Understanding Racial Discrimination Essay Topics

<h1>Understanding Racial Discrimination Essay Topics</h1><p>The subject of racial separation exposition themes has been at the focal point of much conversation and discussion. While some recommend that the theme is as of now excessively warmed and costly, other feel that the subject is excessively fundamental and understudies ought to be disregarded. Likewise with any theme in English language composing, the discussion is bound to seethe on, however whether one is a torch or a harmony creator is just going to be chosen by one's viewpoint.</p><p></p><p>The requirement for an article on race has undoubtedly developed to where one needs to have an assessment on the issue. Regardless of whether one concurs or can't help contradicting the lesson of the issue, is altogether up to the understudy. Numerous individuals need their position known, while others think that its odd and contemptible of addressing.</p><p></p><p>One pr imary premise why such huge numbers of individuals are talking about this issue is a result of the twofold principles inside our general public. In the present society, there are two gatherings: white, and dark. They carry on with an unexpected life in comparison to every other person. For reasons unknown, the two gatherings of individuals can be viewed as some way or another more terrible than all of us, however they are held up as blessed messengers by the remainder of the society.</p><p></p><p>While everybody is splendidly allowed to accept what they need and to be actually who they need, America has a ton of issues as a nation. A significant number of these issues are associated with the occasions of the social equality development. Prejudice and segregation have been an issue in America since the get-go. If one somehow managed to take a gander at the historical backdrop of mankind, one would see that it appears as though everybody has their own rundown o f individuals they might want to leave all of us in peace.</p><p></p><p>Nature itself will change because of man's activities. In the event that a fire must be extinguished by firemen, nature will fill its need. Obviously, with regards to the acknowledgment of contrast, the procedure may not be so clear. In any case, nobody ought to be permitted to oppress someone else, paying little mind to the contrasts between them.</p><p></p><p>A beneficial thing to know is that you don't need to go into school to become familiar with the exercise. In case you're not keen on taking a class to find out about race separation paper points, at that point there is as yet another approach to get instructed. You can get your hands on two or three books about the subject, look at the Internet, or even do a Google search.</p><p></p><p>As long as you recall that the article isn't required perusing, you ought to be fine. In any case, i n the event that you have perused any of the articles or book surveys, you will probably arrive at the resolution that the subject is a long way from basic and too delicate to even consider allowing for simple discussion.</p>

An Interesting Book Review - All My Seven Sisters by Jennifer Egan

An Interesting Book Review - All My Seven Sisters by Jennifer Egan'All My Seven Sisters' by Jennifer Egan is a novel of several issues. From the first page the question arises as to why is Jennifer Egan writing an essay on Frederick Douglass. Is it that she is a fan of Frederick Douglass or is she writing an essay to make a statement about slavery and its evils?It is evident from the first chapter that Jennifer is writing an essay on Frederick Douglass. From this chapter, you learn more about the life of Frederick Douglass who at one time was a slave, he spoke out against slavery, and he led a campaign to free all the slaves.The first thing that you are made aware of when reading this book is the fact that Jennifer is indeed writing an essay on Frederick Douglass. As the character in the novel was a former slave, a reader is given a brief overview of the times during which Frederick Douglass was a slave, he went on to lead campaigns to free all the slaves.There is a discussion in the book about what kind of writings of the author should be used in school curriculums. Jennifer states that her essays are meant to be read for pleasure, not for instruction. So should they be printed in schools, or should it be their own individual entity?The answer to this question is that Jennifer's essays are not to be used in any school curriculum, but are meant to be read in pleasure as they are intended to educate. That is the main concern of the author of this book, and not whether or not they will be used in classrooms.In the second part of the book, 'All My Seven Sisters,' we are given more insight into why Jennifer is writing an essay on Frederick Douglass. Jennifer states that it is not her intention to harm the memory of Frederick Douglass, but to make a statement about his legacy. The author of the book states that Jennifer is in good standing with the American Humanist Association.If you are thinking that the author of the book is either self-absorbed or thoughtless, t hen you have a false sense of the situation. If you are looking for a fast and easy way to draw attention to your cause, then you will find that this book will do the job for you.Once you have finished this book, it will be easier for you to deal with the Humanist Association. This author of the book understands that this book will have the same effect on those who read it as would a play at the theater. Everyone who reads this book will come away from it with a feeling of pride and joy.

