, M. Jr Presentation at the Second National Convention of the Medical Committee for Human Rights, Chicago, 25 March 1966


Nationl institute of health and clinical excellence, last updated(2012). sourced from www.nice.org.uk.

National Institute for Clinical Excellence. (2010). Health and Social Policy. Retrieved October 15, 2011, from http://www.nice.org.uk/nicemedia/live/10944/29390/29390.pdf

National Institute for Clinical Excellence.(2007). Paracetamol. Retrieved 20thSeptember 2011, from http://www.nice.org.uk/guidance/index.jsp?action=byType&type=2&status=3

http://www.nice.org.uk/nicemedia/documents/smoking_and_health_inequalities.pdf

NMC. (2010, March, 04) The code in full. Retrieved from http://www.nmc-uk.org/Nurse-and- midwives/The-code/The-code-in-full/

http://www.nursingtimes.net/nursing-practice-clinical-research/the-government-outlines-plans-to-reduce-health-inequalities/1547847.article

Nursing and Midwifery Council. (May, 2008). The code: Standards of conduct, performance and ethics for nurses and midwives. Retrieved June 17, 2012, from http://www.nmc-uk.org/Documents/Standards/nmcTheCodeStandardsofConductPerformanceAndEthicsForNursesAndMidwives_TextVersion.pdf

Office for National Statistics (2006) Statistics on smoking:England 2006. (PDF 667.23 KB)

Protection from exposure of second hand smoke.( 2007). sourced from World health organization; http://www.who.int/en/

Robertson J, Emerson E, Gregory N, Hatton C, Turner S, Kessissoglou S, et al. (2000) Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities. Research in Developmental Disabilities ;21(6):469-86

Smoke-free workplaces at a glance. Washington DC, World Bank
(http://www1.worldbank.org/tobacco/AAG%20SmokeFree%20Workplaces.pdf, accessed
24 March 2007).


World Health Organisation (2010). Retrieved from http://www.who.org

http://smokefree.nhs.uk/resources/news/campaigns/pregnancy/

http://www.ash.org.uk/stopping-smoking

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_124917

http://www.dh.gov.uk/en/publichealth/healthyliveshealthypeople

http://www.pregnancyhealthtips.co.uk People with learning disabilities, particularly those who have severe learning disabilities, are more likely to be affected by ‘social determinants’ meaning they tend to have:

poorer health
live in poverty and or poor housing condition
more likely to be unemployed
find themselves socially isolated
and can be subjected to discrimination (Emerson and Baines, 2010)
People with learning disabilities, particularly those who have severe learning disabilities, are more likely to be affected by ‘social determinants’ meaning they tend to have:
poorer health
live in poverty and or poor housing condition
more likely to be unemployed
find themselves socially isolated
and can be subjected to discrimination (Emerson and Baines, 2010) Learning disabilities and smoking
Fewer adults with learning disabilities who use learning disability services smoke tobacco compared to the general population (Robertson et al, 2000)

However, rates of smoking among adolescents with mild learning disability are higher than among their peers (Emerson and Turnball, 2005)

Why is this? Example of easy read leaflet Access to health promotion is significantly poorer for people with learning disabilities, Improving Health and Lives identified a need to improve on health literacy. Equity
E.g. Reducing population groups’ differences in PPHCs Downstream interventions E.g. Weight management programmes E.g. 5-a-day campaign E.g. School educational programmes E.g. Stop smoking programmes E.g. Free NRT E.g. Advertising campaigns Prevention and Regulation
E.g. Smoking ban in public places. Communities and Places
E.g. Reducing environmental inequalities.
Education and Skill Development
E.g. Reduce the number of NEETs. Standard of Living
E.g. Tackling debt problems. Employment and Work
E.g. Address stress at work. Early Years
E.g. Increase children and family services. Delivery system
E.g. Feeling good about where you live Delivery system
E.g. BLT Strategy Delivery system
E.g. Birmingham Brighter Futures Delivery system
E.g. Swansea and Wrexham A social determinants approach to public health interventions (UCL Institute of Health Equity) Inequalities are a matter of life and death
Inequalities arise in health because of inequalities in society
the average difference in disability free life expectancy is 17 years
there is a steeper socioeconomic gradient in health dependent upon region and class as shown here Marmot Review ... small “Of all the forms of inequality, injustice in health care is the most shocking and inhumane." Martin Luther King Jr Pregnancy related statistics
The percentage of mothers smoking at delivery was 13.4.% in a 2010/2011 survey and is slowly creeping down compared from 13.5% in 2009/2010 and 14.1% in 2008/2009.
26% of which is over a quarter of mothers smoked at some point in twelve months before or during their pregnancy.
Mothers who smoked before or during their pregnancy just over 55% gave up at some point before the birth.
From 149 primary care trusts smoking prevalence can vary from 30.3% in Blackpool to 2.8% in Brent in greater London.
In comparison statistics of health inequalities in our society
in 2010/2011 28% of the public in routine and manual households smoked compared to a 13% of adults who worked within management and in professional households.
It is found that manual workers start to smoke from an earlier age with results of 48% of men and 40% of women compared to workers from managerial and professional backgrounds , with 33% of men and 28% of women.

