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Scheffers-van Schayck T, Tuithof M, Otten R, Engels R, Kleinjan M. Smoking Behavior of Women Before, During, and after Pregnancy: Indicators of Smoking, Quitting, and Relapse. Eur Addict Res 2019; 25:132-144. [PMID: 30917383 PMCID: PMC6518863 DOI: 10.1159/000498988] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smoking cessation during pregnancy and preventing relapse postpartum is a pivotal public health priority. OBJECTIVES This study examined the risk and protective indicators of women who (a) smoke before pregnancy, (b) smoke during the entire pregnancy, (c) successfully quit smoking during pregnancy, and (d) relapse postpartum. METHOD This paper reports secondary analyses of the Dutch population-based Monitor on Substance Use and Pregnancy (2016). A representative sample of mothers of young children (n = 1,858) completed questionnaires at youth health care centers. Bivariate and multivariate logistic regression analyses were conducted. RESULTS Main results showed that women's smoking around pregnancy was strongly associated with the partner's smoking status before pregnancy, partner's change in smoking during pregnancy, and partner's change in smoking postpartum. Women's educational level and cannabis use before pregnancy were also related with women's smoking before and during pregnancy. Women's intensity of alcohol use before pregnancy was ambiguously related with women's smoking before and during pregnancy. CONCLUSIONS One of the key findings of this study suggests that it is essential that partners quit smoking before pregnancy and do not smoke during pregnancy. If partners continue smoking during pregnancy, they should quit smoking postpartum. Health care professionals can play an important role in addressing partners' smoking and giving them evidence-based cessation support before, during, and after pregnancy.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands,Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands,*Tessa Scheffers-van Schayck, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Da Costakade 45, Utrecht, 3521 VS (The Netherlands), E-Mail
| | - Marlous Tuithof
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands
| | - Roy Otten
- Research and Development, Pluryn, Nijmegen, The Netherlands,ASU REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA,Developmental Psychopathology, Radboud University, Nijmegen, The Netherlands
| | - Rutger Engels
- Executive Board, Erasmus University, Rotterdam, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
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Can Nurturing the Young Be the Key to Tackling Chronic Diseases in the Old? A Narrative Review With a Global Perspective. Ochsner J 2018; 18:364-369. [PMID: 30559622 DOI: 10.31486/toj.18.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background One of the greatest challenges in healthcare today is dealing with a growing burden of multimorbid chronic diseases in an aging population. Awareness is growing that a healthy start in life plays a critical role in reversing this trend, especially for young women, pregnant mothers, and children in their first 2 years of life. Methods We reviewed the international literature on early childhood nutrition and development, based on the landmark Lancet series on maternal and child nutrition and child development, and World Health Organization reports. Results Contemporary literature points to the importance of strategies that focus on early childhood for enhancing both health and socioeconomic outcomes. We discuss programs and initiatives that aim to improve the health of mothers and children at a global level, with a focus on high-income countries such as Australia and the United States. Conclusion Tackling the epidemic of chronic diseases requires a comprehensive life course approach that must include pregnant women and their young children. Healthcare systems and professionals play an important role. The health and well-being of the next generation must be everyone's business.
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Grant A, Morgan M, Gallagher D, Mannay D. Smoking during pregnancy, stigma and secrets: Visual methods exploration in the UK. Women Birth 2018; 33:70-76. [PMID: 30553588 PMCID: PMC7043392 DOI: 10.1016/j.wombi.2018.11.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/23/2018] [Accepted: 11/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Moral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this moral gaze. AIM To gain an in-depth understanding of the health issues affecting 10 low income pregnant women from deprived areas of south Wales, UK. METHODS Participants completed visual activities (timelines, collaging or thought bubbles and dyad sandboxing) prior to each interview. Participants' visual representations were used in place of a topic guide, to direct the interview. Guided by feminist principles, 28 interviews were completed with 10 women. Data were analysed thematically. FINDINGS Smoking was discussed at length during interviews, and this paper focuses on this issue alone. Five of the participants had smoked during pregnancy. Negative reactions were directed towards pregnant women who smoked in public, resulting in maternal smoking being undertaken in private. Participants also reported awkward relationships with midwives and other health professionals, including receipt of public health advice in a judgemental tone. DISCUSSION Smoking during pregnancy is a particularly demonised and stigmatised activity. This stigma is not always related to the level of risk to the foetus, and instead can be seen as a moral judgement about women. We urgently need to move from individualised neo-liberal discourses about the failure of individual smokers, to a more socio-ecological view which avoids victim blaming. CONCLUSION Stigma from friends, family, strangers and health professionals may lead to hidden smoking. This is a barrier to women obtaining evidence based stop smoking support.
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Affiliation(s)
- Aimee Grant
- Qualitative Research Group, Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom.
| | - Melanie Morgan
- Qualitative Research Group, Centre for Trials Research, Cardiff University, 4th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, United Kingdom.
| | - Dunla Gallagher
- Centre for Public Health, Institute of Clinical Sciences, Queen's University Belfast, United Kingdom.
| | - Dawn Mannay
- School of Social Sciences, Cardiff University,Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, United Kingdom.
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Are We Justified in Introducing Carbon Monoxide Testing to Encourage Smoking Cessation in Pregnant Women? HEALTH CARE ANALYSIS 2018; 27:128-145. [DOI: 10.1007/s10728-018-0364-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Affiliation(s)
- Nicola Lindson
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
| | - Elias Klemperer
- University of Vermont; Departments of Psychological Sciences & Psychiatry; 1 S Prospect Street, Mail Stop 482, OH4 Burlington VT USA 05405
| | - Paul Aveyard
- University of Oxford; Nuffield Department of Primary Care Health Sciences; Radcliffe Observatory Quarter Woodstock Road Oxford Oxfordshire UK OX2 6GG
