Health Promotion Against Tobacco

The Problem of Smoking during Pregnancy in Scotland

Latest statistics on smoking among pregnant women in Scotland is daunting. For instance, reports by The UK Centre for Tobacco Control reveal that every year, at least 11,000 Scottish women smoke during their pregnancy (UK Centre for Tobacco Control Studies, 2012). Consequently, various health stakeholders in Scotland have raised concerns regarding the issue and are now implementing various measures to reduce the cases of tobacco smoking during pregnancy.

In absolute figures, research by the UK Centre for Tobacco Control Studies (2012) indicates that in Scotland, the age group of 20-24 is the largest proportion of tobacco smokers during pregnancy. Similar statistics also highlight that in fact, there is a higher prevalence of tobacco smoking during pregnancy among under-20s. Important to note, UK Centre for Tobacco Control Studies measure the prevalence of smoking among pregnant women using the Scottish Index Deprivation Scores (SIMDS) and several pieces of data indicate that the current level of the index might be worrying. Therefore, authorities have called for a more elaborate campaign strategy that would facilitate a reduction of tobacco smoking prevalence among pregnant women in Scotland through health promotion activities. The next section describes some of the theories that can be adopted by health authorities in Scotland to conduct an effective health promotion campaign against tobacco smoking among pregnant women in the borough.


Health Promotion Theories

Various authors have argued that conducting a health promotion exercise that lacks a theoretical foundation or that is not based on any conceptual model makes it difficult for the campaign to conform to the current norms and values of promotion practice. According to Whitehead (2004), these theories are not only useful in identifying the potential points of treatment intervention but also helps in aligning the exercise to the target population’s social, emotional and physical well- being. The following are some of the most commonly applied health promotion theories/modes in anti-tobacco campaigns:

Here, we draw from the work of Irwin Rosenstock to make an argument that health authorities in Scotland can use the HBM of health promotion to develop an anti-tobacco campaign among pregnant women in the borough. Irwin Rosenstock’s emphasis on people’s ability to adopt recommended health or physical behaviours based on their perceived benefits of action and threat of disease is especially useful in this analysis; as it allows for thinking through how health authorities can use the media and other platforms to communicate the threats of smoking during pregnancy and benefits of smoking during pregnancy so as to reduce the prevalence of tobacco addiction among pregnant women in the borough.

However, there are several criticisms that have emerged against the HBM that are worth noting. For instance, Rosenstock (1974) suggest that not all people may be ready to change their behaviour based on rational choice. Besides, Roden (2004) criticizes the theory for mostly focusing on negative attributes and ignoring the positive motivations that promote healthy behaviour.

.1.2 The Transtheoretical Model (1997)

Developed by Carlo DiClemente and James Prochaska, this theory suggests that when adopting healthy behaviours and eliminating unhealthy ones (e.g. tobacco smoking), people tend to go through five major stages that are related to how ready they are to adopt change (Proschaka & Velicer, 1997). According to Reimsma et al (2003), the first stage is the pre-contemplation stage while the second stage is the contemplation stage. Afterward, people get into the preparation stage. The penultimate sate is the action stage while the ultimate stage is the maintenance stage. In short, enthusiasts of this theory suggest that the ability to change health or physical behaviour depends on their motivation and readiness to engage in that particular change.

In this paper, we draw from the works of Carlo DiClemente and James Prochaska to make an argument that any health promotion exercise should take a keen consideration of the target population’s motivation and readiness to adopt particular health behaviour by aligning itself to the various readiness stages/concepts highlighted by this theory.

Carlo DiClemente and James Prochaska’s emphasis on motivation and readiness to adopt a recommended health or physical behaviour is especially useful in the analysis of how health authorities in Scotland can identify the readiness stage of the target population towards stopping tobacco smoking and align their anti-tobacco campaigns among pregnant Scottish women.

