So if I'm driving my 17 year old

[IKnowIAmButWhatAreYou]

and we're both smoking, I can be prosecuted?

Seems strange to me given that a 16 year old can legally smoke.

AIBU to think they should have thought it through a bit more with regards to age?

Not discussing the health implications, more interested in the potential for time-wasting for both smokers & Plod...

We should be able to trust what public health orgs say. There shouldn't be any need for the ordinary public and frontline HCP to have to go through it all and fact check everything

TJE - believe me, I spend a lot of my time with smokers who are desperate to quit. They NEVER do it through Fear, Obligation or Guilt.

They are successful when they have choices, can discuss their habit without someone disapproving. Even reading your words 'morally reprehensible' makes me want to scream.

Demonising people does not solve a problem, it may drive it underground, but it won't solve the problem. Ecigs have done far more to reduce the heath issues than any ban has.

As for figure, less than 25% of the UK population smokes, almost 60% have never smoked. The figures have been reducing nicely. If you want to play with figures

A study looking at children's exposure to secondhand smoking in England, between 1996 and 2007, found that their exposure levels had declined by nearly 70%. remind me, when was the indoor ban introduced?

Levels of cotinine (a biomarker of exposure to tobacco smoke) in non-smoking adults fell significantly (27%) following legislation. This trend did not extend to some population sectors: there was no significant reduction in exposure for those in lower socioeconomic groups or those living in a home where smoking occurs inside on most days So, back to legislating for stupidity or race, as pp upthread have mentioned, it is clear that the cohort (well educated, middle and upper management) that was smoking less, now smokes even less and the cohort that smokes most, lower socioeconomic, has made little change.

There are all sorts of facts, figures and opinions, but that is one clearly measurable indicator. By focussing on cars we have missed a trick. The reduction in hospital admissions for asthma and RTIs is staggering, but it had also happened before the ban, was done with education. Now we really need to refocus on the cohort that needs intervention most.

No, not car drivers.

I keep seeing facts and figures about the service I work in and the Smoking Toolkit, and I am dismayed - they like the measure over the first 9 month after the introduction, but that isn't fair, many started to quit prior to the ban. Also, we haven't really had much of an increase in success with over the counter NRT. Interestingly our successes are better with other medications, support groups etc - but smokers in a lower socioeconomic status don't access them, they use their free prescription to get the NRTs - all of which s borne out by national stats.

The biggest success in both reduction and cessation is in those who buy their own and vape. But that can only be anecdotal at present!

Blanche. You may be changing my mind.

As an ex smoker I do know how hard it was to quit - I tried a number of times before deciding to get pregnant and couldn't - knowing that I was killing myself slowly just wasn't a big enough impetus to go through the pain of stopping. I kidded myself with thoughts of my great uncle, still going strong at 70 despite a 40 a day habit. But I truly cannot comprehend the mindset of people who continue to smoke knowing that it is doing harm to their children, where there really is no ambiguity on the science. In your experience do people who continue to smoke around kids or whilst pregnant justify it to themselves as being not all that harmful (as I did with my own smoking) - or do they accept that it is harmful and are not capable of caring?

In your experience do people who continue to smoke around kids or whilst pregnant justify it to themselves as being not all that harmful (as I did with my own smoking) - or do they accept that it is harmful and are not capable of caring?

Around 12% of pregnant women are still smoking at the time of delivery. They smoke because they don't manage to stop - it's that simple. NICE now have to issue guidance for HCP seeing PG women who are too ashamed to admit they smoke. Writing stuff like your post above, on a forum that is supposed to be supportive, is really unhelpful.

As Pubes pointed put a little earlier, it is the eek factor that makes this popular - after all, these days, who would smoke around their kids?

Sadly the ability of the human race to persuade itself that it will be fine, as you found, is an ever giving gift. For some the last sheet of wrapping paper never comes off, they never get to see the beast unwrapped!

Many of the people I see now are those who just can't. I work in a shop/centre in a very deprived city, high levels of unemployment, illiteracy and dependence n drugs, alcohol and cigarettes. I used to be based in a GP surgery, similar area, same story.