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Medley N, Vogel JP, Care A, Alfirevic Z. Interventions during pregnancy to prevent preterm birth: an overview of Cochrane systematic reviews. Cochrane Database Syst Rev 2018; 11:CD012505. [PMID: 30480756 PMCID: PMC6516886 DOI: 10.1002/14651858.cd012505.pub2] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Preterm birth (PTB) is a major factor contributing to global rates of neonatal death and to longer-term health problems for surviving infants. Both the World Health Organization and the United Nations consider prevention of PTB as central to improving health care for pregnant women and newborn babies. Current preventative clinical strategies show varied efficacy in different populations of pregnant women, frustrating women and health providers alike, while researchers call for better understanding of the underlying mechanisms that lead to PTB. OBJECTIVES We aimed to summarise all evidence for interventions relevant to the prevention of PTB as reported in Cochrane systematic reviews (SRs). We intended to highlight promising interventions and to identify SRs in need of an update. METHODS We searched the Cochrane Database of Systematic Reviews (2 November 2017) with key words to capture any Cochrane SR that prespecified or reported a PTB outcome. Inclusion criteria focused on pregnant women without signs of preterm labour or ruptured amniotic membranes. We included reviews of interventions for pregnant women irrespective of their risk status. We followed standard Cochrane methods.We applied GRADE criteria to evaluate the quality of SR evidence. We assigned graphic icons to classify the effectiveness of interventions as: clear evidence of benefit; clear evidence of harm; clear evidence of no effect or equivalence; possible benefit; possible harm; or unknown benefit or harm. We defined clear evidence of benefit and clear evidence of harm to be GRADE moderate- or high-quality evidence with a confidence interval (CI) that does not cross the line of no effect. Clear evidence of no effect or equivalence is GRADE moderate- or high-quality evidence with a narrow CI crossing the line of no effect. Possible benefit and possible harm refer to GRADE low-quality evidence with a clear effect (CI does not cross the line of no effect) or GRADE moderate- or high-quality evidence with a wide CI. Unknown harm or benefit refers to GRADE low- or very low-quality evidence with a wide CI. MAIN RESULTS We included 83 SRs; 70 had outcome data. Below we highlight key results from a subset of 36 SRs of interventions intended to prevent PTB. OUTCOME preterm birthClear evidence of benefitFour SRs reported clear evidence of benefit to prevent specific populations of pregnant women from giving birth early, including midwife-led continuity models of care versus other models of care for all women; screening for lower genital tract infections for pregnant women less than 37 weeks' gestation and without signs of labour, bleeding or infection; and zinc supplementation for pregnant women without systemic illness. Cervical cerclage showed clear benefit for women with singleton pregnancy and high risk of PTB only.Clear evidence of harmNo included SR reported clear evidence of harm.No effect or equivalenceFor pregnant women at high risk of PTB, bedrest for women with singleton pregnancy and antibiotic prophylaxis during the second and third trimester were of no effect or equivalent to a comparator.Possible benefitFour SRs found possible benefit in: group antenatal care for all pregnant women; antibiotics for pregnant women with asymptomatic bacteriuria; pharmacological interventions for smoking cessation for pregnant women who smoke; and vitamin D supplements alone for women without pre-existing conditions such as diabetes.Possible harmOne SR reported possible harm (increased risk of PTB) with intramuscular progesterone, but this finding is only relevant to women with multiple pregnancy and high risk of PTB. Another review found possible harm with vitamin D, calcium and other minerals for pregnant women without pre-existing conditions. OUTCOME perinatal deathClear evidence of benefitTwo SRs reported clear evidence of benefit to reduce pregnant women's risk of perinatal death: midwife-led continuity models of care for all pregnant women; and fetal and umbilical Doppler for high-risk pregnant women.Clear evidence of harmNo included SR reported clear evidence of harm.No effect or equivalenceFor pregnant women at high risk of PTB, antibiotic prophylaxis during the second and third trimester was of no effect or equivalent to a comparator.Possible benefitOne SR reported possible benefit with cervical cerclage for women with singleton pregnancy and high risk of PTB.Possible harmOne SR reported possible harm associated with a reduced schedule of antenatal visits for pregnant women at low risk of pregnancy complications; importantly, these women already received antenatal care in settings with limited resources. OUTCOMES preterm birth and perinatal deathUnknown benefit or harmFor pregnant women at high risk of PTB for any reason including multiple pregnancy, home uterine monitoring was of unknown benefit or harm. For pregnant women at high risk due to multiple pregnancy: bedrest, prophylactic oral betamimetics, vaginal progesterone and cervical cerclage were all of unknown benefit or harm. AUTHORS' CONCLUSIONS Implications for practiceThe overview serves as a map and guide to all current evidence relevant to PTB prevention published in the Cochrane Library. Of 70 SRs with outcome data, we identified 36 reviews of interventions with the aim of preventing PTB. Just four of these SRs had evidence of clear benefit to women, with an additional four SRs reporting possible benefit. No SR reported clear harm, which is an important finding for women and health providers alike.The overview summarises no evidence for the clinically important interventions of cervical pessary, cervical length assessment and vaginal progesterone because these Cochrane Reviews were not current. These are active areas for PTB research.The graphic icons we assigned to SR effect estimates do not constitute clinical guidance or an endorsement of specific interventions for pregnant women. It remains critical for pregnant women and their healthcare providers to carefully consider whether specific strategies to prevent PTB will be of benefit for individual women, or for specific populations of women.Implications for researchFormal consensus work is needed to establish standard language for overviews of reviews and to define the limits of their interpretation.Clinicians, researchers and funders must address the lack of evidence for interventions relevant to women at high risk of PTB due to multiple pregnancy.
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Affiliation(s)
- Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Joshua P Vogel
- Burnet InstituteMaternal and Child Health85 Commercial RoadMelbourneAustralia
| | - Angharad Care
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Zarko Alfirevic
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Loukopoulou AN, Vardavas CI, Farmakides G, Rosolymos C, Chrelias C, Tzatzarakis M, Tsatsakis A, Myridakis A, Lyberi M, Behrakis PK. Counselling for smoking cessation during pregnancy reduces tobacco-specific nitrosamine (NNAL) concentrations: A randomized controlled trial. Eur J Midwifery 2018; 2:14. [PMID: 33537575 PMCID: PMC7846038 DOI: 10.18332/ejm/99546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 09/25/2018] [Accepted: 11/03/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Smoking cessation during pregnancy is beneficial to both the mother and child. Our objective was to assess if an intensive smoking cessation intervention for pregnant women increases: a) rates of smoking cessation, and b) reduces exposure to tobacco-specific carcinogens during pregnancy. METHODS A two-group single-blinded parallel randomized controlled trial (RCT) was conducted involving 84 pregnant smokers in either a high intensity (n=42) or minimal contact control group (n=42). Women assigned to the high intensity smoking cessation intervention group received a single 30-minute behavioural counselling session and a tailored self-help booklet. The primary outcome measures were: 7-day point prevalence abstinence measured by selfreport and urine cotinine levels, and maternal tobacco specific carcinogens nitrosamine (NNAL) urine concentrations assessed at 32 weeks of gestation. RESULTS A significantly greater percentage of pregnant smokers quit smoking in the high intensity group compared to the low intensity control group (45.2% vs 21.4%; p=0.001). A significant decrease in urine cotinine concentrations was documented in the experimental group (-140.74 ± 361.70 ng/mL; p=0.004), with no significant decrease documented in the control group. A significant decrease in NNAL levels was also documented in the experimental group (158.17 ± 145.03 pg/mL before, 86.43 ± 112.54 pg/mL after; p=0.032) with no significant changes in the control group. CONCLUSIONS The high intensity intervention tested resulted in significantly greater cessation rates. Intensive smoking cessation interventions can be effective in reducing fetal exposure to NNAL. This is the first trial to report on NNAL tobacco-specific carcinogen concentrations before and after an intervention for smoking cessation during pregnancy. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01210118. ABBREVIATIONS 5Αs: ask, advise, asses, assist, arrange; GHQ: general health questionnaire; ANOVA: analysis of variance; RCT: randomized control trials; NNAL: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol.
