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Smoke-free Pregnancy and Families. AHCSA Workshop July 2008. Aim: ‘To increase the incidence of smoke-free pregnancies and smoke-free families, thereby reducing the adverse health outcomes for mothers, babies and their families’. Commenced March 2004 Department of Health SA (2004).

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slide1
Smoke-free

Pregnancy and Families

AHCSA Workshop

July 2008

smoke free pregnancy project
Aim:

‘To increase the incidence of smoke-free pregnancies and smoke-free families, thereby reducing the adverse health outcomes for mothers, babies and their families’.

Commenced March 2004

Department of Health SA (2004)

Smoke-free Pregnancy Project
prevalence
2006 SA Aboriginal pregnant Women 54.2%

Over 50% of the adult Aboriginal pop are current smokers

National Perinatal Statistics Unit (2006)

Government of SA, Pregnancy Outcome in SA 2006

ABS 2004-05

Prevalence
tobacco
4,000 chemicals including carcinogens

Toxic and Mutagenic

More Indigenous people in SA die from smoking tobacco than from any other single cause

Almost half of Indigenous people who die due to smoking tobacco die before the age of 55 years, compared to about 10% of non Indigenous deaths

Reference 4.5

Tobacco
why is tobacco a problem
Smoking is a major contributor of

Heart Disease.

Respiratory problems

Diabetes complications

Reference 43

Why is tobacco a problem?
pregnancy is an ideal time to quit smoking
Pregnancy is an ideal timeto quit smoking
  • A woman is more likely to quit smoking during pregnancy than any other time in her life.
  • Dual (2 for 1 benefit).
  • Increased contact with health care providers.
  • Hugh health and economic return on investment.

References 15,16,17

smoking and reproductive outcomes
Smoking and reproductive outcomes
  • Delayed conception.
  • Infertility

References 20

maternal outcomes smoking and pregnancy
Maternal outcomes smoking and pregnancy
  • Bleeding from the Placenta
  • Premature labour
  • Waters break early
  • More complicated births
  • More miscarriages.

References 2,9,20

baby outcomes smoking and pregnancy
Baby outcomes smoking and pregnancy
  • Baby’s can die*
  • Prematurity*
  • Low birth weight *
  • SIDS
  • Poor lung function
  • Admissions to special care nurseries
  • Neonatal nicotine withdrawal

References 2,4,9,16,25

2 3 of atsi children 0 14 live in house with at least one reg smoker
2/3 of ATSI children 0-14 live in house with at least one reg smoker
  • Colds
  • SIDS
  • Asthma
  • Ear infections
  • Respiratory disease
  • More likely to be smokers

References 4,24

smoking and breastfeeding
Smoking and breastfeeding

Smokers choose bottle feeding more frequently.

Breastfeeding women who smoke are:.

  • Less likely to start breastfeeding.
  • Breastfeed for a shorter time.

References 24,32,33,44

the role of partners families
The role of partners/families
  • Strong influence
  • Women 4 times more likely to smoke when pregnant if partner smokes
  • Support

Barriers to quitting:

  • Unaware of risk to fetus
  • Lack of motivation
  • Stress induced/complex issues at home
  • Is accepted as the “norm”

References 20,24

health workers can help
Health workers can help

You are highly respected within the

community:

  • You are a respected source of information and support.
  • You have a duty of care to pregnant women and their family
  • Your advice is an important motivator in attempts to quit.
  • You have opportunities to give brief advice/support.

References 42

support assists women in not taking it up again
Support assists women in NOT taking it up again
  • Extremely common:55-60% within 6 months of birth70% if partner smokes at 12 months.

References 41

ask and advise
Ask and Advise

Benefits of quitting:

  • Woman and partner
  • Pregnancy
  • Baby
  • Breastfeeding
  • Family

References 37,45,49

assist arrange
Assist / arrange
  • Recently quit
  • Preparing to quit
  • Thinking about quitting
  • Not interesting in quitting
  • Relapse/slip up
  • Partners
  • Refer to:Quitline 13 7848 or 1300 889 010

References 37,49,50

responsibility duty of care
Responsibility – Duty of Care

It is not the health workers responsibility to make pregnant women quit smoking or to stay quit.

