NSR III - BIPS

Euroscip III
Ireland Smoking Cessation Report
National Status Report
Audrey Deane Wannagat
Edited by Marian Flannery
Women of the North West Ltd.,
MoygownaghCommunity Cemtre
Moygownagh
Ballina
Co Mayo

Table of Contents
Context 3
Legislation 3
Statistics 4
National smoking statistics 5
Health behaviour statistics 5
Smoking cessation policy 6
Smoking cessation research 6
Trends in Smoking cessation practice 7
Smoking Cessation Officers
Data deficits 8
Motivational training , DVD’s and 9 - 10
Newsletters
Survey Report 11 - 18
Conclusion 19 - 20
References 21
2

Context
This report sets out to describe the policy and legislation pertinent to the
issue of smoking cessation and pregnancy in Ireland. It gives, where
possible, relevant statistics, maps relevant health policy and legislation and
seeks to describe both good practice smoking cessation interventions - where
accessible - and relevant research.
Draft findings are as follows:
o There is much agreement between policy makers and the various
players that there is a serious deficit in smoking statistics related to
women. There are no statistics available on smoking rates in pregnant
women whether smokers or non smokers.
o Evidence for smoking cessation is weak with no centrally collated
statistics.
o There is a high level of compliance with the recently introduced
smoking ban in the workplace which has resulted in 96% of workplaces
being smoke free.
o The structural reforms within the health services in Ireland will impact
on how smoking cessation services are and will be delivered in the
future.
o Smoking cessation practice is currently delivered in an adhoc and
unmonitored manner with no national guidelines or centrally collated
statistics.
Legislation
On March 29 th 2004 it became illegal to smoke in enclosed working
environments under the Public Health (Tobacco) Acts 2002 and 2004 in the
Republic of Ireland.
This means that it is illegal to smoke in public buildings, pubs, on all types of
public transport, factories, shops, restaurants, hotels, hospitals and offices.
There are some exceptions for example psychiatric hospitals.
A year on from the introduction of the smoking ban in the workplace a report
from the Office for Tobacco Control found the following:
� Compliance with the smoke free legislation is very high
� 94% of all workplaces inspected under the National Tobacco Control
Inspection Programme were smoke-free
3

� 96% of all indoor workers report working in smoke-free environments
since the introduction of the ban
� Air quality in pubs has improved dramatically since the ban
� Levels of carbon monoxide have decreased by 45% in non-smoking
bar workers
� 96% of all indoor workers report working in smoke-free environments
since the ban was introduced
� 98% of people believe that workplaces are healthier
� 96% of people feel that the smoke-free law is a success 1 including
It is interesting to note that under this legislation domestic homes are not
counted as work places. As Ireland continues to have lower numbers, in
comparison with other EU and OECD countries, of women working outside the
home it is possible to assert that many women live in homes were they are
exposed to ETS (exhaled tobacco smoke). Given that ETC is a known
carcinogenic and is a causal factor in low birth weight babies’ 2 research
should be conducted to ascertain the risk to women in the home of ETS.
Statistics
Robust statistics on smoking cessation and pregnancy are not available in
Ireland. Regrettably there is also a data deficit on smoking and pregnancy.
However, we do know that in relation to Ireland it can be argued that there is
a very steep social gradient wherein people from the lower socio-economic
groups experience much worse health status, life expectancy and morbidity.
The smoking related data cited previously also displays a clear socio-economic
gradient with poorer people smoking more.
The following piece of research conducted in Mayo on the west coast of
Ireland by Women of the North West (Moygownagh Community Development
Project), the Irish partner in the European EIRO - SCIP Project 111, gives
evidence of the relevance of including the social determinants when engaging
in health service planning and design. There is a clear correlation between
smoking and low educational attainment with the greatest number of the
interviewed women (80) at the centre of the Irish research having spent less
than eleven years or more in formal education.
It is also necessary to note that those surveyed for purposes of this research
were public hospital patients and more likely not to have private health
insurance for economic reasons. This bears out previous research which
shows a clear link between level of income and smoking prevalence,
particularly for young women.
1 Smoke-Free Workplaces in Ireland: A One Year Review. Office for Tobacco Control. 2005. A
nationally representative sample of 1000 people aged over fifteen years was used in the
report.
2 Babies born with a weight of 2000 grammes or less.
4

