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Antenatal Assessment and Intervention for Tobacco Smoking

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					Antenatal Assessment & Intervention for Tobacco Smoking
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August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

How to use this presentation
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At the end of each slide click the mouse to move to the next slide Alternatively you can use the arrow buttons on the keyboard to move to the previous / next slide You should have met the main objectives by completing the basic presentation, but further information, „Questions & Answers‟ and „Case Studies‟ can be viewed by using the mouse to click on the hyperlinks throughout the presentation

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Objectives
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On completion of this presentation participants should be able to:

– List risks of smoking during pregnancy and risks of parental smoking
– List the benefits of quitting

– Demonstrate smoking cessation advice using the 5A‟s approach – Outline a quit plan

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Tobacco Smoking
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The World Health Organisation describes smoking as „an epidemic that will cause a third of all adult deaths world wide by 2020’ Tobacco – is the major cause of drug related death – is the single greatest preventable cause of premature death & disease Smoking accounts for 82% of drug related deaths 53 Australians die every day from smoking

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Questions & Answers 1

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Why is it that some people smoke all their lives and live to be one hundred, while others never smoke and die young?

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Tobacco Smoking
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Overall in 2001 - daily smoking prevalence was 19.5% – Males 21% – Females 18% Approximately 20% of pregnant women smoke Over 70% of women who quit smoking during pregnancy will resume smoking within 6 months after birth

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Risks of Smoking in Pregnancy
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Risk of low birth weight doubles Prematurity is on third more likely Risk of IUGR more than doubles Risk of stillbirth is increased by about a third Risk of spontaneous abortion increases by about a third Risk of SIDS is almost three times higher Risk of asthma is one and a half times more likely

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Questions & Answers 2

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Smokers have smaller babies - doesn‟t that mean a shorter and easier labour?

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Smoking doesn‟t affect the size of the baby. All my family and friends are smokers and they didn‟t have small babies

August 08

 Women’s and Children’s Health Service. WA

Slide 8

Antenatal Assessment and Intervention for Tobacco Smoking

Risks of Parental Smoking
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For infants and children parental smoking causes: – asthma – poor lung function – croup, bronchitis, bronchiolitis, pneumonia – middle ear disease – meningitis and meningococcal disease – severe bacterial infections For infants and children parental smoking is linked to: – neurodevelopment effects – childhood cancers – accelerated cardiovascular disease

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August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Smoking & Quitting
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Most smokers are aware of the risks of smoking, but not the benefits of quitting Most smokers experience conflict about their smoking. They know it is bad for them, but may enjoy smoking or lack the confidence to quit Try to focus on the benefits of quitting rather than the negative points of smoking Ask smokers to identify the benefits of smoking versus the benefits of quitting

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Benefits of Quitting
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6hrs - heart rate and BP drop 12hrs - nicotine is out of the system and carbon monoxide is out of the lungs 2 days - taste and smell improve 5 days - most nicotine byproducts are gone 1 month - BP returns to normal level and the immune system starts to recover 12 months - chances of dying from heart disease is half that of a continuing smoker

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Quitting early in pregnancy, outcomes are similar to those of non-smokers There are benefits to quitting at any time during pregnancy Other benefits include financial rewards and improved confidence.

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Quitting

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Most smokers want to quit smoking and wish that they had never started 81% of current smokers have a desire to quit 41% try to quit each year 67% of smokers say they prefer to receive cessation advice from health professionals

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Questions & Answers 3

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I‟ve cut down to a low tar brand - isn‟t that OK?

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Smoking & Pregnancy
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Pre-pregnancy quitters – When planning a pregnancy these women stop smoking – Usually aware of health risks for themselves and the baby – Are usually dedicated to becoming smoke free for life and maintain cessation throughout pregnancy and post partum – Are vulnerable to relapse at times of stress – Are often identified as „non-smokers‟ at their first antenatal clinic visit

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Smoking & Pregnancy
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Spontaneous quitters – These women usually quit as soon as they find out they are pregnant – Usually highly motivated to protect their baby – Quit primarily for the health of the baby and only secondarily for themselves – Often see themselves as „stopping smoking for the pregnancy‟ not quitting for life – Most spontaneous quitters will relapse during the postpartum period

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Smoking & Pregnancy
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Pregnancy smokers – Interventions in early pregnancy (up to 20-24 weeks) may assist women in this group to quit – Once women reach third trimester it is unlikely they will quit – A very small percentage may quit post-partum – Interventions for this group should concentrate on harm reduction – Reinforce that there are benefits to quitting at any stage during pregnancy

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Smoking & Pregnancy
Pre-pregnancy Quitter Quit while preparing to become pregnant Usually maintain cessation May be vulnerable to relapse at times of stress

Pregnancy Quitters Quit as soon as they find out they are pregnant Highly motivated to protect their baby Not necessarily quitting - only „stopping for pregnancy Most maintain cessation during pregnancy

Relapsers Vulnerable at times of stress Many are not able to maintain cessation during pregnancy Many cease smoking temporarily during pregnancy and relapse after birth

Pregnancy Smokers Continue to smoke throughout pregnancy Some would like to quit, but are unsuccessful in their attempts Many reduce the number of cigarettes they smoke

August 08

 Women’s and Children’s Health Service. WA

Slide 17

Antenatal Assessment and Intervention for Tobacco Smoking

Questions & Answers 4

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I‟ve smoked my whole pregnancy, what‟s the point in quitting now?