But critics of this theory, through systematic literature reviews, have indicated that there are no effectiveness differentials between stage-based and non-stage-based interventions (Adams & White, 2005). Besides, Prochaska (2006) argues that the theory somewhat adopts an arbitrary division of one stage from the other and that there is little evidence to prove a sequential transformation from one stage to the other.

With the growing evidence of the detrimental effects of tobacco smoking to the health of unborn and their mothers, various control strategies have been developed and applied as part of health promotion actions including community mobilization, increased taxation on tobacco products, peer education, and tobacco marketing restrictions. However, according to Prochaska (2006), there is a need to identify the most effective strategies for the target population. Against this backdrop, the following are some of the most effective anti-tobacco health promotion and caseation technique that can be adopted by Scottish health authorities to reduce the prevalence of tobacco smoking among pregnant women.

The first appropriate strategy that could be applied is peer education, which essentially involves information sharing among demographically matched peer-to pear groups (Medley et al, 2009). According to Golechha (2016), peer education is theoretically based on the premises of health-based behavioural theories, motivation, information, resources model and behavioural skills.

The effectiveness of peer education in the reduction of tobacco smoking among both men and women has been proven by various scholastic pieces of evidence. For instance, an assessment of the effectiveness of a peer-led intervention towards the prevention of smoking uptake in secondary schools showed that such interventions were effective in reducing cases of tobacco smoking among secondary students two years after the intervention. Particularly, according to Campbell et al (2008), the Stop Smoking Schools Trial (ASSIST) was found to be effective two years after the intervention. When further multilevel modelling was conducted to have a better understanding of the intervention, results showed a 22% reduction in odds (odds ratio: 0.78) of developing regular smoking habits in the control school compared to the intervention school. In another study by Uthman et al (2009), results from randomized control trials, with smoking as the main outcome, revealed that peer-education interventions were effective in preventing tobacco smoking uptake. Ideally, Uthman et al (2009) found that interventions that entailed various peer-training models caused a 6% change in the participant’s smoking habits compared to other models such as life-skills training and harm minimization, which only caused a 3% change in smoking habits among high school students in South Africa.

Another important strategy that would be useful in campaigning against the problem of tobacco smoking among women is media advocacy. Ideally, according to Golechha (2016), media advocacy in this context would involve framing and advocating the issue of tobacco smoking among pregnant women using media as a platform. In doing so, such information would be communicated in a manner that attempts to convince pregnant women smokers to change their minds against smoking. In fact, the effectiveness of media advocacy for this purpose was exemplified in The Project Tobacco Reduction Using Effective Strategies and Teamwork (Widley et al, 1995), which used media coverage against tobacco smoking by proposing a set of laws regarding the sale of tobacco products to underage, and shaming vendors who failed to adhere to the law. Widley et al (1995) further state that this intervention was to a larger scale important in promoting smoking prevention.

Here, there are two major communication strategies that can purposefully be used in enhancing the campaign against tobacco smoking among pregnant women in Scotland. According to Golechha (2016), the main aim of strategic communication against tobacco smoking among women is to advance the top –level goals and strategies of health authorities in Scotland towards tobacco smoking among pregnant women.

The first communication strategy that would be effective to implement is the messaging strategy. The strategy would make important aspects of messaging such as duration and intensity. According to Widley et al (1995), messages that have been used in campaigns for a longer period of time may end up being ambiguous and ineffective. Hence, a key strategic consideration would be to come up with a variety of messages to be used, and messaging techniques that consider all types of consumers. For instance, because packet pictorials are more effective in conveying the message to consumers who buy in packets, the strategy should also consider consumers who buy in sticks.

Developing an effective communication channel would also be an important communication strategy during the campaign against tobacco smoking among pregnant women. Whereas most campaigns have used television and radio a most population communication channels, the proliferation of internet use, especially among the youth, makes it a strategic communication channel for anti-tobacco campaigns among women. Besides, the use of various media platform (i.e. media mix) can promote exposure and have wide reachability among the target population.

