Medical inventions and quickly germinating engineering has led to a lessening in the rate of mortality from diseases. However, the fast and invariably altering feverish life style of today has led to the debut of new diseases, unhealthy life style and early, premature deceases. Today 's engineering has provided us with the benefits of early sensing and preventative interventions and replies to some of the antecedently incurable diseases. But it has brought in increased emphasis and unhealthy feeding and other wonts that have in some ways caused more harm than benefit. This study titled `` Smoke: The Heart Breaker '' is a expression at the current state of affairs of coronary bosom diseases caused by smoke, relevant statute laws, policies and patterns, schemes to cover with the state of affairs and hereafter of the disease at local, national and planetary degrees.

The study will get down by discoursing the smoke and coronary bosom disease as a public wellness issue and the grounds for concern. It will supply a background to assist better understand the present state of affairs along with an epidemiology of the disease and its causes, with particular mention to smoke. It will so travel on to describe about the legislative policies and schemes that are being presently undertaken in the part of Burnley, East Lancashire to counter this peculiar wellness issue. The study will besides discourse the policies and enterprises and the position of the wellness issue at national and planetary degree, so as to supply a complete and holistic image of the earnestness of the wellness issue. Finally the study will discourse the current schemes being employed by the authorities every bit good as non-government bureaus to undertake the wellness issue. Recommendations will besides be made to assist do an betterment in the current state of affairs.

2.0 Public Health Issue: Coronary Heart Disease due to Smoking

The term 'Coronary bosom disease ' is used to depict a status of obstruction or break of blood supply to the bosom due to build-up of fatty substances in the coronary arterias ( NHS, 2009 ) . This build-up ( called atheroma ) can take to deficient supply of blood to the bosom doing hurting in the thorax known as angina. A wholly out of use arteria can take to a bosom onslaught ( called myocardial infarction ) ( NHS, 2009 ) . There are assorted mild to critical impacts of this status that even ensue in decease. Harmonizing to the British Heart Foundation Statistics ( 2009 ) , diseases related to the bosom and circulatory issues are the biggest cause of deceases in the UK, ensuing in over 90,000 deceases in the UK in a twelvemonth. This has resulted in non merely raised concerns about the disease but besides turning attempts to increase the consciousness about the disease, its causes, and preventative every bit good as precautional steps that can assist to avoid the disease. The state of affairs is n't any brighter in other parts of the universe.

Harmonizing to the World Health Organisation ( WHO ) , the bulk of states around the universe are affected by coronary bosom disease and the disease is a major slayer, particularly in developing and transitional states of the universe. In a WHO study, cardiovascular diseases ' including coronary bosom disease is considered to be the taking cause of decease and is projected to increase from 17.1 million in 2004 to 23.4 million in 2030 ( WHO, 2004 ) . Among the assorted causes of coronary bosom disease, smoke is regarded to be one of the primary causes. Harmonizing to the WHO study, tobacco-related deceases are expected to lift from 5.4 million in 2004 to 8.3 million in 2030, stand foring 10 % of all planetary deceases ; and smoke has been associated to cardiovascular diseases and subsequent deceases ( WHO, 2004 ) . Harmonizing to a survey conducted in 2008, smoke is the taking cause of cardiovascular diseases including coronary bosom disease ( Bullen, 2008 ) . Though increasing age has been thought as a cause of coronary bosom disease, two surveies have found that improper life style, emphasis, etc are increasing the mortality rates due to coronary bosom disease among the immature population in the UK, USA and Australia ( Nemetz, Roger & A ; Ransom, 2008 ) & A ; ( Ford & A ; Capewell, 2007 ) . Therefore, the turning concern for this disease and its preventable yet common cause is the pick of subject for this study.

2.1 Background and Epidemiology

Cardiovascular diseases including coronary bosom disease have been found to be an indifferent slayer that can make mayhem in any society irrespective of its economic, political, cultural, spiritual, regional or racial individuality. Similarly, baccy smoke ( either active or inactive ) is known to be a major cause of many diseases including the coronary bosom disease. Given the nerve-racking life style in today 's universe, many people take up smoking to undertake the emphasis degrees and in the procedure get addicted. They non merely harm themselves but besides people around them. The part of Burnley in East Lancashire, is no exclusion to this tendency. Bing witness to many friends and household members taking up smoking in the name of alleviating emphasis and so acquiring addicted and eventually stoping up enduring from diseases, particularly coronary bosom disease inspired the pick of subject for this study.