National smoking statistics
The Office for Tobacco Control (OTC) collates and analyses smoking statistics
on a monthly basis. The information comes from a collection of a 1,000
responses a month from people over fifteen years of age. A quota sample of
1,000 people aged over fifteen years and weighted by gender, age, social
class and region. The most recent statistics from January 2006 indicate the
following:
• Overall prevalence of cigarette smoking is 23.9%
• 50.1% of smokers are female, 49.8% are men
• smoking prevalence is highest in the skilled working class C2
• Almost 32% of people in the 19 – 35 age group classified as smokers
• Smoking rates are highest in Dublin 3
Unfortunately the OTC does not capture any statistics on pregnant women
who smoke.
Health behaviour statistics
The SLAN survey is the only longitudinal study on lifestyles, attitudes and
nutrition to be carried out in Ireland. It is conducted by the Centre for Health
Promotion Studies in the National University of Galway. It has been
conducted twice to date, in 2000 and 2002. The next set of results are due in
2007. SLAN does not yield smoking and pregnancy related statistics, but it
does however give socio economic information on smokers. To date it has
given interesting statistics on smoking behaviours with a clear social economic
gradient wherein people from lower social classes smoke more, in particular
women. The 2002 Slan survey gave the following statistics:
o 33% of women aged 18 – 34 years smoked
o 25% of women 35 to 54 years smoked
o 32% of girls aged 15 to 17 years in Social Classes 3 – 4 smoked
o 36% of girls aged 15 to 17 years in Social Classes 5 – 6 smoked
SLAN does not capture pregnancy related statistics.
The BIPS survey concerning smoking and pregnancy conducted in the wider
western region has produced a clear connection between social class and
smoking behaviour. This is particularly apparent in relation to the prevalence
of smoking in pregnancy and low educational attainment. Only 23.50% of
those women surveyed had spent enough time in formal education achieve
the completion of upper secondary level. Moreover, the Slan report makes the
3 Ireland: Current trends in cigarette smoking. Office for Tobacco Control. 2006.
5

argument that young women in the ages from 15-17 form the biggest
tobacco consumer grouping resulting in the figure of 36%.
When one considers that the average age of those women survey in the BIPS
survey was 29 years. With a combination of lower social class and low
educational achievement it can be argued that future studies conducted show
that smoking rates in pregnancy have increased. In the absence of
educational smoking prevention targeting of such social groupings the
prevalence of smoking and pregnancy will increase. Presently the reality is
that the non- segregtion of smoking and pregnancy prevalence ensures that
the national statistics for Ireland appear less. This report makes the
argument that it is only when a closer examination of smoking prevalence and
pregnancy is targeted at specific social groupings that we can come to
identify where there is policy practice failures in the health promotion system.
The Chairperson of the OTC publicly stated that “there needs to be a
concerted and focussed effort by all those interested in women’s health to
develop effective smoking cessation programmes specifically for women”.
Smoking cessation policy
As stated in the 2003 report there are a raft of health strategies in which
smoking cessation is cited as a priority. These strategies include Quality and
Fairness - a health system for you (Irish Health Strategy), Primary Care – a
new direction, the Cardiovascular Health Strategy and the National Health
Promotion Strategy. There will be a third progress report from the
Cardiovascular Strategy due out in 2006 which will give up to date
information on smoking cessation.
There is no shortage of public pronouncements on the challenges facing
smoking cessation policy particularly in relation to the numbers of women
who smoke.
The Director of the National Cancer Registry has stated that in light of the
high numbers of women smokers who wish to quit but find it difficult that “we
owe it to these women to give them the right type of help, and support them
when they need it”. The fact that lung cancer will be a predominantly female
disease by 2020 due to the increasing rates of women sufferers is seen as
cause for concern.
Smoking cessation research
As there is no central database collating relevant health information it is not
possible to definitively comment on the current level of research into smoking
cessation and pregnancy.
6

