Abstract â–¡ 133

BACKGROUND: Mothers particularly those form deprived inner city areas continue to smoke before during and after pregnancy despite efforts from health and allied workers. Antenatal smoking has been associated with increased infant and perinatal mortality, being a highly significant associated risk factor in Sudden Infant Death Syndrome.

DESIGN: Structured home interviews to quantify and qualify the health and social perceptions of families. Themes explored lifestyle including the place of cigarette smoking, social support, post-natal well being of the mother. Decisions to smoke cigarettes were explored with solutions offered on how to quit.

SETTING: Two contrasting areas of Leicester matched in size, one an inner city deprived estate with approximately 600 families with children under 5 years of age, Jarman Score +64.1, and second an owner occupied estate some 6 miles from the city centre Jarman score -6.

SAMPLE: 100 families with new babies randomly selected, from Health Visitor case loads.

RESULTS: The findings highlight the enormous stresses faced by deprived inner city families where extreme poverty, crime, domestic violence and daily crisis are common. Mother in the inner city were younger, mainly single parents, had more children under five, higher levels of postnatal depression and fewer supporting adults when compared to affluent sub-urban mothers. Low social support scores and an increased number of life stresses were associated with increased post-natal depression (Maternal mother support Pearson correlation r= -3 P<0.02, life stresses Pearson correlation r= 0.4 p<0.002, 2 tailed) in the whole sample. Over 60% of mothers in the inner city smoked, compared to 9% in the affluent area. The mean consumption was 19 (range 2-35) in the inner city compared to 5 (range 1-8) in the affluent area. Smoking was seen as a habit (67%), to satisfy a craving (51%). Its perceived benefits were to feel calm (70%), relaxed (80%), to relieve boredom and provide a feel good factor (66%) and a support for the stress of child care (30%) "It relaxes me so I don't loose my temper", it gets me through the day with my son whose a handful". Smokers frequently underestimated the health risks of smoking, for themselves or their children. Smokers solutions on interventions that might help demonstrates a gulf between professionals and clients. The impact of the wide variety of professional led interventions was not seen as persuasive in quitting. Many smokers expressed despair for the success of any intervention, "I probably wouldn't listen to anybody", "I wouldn't give up not with all my problems".

DISCUSSION: The importance attached to smoking in stress filled lives, demonstrates the helplessness of their situation, and the folly of intervention campaigns. A traditional approach to influence mothers priorities is misguided, and omits to tackle the underlying issues of poverty and deprivation. The solutions that are client led and revolve around stress reducing interventions such as realistic child care support through play centres was raised as more likely to be effective.