There are three themes in this paper of interest to a UK audience. The first draws attention to the importance of congruity between the hospital environment and education about the harmfulness of smoking. A smoking policy is an integral part of the education process. Secondly, there are clear benefits to accrue from combining several educational elements in one smoking control programme, which has a synergistic effect. Thirdly, hospital staff are health promoters, too, and their training should reflect the importance of their public health role.
Smoking cessation interventions in the UK are being developed in the context of widening socio-economic differentials in both prevalence and cessation. These differ entials are evident among pregnant women, the group targeted for interventions directed at women. Recent research has suggested that, among the disadvantages associated with low socio-economic status, being dependent on means-tested benefits may be a particularly powerful influence on snuokimg status and a major barrier to quitting. Intervention programmes have been heavily influenced by the transtheoretical model, which maps the quitting process as a patterned sequeuce of 'stages of change'. However, little is known about the stage-of-change profile in the UK population or about the socio- economic patterning of the profile. This paper begins to fill these gaps in the knowledge base of health promotion with respect to women in pregnancy. It reports on a survey of 2000 expectant mothers conducted in 1996 in the West Midlands. First pregnancy was found to have an intervention-like effect, with a high proportion of first-time expectant mothers who entered pregnancy as smokers either planning to quit or having done so. This intervention-like effect was moderated by women's socio-economic circumstances. Being in receipt of means-tested benefits increased the odds of a woman not intending to give up smoking in the foreseeable future.
MOST research examining the relationship between women's smoking and stress has focused on women living on a low income. The present study looked in detail at comparative groups of women in terms of smoking status (that is, smokers, non-smokers and ex-smokers) and social class, and investigated similarities and differences in terms of coping strategies.Results suggest that not all women who smoke do so to relieve stress, though women across all social classes suffer from stress. Health promotion should therefore address itself to promoting positive coping mechanisms for all women. Women who do emphasise smoking as a vital coping strategy are likely to live on a low income, in poor housing and often live in isolated conditions with pre-school children. Health promotion must therefore seek to work with welfare agencies in combating the structural factors which cause women to depend on health-damaging coping strategies. CONSIDERABLE attention has been paid over the last few years to women's smoking habits, not least because the incidence of lung cancer amongst women is nsmg, while the rate for men has decreased'. In the last decade there has been a move towards explaining women's smoking in terms of stress management .Most research examining the relationship between women's smoking and stress has focused on women livmg on a low income&dquo;', though one study which did investigate women across social class categones found little difference between the extent of stress suffered by women smokers and women non-smokers5.There is some evidence to suggest that women are more likely than men to use cigarettes as a way of coping both with uncomfortable feelings'5-', and with stress89. Previous research has highlighted the circumstances in which stress arises in women's hves. Research has documented the number of hours women spend on unpaid work in the home'°. They are often carers of elderly relatives&dquo; and it is usually women who provide informal health care within familiesl2. Research specifically investigating the lmk between stress in women's lives and smoking has described the day-to-day problems women face in canng for children, running a home and trymg to balance these commitments with a job&dquo;.Our project aimed to investigate these ideas further and to compare women smokers with women who had given up cigarettes and women who had never smoked, in order to compare their views on stress and coping strategies. z MethodsThe research was conducted in three stages as indicated in Table 1. Fifteen pilot interviews were carned out with women on low incomes to examine the role cigarettes played in these women's lives. A postal questionnaire was then sent out to a sample of 2,500 women, generated randomly from four electoral wards, to determme social class, smoking status, health beliefs and use of health facllities. Social class was established by the Registrar General's classification of partner's occupation, unless the woman lived alone. For the sake of brevity, throughout this paper professional, managenal and clen...
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