Argumentative Essay Topics About the Government

Argumentative Essay Topics About the GovernmentThere are so many arguments about the government that one can literally run out of argumentative essay topics about the government. To avoid this, I propose that we look at the problems and ideas at hand.There is a long-term debt problem in America. The government has tried to try to solve this problem, but it doesn't work for the reason that the government is not the answer. As a result, a variety of ideas have been proposed to the people of America to help solve this problem, but there seems to be no permanent solution.In our society, we still consider the American people to be a bunch of people who do not do their own jobs, even though that may have been true years ago. Our society seems to make decisions about things as if we were some giant multi-national corporation. In fact, the majority of the people in our country feel that they are better than other people, that they are smarter, that they can do what everyone else can't.This i s the same mentality that caused the Great Depression, the biggest financial meltdown in our history. We have a problem, and we seem to think we are better than everyone else.With this mindset, the government seems to be the answer to the economic problems that we are facing, but we don't seem to see the problem at all. With all of the talk about socialism and communism, and with the recent events in Europe, and with all of the corruption in the government, you would think that we would be less prone to get into an argument with one another. We seem to see all of these different problems everywhere, and yet we are not using our argumentative essay topics about the government to fix the problems.It is all the same argument, and we seem to be fixing everything with something new. Instead of fixing the problem at hand, we seem to be spending more money, wasting money, and spending more time arguing about this problem.Maybe this argumentative essay topic about the government has to do w ith the attitude of America. Maybe America's problem is that they are no longer arguing about the problems. Maybe they are changing the problems and they are no longer talking about fixing them.

Rape Is Not As Common, But It Happens - 1946 Words

Male rape is not as common, but it happens. There has been extensive research done on women and the effects of rape, but little research has explored male rape and the consequences/effects of rape that leaves the victim to deal with after the crime is committed (Walker, Archie, Davies, 2005, p. 69). The article, â€Å"Effects of Rape on Men: A Descriptive Analysis† (2005) focused on male rape victims and the effects that comes after this experience. Walker, Archer, and Davies (2005) conducted a study to extend the research that was done prior on male rape victims based on a clinical population (Walker, Archie, Davies, 2005, p. 69). However, walker and co-authors decided to take a different approach and investigate the effects of rape based on a non-clinical sample of men to provide a detailed analysis of the nature and effects of rape victims (males) who had been anally raped as adults, adults being defined as individuals sixteen years or older (Walker, Archie, Davies, 2005 , p. 70). The method of the study was fairly simple. Men were recruited from different sources through the media in the United Kingdom. The advertisements were placed in sources such as the newspaper, magazines directed at men only. A total of 40 participants took part in this study and was asked to complete a questionnaire asking them questions related to the rape relating to the characteristics of the assault, their perceptions of the assault, and whether they disclosed theShow MoreRelatedRape Culture And Rape Myths1634 Words   |  7 Pagesfrom getting raped. In this paper, I will discuss how living in a rape culture affects women and men, how does rape myths affect society and how we can change the negative effects of living in a rape culture and rape myths. In order to understand this, we must first define what rape is. Rape is unwanted sexual attentions or actions that are directed to a person. Rape can happen to anyone but it is most common to happen women. Rape happens to women around the ages of 16-24 and it is â€Å"considered to beRead MoreRape Essay888 Words   |  4 PagesWalker Intro to Women’s Studies Dr. David Magill March 11th 2013 The Misconceptions and Realities of Rape Why do people rape and what do rapists earn from committing this crime? Is it the pleasure of seeing someone in fear, or pain, or is it the pleasure of their screams? I will never know the answer to these questions. All I know is that rape is beyond immoral and depraved, and is a serious crime. Rape is a very strong word and often makes people feel really uncomfortable talking about it, especiallyRead MoreIs Rape A Crime Committed?1136 Words   |  5 PagesCrime, like many other topics, has common misconceptions. These misconceptions are proliferated by the biased media and other sources and is then passed down generations. People live their entire lives believing that a biased statement is a fact. They, in turn, teach those under them the same lies. The two misconceptions that will be discussed in this paper are about the common belief that rape is a crime committed by strangers and that â€Å"black on black† crime is a valid social construct. It willRead MoreThe Second Rap e Essay1024 Words   |  5 PagesThe Second Rape We live in a world where rape is common and is normalized to be part of a behavior and not a crime. Women are often given tips on how to avoid being raped or how to defend themselves from being rape (Gerdes). Society, in fact, is making people understand