A major research study currently ongoing, a partnership between the Rotunda
Maternity Hospital in Dublin and the Public Health Department of the Health
Services Executive, is expected to have a positive impact on the numbers of
women who smoke through out pregnancy. The following paragraphs
describe the research.
The objective of this research is to establish the effectiveness of motivational
interviewing of pregnant smokers and to reduce the numbers of smoking
mothers to be with a view to becoming standard practice across all maternity
hospitals and units. It is jointly funded by the Irish Heart Foundation and the
Health Service Executive.
It covers the geographic catchment area of the Rotunda hospital. At its core
is the training in motivational interviewing of all relevant hospital staff who
come in contact with smoking pregnant women. Staffs trained to date are all
nurses and midwives, administrative staff, Public Health Nurses (PHNs), Out
Patient Department nurses.
The study began in 2004 with the recruitment, with informed consent, of 500
pregnant smokers who act as the control group. The cases for the study are
now being recruited with 350 involved to date. These cases are offered
ongoing motivational training at each hospital visit beginning with their first
visit to the hospital. They are also given a card to contact the Smoking
Cessation Officers who work in a variety of community settings. In all there
are five opportunities to deliver and repeat the motivational training:
� At the first booking visit
� At 28 and 32 weeks of pregnancy
� The hospital stay for the birth
� At the three month infant developmental visit carried out by a Pubic
Health Nurse
A positive aspect of this ongoing research is that the hospital has included the
delivery of the motivational training as part of its training programme for
student midwives.
An evaluation is planned in the short term which will examine the perceptions
and attitudes of those delivering the training to establish their attitude
towards the training. Modifications to the training will be made if necessary.
Trends in Smoking cessation practice
Smoking Cessation Officers – the key workers
A recommendation from the Cardiovascular Strategy, published in 1999, was
that a Smoking Cessation Officer (SCO) be appointed in each Community Care
7

Area. Community Care Areas are the geographic catchment areas within the
Health Services Executive. This smoking cessation staffs are all based in
regional Health Promotion Departments of the Health Services Executive and
their brief covers:
� policy development
� delivery of smoking cessation programmes
� training of health care professionals
The recruitment of Smoking Cessation Officers has occurred in an adhoc
manner across the country with numbers of officers varying across regions.
There has also been a public service embargo on staff recruitment which has
hindered staffing levels. It is sometimes the case that Smoking Cessation
Officers hold other functions within Health Promotion Units so that not all of
their time is dedicated solely to smoking cessation related activities.
Therefore it is difficult to know at any one time how many smoking cessation
staff are active. As the post holders sometimes have a range of objectives it
is difficult to capture, monitor and evaluate their work load, outputs and most
importantly the effectiveness of their outcomes. This management
information weakness has an obvious impact on strategic resource planning
for smoking cessation at national level.
National Smoking Cessation Guidelines for these smoking cessation staff have
been drawn up but await implementation. The publication of these guidelines
would create cohesion and focus for smoking cessation officers and aid
uniformity of service delivery. There would be an obvious knock on effect for
the reliability and utility of the data and information captured from their work
if it was all captured in the same way.
Data Deficits
It had been envisaged that detail regarding the activities and outcomes of all
the Smoking Cessation officers working with pregnant and mothers who have
given birth in maternity units in Ireland would be available for this report.
Unfortunately due to resources constraints within the HSE this useful
information is unavailable at time of writing. It is known however, that there
are about twenty Smoking cessation staffs working within maternity settings
in Ireland. A seminar is planned for later this year which these officers will
attend and data regarding their outputs and outcomes is currently being
compiled, as mentioned. This seminar is being organised by a senior smoking
cessation officer based in Dublin who also carries a brief as the part time coordinator
of the Irish Smoke Free Hospitals Initiative (a member of the
European Network of Smoke Free Hospitals Initiative) At this point in time it
appears that there is a growing political will to engage other actors as a
means of ensuring that a more specific targeting of research and education
should be happening regarding the growing concern of smoking and
pregnancy prevalence.
8