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Affiliation(s)
| | - Constantine I Vardavas
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
| | | | | | - Charalambos Chrelias
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Maternity Unit, Attikon Hospital, Athens, Greece
| | - Manolis Tzatzarakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Aristeidis Tsatsakis
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
| | - Antonis Myridakis
- Environmental Chemical Processes Laboratory (ECPL), Department of Chemistry, University of Crete, Heraklion, Greece
- Integrative Systems Medicine and Digestive Disease, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, United Kingdom
| | - Maria Lyberi
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis K Behrakis
- George D. Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
- Institute of Public Health, American College of Greece, Athens, Greece
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158
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Washio Y, Humphreys M. Maternal Behavioral Health: Fertile Ground for Behavior Analysis. Perspect Behav Sci 2018; 41:637-652. [PMID: 31976417 PMCID: PMC6701727 DOI: 10.1007/s40614-018-0143-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
The World Health Organization has identified four behavioral health priorities as risk factors for noncommunicable diseases in maternal populations: tobacco use, harmful alcohol use, poor nutrition, and lack of physical activity. These risk factors also significantly affect pregnant and immediately postpartum mothers, doubling the health risk and economic burden by adversely affecting maternal and birth or infant outcomes. Psychosocial and behavioral interventions are ideal for pregnant and immediately postpartum women as opposed to pharmacotherapy. Among other behavioral interventions, the use of incentives based on the principles of reinforcement has been a successful yet controversial way to change health behaviors. Implementing an incentive-based intervention in maternal health often brings up social validity concerns. The existing guideline on how to develop and conduct research in incentive-based interventions for maternal health lacks enough information on the specific variables to control for to maintain the intervention's effectiveness. This article outlines some of the critical variables in implementing an effective behavior-analytic intervention and addressing social validity concerns to change maternal behaviors in a sustainable manner, along with specific research topics needed in the field to prevent adverse maternal, birth, and infant outcomes.
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Affiliation(s)
- Yukiko Washio
- Christiana Care Health System, Newark, DE USA
- University of Delaware, 4755 Ogletown-Stanton Road, Newark, DE 19713 USA
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159
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Wilson SM, Newins AR, Medenblik AM, Kimbrel NA, Dedert EA, Hicks TA, Neal LC, Beckham JC, Calhoun PS. Contingency Management Versus Psychotherapy for Prenatal Smoking Cessation: A Meta-Analysis of Randomized Controlled Trials. Womens Health Issues 2018; 28:514-523. [PMID: 30061033 PMCID: PMC6215492 DOI: 10.1016/j.whi.2018.05.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Prenatal smoking is the leading preventable cause of poor obstetric outcomes, yet treatment options are limited. Past reviews of prenatal smoking cessation have often grouped all counseling into a single category, which ignores the fact that psychotherapy is distinct from brief counseling. The objective of this study was to compare the effect sizes of two intensive interventions for prenatal smoking cessation: contingency management (i.e., financial incentives for abstinence) and psychotherapy. METHODS A systematic search for randomized controlled trials testing the efficacy of contingency management or psychotherapy was completed using PubMed, PsycINFO, Web of Science, the Cochrane Library, and EMBASE. Independent raters extracted data and assessed trials for risk of bias. Treatment effects were analyzed for three times points: late pregnancy, early postpartum, and late postpartum. RESULTS The search yielded 22 studies, and meta-analytic results indicated that interventions (compared with control groups) generally increased the odds of abstinence. Moderator analyses indicated that intervention type (contingency management vs. psychotherapy) accounted for variability in effect sizes. When comparing treatment type, effects of contingency management interventions were significantly greater than those of psychotherapeutic interventions. Although psychotherapy did not affect smoking abstinence, contingency management interventions had significant treatment effects at all three time points. CONCLUSIONS Contingency management seems to be a safe and efficacious prenatal smoking cessation treatment. Although psychotherapy alone did not show an effect on prenatal smoking abstinence, future research may seek to combine this approach with contingency management to promote prenatal smoking cessation.
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Affiliation(s)
- Sarah M Wilson
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina.
| | | | | | - Nathan A Kimbrel
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Eric A Dedert
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | | | - Lydia C Neal
- Duke University School of Medicine, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Jean C Beckham
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina
| | - Patrick S Calhoun
- Duke University School of Medicine, Durham, North Carolina; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, North Carolina; Durham Veterans Affairs Health Care System, Durham, North Carolina; VA Center for Health Services Research in Primary Care, Durham, North Carolina
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Wynne O, Bonevski B. Developments in the Research Base on Reducing Exposure to Second-Hand Smoke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15091873. [PMID: 30200190 PMCID: PMC6164103 DOI: 10.3390/ijerph15091873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Olivia Wynne
- School of Medicine & Public Health, University of Newcastle, University Drive Callaghan, Newcastle, NSW 2308, Australia.
| | - Billie Bonevski
- School of Medicine & Public Health, University of Newcastle, University Drive Callaghan, Newcastle, NSW 2308, Australia.
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Scherman A, Tolosa JE, McEvoy C. Smoking cessation in pregnancy: a continuing challenge in the United States. Ther Adv Drug Saf 2018; 9:457-474. [PMID: 30364850 PMCID: PMC6199686 DOI: 10.1177/2042098618775366] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 03/29/2018] [Indexed: 12/21/2022] Open
Abstract
Despite significant population level declines, smoking during pregnancy remains a major public health issue in the United States (US). Approximately 360,000-500,000 smoke-exposed infants are born yearly, and prenatal smoking remains a leading modifiable cause of poor birth outcomes (e.g. birth < 37 gestational weeks, low birth weight, perinatal mortality). Women who smoke during pregnancy are more likely to be younger and from disadvantaged socioeconomic and racial and ethnic groups, with some US geographic regions reporting increased prenatal smoking rates since 2000. Such disparities in maternal prenatal smoking suggests some pregnant women face unique barriers to cessation. This paper reviews the current state and future direction of smoking cessation in pregnancy in the US. We briefly discuss the etiology of smoking addiction among women, the pathophysiology and effects of tobacco smoke exposure on pregnant women and their offspring, and the emerging issue of electronic nicotine delivery systems. Current population-based and individual smoking cessation interventions are reviewed in the context of pregnancy and barriers to cessation among US women. Finally, we consider interventions that are on the horizon and areas in need of further investigation.
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Affiliation(s)
- Ashley Scherman
- Oregon Health & Science University, 3181 SW
Sam Jackson Park Rd, Portland, OR 97239, USA
| | | | - Cindy McEvoy
- Oregon Health & Science University,
Portland, OR, USA
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162
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Patten CA, Lando H, Resnicow K, Decker PA, Smith CM, Hanza MM, Burhansstipanov L, Scott M. Developing health communication messaging for a social marketing campaign to reduce tobacco use in pregnancy among Alaska Native women. ACTA ACUST UNITED AC 2018; 11:252-262. [PMID: 31548863 DOI: 10.1080/17538068.2018.1495929] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background Despite the high prevalence of tobacco use during pregnancy among Alaska Native and American Indian (AI/AN) women, few efforts have focused on developing tobacco cessation interventions for this group. This paper describes development of messaging for a social media campaign targeting the entire community to reduce tobacco use in pregnancy (cigarette smoking and smokeless tobacco use including a homemade product known as Iqmik) among AN women, as part of a multi-component intervention. Method The study (clinical trial registration #NCT02083081) used mixed methods with two rounds of assessments to develop and refine culturally relevant message appeals. Round 1 used qualitative focus groups and individual interviews (N=60), and Round 2 used quantitative survey interviews (N=52). Each round purposively sampled adult AN pregnant women, family/friends, and Elders in Western Alaska, and included tobacco users and non-users. Round 1 also assessed reasons for tobacco use in pregnancy. Results Qualitative findings generally converged with quantitative results to indicate that many participants preferred factual, loss-framed, visual concepts on how maternal tobacco use harms the fetus, newborn, and child; in contrast to spiritual or emotional appeals, or gain-framed messaging. Stress was indicated as a major reason for tobacco use in pregnancy and strategies to manage stress along with other health pregnancy targets (e.g., prenatal care) were suggested. Conclusions This preliminary study suggests campaign messages targeting the entire community to reduce tobacco use in pregnancy among rural AN women should include factual messaging for being tobacco-free as well as focus on reducing stress and other healthy pregnancy targets.
