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  1. Promoting Smoking Cessation in PregnancyPresentation at the International Conference on Health Promoting Hospitals May 25-28 .Moscow, Soviet Union.Victoria Oladimeji (PhD, MA, MBA, BA, RGN, RM)Lecture in Nursing with speciality in Health PromotionCity UniversitySt Bartholomew School of Nursing and Midwifery, Philpot StWhitechapel London EC1 2EA Tel: 020 7040 5800 020 7040 5887-Direct LineFax: 020 7040 5811. Email: V.I.Oladimeji@city.ac.ukV.I.Oladimeji@city.ac.uk Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  2. Abstract This paper seeks to explore ways of encouraging pregnant women to take greater responsibility for protecting their unborn babies.  Smoking remains one of the potentially preventable factors associated with maternal, foetal and infant mortality and morbidity (HEA, 1994). According to the Health of the Nation England 24% of women smoke during pregnancy and only 33% of these give up during pregnancy. The Health of the Nation set target relating to smoking in pregnancy. The target was to reduce smoking during pregnancy to 15% by the year 2010, which would mean 55,000 fewer women in England who smoke during pregnancy. The saving lives document (DOH 1999) also set new targets for smoking in pregnancy. Problems with smoking during pregnancy are largely and closely linked to health inequalities. Women with partners in Social Class! V and V i.e. manual labour group are more likely to smoke during pregnancy than those in non-manual groups (DOH 1999). The Saving Lives document sets proposal to promote Healthier living and save lives by reducing inequalities in health. The proposal requires action by ALL including Individuals, the Local Authorities/Communities, and the government. The Acheson report (DOH 1998) recommended a reduction in poverty in women of childbearing age, expectant mothers as well as general improvements in the living standards of these people through increased benefits and entitlement.  Implementation of these recommendations will go a long way in reducing stress and smoking habits during pregnancy The desire or motivation to stop smoking is one of the most Important factors for successful cessation. Some effective evidence-based approaches for helping pregnant women quit or cut down on smoking will be discussed. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  3. Smoking in pregnancy is responsible for approximately 17,000 children under 5 years of age requiring hospital admission each year (DOH, 1999). Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  4. In the western world, the dangers of smoking in pregnancy for both mother and child have been well documented (Department of Health, 1998), yet a significant number of women continue to smoke during pregnancy. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  5. Smoking during pregnancy has been associated with a variety of adverse pregnancy outcomes, such as increased risk of spontaneous abortion, low birth weight, prematurity, intrauterine growth restriction, abruptio placentae, placenta previa, and perinatal death (Lumley et al 2001). Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  6. UK Government initiatives The UK government initiatives outlined in the White paper ‘smoking Kills (DOH, 1998) aim to reduce the prevalence of smoking by 25% by the year 2005; and to reduce the percentage of women who smoke during pregnancy from 23% to 15% by the year 2010. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  7. The UK Government acknowledged that achieving such targets would demand not only collaboration with staff in hospitals, but also recognition of the fundamental issues affecting smoking and pregnancy which include values and beliefs. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  8. The Health Belief Model (HBM), Becker ( 1974) asserts that readiness to engage in health behaviour arises from a perceived threat of disease or illness, generated from an individual’s perception of his or her susceptibility to and the potential severity of disease. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  9. The cue for action can be evoked by an individual’s personal perception and motivation or by education.Individuals weigh up the cost and benefits of their actions or change. Individuals also need triggers to goad them into action. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  10. Mcbride (2003) identified pregnancy as one of the teachable moments. The label 'teachable moment' (TM) has been used to describe naturally occurring health events thought to motivate individuals to spontaneously adopt risk-reducing health behaviours.This equates to the ‘trigger’. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  11. In relation to Smoking cessation in pregnancy, a woman may be motivated to quit smoking if she believes that the health of the foetus is at risk. Nurse’s Role is to ensure that information is presented at the right time and in a value-free way which facilitates decision-making. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  12. The (HBM) model also places emphasis on cost-benefits of the change. However, it has been criticised for not taking into consideration the individual’s circumstances and also not helping people through the change. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  13. The stages of change model as proposed by Prochaska & Di Clemente (1992) is aimed at changing addictive behaviour.The model acknowledges and allows for the difficulties in the process of giving up an addiction and the inevitable relapses that may occur. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  14. A relapse results in the individual going backwards to a previous stage, but is not labelled a failure and discarded, but rather encouraged to try again and progress to the next stage when perhaps more prepared. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  15. The Stages of Change Model (Prochaska & Di Clemente,1992)Contemplation Pre-Contemplation PreparationTermination Action MaintenanceRelapse Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  16. In conclusion, it is important to not that lifestyle change intervention need to be supported by a range of societal, structural and organisational changes which make healthy choices easier for the individual. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

  17. ReferencesBecker M.H. (1974) - The Health belief model and sick role behaviour, Health education monographs. winter. Department of Health (1998) Report of the Scientific Committee on Tobacco and Health. The Stationery Office, London. Department of Health (1999) Saving Lives, Our Healthier Nation . The Stationery Office, London. Lumley J., Oliver S. & Waters E. (2001) Interventions for promoting smoking cessation during pregnancy. Cochrane Database System Review (2), CD001055. McBride C.M., Curry S.J., Lando H.A., Pirie P.L., Grothaus L.C., Grothaus L.C. & Nelson J.C. (1999) Prevention of relapse in women who quit smoking during pregnancy. American Journal of Public Health 89, 706–711.Prochaska J.O. & DiClemente C.C. (1992) Stages of change in the modification of problem behaviours in Progress in Behaviour Modification (Herson M., Eisler R. & Miller P.M., eds), Sycamore Press, Sycamore, Illinois, pp. 183–218. Thompson, K. A.; Parahoo, K. P.; McCurry, N.; O'Doherty, E.; Doherty, A. M. (2004) Women's perceptions of support from partners, family members and close friends for smoking cessation during pregnancy—combining quantitative and qualitative findings, Health Education Research: Volume 19(1) January 2004 pp 29-39. Dr V. Oladimeji-International conf on HPH 25-28 May 04 Moscow

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