Advice and encouragement to stop smoking is particularly important (and effective) for pregnant women who are at higher risk of the adverse effects of smoking (Law & Tang 1995). On average 10-25% of women spontaneously attempt to stop smoking during pregnancy, while a further quarter or more try to cut down (McBride 1993).
However, studies indicate that providing appropriate advice and support can achieve additional quit rates among pregnant women of between 5-12% (Amos 1994). Pregnant smokers should be strongly encouraged to quit throughout pregnancy and should be offered intensive counselling treatment. In Scotland, the routine provision of this kind of support would result in an extra 1000 - 2500 pregnant women giving up smoking each year (Amos 1994).
Although a significant minority of women do attempt to stop smoking during pregnancy, about half of those who are successful relapse within a month of giving birth (McBride 1993). One method of addressing relapse would be to ensure that, during pregnancy, expectant mothers receive information about the harmful effects of passive smoking on their children. Cessation support should also be provided for women during the post-natal period. It has also been suggested that if a woman cannot stop smoking in pregnancy then use of NRT may be justified (Tang, Law & Wald 1994). However, more research into pregnancy, tobacco use and NRT needs to be conducted before recommendations can be made.
A US study, updated to current prices and converted to UK currency by Buck and colleagues, found that giving a pregnancy-specific self-help manual was more cost-effective than standard advice. Studies also show that cessation interventions in pregnancy actually lead to immediate cost savings for health authorities, quite apart from the health gains for mothers andtheir children. This is because smoking during pregnancy is related to low birthweight and intensive care for low birthweight babies is extremely costly. By encouraging smoking cessation during pregnancy health authorities can save between 3 and 6 times the cost of the intervention (Buck et al 1997).
Until recently levels of addiction among smokers aged under 16 years have been underestimated. However, data collected on Smokeline, the Health Education Board for Scotland telephone helpline, indicate that since it's launch in 1992, nearly 60% of interactive calls have been from young people in this age group, the majority of whom seek advice about smoking cessation (Network Scotland, 1997). Despite this, there is currently no cessation strategy aimed at young people in Scotland. There is also a lack of data on the effectiveness and cost-effectiveness of smoking cessation interventions for young people.
Fears about gaining weight on stopping smoking often inhibit the success of cessation interventions. Studies have shown that girls' self-perception, especially with regard to physical appearance and global self-worth, is much lower than that of boys (Minagawa et al 1993). Many young girls may therefore take up smoking as a way of controlling weight. A US study has confirmed that concern about weight and weight-regulation is salient for both male and female adolescent smokers. (Page et al 1993) Any effective cessation interventions, including those with young people, need to address issues surrounding weight control and diet.
To achieve a reduction in levels of smoking prevalence in Scotland and the predicted mortality from tobacco related diseases, smoking cessation interventions should be prioritised. Other measures such as restricting smoking in public places, increasing the price of tobacco, enforcing legislation on under-age sales of tobacco and curbing tobacco marketing are also essential parts of an effective tobacco control strategy. The Report of the Scientific Committee on Tobacco and Health points out that policies to increase the price of cigarettes and to restrict smoking in public places are effective in encouraging many people to quit. (SCOTH 1998) Tobacco advertising and promotion also plays an important role in influencing cigarette consumption, particularly among young people.
The implementation of smoking cessation interventions should take place within the context of a wider national strategy aimed at controlling and reducing tobacco use in Scotland.