The effects of second-hand smoke and ways of raising awareness

Secondhand smoke (SHS) is also called environmental tobacco smoke (ETS). It’s a mixture of 2 forms of smoke that come from burning tobacco:

  • Mainstream smoke: The smoke exhaled by a person who smokes.
  • Sidestream smoke: Smoke from the lighted end of a cigarette, pipe, or cigar, or tobacco burning in a hookah. This type of smoke has higher concentrations of nicotine and cancer-causing agents (carcinogens) than mainstream smoke.

When people who don’t smoke are exposed to SHS it’s calledinvoluntary smoking or passive smoking.When you breathe in SHS, you take in nicotine and toxic chemicals the same way people who smoke do. The more SHS you breathe, the higher the levels of these harmful chemicals in your body.

Why is secondhand smoke a problem?

Secondhand smoke (SHS) has the same harmful chemicals that people who smoke inhale. There’s no safe level of exposure for secondhand smoke (SHS).

Secondhand smoke causes cancer

Secondhand smoke is known to cause cancer. It has more than 7,000 chemicals, including at least 70 that can cause cancer.

SHS causes lung cancer, even in people who have never smoked. There’s also some evidence suggesting it might be linked in adults to cancers of the:

Exposure of mothers and babies to SHS is possibly linked to certain childhood cancers:

Secondhand smoke causes other diseases and death

Secondhand smoke can also be harmful in other ways. For instance, breathing secondhand smoke affects the heart and blood vessels, which increases the risk of having a heart attack. Exposure to secondhand smoke increases the risk of developing and dying from heart disease. It also increases the risk of having (and dying from) a stroke.

Secondhand smoke and your children’s health

Young children are most affected by SHS and least able to avoid it. Most of their exposure to SHS comes from adults (parents or others) smoking at home. Studies show that children whose parents smoke:

  • Get sick more often
  • Have more lung infections (like bronchitis and pneumonia)
  • Are more likely to cough, wheeze, and have shortness of breath
  • Get more ear infections

Secondhand smoke can also trigger asthma attacks or make asthma symptoms worse.

Some of these problems might seem small, but they can add up quickly. Think of the expenses, doctor visits, medicines, lost school time, and often lost work time for the parent who must stay home with a sick child. And this doesn’t include the discomforts that the child goes through.

In very young children, SHS also increases the risk for more serious problems, including sudden infant death syndrome (SIDS).

Where is secondhand smoke a problem?

You should be especially concerned about exposure to secondhand smoke (SHS) in these places:

At work

The workplace is a major source of SHS exposure for many adults.

The Occupational Safety and Health Administration (OSHA) and the National Institute for Occupational Safety and Health (NIOSH), federal agencies responsible for health and safety in the workplace, recognize there are no known safe levels of SHS and recommend that exposures be reduced to the lowest possible levels.

The Surgeon General has said that smoke-free workplace policies are the only way to prevent SHS exposure at work. Separating people who smoke from those who don’t, cleaning the air, and ventilating the building cannot prevent exposure if people still smoke inside the building. An extra bonus of workplace smoking restrictions, other than protecting those who don’t smoke, is that they may also encourage people who do to smoke less, or even quit.

In public places

Everyone can be exposed to SHS in public places where smoking is allowed, such as some restaurants, shopping centers, public transportation, parks, and schools. The Surgeon General has suggested people choose smoke-free restaurants and businesses, and let owners of businesses that are not smoke-free know that SHS is harmful to your family’s health.

Public places where children go are a special area of concern. Make sure that your children’s daycare centers and schools are smoke-free.

Some businesses might be afraid to ban smoking, but there’s no strong evidence that going smoke-free is bad for business.

At home

Making your home smoke-free may be one of the most important things you can do for the health of your family. Any family member can develop health problems related to SHS. Children’s growing bodies are especially sensitive to the toxins in SHS. And think about it: we spend more time at home than anywhere else. A smoke-free home protects your family, your guests, and even your pets.

Multi-unit housing where smoking is allowed is a special concern and a subject of research. Tobacco smoke can move through air ducts, wall and floor cracks, elevator shafts, and along crawl spaces to contaminate units on other floors, even those that are far from the smoke. SHS cannot be controlled with ventilation, air cleaning, or by separating those who smoke from those who don’t.

In the car

Americans spend a great deal of time in cars, and if someone smokes there, the toxins can build up quickly – even when the windows are open or the air-conditioner is on. Again, this can be especially harmful to children.

In response to this fact, many expert medical groups have been working to encourage people to make their cars, as well as their homes, smoke-free. Some states and cities even have laws that ban smoking in the car if carrying passengers under a certain age or weight. And many facilities such as city buildings, malls, schools, colleges, and hospitals ban smoking on their grounds, including their parking lots.