There are several causes that can ensue in coronary bosom disease. The NHS lists smoke as the major cause of the disease ( NHS, 2009 ) . The assorted other causes of coronary bosom disease have been listed as high blood force per unit area, high degree of cholesterin in blood, presence of thrombosis and / or diabetes unhealthy life style with no regular exercising, fleshiness and a household history of angina and / or bosom onslaught ( which are familial ) ( Nemetz et al, 2008 ) . The hazard factors associated with coronary bosom diseases which can non be treated, modified or changed include age, gender and heredity ( or race ) . Increasing age increases the hazards of coronary bosom disease and human death from it. Men are found to be at a greater hazard of enduring from coronary bosom disease in comparing to adult females ( Wells, 1999 ) . Heredity of coronary disease or its causes such as diabetes, high blood force per unit area, and cholesterin are besides known to make hazards of coronary bosom conditions. The causes such as smoke, high degree of cholesterin in blood, high blood force per unit area, physical inaction, being overweight and / or fleshiness and diabetes ( diabetes mellitus ) are some of the hazard factors of coronary bosom disease that can be modified, changed and controlled by taking medicine and / or by following a healthy life style. Other hazard factors and causes of the disease include emphasis and intoxicant dependence and can in certain fortunes prove to be fatal causes of the coronary bosom disease ( Ewles & A ; Simnet, 2003 ) .

Comparative informations of the effects of coronary bosom disease in different states do non supply a really positive image ( see appendix 1 ) . Harmonizing to a World Health Organisation study study, the mortality from cardiovascular diseases in 2002 for the developed states like the United Kingdom and the United States was higher than many other developing states like China, India, even Nigeria ( WHO, 2002 ) . It is clear from the informations, that developing states have a much higher mortality rate from cardiovascular and accordingly coronary bosom diseases in the developed states like UK, USA, Germany ; and an of import fact to notice is that the decease rate is higher in the European part in comparing to other parts of the universe. This most likely can be attributed to the inordinate usage of baccy, intoxicant, improper life style that increases emphasis degrees, improper eating wonts that leads to blood sugar and cholesterin in the blood.

The baccy use in different states around the universe besides points towards the ghastliness and outrageousness of the state of affairs, through which one can appreciate the hazard of baccy doing farther deceases due to coronary bosom disease ( WHO, 2008 ) . The WHO report on baccy ingestion in different states show that despite authorities enterprises and ordinances, the baccy ingestion has largely increased and has led to increased mortality particularly in the age groups between 25-45 old ages.

Though coronary bosom disease is of planetary nature without any sort of boundary, assorted specific groups of people are in greater hazard of holding the disease in comparing to others. The affinity to holding coronary bosom disease is dependent on factors such as geographics, heredity, age and gender. Work force are at an increased hazard of enduring from coronary bosom conditions as compared to adult females ( Wells, 1999 ) . Increase in age increases the opportunities of enduring from coronary bosom disease ( DoH, 2004 ) . Coronary bosom conditions are besides known to be prevailing among Mexican Americans, some Asiatic Americans, American Indians, and Native Hawaiians ( American Heart Association, 2010 ) . England is one of the most vulnerable states in Europe when it comes to coronary bosom diseases ( NHS, 2009 ) . Populations in developing and developing states of the universe excessively are at a higher hazard of enduring from coronary bosom disease and related human deaths ( American Heart Association, 2010 ) . Smokers, corpulent people and people with high blood cholesterin are besides included in the high hazard group for coronary bosom disease. Female tobacco users are more susceptible to the disease particularly with increased age since females are more susceptible to the dangers of smoking in comparing to work forces ( WHO, 2002 ) .

With increased impact of aggressive and unhealthy life style and emphasis, the immature population across the developed states of the universe excessively are progressively coming under the hazard of coronary bosom disease ( NHS, 2008 ) . Therefore, these hazard factors result in the coronary bosom disease taking on a pandemic nature if certain precautional and preventative steps are non taken to command the hazard factors that can be influenced.

