People living in poverty are more likely to light up when the going gets tough, according to recent figures. This may have a calming effect for smokers, but it also has dangerous consequences for their children's health.
In most European countries today, the poor are more likely to smoke than the rich. In England, for instance, only 12 per cent of women and 17 per cent of men in the highest socio-economic group are smokers, while in the lowest socio-economic group, corresponding figures are more than two times as high: 33 per cent and 37 per cent respectively, according to 2003 Government figures.
The World Health Organization states, 'The tobacco epidemic exacts a high tribute from the poorest. Smoking contributes more than any other identifiable factor to the gap in healthy life expectancy between the least and most advantaged. An analysis of data from Poland and the UK shows that smoking is responsible for more than half the difference in adult mortality between men with the highest and lowest socio-economic status.
'Further, children from less advantaged families are more exposed to passive smoking than those from affluent backgrounds. In the UK, 54 per cent of the children from lower socio-economic groups were exposed to tobacco smoke in the home, compared with 18 per cent of those from professional backgrounds.'
Elspeth Lee, tobacco control manager for Cancer Research UK, says, 'The general take-up of smoking is not higher in lower socio-economic classes, the issue is around cessation. There are a smaller number of people who give up in these groups.'
Professor Gerard Hasting, from the Centre for Social Marketing at the University of Strathclyde, says, 'Quitting smoking is something you can do if you feel happy, aspirational and able to make a difference to your life - the lower down the scale, the less likely it is so. At the bottom level of the socio-economic scale, the amount of smokers has not shifted in the last 40 years.
'Life is tough and smoking offers one of the few props. It is a way of finding time for themselves, it's a bit of luxury, a vain pleasure, and it satisfies an addiction.'
Joanna Nelson, health team leader at Sure Start Ribbleton in Preston, agrees. 'A lot of the families that we work with are under pressure with issues such as housing, access to health services, education, transport,'
she says. 'All these accumulate to put stress and pressure on families, and the response for some people is to smoke.'
Passive smoking As well as having health implications for themselves, parents' smoking can have harsh side effects on their children's health.
Second-hand smoke is a complex mixture of more than 4,000 chemical compounds, including at least 40 known carcinogens. Tobacco smoke also contains carbon monoxide, which inhibits the blood's ability to carry oxygen to vital organs.
The Royal College of Physicians, in its report Smoking and the Young, estimates that 17,000 children under the age of five are admitted to UK hospitals every year with illnesses resulting from passive smoking.
A leaked report from the Scientific Committee on Tobacco and Health, which advises the Government, last week stated, 'It is evident that no infant, child or adult should be exposed to second-hand smoke.'
The report says that non-smokers living or working in smoke have a 24 per cent higher chance of lung cancer and a 25 per cent higher chance of heart disease. 'Children are at greatest risk in their homes and the evidence strongly links second-hand smoke with an increased risk of pneumonia and bronchitis, asthma attacks, middle ear disease, decreased lung function and sudden infant death syndrome,' the report states.
It concludes that smoking 'is a controllable and preventable form of indoor pollution'. Campaigners claim that Government ministers tried to suppress the report amid fears that it will increase pressure for a ban on smoking in public places. The Government is expected to suggest measures for reducing smoking in public areas but stop short of a total ban in its public health White Paper, due next month.
Professor Hastings says, 'The current debate on smoking in public places is very relevant. We need to get the message across that tobacco smoking is an undesirable thing to do. But as long as it is allowed in every pub in the land, then this message is being undermined.
'Also, should we continue to allow multinational companies to advertise tobacco? Evidently not. Why do we make it so easy to get hold of tobacco and allow packaging that, despite the health warnings, contains so much branding?
'Marketing works by identifying the most attractive target groups - and those on low incomes are a classic case.'
He adds, 'Almost all people want to give up smoking. There are very few enthusiastic smokers. Helping people to give up is about giving as much support as possible - cessation advice and tackling the social disadvantage that drives the need for smoking.'
Cessation advice
Local Sure Start services are on the front line of tackling the risk to children in disadvantaged areas from smoking. The Government has set a target of March 2006 for a 6 per cent reduction in the proportion of mothers who continue to smoke during pregnancy, as well as a target to reduce by 10 per cent the number of children aged nought to four living in Sure Start Local Programme and Children's Centre areas admitted to hospital as an emergency with a lower respiratory tract infection.
A Sure Start spokesperson explained why smoking cessation was identified as a key goal. 'Smoking is the main cause of preventable illness and premature death in the UK, killing over 120,000 people a year. It is a major cause of cancer, heart disease and chronic obstructive lung disease. It is also the single most significant causal factor for the socio-economic difference in the incidence of cancer and heart disease.
'Smoking in pregnancy can cause increased risk of miscarriage, stillbirth and low birth weight. Second-hand smoking is also known to be a cause of Sudden Infant Death Syndrome and childhood respiratory disease.'
Work in local Sure Start areas aimed at encouraging parents to stop smoking includes:
* Empowering parents to make the decision to give up smoking themselves
* Promoting ideas for mothers to identify time for themselves, rather than taking a smoking break
* Encouraging partners of pregnant women to attend smoking cessation clinics
* Providing advice and support to mothers to raise self-esteem and reduce the stress that makes giving up smoking difficult. NW Further information
* NHS Pregnancy Smoking Helpline: 0800 169 9 169
* NHS Smoking Helpline: 0800 169 0 169
* www.dh.gov.uk (search tobacco)
* www. givingupsmoking.co.uk
Case studies
Gainsborough Sure Start
Programme manager Debbie Barnes says, 'Parents in areas of disadvantage can find it harder to access support services. Sure Start is about choice, and we provide support for those parents who want to give up smoking, but we are careful not to alienate those who don't.'
Among a range of initiatives is the Smoke Free Zones project, which encourages families to sign up to not smoking in the presence of children.
Parents decide which award to work towards:
* Gold - no smoking in the house
* Silver - only smoking in one designated room
* Bronze - no smoking when children are present.
After signing up, parents get entered into a prize draw for gift vouchers and also receive a freebie bag of incentives.
'It's a good start for parents who do not want to give up smoking but still want to do something positive for the health of their child,' says Ms Barnes. 'It is also a step towards giving up smoking because they have to leave the social situation to smoke.'
Sunderland Sure Start
The seven Sure Start areas in Sunderland used social marketing techniques to identify what services pregnant women and their families wanted. Janice Ramshaw, specialist pregnancy smoking cessation advisor, says, 'We explored what it is like to be pregnant and a smoker, so that we can provide a sympathetic and non-judgemental service.
'Many said they felt they were on show, that people would point their finger if they smoked in public while pregnant. They felt guilty and did not want to smoke in front of people. Pregnant women also wanted to know how they could give up smoking, and many didn't realise that they could have nicotine replacement therapy while pregnant and breastfeeding.'
Research also showed that some mothers felt smoking was their only chance to relax. 'We now try to suggest other ways that they can have personal time, such as attending Sure Start where there are creches, and finding ways to help them feel better about themselves. Some of our centres provide manicures and massages,' says Ms Ramshaw.
A saving scheme has also been set up for people to put away money they previously spent on smoking. They are now saving for holidays, cars and treats.
Between April 2002 and March 2003, 402 pregnant women were referred to the scheme and 257 set a quit date. Of those who set a date,107 were still not smoking at their four week follow-up (a 42 per cent quit rate).