Stop Smoking Project Is a Breath of Fresh Air at Cardiff Children’s Hospital

Parents and carers who smoke will be offered help to quit the habit when they visit Noah’s Ark Children’s Hospital in Cardiff under a pioneering new scheme aimed at protecting children’s health.

As part of the project, led by the hospital’s team of paediatricians, Noah’s Ark staff will ask parents whether they smoke and if they do, will offer to refer them directly to a smoking cessation advisor.

The scheme, supported by ASH Wales, will be the first of its kind in Wales and aims to reduce the risks to children from exposure to second-hand smoke and prevent them taking up the habit in later life.

Children exposed to second-hand smoke in the home are at higher risk of developing coughs, colds, ear infections, chest conditions such as asthma or pneumonia and meningitis. The risk of Sudden Infant Death Syndrome is doubled for babies who live with a parent or carer who smoke.

Cigarette smoke lingers in the home up to five hours after a cigarette is stubbed out meaning children continue to inhale smoke particles long after a parent has smoked.

Research by the Tobacco Advisory Group of the Royal College of Physicians found that children whose parents smoke are more likely to take up the habit in later life.

Dr Alice Knight who came up with the idea for the project with Dr Gabrielle Jee after treating children with respiratory conditions in the hospital, said: “We are really excited about this project. Our hope is that every health professional at the Children’s Hospital for Wales would feel empowered ask parents and carers whether they smoke and equipped to offer advice and referral to help them stop smoking. The aim is to improve the health of children and young people in Wales by encouraging parents and carers to stop smoking. We want to make every contact count, whether the child or young person is at the Children’s Emergency Department with a broken arm, a routine outpatient clinic or is admitted to one of the Children’s wards.”

Dr Knight went on to say that the project was created with the help of children and young people across Cardiff: “My favourite part of developing the new resources was working with children and young people in Cardiff,” she said.

“We met virtually with young people from Cardiff and Vale Health Youth Board (HYB) to hear their views and opinions on this project. We also asked children aged 8-12 years in Cardiff what they thought about grown-ups smoking and included some quotes on the new Quit leaflets.”

The charity ASH (Action on Smoking and Health) Wales worked in partnership with the Noah’s Ark team to create leaflets that will be handed out to parents and prompts reminding staff to ask parents about whether they smoke.

ASH Wales CEO, Suzanne Cass, said: “We are proud to support this forward -thinking initiative and hope that it will be emulated by other hospitals across Wales.

“In Wales 18% of the adult population smokes, jeopardising the health of thousands of children every year.

“By encouraging parents that smoke to seek help to quit, the team at Noah’s Ark will protect little lungs and ensure more children don’t grow up exposed to this deadly addiction.”

An event was held at the Noah’s Ark Children’s Hospital to launch the project. Staff can find out more by visiting the Child Health intranet page to access resources, a quick referral link and top tips for starting conversations with parents and carers about smoking.

ASH Wales Calls For Financial Incentives and Additional Support For Pregnant Smokers

ASH Wales is calling for pregnant smokers to be offered financial incentives and additional support to quit the habit after new figures show an alarming rise in those smoking throughout their pregnancy in Wales.

According to Welsh Government’s latest Maternity and Birth Statistics around 5,000 babies were born to smoking mothers in 2020.

Smoking rates were highest among pregnant 16 to 19-year-olds with one in three (35%) smoking throughout their pregnancy – an increase of five percentage points since the previous year.

There has also been a rise of five percentage points in the number of women aged 40 to 44 who smoke throughout pregnancy.

Overall, in Wales one in six mothers (17%) were recorded as being smokers at the time they gave birth – one percentage point higher than the previous year. The number of mothers recorded as being smokers at their initial assessment remained the same as the previous year at 17%.

The figures show that 18% of women who were smokers at their initial assessment had quit by the time of the baby’s birth.

Smoking in pregnancy seriously harms the health of both babies and mothers, doubling the likelihood of a still birth and making the risk of a miscarriage up to 32% higher. Babies born to mothers who smoked in pregnancy are 50% more likely to have heart defects and 27% more likely to be born prematurely. The risk of sudden infant death is also three times higher if a mother smokes in pregnancy.

Evidence shows offering financial incentives such as shopping vouchers, have been found to be one of the most effective ways to help women to quit. The 2019 Cochrane Review found that pregnant women who received incentives to quit were more than twice as likely to quit smoking during pregnancy and remain smoke free after their baby’s birth compared to those who did not receive incentives.

Programmes offering pregnant women shopping vouchers as incentives to quit smoking have been successfully run across the UK including by NHS Greater Glasgow and Clyde where women offered incentives were twice as likely to have quit at 34-38 weeks gestation. In the North West region of England, a similar project saw 69% of women who participated quit smoking during pregnancy.