3.0 Schemes, Policies and Enterprises

Given the turning concern about coronary bosom diseases, deceases due to the disease and the impact on the younger population, authorities bureaus around the universe are taking stairss to battle the turning threat. Non-governmental and private bureaus excessively are fall ining the attempts to advance a healthy life style and consciousness about preventative techniques that can assist to convey down the hazards associated with the disease and the lifting instances of human deaths. This subdivision of the study looks at the schemes, docket, policies, that are being undertaken at the local ( NHS East Lancashire, 2010 ) , national and planetary degrees to battle coronary bosom disease.

3.1 Local Public Health

In East Lancashire, several workshops and other programmes have been undertaken to increase consciousness, educate and assist the occupants of the country give up smoke and follow a healthy life style that will assist forestall and contend coronary bosom disease. The MPs in the part are promoting antismoking statute laws and policies being adopted by the governments. The NHS has introduced the construct of fume free zones. The SMYL programme is advancing healthy life style and eating wonts ( NHS East Lancashire, 2010 ) . Another run called 'Could it be you ' was besides started in 2008 to assist people fight coronary bosom disease and follow healthy and preventative life style ( Chime Communications Plc, 2008 ) . The governments in East Lancashire have besides collaborated with different bureaus to get down webs that can advance anti baccy run and raise consciousness on coronary bosom disease ( NHS Networks, 2010 ) . This engagement of the authorities every bit good as non-government bureaus in the country, one can be hopeful that headroom will be made into the affair. However, it is of import that the public realise the criticalness of the state of affairs and take advantages of the programmes being undertaken to hold a long, healthy and disease free life.

3.2 Deductions at the National Level

The National Heart Forum ( 2006 ) indicated that bosom diseases cost the UK around ?29 billion per twelvemonth and was termed as 'economic load ' . There are several programmes that have been taken up by the wellness attention governments and the authorities in coaction with non-government bureaus to advance anti smoking wonts in the state. Several regional programmes such as Bolsover - Teenage Smoking Programme, Corby - Smoking Cessation Programme, Halton - Smoke-free Programme, London Borough of Tower Hamlets - Tobacco Control Alliance, Pendle - Smoke-free Council, Heartbeat Awards, the GO Smokefree Campaign, etc have been launched in an earnest to control the turning consequence of smoke in the state ( I & A ; DeA, 2009 ) . Several governmental statute laws have besides been put into topographic point ( I & A ; DeA, 2007 ) . The Department of Health has besides started programmes such as Start4Life, 5 A Day, National Support Teams and Let 's Get Moving to advance healthy life style that can assist to forestall coronary bosom disease ( DoH, 2010 ) . Therefore the assorted authorities and nongovernment bureaus in UK are doing attempt to command smoking wont and better life style of the citizens of the state thereby guaranting a brighter future free from smoking and coronary bosom disease.

3.3 Global Health

The battle against smoke and coronary bosom disease has taken tremendous proportions with the turning realization that these are two of the most of import slayers in the universe today. Particularly, the apprehension that smoking causes diseases such as the coronary bosom disease non merely in the tobacco user but besides in non-smokers who have been in the presence of tobacco users, has led major administrations and developed states of the universe to taking a base against smoke. The 'Work with Heart ' undertaking by WHO is assisting to distribute the message of preventative actions that can assist in forbiding coronary bosom disease and other cardiovascular diseases ( WHO, 2010a ) . WHO has besides taken up research and planetary partnership enterprises to assist the developing states of the universe battle cardiovascular diseases ( WHO, 2010b ) . Furthermore, WHO has aligned with several states in the universe to advance regional activities under the planetary scheme to counter cardiovascular diseases which includes America, Eastern Mediterranean, Africa, South-East Asia, European part and Western Pacific ( WHO, 2010c ) .

To assist contend the smoke dependence turning among states, WHO has set up the Global Tobacco Surveillance System ( GTSS ) ( WHO, 2010d ) and is besides join forcesing with different international administrations such as the United Nations and the authoritiess of assorted states to assist run against sale and usage of baccy among different states ( WHO, 2010e ) .

4.0 Recommendations and Decision

Upon analyzing the current state of affairs on a local, national and planetary footing, the undermentioned recommendations can be made:

Enterprises to forestall coronary bosom disease and advance anti smoke wonts need to be undertaken at the grass root degree, i.e. at local degree. This will do the enterprises and runs more effectual.