August 08

 Women’s and Children’s Health Service. WA

Slide 18

Antenatal Assessment and Intervention for Tobacco Smoking

The 5A’s - A framework for helping smokers to quit
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Ask the woman about her smoking Advise her to quit or stay quit Assess her willingness to quit or stay quit Assist the woman to quit or stay quit Ask again at the next visit

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Ask
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Have you ever smoked? – A multiple format identifies nonsmokers, ex-smokers (including preconception quitters and spontaneous quitters) and smokers Provide all women with a „Care for my air‟ pack, regardless of smoking status Some women may not want to quit and pressure to quit may make things worse Women who want to quit should be supported Document smoking status, gestation, number of cigarettes smoked per day, quit date, and whether anyone at home smokes
 Women’s and Children’s Health Service. WA

August 08

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Antenatal Assessment and Intervention for Tobacco Smoking

Advise
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Advise all smokers to quit and quitters to stay quit based on: – benefits of quitting themself – benefits of quitting for their baby – health effects of smoking Advice should be clear, concise and personalised

August 08

 Women’s and Children’s Health Service. WA

Slide 21

Antenatal Assessment and Intervention for Tobacco Smoking

Assess
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Assess the woman‟s willingness to quit using the Stages of Change Model. Key features of this model: – Deals with intentional behaviour change – Views change as a process rather than as an event – Change process is characterised by a series of stages – People typically cycle through these stages when attempting to change behaviour

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Assess
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Establish where she is: – ‘Where are you with your quitting?’ – ‘Are you thinking about quitting?’ Establish her motivation and confidence to change her behaviour Spontaneous quitters: – May not have gone through all the stages of change – May be overlooked as non-smokers – 70% relapse 12 months after birth

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Assist
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Not thinking about quitting: – Provide a „Care for my air‟ pack and focus on the benefits of quitting Thinking about quitting: – Address concerns (eg. weight gain, withdrawal symptoms, stress, social impact), discuss reasons to quit, provide information for her partner Preparing to quit: – Set a quit date, discuss support available, assist with a quit plan Recently quit: – Congratulate, review and reinforce benefits
 Women’s and Children’s Health Service. WA Slide 24

August 08

Antenatal Assessment and Intervention for Tobacco Smoking

Ask again
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Follow up at all clinic appointments Ask: – „Are you still smoking?’ – ‘Are you still not smoking?’ Repeat the process as necessary

August 08

 Women’s and Children’s Health Service. WA

Slide 25

Antenatal Assessment and Intervention for Tobacco Smoking

Case study 1
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Sally – G2P0, 18 weeks pregnant, 35yrs old – Used to smoke 10 cigarettes per day – Quit when she discovered she was pregnant, has quit previously for months at a time What sort of quitter is Sally? Where is Sally in the „Stages of Change‟ Model? Using the 5A‟s Model outline the process for smoking cessation advice for Sally. Click here for more information

August 08

 Women’s and Children’s Health Service. WA

Slide 26

Antenatal Assessment and Intervention for Tobacco Smoking

Case study 2
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Anna – G3P1, 15 weeks pregnant, 30 years old – Smokes 25 cigarettes a day, has cut down to a low tar brand – Wants to quit, but has been unsuccessful – Partner smokes in the house, but she usually smokes outside – Her first baby was low birth weight and has asthma What may be some barriers to quitting for Anna? How would address these barriers? How would you monitor Anna‟s progress at subsequent antenatal clinic visits? Click here for more information

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Case study 3
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Christina – G1P0, 24 weeks pregnant, 20yrs old – Smokes a „packet‟ a day – Is a contented smoker – Doesn‟t believe smoking affects the size of the baby – Her sister smoked and her babies were „big‟. “Besides, doesn‟t a small baby mean an easier labour?” Christina is in the „Precontemplation Stage of Change.‟ How could you assist her to move to „Contemplation‟? What advice should you give Christina about hospital admission and smoking? Click here for more information

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

5A’s Flow Chart
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Ask Have you ever smoked?

Yes

Advise Smokers to quit Quitters to stay quit

Affirm choice and complete Tobacco Smoking Assessment MR215.10

Assess Are you interested in quitting?

Assist Not interested Thinking about quitting Planning to quit Recently quit

Complete Tobacco Smoking Assessment MR 215.10 and follow up at future clinic appointments

Ask Again Are you still smoking? Are you still not smoking?

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Quit Plan
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Set a quit date - choose a date in the next month to quit. On this date smoking will cease completely Decide on a quitting method - cold turkey or gradually cutting down. If reducing the number of cigarettes smoked the woman needs to reach zero by their quit date Discuss aspects of addiction - smoking is an addiction which in simple terms is made up of three parts - physical / emotional / habit Strategies to avoid smoking - substitution, distraction, break the association, positive self talk

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Partners and smoking
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Women who smoke are greatly influenced by their partners If the woman‟s partner is a smoker she will find it difficult to quit Women who are smokers will find it easier to succeed in quitting with their partner‟s support, especially if their partner is a smoker and also makes a quit attempt The more times a pregnant woman is exposed to passive smoke the more she inhales Risks of passive smoking for pregnant women include - increased risk of asthma, damage to the baby‟s lungs and increased risk of SIDS

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

The End

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Congratulations, you have completed this education package on assessing and supporting women who smoke tobacco To exit press the „escape‟ key

August 08

 Women’s and Children’s Health Service. WA

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Antenatal Assessment and Intervention for Tobacco Smoking

Disclaimer
"The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed."

August 08

 Women’s and Children’s Health Service. WA

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