Thoughts and suggestions about these statistics ??????

Quiz question : What part of the country has the highest percentage of smoking in pregnancy?
A) The North East or B) London Other statistics of interest Epidemiology is defined as "the study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems and issues.“

The importance of epidemiology ultimately is to gain statistics around a health agenda or topic that is of concern , from statistics as health professionals we can plan , implement and evaluate services that will be available to the public. The Importance of epidemiology in relation to smoking in pregnancy. Taking a look closer to our local area

Western Cheshire have reported 13.1% of women smoked during 2007/2008, the PCT has aimed to reduce the number by 1% per year.
They have been successful in meeting targets reducing numbers to 23%- 18% by 2005 then to 15% in 2010.

Looking it surrounds areas Liverpool reports 16.5% of women smoke during pregnancy.

From these statements above what theme is running through this epidemiological review?? Local Statistics The risks of smoking in pregnancy can cause a variance of complications and even result in severe cases of mortality.
The complications that can arise from smoking in pregnancy:
ectopic pregnancy
Placental abruption
Placenta previa
Still Birth
The rates of still birth vary from developing countries where the percentage of smoking is on the rise compared to a decreased number in developed countries for example.

Australia Canada Germany
Still Birth rate Still birth rate Still birth rate
2009 – 3 per 1000 women 2009 - 3 per 1000 women 2009 – 2 in 1000

United States of America United Kingdom
Still birth rate Still Birth rate
2009 – 3 per 1000 2009 – 4 per 1000


China India Bangledesh
Still birth rates still birth rate still birth rate
2009 – 10 per 1000 2009 – 22 per 1000 2009 – 36 per 1000 Global statistics of interest South West: 13.4% South Central: 10.9% South East coast: 12.3% London: 6.1% West Midlands: 15.1% East Midlands: 15.7% Yorkshire and Humberside: 17.2% North West: 16.9% North East: 20.2% South West: 13.4% South Central: 10.9% South East coast: 12.3% London: 6.1% West Midlands: 15.1% East Midlands: 15.7% Yorkshire and Humberside: 17.2% North West: 16.9% North East: 20.2% Nearly 80% of the more than one billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest (WHO, 2012).
The smoking rates for mothers in routine or manual jobs: 48% smoked in the year before pregnancy or during and 29% throughout pregnancy compared to mothers in managerial or professional jobs whose equivalent percentages were 19% and 7% (Office for national Statistics, 2006).
There is a wide regional inequality in smoking during pregnancy, 7.4% in london compared to 22.2% in the north east (Local Tobacco Profiles, 2011) How can we change this? What are the government ACTUALLY doing? The core of the diagram consists of inherited attributes relating to age, sex and hereditary factors. The inner layer suggests that health is partly determined by individual lifestyle factors, such as patterns of smoking. Moving outwards, the diagram draws attention to relationships with family, friends and significant others within the local community. The next layer focuses on working and living conditions – housing, employment, access to healthcare services and so on. The outer layer highlights broader socio-economic, cultural and environmental forces such as economic development, shifts in welfare systems, political change, social forces and structures. (Childs, Coles & Marjoram, 2009) Britany Spears Lilly Allen Stacy Solomon Reference List; In 2009 the department of health brought out the Health child program, this is a policy followed by midwifes and health visitors on a national scale (Department of Health.2009). This policy was brought in to reduce the amount of women smoking in,during and after pregnancy.

Http:www.dh.gov.uk/prod consum dh/groups/dh digitalassets/@dh/@en/@ps/documents/digitalasset/dh 118525.pdf.