The developing states such as India, Brazil and China need to be targeted with assurance.

Further researches into preventative and healing medical specialties and engineerings for coronary bosom diseases need to be promoted.

Healthy life style demands to be promoted at every degree since preventative patterns are more good than healing 1s.

It is of import to gain that despite several enterprises being taken by local, national and planetary bureaus and authoritiess, smoking tendencies are increasing around the universe and has started to impact the immature population. Coronary bosom disease excessively has started to take its toll on the population around the universe due to the feverish and unhealthy life styles that have come to pervade people 's lives. It is extremely indispensable that for the success of the enterprises and programmes, people must be involved in them and everyone across the Earth has to gain that simple alterations to their life style, eating wonts and anti smoke steps will assist to contend and forestall coronary bosom disease. The alterations in life style will besides convey down coronary bosom disease caused due to other factors such as emphasis, intoxicant, blood sugar and cholesterin. To reason, it can be stated that bar is better than remedy and discontinuing smoke and taking a healthy life style can protect everyone from the soundless slayer, the coronary bosom disease ( Ewles & A ; Simnet, 2003 ) .

Mentions

American Heart Association ( 2010 ) Hazard Factors and Coronary Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.americanheart.org/presenter.jhtml? identifier=4726

ASH ( 2009 ) Ash facts at a glimpse: Execution of the Smoke-free Law in England, Wales and Northern Ireland [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_594.pdf

Ash ( 2007 ) Ash facts at a glimpse: Smoke and Diseases [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_94.pdf

Ash ( 2010 ) Ash facts at a glimpse: Smoke Statisticss [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_93.pdf

Ash ( 2010 ) Ash facts at a glimpse: Tobacco Economicss [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_95.pdf

Ash ( 2009 ) Ash facts at a glimpse: Tobacco Regulations [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_96.pdf

British Heart Foundation Statistics Website ( 2009 ) Mortality [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.heartstats.org/topic.asp? id=17

Bullen, C. ( July, 2008 ) . Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease. Expert Review of Cardiovascular Therapy, Vol. 6, No. 6, pp. 883-895.

Chime Communications Plc ( 2008 ) East Lancashire PCT Enlists BMT to Develop a Campaign to Undertake the Region 's Biggest Killer [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.chime.plc.uk/press-releases/bmt-launches-east-lancashire-pct-campaign-could-it-be-you

Department of Health ( DoH ) ( 2010 ) Public Health [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.dh.gov.uk/en/Publichealth/index.htm

Department of Health ( DoH ) ( 2004 ) The National Service Framework for Coronary Heart Disease: Wining the War on Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4077154

Ewles L, Simnett I. ( 2003 ) . Promoting Health: A Practical Guide. London: Balliere

Tindall.

Ford, E. S. & A ; Capewell, S. ( 2007 ) Coronary Heart Disease Mortality Among Young Adults in the U.S. from 1980 Through 2002. Concealed Levelling of Mortality Rates Journal of the American College of Cardiology Vol. 50, pp. 2128-2132.

Improvement and Development Agency ( I & A ; DeA ) ( 2009 ) Smoking [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.idea.gov.uk/idk/core/page.do? pageId=5889940

Improvement and Development Agency ( I & A ; DeA ) ( 2007 ) Smoke-free Legislation [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.idea.gov.uk/idk/core/page.do? pageId=6166044

National Health Service ( NHS ) ( 2009 ) Health A-Z: Coronary Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx

National Health Service ( NHS ) ( 2008 ) Rates of Heart Disease in the Young [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.nhs.uk/news/2007/January08/Pages/Ratesofheartdiseaseintheyoung.asp

National Heart Forum ( 2006 ) Economic Cost of Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.heartforum.org.uk/AboutCHD_Economicburden.aspx

Nemetz, P. N. , Roger, V. L. , Ransom, J. E. , Bailer, K. R. , Edwards, W. D. , Leibson, C. L. ( 2008 ) Recent Trends in the Prevalence of Coronary Disease: A Population-Based Autopsy Study of Non-natural Deaths Archival of Internal Medicine Vol. 168, No. 3, pp. 264-270.