Motivational Training
Relevant information was requested from these SCOs at national level in
relation to the training they provide, its content, target groups and what
perceptual and attitudinal barriers they encounter in their work.
All smoking cessation officers use motivational interviewing (MI) and the cycle
of change methodologies when delivery training either in either a group
setting or on an individual basis. This type of training makes careful use of
simple and appropriate language to provide people with an understanding of
the complexities of smoking. MI is based on the following principles:
� Expressing empathy: skilful reflective listening
� Developing discrepancy: client presents arguments for change
� Rolling with resistance: avoids arguing
� Supporting self efficacy: client responsible for choosing/carrying out
change 4
The above approach is client centred yet is also a directive method to
enhance intrinsic motivation to change by exploring and resolving
ambivalence. The method, developed by William Miller and Stephan Rollnick,
has been widely examined has proven outcomes as a method of substance
abuse treatment.
In the Health service Executive West region, some 278 professional staff has
been trained. The target groups in the west region were nursing staff, social
workers, occupational therapy health assistants, homecare personnel,
physiotherapy and youth workers. In addition some 28 staff midwives also
participated in the regional training programmes.
The training was conducted over two days. It was facilitated by two health
promotion officers operating with the Health Executive Service. At all times
this motivational training is open to internal staff and personnel working in
the voluntary sector.
Aids to promote motivational training.
DVD’s
It is evident from the work of this project that there are problems in gaining
access to health Service Executive staff for the purpose of delivering
motivational training in smoking cessation methods. In fact the level of access
4 Reproduced from the Smoking, Pregnancy and the Newborn training manual currently in
use in the Rotunda study
9

and co-operation experienced by the Smoking Cessation staff can only be
described as frustrating. During the period and experience of this project we
have encountered the cancellation of motivational training because of poor
attendance. This has caused time delays and financial wastage. Therefore, it
must be argued that the purchase of motivational material in the form of DVD
or Training manuals for the purpose of supporting further motivational
training within the Health Service Executive could very well be seen as a
further waste of money given that there is no real evidence of a political will
to seriously promote training and education of smoking cessation
methodologies.
Newsletters
The promotion of written material (Newsletters) supporting the cessation of
smoking in pregnancy must by its nature have only a limiting effect on an
overall public and professional awareness. Moreover, there is a lack of
support at national level necessary to do this work effectively. This
organisation is very aware that the dissemination of the information contained
in the newsletters produced as part of BIPS (111) is highly dependent on the
professionals who hold power in the health care sector. However, and
thankfully because of the organisations work with the Women’s Health
Advisory Committee, West Regions, the particular connections to disseminate
the newsletter directly to health professionals has been possible.
10

EURO-scip III Survey Report – Ireland
This research was conducted in the Health Service West area. This
administrative health area covers the northwestern, mid western and western
region of Ireland. The questionaire was administrated by Women of the
North West (Moygownagh Community Development Project) located in
Moygownagh Community Centre north of Ballina in County Mayo.
The work of the project is closely linked with the women’s health activity of
the project. The organisation WNW has a long association with women’s
health activity. The association first began at the time of the Beijing United
Nations Women’s Conference 1995. The tradition of gender specific health
promotion connections between Women of the North West and Health
Authorities has enabled this research. This is so because of a close working
connection and co-operation between WNW and the health authorities both
local and national is now well established. However, it must also be
acknowledged that the actual collection of the data for this particualr was not
easy. Furthermore, it must be also stated that gneral data on smoking in
pregnancy in Ireland is not readily available. Neither is there overt evidence
that pregnant women are a source of active anti smoking preventative
measures within the healthcare sector. Cases of preventative measures
appear to be of a pilot nature.
It is against this background that the research aspect of the Irish Euro-scip
111 project was conducted.
The specific aim of this project work was to estimate smoking prevalence
amongst pregnant women at different stages during their pregnancy. The
objective being the creation and updating of a data base in eight countries,
namely; Belgium, Bulgaria, Germany, greece, Ireland and Portugal. The Irish
research site (Women of the North West) are anxious to acknowledge the
assistance and support of the the offices of the HSE West Smoking
Cessation, the Women’s Health Co-ordinator and the regional hospitals
midwifery personnel.
Methodology
Initially, 300 GP’s were targetted throughout the Western area. This route
was chosen because of the potential of access to a wide population of
pregnant women given GP’s provide combined ante-natal care. The cooperation
of the GP’s was sought with the aid of a letter of introduction.
Stamped addressed envelopes were included with the questionaire and letter
of introduction.
By September of 2005 it was apparent that the response rate was slow and
consequently low. Such a response was not adequate to secure 200
completed questionaires.. Therefore, it was decided to engage the assistance
of maternity hospital midwives and key hospital personnel engaged in antismoking
motivational training. The strategy proved benefical to the collection
of the data with just under 200 questionaires having been returned by late
December 2005. However, attention must be drawn to the fact that reliance
on this method of the data collection by the smoking pervention personnel
11