When visiting a new mother, before and after the birth of their child, health care professionals should ask,advice and support the mother to quit smoking and becoming smoke free. The informaiton given to the mother is all about the health benifits to not only them but to their child.
The policy is backed up by the children act 2004," The children act 2004 requires local authorities to prepare and publish an overarching plan setting out their strategy for discharging their functions in relation to children and young people" (Departemnt of health,2009).
When meeting a midwife for the first time, the patient will be asked if they smoke. If the answer is yes then information on the complications will be given to both the mother and the partner, a carbon monoxide test will also be taken. More blood tests and scans will be taken out through out the pregnancy costing the NHS excess funding. By putting policies and guidelines in place this can help not only help reduce the effects of smoking but to reduce the costs for the NHS. (National health service,2012). http://www.youtube.com/watch?v=dRc1LoJZLuo&feature=youtu.be But has it been successful where it really counts? Big and.... ... small Economic burden to society Problems associated with smoking in pregnancy increases risk of infant mortality Miscarriage Still Birth. Low birth weight sudden death Asthma More likely to smoke Glue ear Unknown cost to NHS Benefits of interventions Reduce morbidity and infant mortality Increased choice Reducing costs Increased awareness Potential to reduce inequalities Improving Outcomes 24 weeks completed pregnancy. Still Birth Traumatic experience. support groups Counselling withdrawal Fighting Intimacy issues Increased Closeness Long term condition Asthma in Children Symptoms mild to severe Occasionally life threatening. Affects the airways. "Smoking is the principal cause of the inequalties in death rates between the rich and poor. Put simply smoking is a public heath disaster" Alan Milburn Wheezing Exercise Allergies Inhalers Spacers The government has developed a new tobacco control strategy where it states that

NHS Stop Smoking Services will be more accessible and effective
Aims to increase their use in areas with high smoking rates
Offers nationally accredited training for NHS Stop Smoking Advisors and other health care professionals who support smokers to quit
Implement multi-agency, community-based tobacco control programmes, including more acceddible smoking cessation support services

The strategy has three overarching goals:
Focus on young people with a aim to reduce 11-15 year old smoking rates
Motivating and assisting every smoker to quit
Protecting our families and communiities from tobacco related harm (Nursing Times, 2008)




Reduce the appeal, availability, affordability and attractiveness of smoking for young people through a combination of duty increases, regulatory and legislative measures

Motivate and support quit attempts by improving existing marketing and NHS services, and by introducing new routes to quit that constitute a radical new approach to smoking cessation

Target high rates of smoking within disadvantaged and vulnerable groups and protect against secondhand smoke by promoting 'smokefree communities' in partnership with businesses and civil society Tobacco Control Strategy The Vision 1.1 million children 1,131 deaths a year 30000 emergency adimissions to a&e Epidemiology is defined as "the study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems and issues.“

The importance of epidemiology ultimately is to gain statistics around a health agenda or topic that is of concern , from statistics as health professionals we can plan , implement and evaluate services that will be available to the public. The Importance of epidemiology in relation to smoking in pregnancy. South West: 13.4% South Central: 10.9% South East coast: 12.3% London: 6.1% West Midlands: 15.1% East Midlands: 15.7% Yorkshire and Humberside: 17.2% North West: 16.9% North East: 20.2% Other statistics of interest Pregnancy related statistics
The percentage of mothers smoking at delivery was 13.4.% in a 2010/2011 survey and is slowly creeping down compared from 13.5% in 2009/2010 and 14.1% in 2008/2009.
26% of which is over a quarter of mothers smoked at some point in twelve months before or during their pregnancy.
Mothers who smoked before or during their pregnancy just over 55% gave up at some point before the birth.
From 149 primary care trusts smoking prevalence can vary from 30.3% in Blackpool to 2.8% in Brent in greater London.
In comparison statistics of health inequalities in our society
in 2010/2011 28% of the public in routine and manual households smoked compared to a 13% of adults who worked within management and in professional households.
It is found that manual workers start to smoke from an earlier age with results of 48% of men and 40% of women compared to workers from managerial and professional backgrounds , with 33% of men and 28% of women.

Thoughts and suggestions about these statistics ?

Quiz question : What part of the country has the highest percentage of smoking in pregnancy?
A) The North East or B) London
The code: Standards of conduct, performance and ethics for nurses and midwives
The code: Standards of conduct, performance and ethics for nurses and midwives . We exist to safeguard the health and wellbeing of the public.
. You must treat people as individuals and respect their dignity.
. You must not discriminate in any way against those in your care.
. You must treat people kindly and considerately.
. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support. The role of a Nurse . We exist to safeguard the health and wellbeing of the public.
. You must treat people as individuals and respect their dignity.
. You must not discriminate in any way against those in your care.
. You must treat people kindly and considerately.
. You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support. The role of a Nurse
You must support people in caring for themselves to improve and maintain their health.

You must recognise and respect the contribution that people make to their own care and wellbeing.

You must deliver care based on the best available evidence or best practice

You must ensure any advice you give is evidence-based if you are suggesting healthcare products or services. Nursing Creditability

According to the (Nurses Times, 2009) nurses creditability is effected by there actions in the patient eye.
Therefore is an urgent need to implement effective anti-smoking measures among nursing professionals. Decreasing the number of smokers among healthcare professionals would discourage patients, from smoking and would increase the credibility of anti-smoking campaigns (PubMed,2009). Nurses Responsibility

Standards of conduct must be followed
Taking charge of your own health and well-begin
Nurses to promote good health
Professionals are not to judge patients
Nurses are educators to patients
To promote awareness of diseases
To support and sign post patients The roles that nurses undertake in
Public health

Evaluate health trends and risk factors of population groups and help determine priorities for targeted interventions.