It is their responsibility to ‘ask’ and then provide information and support tailored to her readiness to quit.

References 43

quitline 13 7848
Quitline: 13 7848

Confidential telephone advisory service at the cost of a

Local call. Provides:

  • Support for smokers planning to quit.
  • Information on quitting aids and methods.
  • Strategies for coping with withdrawal and getting past cravings/difficult situations.
  • Tips on managing stress and weight gain.
  • Information on quit courses.
  • Written resources, video/DVD.
  • Call back service.
  • www.quitbecauseyoucan.org.au
harm minimization
Cut back on smokes and smoke outside

Don’t smoke around babies and children

Don’t give smokes to children

Support smoke free health

Services

Encourage a cultural shift

? SA Tobacco Control Strategy

Harm minimization
concluding key messages
Concluding key messages
  • Educating Health workers as they play a pivotal role in addressing smoking
  • It is their responsibility to ask and then provide information and support (duty of care).
  • Support health workers to address their own smoking
  • Have smoke free areas (Health services)
  • Have information and practical help available.
  • Pilot project proposal with Lifestyle coordinators

References 43

slide23
QuitSA is committed to assist in “Closing The Gap”

For more information contact:

Kathryn McKenzie

(08) 8291 4173

www.quitsa.org.au

references
References

1. Commonwealth of Australia 2005. National Tobacco Strategy

2004-2009. Ministerial Council on Drug Strategy, Commonwealth of Australia, November 2004.

2. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon general. Atlanta, GA: U.S. Department of health and Human Services, Centers for Disease Control and prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004

3. Queensland health 2004, Health Determinants Queensland. Queensland Government.

4. NSW Department of Health (Ed.) 2006. Background papers to the National clinical guidelines for the management of drug use during pregnancy, birth and the early development years of the newborn. NSW Department of Health, Sydney.

5. Begg S, Vos T, Barker B, Stevenson C, Stanley L, Lopez AD, 2007. The Burden of Disease and Injury in Australia 2003. PHE 87. Canberra. AIHW.

6. Australian Institute of Health and Welfare 2005. 2004 National Drug Strategy Household Survey: First Results. AIHW cat. No. PHE 57. Canberra: AIHW (Drug Statistics Series No. 13.

slide25
7. Australian Institute of Health and Welfare 2007. The Burden of Disease and Injury in Australia, Canberra

8. Queensland Health 2006. Smoking Among Queensland secondary School Students Aged 12-17 Years 2005, Queensland Government, Brisbane

9. Laws PJ, Grayson N and Sullivan EA 2006. Smoking and Pregnancy. AIHW cat. No. Per 33. Sydney: AIHW National Perinatal Statistics Unit

10. Laws PJ, Grayson N and Sullivan EA 2006. Australia’s mothers and babies 2004. perinatal statistics series no. 18. AIHW cat. No. PER 34. Sydney: AIHW National Perinatal Statistics Unit

11. Tasmanian Department of Health and Human Services, 2006. Council of Obstetric and Pediatric Mortality and Morbidity, Annual Report 2005. Tasmanian Perinatal Database.

12. Department of Health Queensland, 2005.

13. Chan A, Scott J, Nguyen AM, Sage L. Pregnancy Outcome in South Australia 2005. Pregnancy Outcome Unit, Department of Health, Government of South Australia, December 2006.

14. Panjari M, Bell RJ, Astbury J, Bishop SM, Dalais F, Rice GE, 1997. Women who spontaneously quit smoking in early pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology, 37: no 3, pp 271-278.

15. Orleans T, Barker D, Kaufman N & Marx J. Helping pregnant smokers quit: meeting the challenge of the next decade. Tobacco Control 2000; 9 (suppl 3): iii6-iii11 (Autumn).

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16. Lumley J. Oliver S & Waters E. (2003). Interventions for promoting smoking cessation during pregnancy (Cochrane Review). The Cochrane Library, Issue 1. Oxford.

17. Miller M & Wood L. National Tobacco Strategy 1999 to 2002-03 occasional paper. Smoking cessation interventions, review of evidence and implications for best practice in health care settings, August 2001, Commonwealth of Australia, Canberra.