ASH Wales is also calling for measures to provide additional support and monitoring of pregnant smokers, including:

  • Targeted smoking cessation support in areas of Wales where smoking prevalence is highest
  • Specialist support for pregnant teenagers
  • Regular CO monitoring of all pregnant women

ASH Wales CEO Suzanne Cass said: “It is extremely worrying that rates of smoking in pregnancy in Wales remain so high, putting the lives of thousands of babies at risk every year.

“While it is encouraging that 18% of pregnant smokers had quit by the time their baby was born, the numbers still smoking at the time of their birth remain high – particularly among teenagers.

“There is strong evidence that offering pregnant women financial incentives such as shopping vouchers, to quit smoking is highly effective. We would like to see Wales adopt an incentive scheme that encourages women to take up tailored smoking cessation support during their pregnancy.

“Additional support and monitoring of all pregnant women in Wales is also needed as a matter of urgency and we are calling for a package of measures to provide specialist smoking cessation support for all pregnant women in Wales especially teenage smokers.”

Commenting, the Royal College of Midwives (RCM) Director for Wales, Helen Rogers, said:

“It is very concerning that the number of smokers in pregnancy in Wales is not falling. These latest statistics show no real change on last year’s report. What is even more worrying is that one in three girls between the age of 16-19 years old are recorded as smokers at the time of giving birth.  The devastating effects of smoking in pregnancy are well documented, particularly the link between smoking in pregnancy and stillbirths. Efforts now need to be redoubled to improve intervention as a matter of urgency.”

Helen added:

“A concerted effort is needed to target areas in Wales where smoking levels remain high. Quitting smoking is not easy and pregnant women need more specialist support to help them stop for good. We know that higher rates of smoking are closely linked to wider social and financial inequalities in Wales. As a country there is much we can do, not just in maternity services, but much wider across society in other ways, such as education in schools, focusing on positive preconception care, advice, and support. All of this needs investment if we are to truly tackle smoking in pregnancy rates in Wales.

Smoking and mental health: Your questions answered

For Mental Health Awareness Week 2021 we asked Smoking Cessation Practitioner and qualified Mental Health Nurse Fiona Edwards of Swansea Bay University Health Board about the impact of smoking on mental health.

Is it true that smoking can relieve stress?

Many people find that smoking relieves stress, but what is actually happening is that when you smoke you take in nicotine which reaches your brain in a matter of seconds but only lasts for a short time before you start to feel the need to smoke again.  This is when you start to feel withdrawal symptoms such as anxiety and agitation which is relieved when you have the next cigarette.  Most of the stress you feel when you are a smoker is actually nicotine withdrawal and as a former smoker I know this only too well.  By stopping smoking you end the constant cycle of having nicotine, experiencing stressful withdrawal symptoms and the process repeating itself over and over again.  Once you can break that cycle a lot of people find they actually feel much less stressed.

What advice would you give to smokers hoping to quit but worried that cigarette cravings will affect their mental health?

My advice would be to access support from a stop smoking service, who have staff  trained to support you. Using medication to help reduce cravings really does help too. If you have the right amount of support and with the help of medication you are much more likely to be able to quit. Lots of people feel they want to tackle it alone but having the right help really does make a big difference.  In my experience people often find their mental health actually improves when they stop smoking, because they are no longer experiencing those distressing withdrawal symptoms.

What benefits can quitting smoking have on a person’s mental health?

There is now emerging evidence that stopping smoking can be as effective as taking antidepressants for mild to moderate depression. Stopping smoking should be integrated into care for people with mental health problems.  The changes people make when they stop smoking, particularly in terms of avoiding triggers and changing routine can also have big effects on a person’s mental health. For example people may start to eat a healthier diet if they are worried about putting on weight or they might start going out for a short walk to help distract themselves from cravings. Making changes to diet and exercise also has a big impact on a person’s mental health.

If a person already takes medication for their mental health is it possible for them to quit smoking using NRT?

Yes absolutely. Some medications which people take for their mental health may need to be monitored closely and the dose reduced when they quit smoking – but that is a positive as many of the medications people take for mental health can have side effects.

The joy of quitting: Why I’m happier after giving up smoking

To mark Mental Health Awareness Week we asked ex-smoker Laura Mochan to describe her quit smoking journey and how giving up has made her happier and healthier.

The impact quitting smoking has had on my mental health, is profoundly positive. I feel mentally stronger, happier in myself and more aware of what I am capable of when I put my mind to something.

Smoking was my only stress reliever, but now that I have quit, all forms of exercise help me with that. I don’t need to go stand out in the cold garage to light up so that I can feel some relaxation anymore. I can take a brisk walk, a run, an hour at the gym, an exercise class, a long stroll with the dog, do some crafts, catch up on the soaps, take a soak in the bath, meditate, read my book with some music on.