rape and cope around it when it’s unacceptable. Once society acknowledges that rape is bound to happen to any woman, rapists tend to blame the victim. There are several factors in which rape victims are being held responsibleRead MoreSexual Assault Is The Legal Term For Rape922 Words   |  4 Pagesand everybody by throwing your life away? Sexual Assault is a very serious crime that happens all over the world. However, it is most common on college campuses. The question that we ask ourselves is: What are the college administrative doing to stop it? To protect their own students and ensure everyone’s safety? Sexual Assault is the legal term for rape. Recent studies and statistics show that, today, rape is said to be one of the most violent crimes on American campuses (Samson 1). So what exactlyRead MoreDate Rape Among College Students1376 Words   |  6 PagesDate Rape among College Students It’s a typical Saturday night at Purdue tonight. The biggest party of the year is happening at the Gama Alpha Fraternity, and you were invited. You don’t know many of the people that will be attending the party; you only know Jack from Psychology class. You say what the heck, start getting ready and off to the party you go. As soon as you walk in the door you’re greeted by Jack, which he offers you a drink, and you take it. But what you didn’t know is thatRead MoreMotives of Rape Other Than Sexual Desire Essays1061 Words   |  5 PagesMotives of Rape Other Than Sexual Desire Although there are many underlying motives behind why a man would rape, three of the most conspicuous are anger, power, and sadistic purposes. When an average person hears of a rape, he frequently assumes the offender was reacting to sexual frustration or that he was a demented sex-fiend harboring insatiable and perverted lasciviousness. The rape offender is often accused of being primarily motivated by sexual desires, and by committing the act of forcedRead MoreThe Research Phase Of This English Essay Consisted Of Many1740 Words   |  7 Pagesramifications of date rape, more in depth, the effects it has on the victims. I have had very little personal experience with this topic, as I have never experienced date rape firsthand, but I have been educated on the topic. During the summer, there was a sexual assault course called Haven that was a requirement for every student at the University of North Carolina at Greensboro. This course contained information about rape, sexual assaul t, and the ways drugs can be used to rape people. After learningRead MoreRape And Sexual Assault, And Severe Injury Essay958 Words   |  4 PagesRape Sexually transmitted diseases, pregnancy, and severe injury are all results of rape. Sexual assault is a criminal act in which a predator forcibly has intercourse with a person. There are many different types of rape. Stranger rape is a form of rape where victims are randomly chosen and do not know their rapist. The most common type of sexual assault is known as acquaintance rape. Acquaintance rape occurs when the predator knows his, or her, victim. Some examples of acquaintance are includingRead MoreAquaintance Rape Essay667 Words   |  3 PagesAquaintance Rape There are many types of rape. A very important type of rape is acquaintance rape. According to a researcher named R. Lance Shotland, there may be five kinds of acquaintance rape: beginning, early, relational, rape within sexually active couples (RSCA) with battery and RSAC without battery. They are described both in terms of length of the relationship and previous sexual activity. The first type of acquaintance rape is the beginning date rape. This form of rape happens within

CVS case study Free Essays

EGG: no changes +2 edema bilateral ankles Medications: meteorology 20 MGM per day, aspirin 325 MGM per day Answer the questions and submit via Dropped Questions: 1 . What other questions should the nurse ask about the fatigue? Is the fatigue constant or intermittent- to determine what cause could be acute vs.. We will write a custom essay sample on CVS case study or any similar topic only for you Order Now Chronic Is there a simple reason for the fatigue-such as boredom, extra activity, no sleep, etc†¦. What is the quality of your sleep? Have you had any recent illnesses or change in medications ETC or prescribed? Any new stress in your life? Such as family/health [financial/emotional/physical etc.. What does your diet consist of on a daily basis, Is this new? – Also does it Include alcohol/caffeine/smoking If so how much? 2. What other assessments would be for this patient? Maybe some tests such as; EGG, EEK, stress test, sleep test/observation, etc†¦. Lab tests such as CB w/ dif, TTS, LAP, cholesterol, IAC, serum glucose, fasting glucose, U/ A, CPM, 812, ACT†¦ Review of medications, past medical history, vaccination records, environmental factors, family history Assessment of other current problems or homonyms. Weight 3. What are some causes of fatigue? Thermodynamic, anemia, thyroid dysfunctions, auto-immune, DIM, formability, osteoporosis, medications, stress, disturbed sleep patterns, excessive physical activity, obesity, excessive alcohol/smoking/caffeine, imbalanced diet- too much or to less, imbalance in fluid volume, CHEF, COOP, bowel disturbances, fluid and electrolyte imbalances, recent illness viral/infection, and many more. 4. Develop a problem list from objective and subjective data. Problem list: Pain, TN, Hyperglycemia, edema of lower extremities, elevated HER, decreased BP, fatigue, bill lung adventitious sounds 5. What should be included in the plan of care? Teaching – diet/meds/exercise/when to seek medical attention/ reduce risk factors Monitor- Strict 10, Free. Vs., monitor cardiac rhythm, edema-TED/SCUD/elevate, lung sounds, 02 saturation, skin integrity, neuron checks, pain, pulses, lab values, sale of current medication, daily weight. Encourage- compliance with diet, medication regimen, exercise program, and overall health maintenance. Based on the readings, what is the most likely cause of fatigue for this patient? CHEF HER- 112 – Heart pumps harder in attempt to get more blood to the body. Fatigue- Due to less blood and oxygen to vital organs. Edema- Due to the weakness of the heart pumping less fluid to the kidneys. Kidneys release rennin, negotiations, and lodestone which holds on to sodium and attracts fluid into the vascular system. Lung crackles: The weak heart contractions cause fluid to build up in lungs. HEX of MI, TN, and hyperglycemia are all precipitating factors. How to cite CVS case study, Free Case study samples