NHS East Lancashire ( 2010 ) SMYL If you want to populate longer [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.smyl.eastlancspct.nhs.uk/welcome/

NHS Networks ( 2010 ) East Lancashire Public Health Network [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.networks.nhs.uk/networks.php? pid=727

Smoke Free ( 2007 ) Smoke-free Legislation Compliance Data [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.smokefreeengland.co.uk/files/dhs01_03-smokefree_report_final.pdf

Wells, A. J. ( 1999 ) Passive Smoking and Coronary Heart Disease New England Journal of Medicine Vol. 341, No. 9, pp.697-698.

World Health Organisation ( WHO ) ( 2004 ) Causes of Death ( portion 2 ) . The Global Burden of Disease: 2004 Update [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf

World Health Organisation ( WHO ) ( 2010a ) Cardiovascular Diseases: Key messages to protect bosom wellness [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/cardiovascular_diseases/en/

World Health Organisation ( WHO ) ( 2002 ) Global Burden of Disease in 2002: Data Beginnings, Methods and Results [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //apps.who.int/infobase/compare.aspx? dm=10 & A ; countries=818 % 2c250 % 2c414 % 2c484 % 2c554 % 2c566 % 2c643 % 2c710 % 2c826 % 2c840 & A ; year=2002 & A ; sf1=mo.cg.059 & A ; sex=all

World Health Organisation ( WHO ) ( 2010d ) Global Information System on Tobacco Control [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/tobacco/global_data/en/index.html

World Health Organisation ( WHO ) ( 2010e ) Global Network [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/tobacco/global_interaction/en/

World Health Organisation ( WHO ) ( 2010c ) Regional Activities to the Global CVD Strategy [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/cardiovascular_diseases/region/en/

World Health Organisation ( WHO ) ( 2010b ) Research and Global Partnership Initiatives [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/cardiovascular_diseases/research/en/

World Health Organisation ( WHO ) ( 2008 ) Tobacco Use: Infobase [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //apps.who.int/infobase/report.aspx? rid=116 & A ; dm=8

Bibliography

American Heart Association ( 2010 ) Hazard Factors and Coronary Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.americanheart.org/presenter.jhtml? identifier=4726

Ash ( 2007 ) Ash facts at a glimpse: Smoke and Diseases [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_94.pdf

ASH ( 2009 ) Ash facts at a glimpse: Execution of the Smoke-free Law in England, Wales and Northern Ireland [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_594.pdf

Ash ( 2009 ) Ash facts at a glimpse: Tobacco Regulations [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_96.pdf

Ash ( 2010 ) Ash facts at a glimpse: Smoke Statisticss [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_93.pdf

Ash ( 2010 ) Ash facts at a glimpse: Tobacco Economicss [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.ash.org.uk/files/documents/ASH_95.pdf

British Heart Foundation Statistics Website ( 2009 ) Mortality [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.heartstats.org/topic.asp? id=17

Bullen, C. ( July, 2008 ) . Impact of Tobacco Smoking and Smoking Cessation on Cardiovascular Risk and Disease. Expert Review of Cardiovascular Therapy, Vol. 6, No. 6, pp. 883-895.

Chime Communications Plc ( 2008 ) East Lancashire PCT Enlists BMT to Develop a Campaign to Undertake the Region 's Biggest Killer [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.chime.plc.uk/press-releases/bmt-launches-east-lancashire-pct-campaign-could-it-be-you

Department of Health ( DoH ) ( 2004 ) The National Service Framework for Coronary Heart Disease: Wining the War on Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4077154

Department of Health ( DoH ) ( 2010 ) Public Health [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.dh.gov.uk/en/Publichealth/index.htm

Ewles L, Simnett I. ( 2003 ) . Promoting Health: A Practical Guide. London: Balliere Tindall.

Ford, E. S. & A ; Capewell, S. ( 2007 ) Coronary Heart Disease Mortality Among Young Adults in the U.S. from 1980 Through 2002. Concealed Levelling of Mortality Rates Journal of the American College of Cardiology Vol. 50, pp. 2128-2132.

Hill, S. Blakely, T. , Kawachi, I. , Woodward, A. ( 2004 ) Mortality Among `` Never Smokers '' Populating with Smokers: Two Cohort Studies British Medical Journal Vol. 328, No. 7446, pp. 988-989.