18. Wakefield M. Characteristics of pregnant smokers, spontaneous quitters and relapse post partum. Smoking and Pregnancy, A National Consensus Conference. Australian Medical Association, May 1999.

19. Education for Change. Starting smoke free. Report to the Ministry of Health on the National Smokefree Pregnancy Forum,, October 2005. www.efc.co.nz

20. McDermott L, Russell A Dobson A and University of Queensland February 2002. National Tobacco Strategy 19999 to 2002-03 occasional paper. Cigarette smoking among women in Australia, National Drug Strategy, Commonwealth of Australia, Canberra.

21. Wong P and Bauman A 1997. How well does epidemiological evidence hold for the relationship between smoking and adverse obstetric outcomes in New South Wales? Australian and New Zealand Journal of Obstetrics and Gynecology. 37(2): 168-73.

slide27
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23. Tikkanen M, Nuutila M, Hiilesmaa V, Paavonen J, Ylikorkal O. Clinical presentation and risk factors of placental abruption. Department of Obstetrics and Gynecology, University Central Hospital, Helsinki, Finland.Acta Obstetricia et Gynaecologica Scandinavica 2006: 85(6): 700-5

24. British Medical Association, 2007. Breaking the cycle of children’s exposure to tobacco smoke. Science and Education Department, British Medical Association, BMA House, London.

25. U.S Department of Health and Human Services. Women and Smoking. A Report of the Surgeon General, 2001. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health promotion, Office on Smoking and Health.

26. Winstanley M, Woodward S & Walker N. Tobacco in Australia, Facts and Issues, 1995. Second edition, Victorian Smoking and Health program, Australia (Quit Victoria).

slide28
27. Eskenazi B, Castorina R. Association of in utero or postnatal Environmental Tobacco Smoke Exposure and neurodevelopmental and behavioral Problems in Children Background paper. WHO/NCD/TFI/99.11. School of Public Health, University of California, Berkley, CA, USA.

28. Garcia-Algar O, Puig C, Vall O, Pacifici R, Pichini S, Lester BM, Law KL, Stroud LR LaGasse L, Liu J, Niaura R. Effects of Maternal Smoking During pregnancy on Newborn behavior: Neonatal Nicotine Withdrawal Syndrome. Paediatrics 2004; volume 113; no. 3 March 2004 pp. 623-624.

29. Pregnets. Smoking Cessation for Pregnant and Post-partum women: A Toolkit for Health Professionals, 2003. http://www.pregnets.org

30. Acute Otitis Media http://www.aap.org/otitismedia/www/vc/ear/case2/p5.cfm

31. Samet JM. Background Paper, Synthesis: The Health Effects of Tobacco Smoke Exposure on Children. Department of Epidemiology School of Hygiene and Public Health, John Hopkins University, Baltimore USA. For WHO International Consultation on Environmental Tobacco Smoke (ETS) and Child Health, Geneva, Switzerland, 1999.

slide29
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33. Amir LH and Donath SM. Birth 2002; 29(2): 112-23.

34. Riordan J 2005. Breastfeeding and Human Lactation. Third Edition. School of Nursing, Wichita State University, Wichita, Kansas. United States of America. Jones and Bartlett Publishers, Boston.

35. Guidelines for healthcare professionals on using Nicotine Replacement Therapy for smokers not ready to stop smoking. Action on Smoking and health February 2007.

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37. Clinical Practice Guideline for Smoking Cessation in Pregnancy. Centre for Clinical Studies, Mater Health Services,

Brisbane, 2005

38. Lumley, J., Oliver, S., Waters, E. Interventions for Promoting Smoking Cessation during Pregnancy. In The Cochrane Database of Systematic Reviews, Issue 3, 2002. Oxford: Update software, 2003.

slide30
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41. Wakefield M, Jones W, 1998. Effects of a smoking cessation program for pregnant women and their partners attending a public hospital antenatal clinic. Australia and New Zealand Journal of Public Health 1998, 22 (3 Suppl): 313-20.

42. http://whyquit.com/whyquit/LinksAAddiction.html

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