Stub it out

Smoking during pregnancy is bad for mothers and their babies.
Studies show that babies whose mothers smoked while pregnant suffer
from serious health risks and are more likely to develop behaviour
problems and to become offenders.¹

One of the key promises in the government’s 1998 white
paper Smoking Kills was special support to discourage
pregnant women from smoking. The government set a target to reduce
the number of women who smoke during pregnancy from 23 to 15 per
cent by 2010. Measures taken so far include setting up a telephone
helpline to support pregnant women stop smoking, a poster
advertising campaign, and targeted warnings on cigarette packs.
Sure Start local programmes are expected to achieve a 6 per cent
reduction in smoking by pregnant women by March 2006 as well as a
reduction in smoking among mothers of young children who
didn’t stop when they were pregnant.

But how can those working with pregnant women and parents of
young children persuade them to kick the habit? Liz Stevenson, a
community nurse with the Oxford City Primary Care Trust, offers
one-to-one support and advice to pregnant women looking to stop
smoking as well as training and advice to GPs and midwives.
Pregnant women who have said that they want to stop smoking are
referred to her for an intensive programme of support throughout
their pregnancy.

She explains that there is a big difference between supporting
mothers who want help giving up, and making contact with others in
the wider community who may not yet be at that stage. “Reaching
low-income groups who haven’t identified the need for change
and getting the message across is more difficult. There is no good
practice to draw on: it is a relatively new area”.

The Department for Education and Skills is due to publish
details of Sure Start’s efforts to reduce smoking. We
shouldn’t be too surprised if the target hasn’t been
met and neither should the government. It is a huge challenge and
any progress should be applauded.

Organisations such as the charity Quit have shown the need for
more support for practitioners working to help parents give up
smoking.

“Encouraging pregnant women to give up smoking is a real
challenge,” explains Stevenson. “You can’t just tell them
that smoking is bad for them: the support needs to be offered in a
neutral and non-threatening way as part of a wider package,
involving partners, families and friends”.

Pregnant smokers often face particular difficulties. Women in
households where no one is in work are much more likely to smoke
during pregnancy than women with jobs.² For some women,
being pregnant can be an additional stress, and given the link
between smoking, stress and depression it can be even harder to
quit.

Two mothers of young children who smoked throughout their
pregnancies and continue to smoke talked to 0-19. The first mother
says: “I know I should stop, but I just can’t do it at the
moment. My son has got health problems and I am on antidepressants,
I can’t give up fags now.”

The other mother, with four children aged between one and seven
had managed to cut down from 20 to 10 cigarettes a day while
pregnant, but went back up to 20 a day after birth. “It’s the
only treat that I have just for me”.

Stopping smoking programmes with pregnant women run by Sure
Start and family centres often focus on delivering the no smoking
message as part of a wider, holistic health package.

“Health days enabling pregnant women and parents to try out
massage and aromatherapy can be very successful. Advice on smoking
is delivered alongside stress management and information on healthy
eating, which can make it less threatening and more enjoyable,”
says Stevenson. Other initiatives have an explicitly “pampering”
focus: information on stopping smoking is available with nail-bars
and health, beauty and make-up advice.

Some mothers say that a cigarette can function as “time out”
from the children. Some initiatives have tried to harness the time
out factor by providing a café where parents can have a break
while their children are cared for in a crèche. These cafes
may also offer housing and money advice, an approach which
acknowledges that smoking is part of a wider culture.

“In order to be able to give up, mothers have to reach a point
where the things they don’t like about the behaviour outweigh
the attractions,” explains Stevenson.

Involving a range of agencies also can help to get the message
across. One of the many concerns about parents who smoke is the
increased risk of fire-related accidents. Consequently, the stop
smoking message can be delivered by community fire brigades, which
will also offer advice on safety and smoke alarms. Community
liaison fire officers can provide home visits for parents of young
children.

Stevenson warns that results from such programmes are rarely
instant. “Often it takes many attempts before an individual can
give up. First of all, they have got to feel able and ready to
change their behaviour. Those working with parents may end up
spending a lot of time just raising the issue, and trying to start
a dialogue that may eventually lead to change”.

¹ Department for Education
and Skills, Support from the Start, 2002

² Department for Work and
Pensions, Families and Children in Britain,
2004

– For further information Supporting Change: A Guide to
Helping Lone Parents Quit Smoking is available from Quit at www.quit.org.uk.

Smoking pregnancy and child health

• Women who smoke are at more risk of miscarriage, ectopic
  pregnancy, premature birth and stillbirth as well as some foetal
  malformations.
• Stopping smoking in the first three months greatly reduces the
  risk of low birth weight, and stopping at any stage in pregnancy
  brings proportional health benefit.
• Babies born to mothers who smoke have poorer lung function, and
  increased risk of cot death. They may be smaller and lighter.
  Children exposed to passive smoke are more likely to develop middle
  ear disease.
• Passive smoke can cause asthma in children and increase the
  severity of attacks in those already affected.
• A number of reports show children of smokers have a poorer
  performance at school and some studies suggest links between
  behavioural problems such as hyperactivity, and maternal
  smoking.

From: British Medical Association: Smoking and Reproductive
Life: The Impact of Smoking on Sexual, Reproductive and Child
Health (2004). Available at www.bma.org.uk.