in particular has resulted in an over representation of smokers amongst
those pregnant women interviewed. Pregnant women smokers referred for
smoking prevention were the group targetted at University College Hospital
Galway.likewise those women interviewed by public maternity personnel are
in the main more likely to be in direct contact with lower socio economic
groupings of women.Account must be taken of the fact that in Ireland middle
and upper class pregnant are most likely to avail of private maternity care.
Results
Question 1: Check if the woman is in the third trimester of
pregnancy or after delivery at the maternity…
The majority of those pregnant women interviewed were in the third trimester
of pregnancy, the resulting percentage being 64%. Thirty six percent of the
target group were interviewed after delivery.
Table 1.
Frequen
cy %
third trimester 128 64%
maternity 72 36%
Total 200 100%
Question 2: When did you discover you were pregnant?
Seventy-eight per cent of the women discovered they were pregnant in the
first trimester of their pregnancy. Interestingly, the largest percentage
(94.50%) acknowledged the discovery of their pregnancy after the first three
months stage.
12

Table 2.
first trimester (1.-
13.week)
second trimester (14.-
26.week)
third trimester
(>26.week)
Frequen
cy %
13
Cumulati
ve
Frequen
cy
156 78% 156 78%
Cumulati
ve
%
33 16.5% 189 94.5%
11 5.5% 200 100%
Question 3: Did you ever smoke?
Table 3
Frequency % Cumulative
Frequency
Cumulative
%
Yes 160 80% 160 80%
No 40 20% 200 100%
Response to question 3.
Eighty percent (80%) of the women interviewed admitted to having smoked
with a further 20% claiming non-smoker status.(Question 3.)
Question 4: Are you an ex-smoker or present smoker?
The further line of questioning to establish present smoking status resulted in
the following;
One percent declined to answer. Twenty seven percent (27%) claimed exsmoker
status while a high of 52% were present smokers. A mere 20.0% of
the women never smoked. This leaves an overall figure of 47% of the women
in the no smoking during pregnancy category.

Table 4
Smoking status (all)
smoker
Frequen
cy %
Cumulati
ve
Frequen
cy
No answer 2 1.0% 2 1%
never
smoking
present
smoker
40 20% 42 21%
104 52% 146 73%
14
Cumulati
ve
Percent
ex-smoker 54 27% 200 100%
Question 5: When did you quit smoking? (Ex-smokers only)
A combination of the planning of the pregnancy and the confirmation of
pregnancy caused the majority (77.8%) to cease smoking. Just over half of
the interviewees had chosen to quit smoking prior to the pregnancy. A further
breakdown of the figures tells us that 31.5% of the interviewed women quit
smoking at the time they found out about their pregnancy. Just over f
(22.2%) of the interviewees were motivated to stop smoking during the
pregnancy.
Table 5. Time of quitting smoking for present ex-smokers
before you found out about this
pregnancy
at the time you found out about this
pregnancy
Frequen
cy %
Cumulat
ive
Frequen
cy
Cumulat
ive
%
25 46.3% 25 46.3%
17 31.5% 42 77.8%
during this pregnancy 12 22.2% 54 100