Strategic Management Nestle free essay sample

This report will focus on Nestle SA and will look into the industry the company is competing in. Based on various strategic analysis models the report will evaluate why the company has been so successful over the past century and how is Nestle managing to sustain constant growth and achieve great performance in the food and beverage industry. Company Background The Nestle Company started in 1866 with a one man’s idea and then it turned into one of the world’s biggest corporations. Henri Nestle was a pharmacist and he decided to develop a formula for a substitute of the mothers’ milk. The formula was so successful that there was a demand for it on different markets and it was attracting interests from different companies that wanted to merge or participate in Nestle’s business. Throughout the years the company has gone trough many different stages, mergers and name changes to come to the name Nestle SA at the end and to become the world’s biggest beverage and food company. We will write a custom essay sample on Strategic Management Nestle or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page The Nestle headquarters are located in Switzerland in the relatively small city called Vevey, but the company had manufacturing units all over the world in almost every country they operate in. There is a Nestle case that has been published in 1996 that states the company employed 230,000 people with $71. 7 billion in sales (Rodgers, 2000). Going into 2012, nestle has increased their employees 328,000 people worldwide and reporting just over $83. 3 billion in sales for 2011. The Nestle Company is expanding and developing year after year. They are expanding the wide range of products and brands they are offering on the market. They are participating in different industries by offering variety of products as ready foods, soft drinks, chocolates and ice creams, breakfast cereals, bottled water, pet care, dairy and pharmaceutical products. Nestle’s main business strategy is to achieve growth through product innovation and renovation. This particular strategy has enabled Nestle to be a step ahead of the competition and to meet consumers’ expectation through delivering affordable healthy products Nestle’s Corporate Mission Nestle’s brand and products are the focus of continual innovation and renovation so that they meet and exceed our consumers’ expectations. We seek to ensure that our products are available whenever, wherever and however our consumers want them. (NESTLE. COM) Nestle’s Objectives Nestle’s main objectives are to offer convenient, tasty, and nutritious and safety products to help consumers’ all over the world and from all ages to improve their health and well-being. As well as to meet the needs and desires of today and tomorrow’s consumers, Nestle is strongly committed to Research and Development to improve existing products and develop new foods with specific health benefits. (NESTLE. COM) SWOT Analysis: Internal External Exhibit 1 Strengths The sales of Nestle are showing that the company is one of the largest food and beverage companies. Having and established and strong brand name the products are easily accepted on the market. Therefore reducing the risk of investments and pushing the strong brand awareness as one of the major competitive advantages for Nestle. The company had set a transparent manufacturing process in order to promote nutrition and consumers’ satisfaction and well-being. On the other hand Nestle has a very strong distribution channels ad very good suppliers relations, which leads them toward growth in sales year after year. Further strengths of the company are the skilled and educated labour they are employing. The wide range of products Nestle has on the market is also a very big strength because anything a consumer might need they can find in the face of Nestle. Other strength of the company is the product innovation, Nestle has been constantly introducing new products to their market, therefore expanding the product range and attracting new customers from different backgrounds. Research and development is also a major strength of Nestle. There are centres in 17 locations worldwide that are concentrated on researching new technologies and ways of innovative new products or to improve already existing ones. Weaknesses One of the major weaknesses that Nestle is facing is the mature market they are operating in. When the market is mature it can give stronger competition to the new entrants. As well the company should focus on consumer research on different target markets for different products. Not every product is right for every market and Nestle should focus on consumer research in order to avoid that weakness. Russia had been a very difficult market for Nestle and because of the big area the Russian market is covering it is always affecting the general performance of the