Those who can have, or come in, take the best advice, find or set up a support group, use ecigs. Many of these work and have a higher standard of education. The majority have never worked, maybe have not had a working adult in the family for 2 or 3 generations. They tend to have a list of explanations a mile long, something always goes wrong, falls off, costs too much or is the wrong colour and anyway "the babs' are used to it", you see?

It is these people, who are highly unlikely to own a car, who are the last bastion of smoking. Whole extended families live in close quarters, all smoke, often from pre-teen. They are my greatest client group, always have been for all substances and the cooking sessions and the exercise sessions we also run.

They also find the untruths in a lot of the science (see earlier posts). They are absolutely brilliant at doing this. If a single scintilla of contrary science exists they will know about it. This is shy I was dismayed that I did not have the 'smokiest bar' factoid at my fingertips, a colleague seeks them out so we can try to counteract them!

Why? I'm genuinely interested as to the thought processes that mean people don't manage to stop, because it's only by understanding those that we can help people to stop. When I said not capable of caring I didn't mean it judgementally, but more that they have other unaddressed mental health issues that genuinely make them incapable - in the way that my alcohol consumption was way too high when depressed but I really couldn't do anything about the drinking until I had help with the depression.

I don't believe any parent gets to the stage of being so careless of their kids that they know, properly know that they are harming them and yet continue to deliberately do sonless there is an underlying issue. But I wonder whether that is the problem that needs addressing, or whether it's about education. I've seen pregnant women continue to smoke and tell themselves that it's OK because the stress caused by stopping would be worse for the baby than the cigarettes - people do latch onto misinformation to justify their behaviour to themselves and others, so would funding a programme of real one on one education about the harm done to children by smoking have an effect?

Cross posted Blanche - thx.

So funding e-cigs for that group rather than NRT would help?

The main underlying issue is that, for the main, they see no repercussions.

No baby has a health condition that another baby has had. Ill health, chest infections and all sorts of other concomitant issues are normal, in their lives.

I am trying to pick my words carefully here. I am only too aware that the people I work with have a jaundiced view and have grown their own callouses. I cannot use the terminology of work - think NFN, Normal for Norfolk etc.

The main client group I see are non achievers, over many generations. They are suspicious, not inclined to gratitude for help, very inclined to formally complain if they are not offered everything, immediately, and have lived with people like me, you, everyone else, looking down on them, judging (which we do as we become exhausted by the constant dripping tap ness of it).

To tell them that their smoking may have caused illness or even death can put me at physical risk, will almost certainly be the cause of a formal complaint and will definitely stop them engaging with the service.

That is the reality of a lot of health care work, sadly.

The other group (in addition to those on low income and with a lot of overlap) that has extremely high rates of smoking is those with MH issues so that is definitely a big factor but it doesn't mean they don't care! There are all sorts of reasons why some people find it much much harder to quit than others and for a lot of women, becoming pregnant doesn't magically give them more willpower. Also not everybody is filled with joy at being pregnant in the first place, some will have far more pressing substance misuse issues ... It's a complicated picture.

Yes, smokers do latch onto misinformation to justify what they are doing but this is to cope with the fact they have been unable to quit.

Sorry if I was snippy with you but I think it is a real problem that pregnant smokers are vilified so much, it makes it incredibly hard for them to ask for help. MN is I think particularly bad at supporting PG smokers because of the amount of kneejerk judgmental posts you always get on the topic.

I don't think more education is the answer - smokers know, pregnant smokers know. I think if there is funding to be had it needs to go into proper, well-advertised, non-judgmental support, especially for those with complex needs. There was a thread earlier this year started by a PG smoker who had been waiting 10 weeks for a specialist stop smoking referral. It was taking ages because she had MH issues and nobody was quite sure which service she should be accessing because of this.

Absolutely!

But as for service... I work for a partnership, local NHS and a couple of health charities. None of our service users have to wait for more than 2 week, as some of the groups only run once a fortnight.