Consumption amongst present smokers:
Question 6: How many cigarettes did you smoke yesterday?
The present smokers smoked 2 – 40 cigarettes per day giving an average
smoking consumption of ten cigarettes per day (median 10.0).
Question 7: How many cigarettes did you smoke per day before you
discovered this pregnancy?
Those women interviewed acknowledged that they smoked 0 – 50 cigarettes
(median 25.0) giving an average of 25 per day.
Question 8: During this pregnancy, did you try to reduce smoking?
Table 6.
During Frequency % Cumulative
15
Frequency
Cumulative
%
Yes 86 82.7% 86 82.9%
No 17 16.3% 103 99.0%
No answer 1 .9% 104 100
The answering to question eight has indicated a strong motivation amongst
those interviewed to reduce tobacco consumption during their pregnancy with
almost 82.69. % saying yes while the much lesser figure of 16.35 indicated
no. A raw linkage of these facts with the results to question five is further
proof that there was strong motivation to quit smoking during pregnancy
amongst the respondents.
Question 9: During the three months before you got pregnant, did
you try to quit?
Table 7. (Present Smokers)
Before Frequency % Cumulative Cumulative
Frequency Percent
Yes 38 36.5% 38 36.5%
No 63 60.5% 101 97.1%

No answer 3 2.8% 104 100
Most of the present smokers (97.1%) did not try to quit smoking during the
three months before they got pregnant. This line of answering can be linked
with the percentage of women who did not have knowledge of their
pregnancy until after 13 weeks. (94.50%) However, it does not in any way
indicate that more previous knowledge would have caused this group to
change their smoking behaviour.
Question 10 (11): At home (at work) are you regularly exposed to
passive smoke
Just over a half of the pregnant women interviewed were exposed to passive
smoking in their homes. The present smoker’s exposure to smoking stands at
a high of 30%. Furthermore, the percentage of those women who had never
smoked experienced passive smoking at a figure of 9.50% with 11.5% of exsmokers
being exposed.
Question 10 (11): At home (at work) are you regularly exposed to
passive smoke
Table 8 Passive smoking at home
At home
16
never
smoking
present
smoker
exsmoker
Total
passive
smoke yes 19 60 23 103
exposure no 20 43 31 95
Total 39 103 54 198
Proportion exposed
among those who smoke 48.7% 58.3% 42.6% 52%
2 no answer
Not exposed to passive smoking home
A further break down of the results tells us that those women who never
smoked and who were not exposed measured 10%. Of note is the figure of
ex-smokers who indicated non-exposure to passive smoking at 15.5%. The
highest measurement is claimed by present smokers 21.50% indicating that
they are not exposed to passive smoking in the home. Likewise the line of
questioning relating the exposure of present smokers to passive smoking in
the workplace secured a figure of 29% saying no.
Moreover, the practice of passive smoking exposure in the workplace
indicated a high level of non-exposure at 55.50%. Six and a half percent
(both ex-smokers and non smokers( have indicated that they have exposure
to passive smoking in the work place which in turn indicates a lack of
monitoring of the law which prohibits smoking in the work place. The
relevance of the workplace line of questioning is not so significant given that

34.50% of the interviewees did not work outside the home. 2 persons
declined to answer.
Passive smoking at work (question 11)
Table 9 Passive smoking at work
At work
17
never
smokin
g
presen
t
smoke
r
exsmoke
r Total
passive
smoke yes 2 10 1 13
exposure no 14 58 37 111
do not work 24 29 16 69
7 no answer
Total 40 97 54 193
Proportion exposed
among those who work 12.5% 14.7% 2.6%
Combined results 10 and 11 table (work and home)
Passive smoking at home or at work
At home
or at
work
never
smokin
g
presen
t
smoke
r
10.5
%
exsmoke
r Total
passive
smoke yes 19 61 24 105
exposure no 20 38 30 89
Total 39 99 54 194
Proportion exposed
among those who work 48.7% 61.6% 44.4%
6 women did not respond
Question 12: (Age of the interviewees). How old are you?
54.1
%

