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Smoke-free Pregnancy and Families

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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Smoke-free Pregnancy and Families

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  1. Smoke-free Pregnancy and Families AHCSA Workshop July 2008

  2. 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

  3. 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

  4. 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

  5. Smoking is a major contributor of Heart Disease. Respiratory problems Diabetes complications Reference 43 Why is tobacco a problem?

  6. Why worry about smoking ?

  7. 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

  8. Smoking and reproductive outcomes • Delayed conception. • Infertility References 20

  9. Maternal outcomes smoking and pregnancy • Bleeding from the Placenta • Premature labour • Waters break early • More complicated births • More miscarriages. References 2,9,20

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. Ask and Advise Benefits of quitting: • Woman and partner • Pregnancy • Baby • Breastfeeding • Family References 37,45,49

  17. 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

  18. 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

  19. 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

  20. 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

  21. 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

  22. QuitSA is committed to assist in “Closing The Gap” For more information contact: Kathryn McKenzie (08) 8291 4173 www.quitsa.org.au

  23. 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.

  24. 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).

  25. 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.

  26. 22. Anath CV, Savitz DA, Luther ER. Maternal cigarette smoking as a risk factor for placental abruption, placenta praevia, and uterine bleeding in pregnancy. American Journal of Epidemiology. Vol 144, No 9, 1996, pp881-889. 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).

  27. 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.

  28. 32. Lawrence RA and Lawrence RM 1999. Breastfeeding A Guide for the Medical Profession. Sixth edition. Department of Pediatrics, University of Florida College of Medicine. Gainesville, Florida. Elsevier Mosby publishers 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. 36. Lumley J. Overview of current research and directions on health effects of smoking and benefits of quitting during pregnancy. Smoking and Pregnancy, A national consensus conference. Australian Medical Association, May 1999. 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.

  29. 39. Fiore EB, Bailey WC, Cohen SJ et al. Treating Tobacco Use and Dependence. A Clinical Practice Guideline. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service; 2000. 40. Education for Change. www.efc.co.nz 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 43. Quit Victoria, Victorian smoking and Health program, 1995. 44. Hickling J & Hoey M. Evaluation of the South Australian Smoke-free Pregnancy Project. Tobacco Control research and Evaluation Program, Adelaide, May 2006. 45. Anti-Cancer Council of Victoria: Literature review, Smoking cessation in pregnancy. Three centres Consensus Guidelines on Antenatal care Project, May 2001. 46. Cowan S, Bradley A and Cossey A. Starship presentation. Education for Change. From “too hard” to “can do”, protecting children from tobacco. www.efc.co.nz, July 2004. 47. Cowan S and Langley L. Identifying and addressing exposure to smoking for patients in NZ hospitals. Education for Change 2004.

  30. 48. Melvin CL, Dolan-Mullen P, Windsor RA, Whiteside HP and Goldenberg RL 2000. Recommended cessation counseling for pregnant women who smoke: A review of the evidence. Tobacco Control, 9 (Supplement 3), III80-III84. 49. American College of Obstetricians and Gynecologists Smoking Cessation During Pregnancy. A Clinician’s Guide to helping Pregnant Women Quit Smoking. Lecture Guide.. Robert Woods Foundation, 2002. 50. American Psychiatric Association. Practice guideline for the treatment of patients with nicotine dependence. Am J Psychiatry, Oct 1996; 153: 1 – 31. 51. Brodribb W 2004. Breastfeeding Management third edition. Australian Breastfeeding Association. Ligare Pty Ltd, Riverwood NSW. 52. Donath SM, Amir LH and ALSPAC Study team. The relationship between maternal smoking and breastfeeding duration after adjustment for maternal feeding intention. Acta Paediatr 2004: 93: 1514-18. 53. Goodwin RD, Keyes K and Simuro N. Mental Disorders and Nicotine Dependence Among Pregnant Women in the United States. American College of Obstetricians and Gynecologists. Obstetrics and Gynecology, Vol. 109, NO. 4, April 2007. 54.www.rethink.org/living_with_mental_illness/everyday_living/physical_health_and_wellbeing/staying_healthy/smoking.html

  31. 55. Centre for Epidemiology and Research. NSW Department of Health. New South Wales Mothers and Babies 2005. NSW Public Health Bull 2007 56. Benowitz NL 1991. Nicotine replacement therapy during pregnancy. Journal of the American Medical Association, 266: 3174-3177. 57. US Department of Health and Human services 1990. The health benefits of smoking cessation: a report of the Surgeon General. Rockville, maryland: Public Health service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health. 58. Stewart ML and Li SQ. Northern Territory Midwives Collection: Mothers and Babies 2000-2002. Department of Health and Community Services, Northern Territory, 2005.

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