STILL uptake is low, or rather consistent uptake is low. We used to run a minibus, we stopped as it wasn't used by anyone. Now the same people that didn't use it complain they can't get to us as it doesn't run any more. We, apparently, have taken away their right to the service by removing the free minibus.

So it isn't always accessibility either!

But my clients aren't the only smokers, but they are not unusual. Many pockets of similar populations exist all over the country.

They do illustrate the problem well!

And had I seen that post, Pubes, I would have told her to demand referral to a non specialist/ordinary cessation service. Being pregnant or depressed does not change the first few steps of NRT and all Support to Stop centres should be able and willing to take that referral.

A 10 week wait is disgusting and utterly unnecessary!

Yes, support is patchy. It's one of the areas of the NHS that seems to have been mostly (all?) privatised. You can tell quite a lot by looking at the job ads, for example compare Leicester and Scunthorpe. Some is excellent, some is shit. My local service is run by a football club and I suspect rather a lot of them are ex-chuggers come from a sales background.

And on ecigs, while services are rapidly moving to incorporate this sort of advice, Lancashire County Council decides to put out stuff like .

There are massive failings in smoking cessation in mental health although it seems to be slowly improving. I don't know how things are in midwifery, I'd be interested if anybody has up-to-date experience. People with complex needs need proper HCP, not salespeople. In the thread I mentioned, the stop smoking MW didn't want to deal with her because she had MH issues, the MH stop smoking people didn't want to see her because she was pregnant. She tried to self-refer but they told her she needed a specialist.

Ludicrous. Even back in 2001, when I started, the point was that, whatever the MH issues, pregnant or not, a smoker could be given initial guidance and even start NRT as it was better than doing nothing.

In my experience cessation workers have always been non NHS by preference - they get all medical and prissy faced I was/am a charity based worker, working in partnership with an NHS project. The NHS pays for my training, provide the main venue and part pay my wages. It has been like that for about 15 years. I am lucky, they extend that to the other sessions I run (mainly based around healthy eating, basic cooking and exercise for physical and mental health, the latter is my specialist subject).

I'm not having a pop at all cessation workers. Lots of you are highly experienced and do a fantastic job We do still need specialist midwifery services and specialist MH services though, as well as proper joined-up services for people who are in both those groups (and others) and those services need to be people with lots of relevant experience and expertise.

Looking at that Scunthorpe ad, I wouldn't expect that person to be able to work effectively with a smoker who was both pregnant and had serious MH issues. I don't think that would be fair on either the worker or the client.

Why specialist services during pregnancy?

NICE guidelines require midwives to ascertain smoking status, carry CO monitors and refer to the local cessation service - that would be me!

In the absence of other problems cessation is broadly similar for pregnant and breastfeeding women. There is a slight change in the NRT we would recommend (16 hour instead of 24 hour patches) but the patch is better than the cigarette. I can't recommend vaping, officially, as there is no evidence...

As for MH issues, we are lucky, we have the group sessions on site. But the NRT prescription is no different. Our clients can start NRT like anyone else and wait for a referral to the group sessions, if they need them. To be honest, we recommend vaping more to this group. Health first, psychological dependency second. So we aim for replacing the cigarette habit with a vape habit, which works more easily than anticipated, one theory is that the self medication of the vape plus the vape action mimicking smoking is as effective as in the wider population. But we always refer for both psychotherapy and a pharma review.

But the NRT doesn't have to change, which is why I wouldn't allow any client sit and wait for a specialist referral for cessation. In fact the GP or midwife should be the one referring to us! That is the crux of it, communication between referral partners. It is reliably shite, unfortunately. The one thing I can guarantee is that at least once a month I get a client who has been referred by their GP but whose relevant medical history has not been forwarded, due to 'issues of confidentiality'.

I am planning (dreaming) a workshop. Ideally we will role play a GP sending a cardiac patient for surgery, with the GP withholding information from the surgical team. The reasons role played will come directly from those we get in our clinic. The very people who have used those reasons will be in the audience!

I wonder if I will get any funding

Sorry, I didn't really address your question did I?

Both pregnant and MH issues... would probably be referred all round the houses. They should be referred to us twice, maybe three times, MH team, midwife and possibly GP/PN. In reality everyone would hesitate and double think themselves.