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Affiliation(s)
- Christi A Patten
- Mayo Clinic, Department of Psychiatry and Psychology, BioBusiness Bldg 5-26, 200 First Street SW, Rochester, MN 55905, ,
| | - Harry Lando
- University of Minnesota, 1300 2 St, Ste 200, Minneapolis, MN 55454, ,
| | - Kenneth Resnicow
- University of Michigan, 109 S. Observatory, 3867 SPH1, Ann Arbor, MI 48109, ,
| | - Paul A Decker
- Mayo Clinic, Department of Health Sciences Research, Harwick 7, 200 First Street SW, Rochester, MN 55905, ,
| | - Christina M Smith
- Mayo Clinic, Department of Health Sciences Research, Harwick 7, 200 First Street SW, Rochester, MN 55905, ,
| | - Marcelo M Hanza
- Mayo Clinic, Department of Development, Gonda Building, 200 First Street SW, Rochester, MN 55905, ,
| | | | - Matthew Scott
- Yukon Kuskokwim Health Corporation, P.O. Box 528, Bethel, AK 99559-0528, ,
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Griffiths SE, Parsons J, Naughton F, Fulton EA, Tombor I, Brown KE. Are digital interventions for smoking cessation in pregnancy effective? A systematic review and meta-analysis. Health Psychol Rev 2018; 12:333-356. [PMID: 29912621 DOI: 10.1080/17437199.2018.1488602] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Smoking in pregnancy remains a global public health issue due to foetal health risks and potential maternal complications. The aims of this systematic review and meta-analysis were to explore: (1) whether digital interventions for pregnancy smoking cessation are effective, (2) the impact of intervention platform on smoking cessation, (3) the associations between specific Behaviour Change Techniques (BCTs) delivered within interventions and smoking cessation and (4) the association between the total number of BCTs delivered and smoking cessation. Systematic searches of 9 databases resulted in the inclusion of 12 published articles (n = 2970). The primary meta-analysis produced a sample-weighted odds ratio (OR) of 1.44 (95% CI 1.04-2.00, p = .03) in favour of digital interventions compared with comparison groups. Computer-based (OR = 3.06, 95% CI 1.28-7.33) and text-message interventions (OR = 1.59, 95% CI 1.07-2.38) were the most effective digital platform. Moderator analyses revealed seven BCTs associated with smoking cessation: information about antecedents; action planning; problem solving; goal setting (behaviour); review behaviour goals; social support (unspecified); and pros and cons. A meta-regression suggested that interventions using larger numbers of BCTs produced the greatest effects. This paper highlights the potential for digital interventions to improve rates of smoking cessation in pregnancy.
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Affiliation(s)
- Sarah Ellen Griffiths
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK
| | - Joanne Parsons
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK
| | - Felix Naughton
- b School of Health Sciences , University of East Anglia , Norwich , UK
| | - Emily Anne Fulton
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK.,c Public Health Warwickshire , Warwickshire County Council , Warwick , UK
| | - Ildiko Tombor
- d Department of Behavioural Science and Health , University College London , London , UK
| | - Katherine E Brown
- a Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences , Coventry University , Coventry , UK.,c Public Health Warwickshire , Warwickshire County Council , Warwick , UK
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164
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Louw KA. Substance use in pregnancy: The medical challenge. Obstet Med 2018; 11:54-66. [PMID: 29997687 PMCID: PMC6038015 DOI: 10.1177/1753495x17750299] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/20/2017] [Indexed: 01/04/2023] Open
Abstract
Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.
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Affiliation(s)
- Kerry-Ann Louw
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
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165
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Berlin N, Goldzahl L, Bauld L, Hoddinott P, Berlin I. Public acceptability of financial incentives to reward pregnant smokers who quit smoking: a United Kingdom-France comparison. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:697-708. [PMID: 28646249 PMCID: PMC5948294 DOI: 10.1007/s10198-017-0914-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 06/06/2017] [Indexed: 08/15/2023]
Abstract
A substantial amount of research has been conducted on financial incentives to increase abstinence from smoking among pregnant smokers. If demonstrated to be effective, financial incentives could be proposed as part of health care interventions to help pregnant smokers quit. Public acceptability is important; as such interventions could be publicly funded. Concerns remain about the acceptability of these interventions in the general population. We aimed to assess the acceptability of financial incentives to reward pregnant smokers who stop smoking using a survey conducted in the UK and then subsequently in France, two developed countries with different cultural and social backgrounds. More French than British respondents agreed with financial incentives for rewarding quitting smoking during pregnancy, not smoking after delivery, keeping a smoke-free household, health service payment for meeting target and the maximum amount of the reward. However, fully adjusted models showed significant differences only for the two latter items. More British than French respondents were neutral toward financial incentives. Differences between the representative samples of French and British individuals demonstrate that implementation of financial incentive policies may not be transferable from one country to another.
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Affiliation(s)
- Noémi Berlin
- Department of Economics, European University Institute, Villa la Fonte, Via delle Fontanelle, 18, 50014 San Domenico Di Fiesole, Italy
| | | | - Linda Bauld
- UK Centre for Tobacco and Alcohol Studies and Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Pat Hoddinott
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Ivan Berlin
- Department of Pharmacology, Hôpital Pitié-Salpetrière, Faculté de médecine-Université P. & M. Curie, INSERM U1018, Paris, France
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166
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Firoz T, McCaw‐Binns A, Filippi V, Magee LA, Costa ML, Cecatti JG, Barreix M, Adanu R, Chou D, Say L. A framework for healthcare interventions to address maternal morbidity. Int J Gynaecol Obstet 2018; 141 Suppl 1:61-68. [PMID: 29851114 PMCID: PMC6001624 DOI: 10.1002/ijgo.12469] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Maternal health services should move beyond the focus on emergency obstetric care, to a broader approach that encompasses preventive and early interventions, and integration with existing services. Health systems need to respond by prioritizing funding for developing integrated health programs, and workforce strengthening. The MMWG's efforts have highlighted the changing landscape of maternal health, and the need to expand the narrow focus of maternal health, moving beyond surviving to thriving.