All of these things helped take my mind off the habit I had broken. I decided to stop smoking because I felt guilty (on my little boy), I wanted to become healthier, I was sick of being out of breath after just running up the stairs and since working with a new volunteer who smokes, I became very aware of how disgusting I smelled, too.

I was initially concerned about how I would handle not being able to lean on that cigarette for stress relief, but I dug deep and found strength I never even knew I had – and a whole heap of stubbornness, too. I made sure my fridge and cupboards were filled with healthy snacks, that I had things to keep me as busy as possible over the first couple of months and a new routine where I was allowing myself more sleep. I also slightly changed my daily routine so that I didn’t have pockets of free time where I knew I would be thinking about a cigarette.

Now, at 16 months later, I rarely think about smoking. I still have the odd urge here and there (and they pop up out of nowhere – not sue to stress etc, just totally random), but they don’t bother me.

My mental health has vastly improved. I am so proud of myself it’s unreal! My family and friends – (most of them) and me, included – didn’t think I could do it. My best friend and son were the only ones who believed in me, and after the first two weeks of quitting, I found belief in myself, too. It was a brilliant feeling and I still smile about it all now.

I am FREE of sucking deadly chemicals down into my body… the only body I will have in this life… and it’s just a fantastic feeling. I have achieved something I never, ever thought I could, and the effects of this on other areas of my life is noticeable, too.

My advice to anyone who wants to give up, is that you have to WANT to give up. There is little point in putting yourself through it if you don’t really want to. I loved a cigarette and I miss them when I think about them (which isn’t often nowadays, thankfully), but now that I am on the other side of it, I can’t believe the damage I was intentionally doing to myself for something that is not a necessity, very unhealthy, very expensive, very smelly (especially your breath and fingers) and is ultimately a drag on your subconscious.

No one ‘wants’ to harm themselves by smoking, none of us want to fork out money we can’t really afford for cigarettes, when it can be much better spent elsewhere (I’ve saved almost £500 by putting my ‘cig money’ in a jar when I can afford to – which isn’t all the time, but I try so that it will come in handy for Christmas). The quiet worry in the back of my mind that I might become very ill through smoking, has gone – it’s a great feeling.

I feel calmer, healthier, stronger and able to try things I never thought I would. Those first three days are excruciating. The following couple of weeks are really hard. The two to three months after that are a lot easier, and by six months you’ve broken the back of it and need never have to look back. I’ve said it a million times over and I am absolutely adamant: if I can give up smoking, Anyone can!

ASH Wales calls for financial incentives and additional support to stop pregnant women from smoking

ASH Wales is calling for pregnant smokers to be offered financial incentives and additional support to quit the habit after new figures show an alarming rise in those smoking throughout their pregnancy in Wales.

According to Welsh Government’s latest Maternity and Birth Statistics around 5,000 babies were born to smoking mothers in 2020.

Smoking rates were highest among pregnant 16 to 19-year-olds with one in three (35%) smoking throughout their pregnancy – an increase of five percentage points since the previous year.

There has also been a rise of five percentage points in the number of women aged 40 to 44 who smoke throughout pregnancy.

Overall, in Wales one in six mothers (17%) were recorded as being smokers at the time they gave birth – one percentage point higher than the previous year. The number of mothers recorded as being smokers at their initial assessment remained the same as the previous year at 17%.

The figures show that 18% of women who were smokers at their initial assessment had quit by the time of the baby’s birth.

Smoking in pregnancy seriously harms the health of both babies and mothers, doubling the likelihood of a still birth and making the risk of a miscarriage up to 32% higher. Babies born to mothers who smoked in pregnancy are 50% more likely to have heart defects and 27% more likely to be born prematurely. The risk of sudden infant death is also three times higher if a mother smokes in pregnancy.

Evidence shows offering financial incentives such as shopping vouchers, have been found to be one of the most effective ways to help women to quit. The 2019 Cochrane Review found that pregnant women who received incentives to quit were more than twice as likely to quit smoking during pregnancy and remain smoke free after their baby’s birth compared to those who did not receive incentives.

Programmes offering pregnant women shopping vouchers as incentives to quit smoking have been successfully run across the UK including by NHS Greater Glasgow and Clyde where women offered incentives were twice as likely to have quit at 34-38 weeks gestation. In the North West region of England, a similar project saw 69% of women who participated quit smoking during pregnancy.

ASH Wales is also calling for measures to provide additional support and monitoring of pregnant smokers, including:

  • Targeted smoking cessation support in areas of Wales where smoking prevalence is highest
  • Specialist support for pregnant teenagers
  • Regular CO monitoring of all pregnant women

ASH Wales CEO Suzanne Cass said: “It is extremely worrying that rates of smoking in pregnancy in Wales remain so high, putting the lives of thousands of babies at risk every year.