Improvement and Development Agency ( I & A ; DeA ) ( 2007 ) Smoke-free Legislation [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.idea.gov.uk/idk/core/page.do? pageId=6166044

Improvement and Development Agency ( I & A ; DeA ) ( 2009 ) Smoking [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.idea.gov.uk/idk/core/page.do? pageId=5889940

Jiang, H.E. , Vupputuri, S. , Allen, K. , Prerost, M. R. , Hughes, J. , Whelton, P. K. ( 1999 ) Passive Smoking and the Hazard of Coronary Heart Disease - A Meta Analysis of Epidemiological Studies New England Journal of Medicine Vol. 340, No. 12, pp. 920-926.

Kaur, S. , Cohen, A. , Dolor, R. , Coffman, C.J. , Bastian, L.A. ( 2004 ) The Impact of Environmental Tobacco Smoke on Women 's Hazard of Diing from Heart Disease: A Meta Analysis Journal of Women 's Health Vol. 13, No. 8, pp. 888-897.

National Health Service ( NHS ) ( 2008 ) Rates of Heart Disease in the Young [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.nhs.uk/news/2007/January08/Pages/Ratesofheartdiseaseintheyoung.asp

National Health Service ( NHS ) ( 2009 ) Health A-Z: Coronary Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.nhs.uk/conditions/Coronary-heart-disease/Pages/Introduction.aspx

National Heart Forum ( 2006 ) Economic Cost of Heart Disease [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.heartforum.org.uk/AboutCHD_Economicburden.aspx

Nemetz, P. N. , Roger, V. L. , Ransom, J. E. , Bailer, K. R. , Edwards, W. D. , Leibson, C. L. ( 2008 ) Recent Trends in the Prevalence of Coronary Disease: A Population-Based Autopsy Study of Non-natural Deaths Archival of Internal Medicine Vol. 168, No. 3, pp. 264-270.

NHS East Lancashire ( 2010 ) SMYL If you want to populate longer [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.smyl.eastlancspct.nhs.uk/welcome/

NHS Networks ( 2010 ) East Lancashire Public Health Network [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.networks.nhs.uk/networks.php? pid=727

Smoke Free ( 2007 ) Smoke-free Legislation Compliance Data [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.smokefreeengland.co.uk/files/dhs01_03-smokefree_report_final.pdf

Wells, A. J. ( 1999 ) Passive Smoking and Coronary Heart Disease New England Journal of Medicine Vol. 341, No. 9, pp.697-698.

Whincup, P. H. , Gilg, J. A. , Emberson, J. R. , Jarvis, M. J. , Feyerabend, C. , Bryant, A. , Wakler, M. , Cook, D. G. ( 2004 ) Passive Smoking and Risk of Coronary Disease and Stroke: Prospective Study with Cotinine Measurement British Medical Journal Vol. 329, No. 7459, pp. 200-205.

World Health Organisation ( WHO ) ( 2002 ) Global Burden of Disease in 2002: Data Beginnings, Methods and Results [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //apps.who.int/infobase/compare.aspx? dm=10 & A ; countries=818 % 2c250 % 2c414 % 2c484 % 2c554 % 2c566 % 2c643 % 2c710 % 2c826 % 2c840 & A ; year=2002 & A ; sf1=mo.cg.059 & A ; sex=all

World Health Organisation ( WHO ) ( 2004 ) Causes of Death ( portion 2 ) . The Global Burden of Disease: 2004 Update [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_part2.pdf

World Health Organisation ( WHO ) ( 2008 ) Tobacco Use: Infobase [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //apps.who.int/infobase/report.aspx? rid=116 & A ; dm=8

World Health Organisation ( WHO ) ( 2010a ) Cardiovascular Diseases: Key messages to protect bosom wellness [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/cardiovascular_diseases/en/

World Health Organisation ( WHO ) ( 2010b ) Research and Global Partnership Initiatives [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/cardiovascular_diseases/research/en/

World Health Organisation ( WHO ) ( 2010c ) Regional Activities to the Global CVD Strategy [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/cardiovascular_diseases/region/en/

World Health Organisation ( WHO ) ( 2010d ) Global Information System on Tobacco Control [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/tobacco/global_data/en/index.html

World Health Organisation ( WHO ) ( 2010e ) Global Network [ Online ] last accessed 2nd December 2009 at hypertext transfer protocol: //www.who.int/tobacco/global_interaction/en/