There is no safe level of exposure to secondhand smoke (SHS). Any exposure is harmful.

The only way to fully protect people who don’t smoke from SHS indoors is to prohibit all smoking in that indoor space or building. Separating those who smoke from those who don’t, cleaning the air, and ventilating buildings cannot keep people who don’t smoke from being exposed to SHS.

What can be done about secondhand smoke?

Many US local and state governments, and even federal governments in some other countries, have decided that protecting the health of employees and others in public places is of the utmost importance and have passed clean indoor air laws. Although the laws vary from place to place, they are becoming more common. Detailed information on smoking restrictions in each state is available from the American Lung Association.

You don’t have to wait for the government to act. Even if you smoke, you can decide to make your home and car smoke-free. This is the safest thing to do for your children, other family members, pets, and guests.

Are lingering smoking odors harmful?

There’s very little research so far on whether lingering tobacco smoke odors or residuals from it on surfaces can cause cancer in people. Research does show that particles from secondhand tobacco smoke can settle in dust and on surfaces and remain there long after the smoke is gone. Some studies suggest the particles can last for months. Even though it’s no longer in the form of smoke, researchers often call this thirdhand smoke (THS) or residual tobacco smoke.

Particles that settle out from tobacco smoke have been shown to combine with gases in the air to form cancer-causing compounds that settle onto surfaces. For instance, some of the carcinogens that are known to cause lung cancer have been found in dust samples taken from the homes of people who smoke. Research has also shown that thirdhand smoke can damage human DNA in cell cultures and might increase lung cancer risk in lab animals.

Though it’s not yet clear if such smoke residue can cause cancer, any effects would probably be small compared with direct exposure to SHS. Still, the compounds may be stirred up and inhaled with other house dust, and may also be accidentally taken in through the mouth. Because of this, any risk the compounds pose is probably greater for babies and children who play on the floor and often put things in their mouths.

The health risks of THS are an active area of research.

Is exposure to secondhand e-cigarette aerosol harmful?

As e-cigarettes and similar devices have become more popular in recent years, a growing concern is whether the aerosol of tiny particles exhaled by users, sometimes referred to as secondhand vapor, is harmful to other people who breathe it in.

Scientists are still learning about the health effects of being exposed to secondhand e-cigarette aerosol. However, the US Surgeon General has concluded that e-cigarette aerosol is not harmless. Secondhand aerosol can expose others to nicotine, and possibly to other harmful chemicals.

Smoke-free and tobacco-free policies already in place should also cover e-cigarettes. This will help non-users avoid being exposed to potentially harmful e-cigarette aerosol.

Certified Nurse Assistant Preparatory School

The opening of Certified Nurse Assistant (CAN) Preparatory School is supported by the necessity to effectively prepare applicants for state examination that has to be passed in order to obtain the license of the Certified Nurse Assistant. The major objectives of the school include:

  • to give students the idea of health care field occupied by nursing assistants;
  • to introduce basic competencies that are required to obtain the license;
  • to provide students with specific knowledge in narrow areas of application for them to become specialized professionals;
  • to give students guidelines that would be necessary to align with national and state laws for getting access to the nursing assistant positions in health care institutions;
  • to ensure the opportunity to continue education and acquire new knowledge and skills after completing the initially required program.

School Mission

The mission of the Certified Nurse Assistant (CAN) school is to provide educational opportunities that are focused on both theoretical knowledge and practical skills that would give students the notion of their duties and responsibilities to provide high-quality health care.

The school recognizes the importance of proper preparation that develops not only professional but also personal qualities such as self-confidence, dignity, ethical standards, etc. Thus, the mission of the school also includes individual development.

The Keys to Success of the School

While searching for the best possible variant of a Certified Nurse Assistant (CAN) school, future students may encounter a lot of various options as a huge number of colleges and universities offer nursing preparatory courses. The following factors should serve as keys to the popularity and success of the school I am going to open:

  • the school will be certified by the state and offer its students certified curriculum answering all the standards;
  • it will provide clear and comprehensive programs without attempting to confuse students with a huge number of different titles for a nursing assistant that mean one and the same thing; the emphasis will be put on quality, not on the seeming variety;
  • the school will ensure the opportunity to learn and work under the supervision of a registered nurse or a doctor;
  • it will give students a chance to obtain practical experience through helping patients in various settings including hospitals, nursing homes, day healthcare institutions, and even at their homes;
  • the Certified Nurse Assistant (CAN) school will encourage research projects that will be aimed to track the dynamics of the patient’s condition and deduce theoretical implications of the changes that take place;
  • the school will not only teach students to provide care and supervise treatment but will also give them practical skills that are contiguous with their direct responsibilities (e.g., assisting patients in bathing, toiletry, making their beds, tiding their places, putting on and taking off their clothes, etc.)
  • theoretical classes will interchange with practical tasks for students to be able to establish connections between practice and theory;
  • classroom instructions provided by the school will include not only an introductory course to healthcare but also information on psychology, patient safety, nutrition, readmission, risk groups, intensive treatments, etc.;
  • the school will give students an opportunity to have the latest immunization in the process of a physical examination that will have to undergo;
  • the tuition that the school is going to charge will also cover additional accreditations courses so that students will not have to pay extra for them;
  • the duration of the preparatory program will be flexible (from four up to eighteen weeks according to the individual needs), which means that students will be able to regulate the duration of their practice in clinical settings;
  • all the students will be prepared to pass the required state examination;
  • online training will be offered to those who cannot afford the tuition or cannot be present in person.

Target Market and Segmentation

The target market of the school will include women aged between 25 and 55, possessing a high school diploma. The school will be situated in Florida, which means that the population will be able to pay fees set by the school for the quality of the education. Moreover, the area is characterized by the increasing number of individuals who are looking for the position of nurses, which creates the demand for education.

The market is going to be segmented:

  • geographically;
  • by race;
  • by age;
  • by education (no high school diploma, GED certificate, high school diploma, etc.);
  • by income;
  • psychologically.

Industry Trends and Competition

There is a growing demand for higher education in the region; however, most schools do not specialize in nursing training and offer a number of different courses in lots of areas.

It means that most students will be eager to join the school as it will give them a chance to become Certified Nurse Assistant (CAN) in the short term. There will be very little competition because of the narrow specialization of the school.

Competitive Pricing of the Program

The pricing of the program will be identified by the costs of its promotion and the profit that is expected. In order to allow the school to stay competitive, the price of the course will include not only preparation but also two attempts of the examination.

This way, students will have more trust in the program because of the extra chance to pass the accreditation and will have to pay less for the course as the total sum will cover the cost of the examination.

Advertising Strategy and Methods of the School

To win the target audience, the school will invest in advertising via social networks and influential search engines such as Google. Moreover, placing an advertisement in local newspapers may also be applicable to the situation.

A campaign will be launched to visit schools and encourage high school students to join the profession. Therefore, the methods will include both direct and indirect contact with the target audience.

Strengths, Weaknesses, Opportunities, and Threats

The price of the course will cover all the required expenses, which means that the students will not have to pay extra. This approach will simplify the process.

However, this strength can be undermined because of the flexible curriculum as most schools adhere to the fixed period of training (app. 3-4 weeks), which allows them to have a bigger number of students.

If the school is successful, there is an opportunity to open several others in the neighboring regions for students to be able to choose the most comfortable location. The venture may be threatened by the decline in the popularity of the profession as well as by the absence of the required number of educational specialists.

Competitive Edge and Marketing Strategy

The competitiveness of the course will be maintained by the quality of the education that it is going to ensure. Moreover, the program will be taught in a considerably different manner as compared to other Certified Nurse Assistant (CAN) schools since it is going to be individualized.

The payment plan will also provide a competitive advantage. The marketing strategy will be aimed at and informing potential students why the conditions and pricing are much more profitable than those proposed by other institutions. The emphasis will be made on flexibility, advanced technology, qualified educators, and the opportunity to study online.

Enrollment Strategy and Forecasts

The enrollment strategy will depend on demand. If the forecasted number of students will be exceeded, it will be necessary to introduce competition in the form of preliminary tests. Another option is to create a waiting list for those whose preparation is not so urgent. However, with the opening of other schools, the problem is likely to be resolved for good.

Milestones, Accreditation, and Program Approval

Milestones are going to mark specific points of the project timeline. The first significant milestone will be the state exam after the preparation. Another one will come with the results of the second try when the mistakes of the previous course are taken into consideration.

The school will seek state accreditation and approval of the curriculum in order to ensure the quality of the preparation. For this purpose, the state committee will be invited to assess the correspondence of the institution to the national standards.

Women with disabilities: pregnancy and childbirth

Although most women with disabilities are able to become pregnant, to have normal labor and delivery experiences, and to care for their children without problems, some women with disabilities have experiences that require some thought and advanced planning on the part of the women, their families, and their health care providers.

Responses to Pregnancy in Women with Disabilities

Although women with disabilities are increasingly choosing to become pregnant and to become mothers, they may encounter negative experiences from others who doubt their ability to become pregnant, carry the baby to term, deliver safely and care for a newborn. As a result, it is important for nurses to recognize that women with disabilities may be hesitant to seek care because they anticipate such negative reactions from others, including health care providers.