The Acheson’s Report has been adopted while considering certain issues of health for instance smoking by pregnant women. Smoking among pregnant women has been proven to be the principal cause of inequalities for infant deaths between the poor and rich within the UK. The recommendations for this report are majorly to improve the conditions of health and minimize the rate of smoking among pregnant women in the UK. The report highlights the ways of reducing the smoking by the pregnant women for the promotion of healthy weight at birth and minimizes many risks that cause sudden deaths among the infants (Masters et al, 2017). The Acheson’s Report indicates the action taken to minimize smoking among the pregnant women, for example, provision of advice and the support for women to quit through the GPs and the midwives. It is also provided by the NHS services that assist these women to stop smoking through presence of a dedicated NHS smoking helpline for pregnant women (Bjørn Jensen, Lukic and Gulis, 2018). The provision of support intensively to most mothers who are vulnerable below the age of 20 by use of the Family Nurse Partnership Programme. There have also been the NHS marketing campaigns about smoking while the women are pregnant and signposting the support availability which is available for the mothers.

Initially, smoking was having a higher priority in the early stages in the UK; an indication on the document in the Government’s first white Papers on health was about the smoking kills (1998). The report emphasized on the paper that smoking can contribute to various gaps within the healthy life expectancy which occurs either between most advantaged and the most deprived which can be higher than any factor that is identifiable. In the UK, the government announced already the intention of banning the advertisements about tobacco (Csikar et al, 2016). Consequently, the government also organized a series of measures that can assist people in giving up for smoking. For instance, the report had an indication of the conditions for the abolition of the advertisements of tobacco within the life of government early (February 2003). The government also reported on the introduction for nicotine therapy replacement on the prescription (April 2001). This was a report by Acheson to the way of supporting the groups who had been disadvantaged and wasted so that these women could give up the smoking. There has also been the comprehensive provision of NHS cessation for smoking services. This was introduced in 1999 within the Health Action Zones, the services give the therapy, therefore, becomes the most support model which is very intensive (Weinberger et al, 2016). The regulations subsequently have been introduced that are hard hitting with warning pictures on all the products for tobacco, and also further support with the stop smoking social campaigns through marketing to provide support and motivate the women smokers so that they are able to stop smoking.

The recommendations on the Acheson’s Report indicates certain policies that help minimize the tobacco smoking for example; the recommendation of the policies that help minimize smoking of tobacco among the pregnant women such as restricting the smoking within the area of public, abolition of the advertisement of tobacco and promotion, mass media, the initiatives for education and the community as well as the recommendations to increase real prices for tobacco to discourage pregnant women from habitual smoking (Hu et al, 2016). The increases are to be introduced in tandem along with the policies for the improvement of the living standard for women under pregnancy and these policies assist these particular women to become ex-smokers.

The GPs should be taking the opportunities to provide advises to all the women under pregnancy who are smoking so they quit during the consultation periods. The women who are ready to stop should be referred to the services of intensive support, for instance, the NHS Stop Smoking Services. If for example, these women are not able to accept or are unwilling the referrals, then they can be given the pharmacotherapy which is in line with the technology of NICE appraisal for guidance (Quick et al, 2017). The status of women who are under pregnancy and are smoking should be reviewed and recorded with the individual once every year.

The recommendations outline that all the other professionals in health sectors, for example, the pharmacists, hospital clinicians, and the dentists should be referring the women smoking to the intensive support services, for instance, the NHS Stop Smoking Services (Usher-Smith, 2018). In the case where any woman under pregnancy is not willing or is not able to agree with the support, the practitioners that are having the suitable training are supposed to offer the pharmacotherapy prescription that is in line with the technology of NICE appraisal guidance. If it is possible, the status of women smoking and are not ready so that they can stop smoking are to be recorded within the records of the clinics and then reviewed once a year with the individual woman.