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Affiliation(s)
| | - Affette McCaw‐Binns
- Department of Community Health and PsychiatryUniversity of the West IndiesMona, KingstonJamaica
| | - Veronique Filippi
- Department of Infectious Disease EpidemiologyLondon School of Hygiene and Tropical MedicineLondonUK
| | - Laura A. Magee
- Department of Women's HealthKing's College LondonLondonUK
| | - Maria L. Costa
- Department of Obstetrics and GynecologyUniversity of CampinasSão PauloBrazil
| | - Jose G. Cecatti
- Department of Obstetrics and GynecologyUniversity of CampinasSão PauloBrazil
| | - Maria Barreix
- UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and ResearchWHOGenevaSwitzerland
| | - Richard Adanu
- School of Public HealthDepartment of Population, Family and Reproductive HealthUniversity of GhanaAccraGhana
| | - Doris Chou
- UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and ResearchWHOGenevaSwitzerland
| | - Lale Say
- UNDP–UNFPA–UNICEF–WHO–World Bank Special Programme of ResearchDevelopment and Research Training in Human Reproduction (HRP)Department of Reproductive Health and ResearchWHOGenevaSwitzerland
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167
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Meghea CI, Brinzaniuc A, Sidor A, Chereches RM, Mihu D, Iuhas CI, Stamatian F, Caracostea G, Dascal MD, Foley K, Baban A, Voice TC, Blaga OM. A couples-focused intervention for smoking cessation during pregnancy: The study protocol of the Quit Together pilot randomized controlled trial. Tob Prev Cessat 2018; 4:17. [PMID: 30906906 PMCID: PMC6430127 DOI: 10.18332/tpc/89926] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 04/12/2018] [Accepted: 04/13/2018] [Indexed: 11/24/2022]
Abstract
Tobacco smoking remains the leading global cause of preventable disease and death. Preconception and pregnancy smoking are high in Central and Eastern Europe. Quit Together is a partnership between a US university and a Romanian university, obstetrics and gynecology clinics in Romania, and other community partners in Romania. The objective of the Quit Together pilot study is to adapt, enhance and test the implementation feasibility and initial efficacy of an evidence-based pregnancy and postnatal couple intervention for smoking cessation in Romania. Quit Together builds on the Motivation and Problem Solving (MAPS) approach, enhanced by targeting the couples' smoking behavior and focusing on dyadic efficacy for smoking cessation. The study is an ongoing randomized controlled trial of 120 Romanian pregnant smokers and their partners. Participants are randomized to: 1) an intervention arm consisting, typically, of up to 8 prenatal and postnatal telephone counseling calls for the women and 4 for their partners, combining motivational strategies and problem-solving/coping skills to encourage the woman to quit smoking and the partner to support her decision; and 2) a control arm (usual care). The primary outcome is maternal biochemically verified smoking abstinence at 3 months postpartum. Quit Together has the potential to identify effective strategies to increase maternal smoking cessation during pregnancy and smoking abstinence after birth. If effective, Quit Together is expected to have a sustainable positive impact on the health of the child, mother and partner, and potentially reduced health system costs.
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Affiliation(s)
- Cristian I. Meghea
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, Michigan, USA
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Brinzaniuc
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Alexandra Sidor
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Razvan M. Chereches
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Dan Mihu
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Dominic Stanca Clinic, Cluj-Napoca, Romania
| | - Cristian I. Iuhas
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Dominic Stanca Clinic, Cluj-Napoca, Romania
| | - Florin Stamatian
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Clinic I, Cluj-Napoca, Romania
| | - Gabriela Caracostea
- Iuliu Hatieganu University of Medicine and Pharmacy, Department of Obstetrics and Gynaecology Clinic I, Cluj-Napoca, Romania
| | - Marina D. Dascal
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Kristie Foley
- Department of Implementation Science, Division of Public Health Sciences, Wake Forest University, North Carolina, USA
| | - Adriana Baban
- Department of Psychology, Babeșș-Bolyai University, Cluj-Napoca, Romania
| | - Thomas C. Voice
- Department of Civil and Environmental Engineering, College of Engineering, Michigan State University, Michigan, USA
| | - Oana M. Blaga
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeșș-Bolyai University, Cluj-Napoca, Romania
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168
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The practices of French general practitioners regarding screening and counselling pregnant women for tobacco smoking and alcohol drinking. Int J Public Health 2018; 63:631-640. [PMID: 29679105 DOI: 10.1007/s00038-018-1103-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 03/02/2018] [Accepted: 04/06/2018] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES Our study aims to describe French general practitioners' (GPs') practices toward pregnant patients regarding alcohol consumption and smoking and to highlight factors associated with specific practices. METHODS In 2015, a representative sample of 1414 French GPs completed a telephone survey based on a stratified random sampling. RESULTS 61% of GPs declared screening for alcohol use and 82% for smoking at least once with each pregnant patient; quitting was not systematically advised either for alcohol or for smoking. GPs' practices were significantly better among those who had more recent ongoing training. GPs who drank regularly were less likely to screen for alcohol use and GPs' drinking frequency was inversely related to recommending quitting. Current and former smokers were less likely to recommend quitting to pregnant patients smoking over five cigarettes per day. CONCLUSIONS Screening and counselling practices for substance use during pregnancy are heterogeneous among French GPs and are notably related to their personal consumption. GP's role in preventing substance use during pregnancy could be strengthened by actions regarding their own consumption and by modifications in their initial and ongoing training.
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Abstract
Quitting smoking helps smokers maintain their health and extend their lifespan by 10 or more years. Treatment strategies for smoking cessation should be tailored to individual smokers with special needs based on their specific circumstances. It is recommended that pregnant women adopt smoking cessation through counseling and behavioral interventions because the safety of medications has yet to be established. Counseling is the main strategy for smoking cessation in adolescents and nicotine replacement therapy can be used with caution in individuals with serious nicotine dependence. It is important for smokers with psychiatric diseases to quit smoking following accurate assessment of their depression status. Nicotine replacement therapy, varenicline, and bupropion can be used for smoking cessation in smokers with psychiatric disorders. The incidence of cardiovascular disease decreased according to the smoking status and the duration of smoking cessation. In smokers with chronic obstructive pulmonary disease (COPD) who used a combination of counseling and pharmacotherapy the quitting rate was more than twice as high as subjects who used behavioral interventions alone. Varenicline can be used as the most effective anti-smoking drug by most smokers including those with psychiatric disorders, cardiovascular disease, and COPD.
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Affiliation(s)
- Eun Mi Chun
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Korea.
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170
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Ilozumba O, Abejirinde IOO, Dieleman M, Bardají A, Broerse JEW, Van Belle S. Targeting strategies of mHealth interventions for maternal health in low and middle-income countries: a systematic review protocol. BMJ Open 2018; 8:e019345. [PMID: 29478019 PMCID: PMC5855310 DOI: 10.1136/bmjopen-2017-019345] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Recently, there has been a steady increase in mobile health (mHealth) interventions aimed at improving maternal health of women in low-income and middle-income countries. While there is evidence indicating that these interventions contribute to improvements in maternal health outcomes, other studies indicate inconclusive results. This uncertainty has raised additional questions, one of which pertains to the role of targeting strategies in implementing mHealth interventions and the focus on pregnant women and health workers as target groups. This review aims to assess who is targeted in different mHealth interventions and the importance of targeting strategies in maternal mHealth interventions. METHODS AND ANALYSIS We will search for peer-reviewed, English-language literature published between 1999 and July 2017 in PubMed, Web of Knowledge (Science Direct, EMBASE) and Cochrane Central Registers of Controlled Trials. The study scope is defined by the Population, Intervention, Comparison and Outcomes framework: P, community members with maternal or reproductive needs; I, electronic health or mHealth programmes geared at improving maternal or reproductive health; C, other non-electronic health or mHealth-based interventions; O, maternal health measures including family planning, antenatal care attendance, health facility delivery and postnatal care attendance. ETHICS AND DISSEMINATION This study is a review of already published or publicly available data and needs no ethical approval. Review results will be published in a peer-reviewed journal and presented at international conferences. PROSPERO REGISTRATION NUMBER CRD42017072280.