Although preconception care is recommended for many women with disabilities to ensure that they are in good health prior to conceiving because of the potential for health issues, many women do not seek preconception care and some even forgo prenatal care because of possible negative reactions from health care clinicians. Women with disabilities have reported that health care providers’ initial reactions to the idea of pregnancy is to try to discourage them from considering pregnancy, to assume that they are seeking termination of their pregnancy, or to make negative comments about them being irresponsible in considering pregnancy and motherhood.

Thus, it is important to acknowledge their efforts to ensure a healthy pregnancy and to avoid negative verbal and non-verbal responses to women with disabilities considering pregnancy or who are already pregnant at the time of their first visit to a health care provider for obstetric care.

Women with disabilities who are taking medication as part of the management of their disabling condition are often concerned about the effect of those medications on a fetus. Collaboration among several types of health care providers about the potential effects of medication may be needed to ensure the best preconception and prenatal care for women with disabilities.

Prenatal Care Issues  

Many women with disabilities report difficulty finding a health care provider with experience in providing obstetrical care to women with disabilities or who is willing to assume care for them during pregnancy. Women with disabilities that limit their mobility have reported inaccessible physician offices and clinics, not being weighed even once during their pregnancy, and receiving no help in transferring to a high, non-adjustable exam table in the absence of an adjustable table.

During the prenatal period, women with disabilities that affect their mobility are at higher risk than women without disabilities for several health issues.  These include a high risk for urinary tract infections, impaired balance and gait due to change in their center of gravity, increased risk for falls, and changes in bowel and bladder management. Women who are wheelchair users are at increased risk for pressure ulcers during pregnancy and for growing out of their wheelchairs because of weight gain. Women with spinal cord injuries at or above the 6th thoracic level (T6) are at increased risk for a disorder called autonomic dysreflexia (AD), with potentially life-threatening hypertension.  It may also occur but is less common in women with spinal cord injuries at T7 to T10 and other neurological disorders such as multiple sclerosis and Guillain-Barre syndrome.  AD can occur with labor and delivery, a urinary tract infection, a pressure ulcer, or a full bowel. Because of the seriousness of this complication, women with spinal cord injuries and others at risk for AD, typically receive care from an OB/Gyn provider who provides care for women at high risk.

Women with disabilities often find prenatal classes uninformative and not helpful because the class instructors are not knowledgeable about their disabilities and possible effects on pregnancy, labor and delivery.  Therefore, nurses and others providing prenatal care need to make special efforts to identify the questions and concerns of women with disabilities about prenatal care, labor and delivery, and the post-partum period, including strategies or modifications that may be needed to enable them to care for their infants. Efforts to anticipate challenges that may occur during labor and delivery should be undertaken to minimize women’s concerns and risk for negative outcomes. In addition, attention should be given early in pregnancy to identify modifications and to acquire specific childcare equipment that may be helpful to women with disabilities to care for their infants.

Labor & Delivery Issues 

With appropriate planning and management, most women with disabilities have labor and delivery experiences similar to those of other pregnant women. Most women with disabilities prefer to have a vaginal delivery. More women with disabilities than women without disabilities have Cesarean sections, although disability by itself is not an indication for Cesarean section.  It is important to realize that even women with neurological disorders, such as multiple sclerosis or spinal cord injury, that affect sensation often experience spasm, abdominal pressure and pain or discomfort associated with contractions.

In some cases, obstetrical care providers refer women with disabilities to the anesthesia team during the last month or so of pregnancy to ensure that any issues that might affect anesthesia, labor and delivery are considered prior to the onset of labor.  For example, women with spinal cord injuries or musculoskeletal disabilities (e.g., spina bifida, osteogenesis imperfecta, cerebral palsy) often have specific issues that may require special planning prior to receiving epidural anesthesia for delivery.

Postpartum  

Many women with disability find themselves on postpartum nursing units in inaccessible rooms, making their recovery and self-care difficult. Depending on the type of delivery they had (vaginal delivery vs. Cesarean section) and the nature of their disability, they may have difficulty managing an episiotomy incision following a vaginal delivery.

Many women with disabilities plan to breastfeed their babies although some women need modifications in breastfeeding positions and strategies to hold their baby for breastfeeding.  Nurses who are knowledgeable and sensitive to the needs of women with disabilities and their preferences for breastfeeding can be very helpful in assisting women in breastfeeding. Referral to lactation consultants may also be helpful to any woman wanting to breastfeed, including women with disabilities.

Childcare  

Most women with disabilities, including those with severe disabilities, are very resourceful and find ways to do an excellent job in taking care of their infants. Some modifications may be needed, such as a side-opening crib that open like a door and can be opened by a mother from her wheelchair.  Because of concern that they might be considered incompetent mothers if they ask too many questions, some women with disabilities are reluctant to ask their health care providers questions about childcare issues.