The strategic authorities for health, for example, the NHS hospital trusts, the primary care trusts (PCTs), local authorities, community pharmacies and the local groups within the community should be reviewing the cessation smoking policies and the practices of taking into account the recommendations. The cessation for smoking support and advice should readily be available within the community, the primary and secondary settings to every woman under pregnancy and are smoking. The local commissioners and policymakers should have a hard target for reaching deprived women under pregnancy and pay attention to their needs.

Health Promotion Programs

It is evident enough that smoking cigarettes entire pregnancy is the fundamentally avoidable cause of adverse pregnancy outcomes. Its consequence is seen in severe long and short term adverse effects on mother and fetus. The research has demonstrated that pregnant women who smoke risks of spontaneous abortion and ectopic pregnancy. It involves risks of various complications such as premature rupture of membranes, abruption placentae, and placenta previa. Smoke contains over forty toxic substances especially nicotine. Nicotine is a poisonous substance known for crossing placenta ( HSCIC Report, 2016). Fetal circulation and amniotic fluid demonstrate a higher level of nicotine than mother’s distribution and plasma.

The HSCIC research further exhibits that nicotine reduces the availability of oxygen to the fetus, decreases the fetus breathing movement and increases fetal heart rate. The reports from surgeons general on health consequences of involuntary exposure of tobacco indicate sufficient evidence linking the infant exposure to second-hand smoke to Sudden Infant Death Syndrome (SIDS), birth weight reduction and mental problems. Additionally, the report reveals that exposing the fetus to smoke increases the chances of ear problems, acute respiratory infections and, more severe asthma.

Education and Counseling Pyramid Approach

The interventions include asking all pregnant women about smoke use and offering better counseling which is a pregnancy-tailored for those who smoke. Identify and enhanced educational messages and formats that have demonstrated to improve knowledge, skills, and behavior regarding target population such as most vulnerable pregnant and childbearing women. According to Joe (2016), the message's contents touch nutrition, smoking, weight, and oral health in social media formats, websites, home visiting, clinical health, and prenatal care visits. Design and conduct effective health communication vide social marketing campaigns that promotes norms of health behavior prior, during and post-pregnancies. Making good use of paraprofessionals like peer counselors, community health workers, and lay health advisors

Joe (2016) states that the plan offers a routine preconception health visits to reproductive age women. The tours include risks factor follow up and screening, chronical medical condition management and plan pregnancy contraception. The visit involves all stakeholders. Offer comprehensive, timely, continuous and recommended prenatal care services to pregnant women. Implement innovative fetal models such as centering pregnancy, and improve preterm births. Build effective outreach programs and engagement with locals.

The approach support evidence-based home visiting programs to the most vulnerable women. The initiatives ensure that pregnant youth in short-term care have access to comprehensive and timely support services and prenatal care. Mobilizes and make use of community health care workers to improve social support for dangered pregnant women and their families to enhance healthy behavior practices.

The Problem of Smoking during Pregnancy in Scotland

Approach to this plan will mobilize and engage multiple community sectors in discussing, recognizing and intervening to enhance a consistent health message, policies, and behaviors. A funding mechanism to simplify, expedited low-income women enrollment in Medicaid, suitable for family planning coverage and prenatal care. Implementation and support of entire state Medicaid general standards for prenatal care, exploitation of health information technology to expedite more robust enrollment, risks assessment, screening, referral and coordination of follow up care, publication of derived specific quality data from the hospital for continuous improvement of healthcare system delivery and to make timely availability of state and local data through electronic birth certification to improve health care quality.