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Affiliation(s)
- Onaedo Ilozumba
- Faculty of Sciences, Vrije universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Ibukun-Oluwa Omolade Abejirinde
- Faculty of Sciences, Vrije universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Marjolein Dieleman
- Faculty of Sciences, Vrije universiteit Amsterdam, Amsterdam, The Netherlands
| | - Azucena Bardají
- ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | | | - Sara Van Belle
- Department of Public Health, Instituut voor Tropische Geneeskunde, Antwerpen, Belgium
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Campbell KA, Fergie L, Coleman-Haynes T, Cooper S, Lorencatto F, Ussher M, Dyas J, Coleman T. Improving Behavioral Support for Smoking Cessation in Pregnancy: What Are the Barriers to Stopping and Which Behavior Change Techniques Can Influence These? Application of Theoretical Domains Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E359. [PMID: 29462994 PMCID: PMC5858428 DOI: 10.3390/ijerph15020359] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 02/02/2018] [Accepted: 02/13/2018] [Indexed: 01/18/2023]
Abstract
Behavioral support interventions are used to help pregnant smokers stop; however, of those tested, few are proven effective. Systematic research developing effective pregnancy-specific behavior change techniques (BCTs) is ongoing. This paper reports contributory work identifying potentially-effective BCTs relative to known important barriers and facilitators (B&Fs) to smoking cessation in pregnancy; to detect priority areas for BCTs development. A Nominal Group Technique with cessation experts (n = 12) elicited an expert consensus on B&Fs most influencing women's smoking cessation and those most modifiable through behavioral support. Effective cessation interventions in randomized trials from a recent Cochrane review were coded into component BCTs using existing taxonomies. B&Fs were categorized using Theoretical Domains Framework (TDF) domains. Matrices, mapping BCT taxonomies against TDF domains, were consulted to investigate the extent to which BCTs in existing interventions target key B&Fs. Experts ranked "smoking a social norm" and "quitting not a priority" as most important barriers and "desire to protect baby" an important facilitator to quitting. From 14 trials, 23 potentially-effective BCTs were identified (e.g., information about consequences). Most B&Fs fell into "Social Influences", "Knowledge", "Emotions" and "Intentions" TDF domains; few potentially-effective BCTs mapped onto every TDF domain. B&Fs identified by experts as important to cessation, are not sufficiently targeted by BCT's currently within interventions for smoking cessation in pregnancy.
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Affiliation(s)
- Katarzyna A Campbell
- Division of Primary Care, University of Nottingham, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Libby Fergie
- Division of Primary Care, University of Nottingham, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Tom Coleman-Haynes
- Division of Primary Care, University of Nottingham, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Fabiana Lorencatto
- Centre for Behaviour Change, University College London, London WC1E 7HB, UK.
| | - Michael Ussher
- Division of Population Health Sciences and Education, St George's University of London, London, UK and Institute of Social Marketing, University of Stirling, Stirling, FK9 4LA Scotland, UK.
| | - Jane Dyas
- Division of Primary Care, University of Nottingham, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK.
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172
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Behbod B, Sharma M, Baxi R, Roseby R, Webster P. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane Database Syst Rev 2018; 1:CD001746. [PMID: 29383710 PMCID: PMC6491082 DOI: 10.1002/14651858.cd001746.pub4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children's exposure to other people's tobacco smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children in child care or educational settings are also at risk of exposure to ETS. Preventing exposure to ETS during infancy and childhood has significant potential to improve children's health worldwide. OBJECTIVES To determine the effectiveness of interventions designed to reduce exposure of children to environmental tobacco smoke, or ETS. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), and the Social Science Citation Index & Science Citation Index (Web of Knowledge). We conducted the most recent search in February 2017. SELECTION CRITERIA We included controlled trials, with or without random allocation, that enrolled participants (parents and other family members, child care workers, and teachers) involved in the care and education of infants and young children (from birth to 12 years of age). All mechanisms for reducing children's ETS exposure were eligible, including smoking prevention, cessation, and control programmes. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies and extracted data. Due to heterogeneity of methods and outcome measures, we did not pool results but instead synthesised study findings narratively. MAIN RESULTS Seventy-eight studies met the inclusion criteria, and we assessed all evidence to be of low or very low quality based on GRADE assessment. We judged nine studies to be at low risk of bias, 35 to have unclear overall risk of bias, and 34 to have high risk of bias. Twenty-one interventions targeted populations or community settings, 27 studies were conducted in the well-child healthcare setting and 26 in the ill-child healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether visits were made to well- or ill-children, and another included visits to both well- and ill-children. Forty-five studies were reported from North America, 22 from other high-income countries, and 11 from low- or middle-income countries. Only 26 of the 78 studies reported a beneficial intervention effect for reduction of child ETS exposure, 24 of which were statistically significant. Of these 24 studies, 13 used objective measures of children's ETS exposure. We were unable to pinpoint what made these programmes effective. Studies showing a significant effect used a range of interventions: nine used in-person counselling or motivational interviewing; another study used telephone counselling, and one used a combination of in-person and telephone counselling; three used multi-component counselling-based interventions; two used multi-component education-based interventions; one used a school-based strategy; four used educational interventions, including one that used picture books; one used a smoking cessation intervention; one used a brief intervention; and another did not describe the intervention. Of the 52 studies that did not show a significant reduction in child ETS exposure, 19 used more intensive counselling approaches, including motivational interviewing, education, coaching, and smoking cessation brief advice. Other interventions consisted of brief advice or counselling (10 studies), feedback of a biological measure of children's ETS exposure (six studies), nicotine replacement therapy (two studies), feedback of maternal cotinine (one study), computerised risk assessment (one study), telephone smoking cessation support (two studies), educational home visits (eight studies), group sessions (one study), educational materials (three studies), and school-based policy and health promotion (one study). Some studies employed more than one intervention. 35 of the 78 studies reported a reduction in ETS exposure for children, irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure but rather sought to reduce symptoms of asthma, and found a significant reduction in symptoms among the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions. AUTHORS' CONCLUSIONS A minority of interventions have been shown to reduce children's exposure to environmental tobacco smoke and improve children's health, but the features that differentiate the effective interventions from those without clear evidence of effectiveness remain unclear. The evidence was judged to be of low or very low quality, as many of the trials are at a high risk of bias, are small and inadequately powered, with heterogeneous interventions and populations.