company. Opportunities The world is now recovering from a very bad recession from the past few years. Thus the demand for Nestle products should increase as customers’ budgets are increasing too. Because the consumers’ budgets are increasing customers are getting more and more health oriented and health conscious. Therefore there is a big opportunity for Nestle to introduce more health-based products before the competition. On the other side in some South Asian countries like Pakistan and Bangladesh, consumers are mainly driven by the price rather than health or nutrition and there is a opportunity for Nestle as well to introduce a variety of affordable products for the appropriate markets. About 70% of the countries are developing at the moment and there is a massive opportunity for worldwide companies like Nestle to enter these markets and capture the full potential first. Threats Many of the markets that Nestle is in or entering are already mature, which rises security and health issues as well as speeding the product life cycle process. Others major threat is the devaluation of different currencies against the dollar that can affect Nestle’s prices. A slow down in local economy can affect sales, prices and overall performance of the company. STARS The stars are representing a high market growth and a high market share. In the case of Nestle, all the beverage products they are manufacturing are the Stars of their company. By building a strong brand name and being a leader in different sectors with brands like Nescafe, Nestea, Milo and DANONE the beverages are the strongest wing of Nestle. Capturing the biggest market share in comparison with the rest of their products. As of 2010 the sales of Nestle beverages were 18,114 (millions), in 2011 18. 204 (millions) so there is a constant growth and market expansion. CASH COWS The cash cows of Nestle are the baby food products and the dairy products which are in the growth stage at the moment so the company has to focus on them in order to make them Stars too. DOGS The dogs represent a low market share and a low product growth. In the Nestle organisation the pharmaceutical products are the Dogs. In 2010, the sales of pharmaceutical products and cosmetics were reported just over 5,109 (millions). The company should focus on that market and look for ways to penetrate it with different tools in order to be able to capture the full potential of the industry. The question marks have low market share and high market growth. Nestles breakfast cereals are their question marks. In the question mark section the company should pick the products they think have best performance and drop slower selling products or renovate them in order to be boosted to Stars. Mckinsey’s 7-S Framework of Nestle: The main purpose of the 7S model is to present a company as a combination of its parts and to show that the organizations’ ability to compete is based mainly on its internal dynamics. The McKinsey framework shows that the structure and the strategy both influence the overall performance and the management effectiveness of an organization. (P. T. Joseph) 1. Shared values of Nestle: Nestle’s organisation is sharing the same values in all of the countries they are operating in when of course considering the local culture and adapting to the environment they are in. One of Nestle’s main objectives is to produce and distribute products that create and add value for their stakeholders. Nestle realizes that consumers invest a lot of trust in their brands and that they should be corporate social responsible in order to retain their customers and keep the good company image. They do not tolerate short-term profits that will affect the corporation overall image and might put distrust in their consumers. They are also committed to respect and follow all the laws of the different markets they are operating in. The company is very aware of the fact that their positive performance is mainly depending on the management and their employees. Therefore the Nestle organisation is focusing on recruiting, sourcing and training employees in order to ensure that everyone is professional and has the right knowledge and attitude for their position. 2. Structure of Nestle: The Nestle organization is divided into 3 separate zones based on continents. Every zone has their own directors. The company has functional and decentralized organizational structure. 3. Strategy of Nestle: Nestle as an organisation is using a 4-pillar strategy that gives them the opportunity to achieve profits over their weighted cost of capital. Nestle’s business strategy consist of the following parts: †¢Whenever, wherever, however †¢Innovation and Renovation †¢Communication and commitment to consumers †¢Efficiency in their operations Nestle is focused on moving from slow growth product portfolio to a fast high volume based growth portfolio. Therefore the company is constantly innovating and renovating their already existing produ cts in order to meet all of their customers needs. 4. Skills in Nestle: Nestle’s main skills are concentrated in technology and Research and Development that helps develop new innovative products or re-engineer existing ones. All of their laboratories and manufacturing units have the latest technologies and equipment. All of the products they are manufacturing pass a long series of tests to ensure that all quality standards are met in the production process. Other main skill is the ability to penetrate new markets through again strong market research. Nestle managed to build strong brand awareness and a positive image in difficult markets like the Pakistani, the Bangladeshi and in the African market. 5. Staff in Nestle: Nestle is the biggest food and beverage company.