“While it is encouraging that 18% of pregnant smokers had quit by the time their baby was born, the numbers still smoking at the time of their birth remain high – particularly among teenagers.

“There is strong evidence that offering pregnant women financial incentives such as shopping vouchers, to quit smoking is highly effective. We would like to see Wales adopt an incentive scheme that encourages women to take up tailored smoking cessation support during their pregnancy.

“Additional support and monitoring of all pregnant women in Wales is also needed as a matter of urgency and we are calling for a package of measures to provide specialist smoking cessation support for all pregnant women in Wales especially teenage smokers.”

Commenting, the Royal College of Midwives (RCM) Director for Wales, Helen Rogers, said:

“It is very concerning that the number of smokers in pregnancy in Wales is not falling. These latest statistics show no real change on last year’s report. What is even more worrying is that one in three girls between the age of 16-19 years old are recorded as smokers at the time of giving birth.  The devastating effects of smoking in pregnancy are well documented, particularly the link between smoking in pregnancy and stillbirths. Efforts now need to be redoubled to improve intervention as a matter of urgency.”

Helen added:

“A concerted effort is needed to target areas in Wales where smoking levels remain high. Quitting smoking is not easy and pregnant women need more specialist support to help them stop for good. We know that higher rates of smoking are closely linked to wider social and financial inequalities in Wales. As a country there is much we can do, not just in maternity services, but much wider across society in other ways, such as education in schools, focusing on positive preconception care, advice, and support. All of this needs investment if we are to truly tackle smoking in pregnancy rates in Wales.”

Guiding People To Quit Smoking For Good

Philip Garrod is a senior practitioner for the hospital smoking and wellbeing service at Hywel Dda University Health Board. He tells us why he is so passionate about helping patients and hospital staff to quit the habit:

“I’ve always been passionate about healthcare and worked in the NHS for many years.  Becoming a smoking cessation practitioner really appealed to me as I had an opportunity to make a real difference in people’s lives. I’d also seen at first-hand how family member’s lives are affected by smoking so it was an area that really interested me.

My role is to guide patients through behavioural change and provide them with the skills, knowledge and confidence they need to become a more active participant in improving their own health. It’s a true working partnership with each patient.

“Sometimes patients self-refer and others are referred by a specialist practitioner or a consultant as quitting smoking can have huge benefit in the management of chronic conditions, length of hospital stay and will improve wound healing and response to treatment.

“The patients I work with are so varied which makes my role really exciting. We have patients that are really quite young, maternal health patients, some that are physically fit and others with health limiting conditions. It is rewarding when people’s quality of life and self-esteem improve once they are able to quit.

We also work with staff from the health board who smoke and which presents a good opportunity for them to promote the service to patients but also helps them manage their withdrawal during their working day. The new legislation has banned people from smoking on the hospital grounds but we are keen to reassure people that we are here to help. Nicotine Replacement can be given to prevent discomfort experienced as a result of a hospital stay, whether a patient, visitor or a member of staff, we have advisors on each site to help.

Since the start of the Covid-19 pandemic there has been an increase in patients wanting to have smoking cessation support, which is great. It’s not always easy and we try to have a flexible approach tailored around the patient’s needs. We remind patients that the door is always open for them regarding treatment. Sometimes the time may just not be right but we don’t want them to give up giving up.

There are many barriers to quitting and sometimes change is hard but we can work through these issues with the individual and give them their best chance of quitting successfully. COVID has been a frightening time for people and many want to talk about that. We are also work closely with other services such as the local drug & alcohol teams, social prescribers, exercise and nutrition experts.

There are so many examples of patients that I have worked with that make me really proud. I remember an elderly lady who was admitted through A&E because she was struggling to breathe. She was asthmatic and has COPD and was regularly taking respiratory medicine.

The patient had considered giving up previously but it was never the right time. She was in her 80s and had smoked for many years. We listened to her history and tried to understand why she smoked. She said to me: ‘I don’t think I’ll ever be able to stop, this is my life I enjoy doing it’.

She was really struggling in the mornings with a repetitive cough and the knock on effects was causing her incontinence because she was coughing so much. She thought she would never be able to go out in social circumstances because the cough would embarrass her. We treated her with nicotine replacement therapy, supported her with behavioural and motivational support and listened to the patient to understand the things she really wanted out of her treatment.

In no time at all she started using the medication really proactively and she really engaged and attended appointments. Soon the patient started to notice the benefits to her own health, her cough had improved dramatically and that was the icing on the cake. She set a goal to attend a family wedding but was so anxious as her cough had embarrassed and brought unwanted attention at previous gatherings. This had prevented her accepting invitations for years. We coached and supported her and continued our treatment and the patient grew in confidence and she managed to attend the family wedding. Her confidence and quality of life improved as well as her finances. That was such a rewarding exchange.”