Work within communities to develop public policy and targeted health promotion and disease prevention activities.

Participate in assessing and evaluating health care services to ensure that patients are informed of programs and services available.

Provide health education, care management and primary care to individuals and families who are members of vulnerable populations and high risk groups. The Boorman Report (2009)
In 2009, the Boorman report highlighted the importance of NHS staff health and wellbeing, not only for individual employees but also so they can delivery quality healthcare. http://smokefree.nhs.uk According to the Department of Health (2011) Public Health in England has a key role in sharing and signposting evidence for the most effective outcomes, which includes the best cost-effective interventions to improve and protect public health. The government often highlights the detamental factors this can be done via campaigns. Sefton PCT developed their own spin on health promotion for pregnant women with the "Quit for Two" campaign. Epidemiology is defined as "the study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems and issues.“

The importance of epidemiology ultimately is to gain statistics around a health agenda or topic that is of concern , from statistics as health professionals we can plan , implement and evaluate services that will be available to the public. The Importance of epidemiology in relation to smoking in pregnancy. South West: 13.4% South Central: 10.9% South East coast: 12.3% London: 6.1% West Midlands: 15.1% East Midlands: 15.7% Yorkshire and Humberside: 17.2% North West: 16.9% North East: 20.2% The risks of smoking in pregnancy can cause a variance of complications and even result in severe cases of mortality.
The complications that can arise from smoking in pregnancy:
ectopic pregnancy
Placental abruption
Placenta previa
Still Birth
The rates of still birth vary from developing countries where the percentage of smoking is on the rise compared to a decreased number in developed countries for example.

Australia Canada Germany
Still Birth rate Still birth rate Still birth rate
2009 – 3 per 1000 women 2009 - 3 per 1000 women 2009 – 2 in 1000

United States of America United Kingdom
Still birth rate Still Birth rate
2009 – 3 per 1000 2009 – 4 per 1000


China India Bangladesh
Still birth rates still birth rate still birth rate
2009 – 10 per 1000 2009 – 22 per 1000 2009 – 36 per 1000 Global statistics of interest Taking a look closer to our local area

Western Cheshire have reported 13.1% of women smoked during 2007/2008, the PCT has aimed to reduce the number by 1% per year.
They have been successful in meeting targets reducing numbers to 23%- 18% by 2005 then to 15% in 2010.

Looking at surrounding areas Liverpool reports 16.5% of women smoke during pregnancy.

From these statements above what theme is running through this epidemiological review?? Local Statistics As health professionals it is our role, responsibility and duty of care to educate to the public the importance of good physical, psychological and sociological health .
Overall epidemiology is a defining tool to be used to assess, plan, implement and then evaluate the outcome of the services, agendas and we promote.
Overall statistics have shown a need form more accessable services , promoting equality and diversity within our community and society , therefore resulting in better health and wellbeing for mother and baby. Plan, implement and evaluate Presentation by
Louise Proctor
Charlotte Jackson
Gabrielle Craig
Paul Mannion
Liz Davies
Samantha Shone
Becky Warburton Image Sourced stockphoto.com Further References what do you think is the estimated cost to the NHS? BBC.(2012).Retrieved from http://www.bbc.co.uk/news/health-17056866
Western Cheshire Primary Care Trust.(2008).Retrieved from http://www.wcheshirepct.nhs.uk/default.asp?page=Joint_Strategic_Needs_Assessment/7_smoking_in_pregnancy.asp.
NHS the information centre.(2006).Retrieved from www.ic.nhs.uk.
Liverpool Primary Care Trust.(2009).retrieved from http://www.liverpoolpct.nhs.uk/Library/Your_PCT/About_us/Population_we_serve/Liverpool%20Health%20profile%20-%205th%20link.pdf.
World Health Organization.(2009). Retrieved from http://www.who.int/gho/countries/en/index.html. NHS(2012).Commissioning services for quitting smoking in pregnancy and following childbirth. Retrieved from http://www.nice.org.uk/usingguidance/commissioningguides/quittingsmokinginpregnancy/CommissioningQSIP.jsp#5 NHS Choices(2011).Stillbirth retrieved from http://www.nhs.uk/conditions/Stillbirth/Pages/Definition.aspx NHSchoices(2011).Asthma. retrieved from http://www.nhs.uk/conditions/asthma/pages/introduction.aspx sands
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