Smoking in pregnancy The WritePass Journal

Smoking in pregnancy Introduction Smoking in pregnancy IntroductionScenarioThe public health issue from the case studyCostImpact of smoking in pregnancyHealth promotion modelsThe woman’s needs and midwifery care involvedThe role of midwife in public health and health promotionConclusionRelated Introduction The purpose of this essay is to identify a public health issue with a woman I cared for in practice.   Using a health promotion model to critically analyse the woman’s needs and outline the midwifery care given to address the issue.   Discussing health promotion, theories influencing midwife practice and the role of the midwife in public health and health promotion.   For the purpose of maintaining confidentiality in accordance with the Nursing and Midwifery Council (NMC) the code: standards of conduct performance and ethics for nurses and midwives (NMC 2008), the pseudonym Miss will be used to refer to my client.   Different source of literature will be used to support my discussion throughout the essay. Scenario Miss Yardley, a young woman of white British origin, twenty one year old primipara, eleven weeks plus four days gestation according to her last menstrual period. She attended the maternity booking clinic with her long term partner for history taking.   She lived with her partner in a private accommodation though recently both she and her partner had moved in with her mother who lives in a council rented apartment, as they could no longer afford payment for their flat.   She was unemployed due to a recent redundancy from the company she had worked in since leaving secondary school aged sixteen.   Her partner is employed but on a low paid salary as a call centre operator.   On several occasions she had searched for new employment with no success.   She expressed not to have any medical or obstetric problems.   Miss Yardley expressed that she used to drink alcohol only on social occasions but stopped when she became aware of the pregnancy.   She willing expressed when aske d regarding smoking that she smoked up to fifteen cigarettes a day or more depending on how she was feeling emotionally.   She tried quitting on one occasion though due to overwhelming personal issues at the time was unable to give up smoking.   Her partner never smoked but her mother smoked up to ten cigarettes a day.   She expressed willingness to quit smoking but felt worried that she may not be able to completely give up as she tends to be drawn to smoke more when stressed and now that she is unemployed there is more time available for her to smoke. The public health issue from the case study The importance of smoking as a public health issue has been identified in various key policies and strategy papers.   The government white paper on tobacco 1998: smoking kills targets pregnant women as a priority group requiring intervention.   According to the Department of Health (a smoke free future) ‘smoking remains one of few modifiable risk factor in pregnancy’ (DH, 2010, p.22), it states that smoking rates are highest in routine and manual groups, lower socioeconomic groups and certain minority and vulnerable groups. In the mid 1950 smoking levels between socioeconomic groups were similar, however since the 1960 onwards the more advantaged socioeconomic group acted in response to increasing evidence about the harmful effects of tobacco use (DH 2011).   Figure 8 (in appendix) in the strategy shows correlation between the prevalence of smoking and net income.   Therefore reducing smoking rates in these groups of people has been identified as a critical facto r in reducing health inequalities. The good practice guide 3 (Public health agency 2010) also indicates a clear link between smoking in pregnancy and social disadvantage, it states evidence indicates while women know that tobacco use is damaging   their health, for many smoking is a means of coping with poverty, disadvantage and lack of control over aspects of life.   In contribution to social disadvantage, the highest prevalence of smoking is noted in the 20-34 age group (Office for National Statistics (ONS), 2006).The most recent white paper Healthy lives, healthy people (DH 2011) sets to reduce national rates in smoking amongst pregnant women to 11 percent from the current 2009/10 rate of 14 percent.   It states that tobacco smoking remains one of the most significant public health challenges in England. Cost Smoking has remained prominent in public health globally and it continues to be a major factor for health inequalities in the UK. The world health organisation (WHO), 2011) states over the cause of the 21th century, tobacco use could kill a billion people or more unless urgent action is taken.   The need for support identified in various literature and government strategy to enable pregnant women to maintain healthy lifestyles during and after pregnancy has impacted in my decision to identify smoking as a public health need for my client. Impact of smoking in pregnancy Maternal smoking is not only harmful during pregnancy but has a long term effects on the baby after birth, 4000 chemicals of which some are marked irritant properties and some 60 are known or suspected to be carcinogenic can be found in tobacco smoke (WHO, 2004).   Some of the risk associated with smoking during pregnancy includes intrauterine growth restriction, placenta previa, and abruptio placentae (Vanderhoeven and Tolosa 2010).   Poor outcomes such as preterm rupture of membranes, low birth weight and perinatal mortality have been highlighted (Vanderhoeven et al, 2010). Lagan and Casson 2010, indicates smoking to be associated with increased risk of miscarriage, respiratory problems for the child and sudden infant death (SID).   Research carried out by University College London (UCL) concluded that babies born to women who smoke are at increased risk of having certain birth defects such as missing or deformed limbs, clubfoot, gastrointestinal, skull and eye defects and cl eft lip or palate (Campbell 2011).   