Work in hand with other community sectors, government agencies to address socio-economic health determinants such as essay access to health care, education, social support, affordable health housing and healthy community environment

The necessary stakeholders in the campaigns include the government agencies or sectors and health-related sector such as HSCIC, National Institute for Health and Care Excellence, British Psychological Society, Nursing associations, Community health care ( HSCIC Report, 2016). They for a more significant portion of the stakeholders and they are involved in peripherals and support. They are core in the stakeholder's wheel. Other stakeholders are private sectors, non-health related sector, and community or grassroots sectors containing the larger audiences. The stakeholders meeting will be scheduled at least once a month to brainstorm on strategies effectiveness. Other resources required are as follows:

The television campaign is one of the Health communication strategies that aim at changing people's behavior’s knowledge and attitudes. The primary targeted audience in the campaign is women, and the research shows that the majority of women watch TVs as compared to men (Allison, et al. 2016). The TV campaign will increase risk perception, influence social norms, empower women to change and improve their health conditions. Additionally, Tv’s will reinforce positive behaviors and increase the availability of support and needed services.

Flyers or Brochures

Brochures and Flyers are communication channels that can reach a wide audience. The documents can shape mass media, small group, interpersonal and community level campaigns. The campaigns suit the strategies of changing peoples knowledge, behavior and attitudes by increasing smoking risks perception as well as empowering women to improve. The other materials include the use of social media, radio, Newspapers.

Outcome evaluation examines the extent to which the project has achieved its outcomes in the set out our goals. It determines whether the service or benefits to clients are meeting their needs for the smoking problem among pregnant women. At times outcome evaluation is referred to summative of impacts evaluation. The review associated with assessing the endpoints of such as quality of life and equity, systematic review of the effectiveness of the outcome evaluation in reducing the smoking problem among pregnant women (Liu, Davidson, Bhopal, et al. 2013). The eight research that Mets the quality criteria inclusion, extensive media campaigns reduces smoking among pregnant women in Scotland by 13%. The economic viability of the companies indicates that the societal benefits much from the campaign in terms of costs, feasibility, accuracy, support or ethics.

It used in assessing and monitor documents program implementations. Process Evaluation assists in understanding the links between specific elements of program results. The scope and implementation of the evaluation have grown in complexity as its utility and importance becomes more widely recognized. Various practical frameworks and practical models are available to guide the administrators of the smoking problem among pregnant women in Scotland campaign (Brittin, Jones & Renee, 2016). The structures include collaborative community initiatives and the evaluation process. The evaluations provide a systematic and comprehensive approach to developing an evaluation approach. The elements include recruitment, context, reach.

The data from the research conducted in Canada concerning a health promotion campaign on the smoking problem with pregnant women indicates that women are likely to quit smoking or smoke fewer cigarettes than any other time in life. However, the same research reveals that it is hard for women to leave tobacco during pregnancy. The study states that through the health promotion campaign carried out in Canada between 2015/2016 only 10.6% smokes during pregnancy a significant decrease of 3% from the same research survey conducted in 2013/2014 (Elisa, et al.2018). It is a clear indication that a health promotion campaign can be reduced or curbs the smoking problem with women in pregnant women.

A fundamental assumption underpinning this project of the Health Promotion Campaign aims at reducing the smoking problem among pregnant women in Scotland is useful, what works best, in what population. Health Promotion campaigns begin by seeking an evidence-based recommendation. The researcher identifies and summerises information available on promotion intervention, increasing physical activities and creating health awareness on the effects of smoking on pregnant women and the general populace (Debora, 2014). Method: the researcher undertook a systematic review of for health promotion interventions, for smoking cessation. Relevant guidelines identified from the clinical evidence, National Institute of Health and Clinical Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) database.

The researcher also searched systematic international review from the established database known as the Campell Collaboration as well as The Cochrane Library, the Database of Abstract Review (DARE). National Institute of Health Technology Assessment (NIHR HTA) (Debora, 2014). Results Fifteen relevant guidelines and 111 systematic reviews identified. Most of the evidence defined as a targeted individual. There was an important recommendation for the Health Promotion Campaign aims at reducing the smoking problem among pregnant women in Scotland. The most reliable evidence of the Health Promotional Campaign is creating awareness of the risk of smoke on pregnant women. In conclusion, some guidelines and systematic reviews summarized and sorted to promote campaign aims at reducing the smoking problem among pregnant women.

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