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Affiliation(s)
- Behrooz Behbod
- University of OxfordNuffield Department of Population HealthOxfordUK
- University of Nicosia Medical SchoolDepartment of Primary Care and Population HealthNicosiaCyprus
| | - Mohit Sharma
- University of OxfordNuffield Department of Population HealthOxfordUK
| | - Ruchi Baxi
- University of OxfordNuffield Department of Population HealthOxfordUK
| | - Robert Roseby
- Monash Children's HospitalClaytonMelbourneVictoriaAustralia
| | - Premila Webster
- University of OxfordNuffield Department of Population HealthOxfordUK
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Longman JM, Adams CM, Johnston JJ, Passey ME. Improving implementation of the smoking cessation guidelines with pregnant women: How to support clinicians? Midwifery 2017; 58:137-144. [PMID: 29367150 DOI: 10.1016/j.midw.2017.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/12/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE this study aimed to explore the enablers and barriers to implementation of the Australian smoking cessation in pregnancy guidelines. These guidelines direct clinicians to follow the 5As of cessation: Ask, Advise, Assess, Assist and Arrange follow-up. DESIGN semi-structured interviews based on the Theoretical Domains Framework (TDF) elicited clinicians' views and experiences of implementing the guidelines. SETTING antenatal care in the NSW public health system. PARTICIPANTS 27 maternity service managers, obstetricians and midwives. FINDINGS participants confirmed that implementation of the smoking cessation guidelines was sub-optimal. This was particularly the case with Assist and Arrange follow up at the initial visit, and with following any of the 5As at subsequent visits. Key barriers included systems which did not support implementation or monitoring, lack of knowledge, skills and training, perceived time restrictions, 'difficult conversations' and perceiving smoking as a social activity. Enablers included clinicians' knowledge of the harms of smoking in pregnancy, clinicians' skills in communicating with pregnant women, positive emotions, professional role and identity, the potential of training and of champions to influence practice, and systems that regulated behaviour. KEY CONCLUSIONS these findings will contribute to the development of a multifaceted intervention to support clinicians in implementing the guidelines. IMPLICATIONS FOR PRACTICE Building on existing strengths, antenatal care providers may be supported in implementing the guidelines by working with systems which remind and support implementation, the clear reframing of smoking as an addiction, knowledge and skills development and by realizing the potential of leadership to maximise the impact of reinforcement and social influence.
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Affiliation(s)
- Jo M Longman
- University of Sydney School of Public Health (University Centre for Rural Health - North Coast), Lismore, NSW 2480, Australia.
| | | | - Jennifer J Johnston
- University of Sydney School of Public Health (University Centre for Rural Health - North Coast), Lismore, NSW 2480, Australia; Northern NSW Local Health District, Lismore, Australia
| | - Megan E Passey
- University of Sydney School of Public Health (University Centre for Rural Health - North Coast), Lismore, NSW 2480, Australia; Northern NSW Local Health District, Lismore, Australia
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England L, Tong VT, Rockhill K, Hsia J, McAfee T, Patel D, Rupp K, Conrey EJ, Valdivieso C, Davis KC. Evaluation of a federally funded mass media campaign and smoking cessation in pregnant women: a population-based study in three states. BMJ Open 2017; 7:e016826. [PMID: 29259054 PMCID: PMC5778314 DOI: 10.1136/bmjopen-2017-016826] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES In 2012, theCenters for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women. METHODS We used 2009-2013 certificates of live births in three US states: Indiana, Kentucky and Ohio. Smoking cessation by the third trimester of pregnancy was examined among women who smoked in the 3 months prepregnancy. Campaign exposure was defined as overlap between the airing of Tips 2012 (March 19-June 10) and the prepregnancy and pregnancy periods. Women who delivered before Tips 2012 were not exposed. Adjusted logistic regression was used to determine whether exposure to Tips was independently associated with smoking cessation. RESULTS Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10). CONCLUSIONS Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women.
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Affiliation(s)
- Lucinda England
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Van T Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Karilynn Rockhill
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jason Hsia
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Tim McAfee
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Deesha Patel
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Katelin Rupp
- Indiana State Department of Health, Tobacco Prevention and Cessation Commission, Indianapolis, Indiana, USA
| | - Elizabeth J Conrey
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Ohio Department of Mental Health, Columbus, Ohio, USA
| | | | - Kevin C Davis
- Center for Health Policy Science and Tobacco, RTI International, Research Triangle Park, North Carolina, USA
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Abstract
BACKGROUND Healthcare professionals, including nurses, frequently advise people to improve their health by stopping smoking. Such advice may be brief, or part of more intensive interventions. OBJECTIVES To determine the effectiveness of nursing-delivered smoking cessation interventions in adults. To establish whether nursing-delivered smoking cessation interventions are more effective than no intervention; are more effective if the intervention is more intensive; differ in effectiveness with health state and setting of the participants; are more effective if they include follow-ups; are more effective if they include aids that demonstrate the pathophysiological effect of smoking. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register and CINAHL in January 2017. SELECTION CRITERIA Randomized trials of smoking cessation interventions delivered by nurses or health visitors with follow-up of at least six months. DATA COLLECTION AND ANALYSIS Two review authors extracted data independently. The main outcome measure was abstinence from smoking after at least six months of follow-up. We used the most rigorous definition of abstinence for each trial, and biochemically-validated rates if available. Where statistically and clinically appropriate, we pooled studies using a Mantel-Haenszel fixed-effect model and reported the outcome as a risk ratio (RR) with a 95% confidence interval (CI). MAIN RESULTS Fifty-eight studies met the inclusion criteria, nine of which are new for this update. Pooling 44 studies (over 20,000 participants) comparing a nursing intervention to a control or to usual care, we found the intervention increased the likelihood of quitting (RR 1.29, 95% CI 1.21 to 1.38); however, statistical heterogeneity was moderate (I2 = 50%) and not explained by subgroup analysis. Because of this, we judged the quality of evidence to be moderate. Despite most studies being at unclear risk of bias in at least one domain, we did not downgrade the quality of evidence further, as restricting the main analysis to only those studies at low risk of bias did not significantly alter the effect estimate. Subgroup analyses found no evidence that high-intensity interventions, interventions with additional follow-up or interventions including aids that demonstrate the pathophysiological effect of smoking are more effective than lower intensity interventions, or interventions without additional follow-up or aids. There was no evidence that the effect of support differed by patient group or across healthcare settings. AUTHORS' CONCLUSIONS There is moderate quality evidence that behavioural support to motivate and sustain smoking cessation delivered by nurses can lead to a modest increase in the number of people who achieve prolonged abstinence. There is insufficient evidence to assess whether more intensive interventions, those incorporating additional follow-up, or those incorporating pathophysiological feedback are more effective than one-off support. There was no evidence that the effect of support differed by patient group or across healthcare settings.