Babies born of mothers who smoke have frequent respiratory problems at birth and in their first year, they are at risk of developing asthma and a higher rate of stillbirth is noted (Viccars, 2009). Miss Yardley smokes 15 or more cigarettes a day and her mother is also identified as a smoker, this puts the unborn baby at risk of effects due to direct smoking and passive smoking.   Mitchell et al (citied in Viccars, 2009) states that babies of women who smoke 15 cigarettes a day have 15 times greater risk of dying from SID compared to babies of non-smokers.     Further research showed a link between smoking during pregnancy and low levels of high density lipoprotein (HDL) cholesterol in children whose mother’s smoked whilst pregnant.   It concluded that they had 10-15 percent risk of experiencing heart disease compared to children with non smoking mothers (Health express, 2011). From the discussion above it is evident the issue of smoking would need to be addressed at each opportunity with Miss Yardley when providing care and advice. This would enable screening and monitoring of smoking status, education on the effects of smoking to the outcome of her pregnancy and adequate support to ensure effects to pregnancy and the general health of mother and baby is eradicated or minimised. Health promotion models WHO defines health promotion a process of enabling people to increase control over and to improve, their health.   It implies that the ideology moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions. Naidoo and Wills (2010), states ‘health promotion is based on theories about what influences people’s health and what are effective interventions or strategies to improve health.   There are five different approaches to health promotion, medical, behaviour change, educational, client approach and societal change approach (Scriven 2010).   Different health promotion models have been developed to enable a planned intervention to improve health. Tannahill model (Downie et al 1996 citied in Naidoo and Wills 2009), addresses health promotion over three overlapping spheres of activity, preventive education, prevention and health protection. The model suggest that all approach interlink, in practice this could be difficult to implement and due to the overlapping of spheres, focus on what needs to be achieved could be confused.   The prevention sphere of the model relies mainly on the medical approach , Barnes (2009) suggest that medical approach could be perceived as a top down approach and that when providing health promotion intervention client involvement is necessary to help maintain individual focus (client centred care). In comparison, the Tones model which is an empowerment model sets to enable people to gain control over their own health (citied in Naidoo and Wills, 2009). ‘Tones consider education to be the key in empowering both lay and professional people’ (Naidoo et al 2009).     The empowerment approach relies on educating client and the information conveyed would be highly medicalised to show importance of the issue.   In relation to Miss Yardley who has tried but failed to quit smoking, empowering her through the use of education to convey the risk of smoking though unavoidable as a health professional, could have a counter active effect. Dunkley (2000), states that the aim of mass campaign is to raise awareness, however it may increase feeling of guilt and stress which may be relieved by the aid of another cigarette. Therefore the effectiveness of this model’s approach for my client is questioned. Tones and Tannahill model both mainly makes use of the medical and educational approach, this makes it difficult to address socioeconomic factors that have documented risk with smoking.   As my clients issue is related to smoking and there is a socioeconomic factor present, it would be inapplicable to use these models of health promotion. During the booking appointment, Miss Yardley willing expressed to have tried quitting with no success and that she would like to quit though factors such as not having a job contributed to her smoking.   ‘Nicotine addiction is identified as a major factor for women continuing to smoke during pregnancy’ (Lagan et al 2010).   There is a link between stress and the use of tobacco as a relieve method. Gorman (2008) states ‘that smoking represents a significant challenge for pregnant women, as it compounds the stress of pregnancy and may be further complicated by additional factors such as disadvantage’.   McCurry et al 2002 (citied in Lagan et al 2010) also indicates smoking to be a mechanism of coping with disadvantage, stress and perceived lack of control over life.   According to Earp and Ennett (1991) an ecological perspective implies that behaviour results from interaction of both individual and environmental factors (Citied in Lagan et al, 2010).   Various literatures have made use of behaviour model when planning intervention for smoking. Prochaska and DiClemente’s trans-theoretical model (Naidoo et al, 2009); will be used to manage the care of Miss Yardley.   The model describes the process of change; it is derived from their work on encouraging change in additive behaviours (Naidoo el at, 2009).   This model is applicable to my client has it addresses her behaviour which is the main attribute in smoking and enables a woman centred approach. Woman centred care is expressed as choice, control and continuity of care in the Changing Childbirth report (DH, 1993 cities in Leap 2009).   Ã‚  Behavioural change approach enables the use of communication and counselling, empowerment, decision making, fostering community groups and social support networks (Dunkley 2000).   