The interviewed women ranged in age from 20 to 44 years (median 28). The
grouping of present smokers were slightly older (median 29) than the never
smokers (median 28). The ex-smokers (median 28) corresponded with the
average for never smokers.
Table 10 Age
N Miss Min
Ma
x
18
Mea
n
never smoking 40 0 21 41 28.7 28
present smoker 103 0 20 44 30.1 29
ex-smoker 54 0 23 41 29.4 28
Total 197 0 20 44 29.6 28
3 no answer
Media
n
Question 13: How many years have you spent in school?
Educational Status
The greatest number of the interviewed women (80) at the centre of the Irish
research spent less than eleven years or more in formal education. This
leads to the conclusion that 40% of the interviewees had not completed lower
secondary level. Furthermore, a staggering 10.50% of the target group had
not participated in secondary level education.
Only 33.50% indicated that they had spent enough time in school to complete
the lower secondary cycle. A mere 47 women (23.50%) had spent enough
time in school to complete the upper secondary level.
Table 11.
Educational attainment (years attended)
Table 1. Years of School by smoking status at the time of the interview
never
smoking %
present
smoker %
exsmoker
% total

Conclusion
The organisational reform of Irish Health Service currently ongoing has given
rise to additional uncertainties and frustration for staff on the ground. The
reform certainly created uncertainty for the executive of this project work.
There is an often repeated mantra of not knowing how jobs will be configured
with reporting lines unclear in many cases. The previous example of the
three regional health authorities in the Dublin area and the length of time it
took for the merging of these bodies to be completed and bear fruit does not
bode well for the current larger scale reform.
Improved mechanisms for information sharing should contribute to greater
clarity and visibility of Smoking Cessation Officers and their work. In the
interim period, however, smoking cessation officers continue to work in an
isolated manner, with poor information sharing at either regional or national
level.
Community Development work has a role to play in motivating communities
towards greater responsibility and care of health in the community. This is an
issue for policy makers and the promotion of active citizenship.
Engaging communities in the development of health policy planning and the
design, delivery and ongoing monitoring and evaluation of health services is
good practice and means that the social determinants of health are more
likely to be considered. When the social determinants such as housing,
employment, poverty, education, access to health and other elements such as
resources available to communities, gender, age and ethnicity are taken into
account it becomes very evident that differences in health outcomes are
closely related to one’s experience of these determinants.
It is hoped that the reform of the health services, with the clear demarcation
between policy making (Department of Health and Children) and service
design and delivery (Health Services Executive), will bring clarity to smoking
cessation strategies and outcomes at national, regional and community level.
In January 2005 the eleven previous health board entities - each with their
own governance, management and information systems – were rationalised
into four regions. This move should, in the longer term, streamline delivery
of services and facilitate easier information sharing across the regions. There
is, however, clearly a transition period during which uncertainties impact on
motivation and clarity for those providing services on the ground.
As smoking cessation falls within the new Population Health Directorate of the
HSE there will be much work needed to bed in the various strands of work
and align the various strategies within their new locations. When this
consolidation is achieved there will be an opportunity for smoking cessation
work to become more visible at both Local Health Office (LHO) and regional
19

levels. Outcomes of the structural changes should be the delivery of national
smoking cessation guidelines. Other benefits should include better data
wherein smoking cessation outcomes, previously poorly reported upon should
improve.
20

References
Building Healthier Hearts. The Report of the Cardiovascular Health Strategy
Group. Department of Health and Children.1999.
Irish Women and Tobacco: Knowledge, Attitudes and Beliefs. Office for
Tobacco Control. 2003.
National Health & Lifestyle Surveys Survey of Lifestyle, Attitudes and Nutrition
(SLAN) and the Irish Health Behaviour in School-Aged Children (HBSC).
Centre for Health Promotion Studies. National University of Ireland Galway
2003.
Smoke-Free Workplaces in Ireland: A One-Year Review. Office for Tobacco
Control. 2005.
O’ Byrne, Irene. Smoking Cessation Officer, H.S.E. Western Region, University
College Hospital, Galway.
Staunton A. Mayo County Hospital, Maternity Services, Castlebar, Co. Mayo.
Birrane T. Health Promotion, H.S.E. Western Region, Castlebar, Co. Mayo.
Maternity Unit, Portiuncula Hospital, Ballinasloe, C.o Galway.
Women’s Health Advisory Committee, H.S.E. West Region, Primary Care
Department, Merlin Park, Galway.
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