But if such a person got to me, I would NRT for pregnancy and refer to group sessions for MH issues. I would focus on control and habit replication, 16 hour patch and a pretend cigarette (commonly known as an Argos or bookies pen with the middle removed ). I may also be tempted to mention vaping... again nicotine would be ingested anyway and habit replication and feelings of control may be more important!

Sorry, you have got me on the outside of some white wine and pondering the variables. I shall cease typing, finish my wine and poddle off to bed

What if a 17 yo is sitting in a stationary car smoking. Can they be prosecuted for smoking in a car with themselves.

I think this new not smoking in cars with children law is brilliant.

As and adult I could walk out of a pub if I didn't want to be in a smokey atmosphere. As a child I couldn't get out of the car if my parents were smoking.

No child should have a long smoke filled journey inflicted on them.

When I asked my mother why she allowed my dad to smoke in the car she protested "I didn't like it either, it wasn't just you."

I wish this law had come in a couple of years ago so I could have reported our vile neighbour who parked up everyday and smoked outside her house with the baby asleep inside lazy bitch didn't wanted to stand outside the car.

All three of her kids have asthma and the youngest is in and out of hospital with chest problems.

Goodness, Blanche, your vitriol gets in the way of your accuracy when you're accusing people, doesn't it? Pubes's link would have been relevant had I quoted 23 times (per the FF article), which I didn't.

On the bars point - AAP quotes Edwards R, et al. N Z Med J. 2006 on this issue in this article, which contains references to numerous other studies.

There is clearly more work to be done and you and I clearly disagree on (a) the purpose of this law (to me, better protection for children now is the right place to start), (b) whether it's a good place to start and (c) whether the evidence base is sufficient to justify action (I tend to the precautionary principle where children are concerned). But heavens, let's try to keep it civil and avoid misrepresentation, eh?

Vitriol? Wasn't aware I had any, certainly not on this thread! Not making any accusations against posters, just the measurable, deliberate mis statement of facts that get turned into truths, and that is incontrovertibly shown in some of the previous links.

It is the absolute statements that cause misunderstandings, the convenient stats winkled out of small scale studies, that the authors own conclusions don't state. That is such poor science, would get any research thrown out, but let a politically minded NGO get a hold of a paper and spout the outliers as 'average', change words to meet their own needs etc and what happens?

The lies become truths and taxes are spent erroneously.

That is not misrepresentation, that is what has happened, and has been acknowledged and a correction made, in this case, with that specific stat. I quoted from the referenced article, not others that were available at the time or later.

And if being ultra precautionary where children are concerned then you really can forget cars. Go to any 'sink estate', homes were there is no waged adult. There you will find children living in homes with 2+ smokers. Those kids spend what, 8 hours every weekday, more of a weekend, indoors with those smokers.

A little more harm done there than in a car, I think.

That is the point I have been trying to make. The difference between the stated aim of this law and the reality of where children are most likely to be 'smoked at'.

Which of the studies cited by AAP in the piece I linked to do you consider 'such poor science', out of interest?

??? I think that is a misunderstanding, Jassy??

I have not said any of the papers anyone has linked to are poor science. I have clearly explained that it is not the papers but the way they have been used - I gave specific examples of which words had been changed in order to misrepresent the original study!

And in the meantime you've dismissed the evidence base from the primary sources cited - which is what I've been referring to, particularly in discussing whether the evidence is sufficient to act.

No, I haven't ignored it. As I have said, any misrepresentation of facts is abhorrent to me as it has long term, negative effects. It should bother you that you have been deliberately lied to.

Jassy, you seem to be asking me to repeat everything I have already posted. I have not dismissed or ignored that cars studies. I have questioned the use to which they were put; I have questioned the overall impact of a few minutes in a car to hours in a house; I have explained my viewpoint in some detail.

.

I'm sorry if you get that impression. You dismissed my view of whether the precautionary principle should be applied by dismissing the evidence base - some of which deals directly with the house v cars point. I was simply curious which part you had an issue with.