The process of change includes precontemplation, contemplation, preparing to change, making change and maintenance. The woman’s needs and midwifery care involved All care given was in accordance with the National institute for health and clinical excellence (NICE, 2010): public health guidance 26. Precontemplation: in this stage change to lifestyle has not been considered.   Miss Yardley has progressed from this stage has she identified willingness to try quitting.   This shows the limitation of the model when used with an individual who is thinking of changing. Contemplation: the individual is thinking about change. The client’s willingness indicated readiness for change, adequate information was giving during the booking appointment through leaflets and other forms of resources.   Due to the step by step structure of the model, it was easy to identify the stage of change. Preparing to change: Miss Yardley has read all the information given and had taken up the referral.   Though she continued to smoke but expressed to have cut down to 10 cigarettes a day.   This shows the effectiveness of the model, though she is not at the point of change the use of counselling and information regarding risk has empowered some form of change. Making the change: a date was choose.   She had cut down from 10 to about 8 a day depending on her moods; she maintained her appointment with the specialist. Maintenance: there is a possibility of relapse at this stage as change is not a smooth process (Naidoo et al, 2009). In Miss Yardley’s case change would have to be assessed through to the postnatal period, in order to determine adequate health improvement.   Ã‚  According to At booking, Miss Yardley’s pregnancy was considered low risk, which meant that her care was given mainly in the community.   Her exposure to smoking was identified through discussion.   Carbon monoxide test was not carried out as it is unavailable in the located hospital.   Information regarding the risk of smoking in pregnancy to her and the unborn child was explained and information leaflets and contact numbers to relevant smoking services given.   Passive smoking was addressed and the effects pointed out.   The benefits of stopping smoking to her health and that of the pregnancy outcome were highlighted, financial benefit was also explained.   The need to quit, rather than cut down was explained.     Ã‚  Informed consent was given and referral made to the community smoking cessation midwife.   Encouragement and praise was given at this stage.   As she identified her mother to be a smoker, information on how to reduce passive smoking was explained and rel evant stop smoking service contact were given to help her mother.   The pregnancy book by the Department of Health was given for general education on pregnancy and the section on rights and benefits was highlighted to help with benefits as she was unemployed.   Care given was accurately recorded in accordance with NMC code (2008) to enable continuity of care. At 28 weeks plus four days, she was seen for a routine follow up antenatal appointment with the midwife. She expressed to be well, no concerns regarding fetal movement noted, no abnormalities detected with other routine examination such as symphysis fundal height measure.   The appointment was used as an opportunity to assess her exposure to smoke, and to identify whether smoking cessation was maintained.   Benefits of quitting were further stressed and encouragement was given.   From her appointment with the smoking specialist, it was evident from documentation that improvement were being made in regards to the carbon monoxide readings as she had reduced the amount of cigarette smoked and was preparing to achieve a set date. The role of midwife in public health and health promotion Midwives have been identified as health professional responsible for identifying this target group of smokers (pregnant women).  Ã‚   Midwives have access to the life cycle of very important group of people; therefore they play a part in the government target of reducing smoking in pregnancy (Pollock 2003).   Partnership with woman is essential in achieving health promotion and maintaining government set public health targets.   According to Leap, (citied in Ebert et al, 2009), ‘midwives reported their role as facilitating choice and empowering women through partnership and effective communication’.   the midwifery partnership model of care   Communication is an important role for midwives, in health promotion it enables continuity of care through adequate documentation, verbal interaction with women enables relationship to be formed which further improves women centred care approach.   Byrd (2006) ‘states that relationship are able to persist trust and attachment developing as long as people fulfil perceived obligations of behaviour and communication’ (Ebert et al 2009).  Ã‚  Ã‚   Multidisciplinary team working to enable adequate care is provided is also a vital role of midwives in health promoting and improving public health.  Ã‚   Midwives and nurses frequently utilise holistic concept of health to underpin practice (Beldon and Crozler 2005).   Therefore when provide health promotion it is important that the women’s needs is addressed holistically in accordance with midwifery practice and not based on medical interpretation. Conclusion In conclusion, it is evident that smoking during pregnancy is an important aspect of public health and therefore an important part of midwifery practice.   In particular, health promotion in daily practice is required to prevent any further complication to mothers and their unborn babies.   Smoking is a major public health issue that continues to contribute to social and health inequalities.  Ã‚   Working with Miss Yardley enabled me to provide care tailored to her needs and goal set to quit smoking and were identified by the client.   Though I was unable to follow her care care through, I feel adequate support provided through the smoking cessation referral would enable her to maintain her set goal and improve her health and that of the unborn child.