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Affiliation(s)
- Virginia Hill Rice
- Wayne State UniversityCollege of Nursing5557 Cass AvenueDetroitMichiganUSA48202
| | - Laura Heath
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Jonathan Livingstone‐Banks
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Fanshawe TR, Halliwell W, Lindson N, Aveyard P, Livingstone‐Banks J, Hartmann‐Boyce J. Tobacco cessation interventions for young people. Cochrane Database Syst Rev 2017; 11:CD003289. [PMID: 29148565 PMCID: PMC6486118 DOI: 10.1002/14651858.cd003289.pub6] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Most tobacco control programmes for adolescents are based around prevention of uptake, but teenage smoking is still common. It is unclear if interventions that are effective for adults can also help adolescents to quit. This is the update of a Cochrane Review first published in 2006. OBJECTIVES To evaluate the effectiveness of strategies that help young people to stop smoking tobacco. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's Specialized Register in June 2017. This includes reports for trials identified in CENTRAL, MEDLINE, Embase and PsyclNFO. SELECTION CRITERIA We included individually and cluster-randomized controlled trials recruiting young people, aged under 20 years, who were regular tobacco smokers. We included any interventions for smoking cessation; these could include pharmacotherapy, psycho-social interventions and complex programmes targeting families, schools or communities. We excluded programmes primarily aimed at prevention of uptake. The primary outcome was smoking status after at least six months' follow-up among those who smoked at baseline. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the eligibility of candidate trials and extracted data. We evaluated included studies for risk of bias using standard Cochrane methodology and grouped them by intervention type and by the theoretical basis of the intervention. Where meta-analysis was appropriate, we estimated pooled risk ratios using a Mantel-Haenszel fixed-effect method, based on the quit rates at six months' follow-up. MAIN RESULTS Forty-one trials involving more than 13,000 young people met our inclusion criteria (26 individually randomized controlled trials and 15 cluster-randomized trials). We judged the majority of studies to be at high or unclear risk of bias in at least one domain. Interventions were varied, with the majority adopting forms of individual or group counselling, with or without additional self-help materials to form complex interventions. Eight studies used primarily computer or messaging interventions, and four small studies used pharmacological interventions (nicotine patch or gum, or bupropion). There was evidence of an intervention effect for group counselling (9 studies, risk ratio (RR) 1.35, 95% confidence interval (CI) 1.03 to 1.77), but not for individual counselling (7 studies, RR 1.07, 95% CI 0.83 to 1.39), mixed delivery methods (8 studies, RR 1.26, 95% CI 0.95 to 1.66) or the computer or messaging interventions (pooled RRs between 0.79 and 1.18, 9 studies in total). There was no clear evidence for the effectiveness of pharmacological interventions, although confidence intervals were wide (nicotine replacement therapy 3 studies, RR 1.11, 95% CI 0.48 to 2.58; bupropion 1 study RR 1.49, 95% CI 0.55 to 4.02). No subgroup precluded the possibility of a clinically important effect. Studies of pharmacotherapies reported some adverse events considered related to study treatment, though most were mild, whereas no adverse events were reported in studies of behavioural interventions. Our certainty in the findings for all comparisons is low or very low, mainly because of the clinical heterogeneity of the interventions, imprecision in the effect size estimates, and issues with risk of bias. AUTHORS' CONCLUSIONS There is limited evidence that either behavioural support or smoking cessation medication increases the proportion of young people that stop smoking in the long-term. Findings are most promising for group-based behavioural interventions, but evidence remains limited for all intervention types. There continues to be a need for well-designed, adequately powered, randomized controlled trials of interventions for this population of smokers.
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Affiliation(s)
- Thomas R Fanshawe
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - William Halliwell
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - Nicola Lindson
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
| | - Paul Aveyard
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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Higgins ST, Redner R, Arger CA, Kurti AN, Priest JS, Bunn JY. Use of higher-nicotine/tar-yield (regular full-flavor) cigarettes is associated with nicotine dependence and smoking during pregnancy among U.S. women. Prev Med 2017; 104:57-62. [PMID: 28789980 PMCID: PMC5858192 DOI: 10.1016/j.ypmed.2017.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/26/2017] [Accepted: 07/31/2017] [Indexed: 02/07/2023]
Abstract
The present study examined full-flavor cigarette use among women of reproductive age to assess whether use is associated with greater nicotine dependence and smoking during pregnancy. We used data from the National Survey on Drug Use and Health (2005-2014). Consecutive years were combined to assure sufficient numbers of pregnant women. We examined whether use of full-flavor cigarettes was associated with greater odds of nicotine dependence using the Fagerstrom Test for Nicotine Dependence and Nicotine Dependence Syndrome Scale (NDSS), controlling for other smoking characteristics. We next compared prevalence of smoking and use of full-flavor versus lower-yield cigarettes among non-pregnant versus pregnant women and across trimesters. Lastly, we examined whether pregnancy was associated with greater odds of using full-flavor cigarettes after controlling for potential confounders. Use of full-flavor cigarettes was associated with greater adjusted odds of nicotine dependence compared to lower yields among non-pregnant (Fagerstrom: 2.50, 95% CI: 2.32,2.70; NDSS: 1.75, 95% CI: 1.62,1.88) and pregnant (Fagerstrom: 1.53, 95% CI: 1.13,2.05; NDSS: 1.53, 95% CI: 1.12,2.10) smokers. As smoking prevalence decreased among pregnant compared to non-pregnant women (14.31±0.55% versus 22.73±0.17%), prevalence of using full-flavor cigarettes increased (54.82±1.63% versus 38.86±0.35%). Similarly, as smoking prevalence decreased from 1st to 3rd trimester (19.65±1.2%, 12.50±0.84%, 11.3±0.83%), prevalence of using full-flavor cigarettes increased (53.12±2.53%, 50.57+2.92%, 63.63±3.19%). Overall, pregnancy was associated with 1.43 (95% CI: 1.22, 1.68) greater adjusted odds of full-flavor cigarette use. These results indicate that users of full-flavor cigarettes have greater nicotine-dependence risk and lower likelihood of quitting smoking during pregnancy, relationships with potential for serious adverse maternal-infant health impacts.
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Affiliation(s)
- Stephen T Higgins
- University of Vermont Tobacco Center of Regulatory Science, United States; Departments of Psychiatry, University of Vermont, United States; Psychological Science, University of Vermont, United States.
| | - Ryan Redner
- University of Vermont Tobacco Center of Regulatory Science, United States; Rehabilitation Institute, Southern Illinois University, United States
| | - Christopher A Arger
- University of Vermont Tobacco Center of Regulatory Science, United States; Departments of Psychiatry, University of Vermont, United States
| | - Allison N Kurti
- University of Vermont Tobacco Center of Regulatory Science, United States
| | - Jeff S Priest
- University of Vermont Tobacco Center of Regulatory Science, United States; Medical Biostatistics, University of Vermont, United States
| | - Janice Y Bunn
- University of Vermont Tobacco Center of Regulatory Science, United States; Medical Biostatistics, University of Vermont, United States
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178
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Tobacco Use and Women's Health. Nurs Womens Health 2017; 21:406-408. [PMID: 28987214 DOI: 10.1016/s1751-4851(17)30267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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179
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Gould GS, Bar-Zeev Y, Bovill M, Atkins L, Gruppetta M, Clarke MJ, Bonevski B. Designing an implementation intervention with the Behaviour Change Wheel for health provider smoking cessation care for Australian Indigenous pregnant women. Implement Sci 2017; 12:114. [PMID: 28915815 PMCID: PMC5602934 DOI: 10.1186/s13012-017-0645-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indigenous smoking rates are up to 80% among pregnant women: prevalence among pregnant Australian Indigenous women was 45% in 2014, contributing significantly to the health gap for Indigenous Australians. We aimed to develop an implementation intervention to improve smoking cessation care (SCC) for pregnant Indigenous smokers, an outcome to be achieved by training health providers at Aboriginal Medical Services (AMS) in a culturally competent approach, developed collaboratively with AMS. METHOD The Behaviour Change Wheel (BCW), incorporating the COM-B model (capability, opportunity and motivation for behavioural interventions), provided a framework for the development of the Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy implementation intervention at provider and patient levels. We identified evidence-practice gaps through (i) systematic literature reviews, (ii) a national survey of clinicians and (iii) a qualitative study of smoking and quitting with Aboriginal mothers. We followed the three stages recommended in Michie et al.'s "Behaviour Change Wheel" guide. RESULTS Targets identified for health provider behaviour change included the following: capability (psychological capability, knowledge and skills) by training clinicians in pharmacotherapy to assist women to quit; motivation (optimism) by presenting evidence of effectiveness, and positive testimonials from patients and clinicians; and opportunity (environmental context and resources) by promoting a whole-of-service approach and structuring consultations using a flipchart and prompts. Education and training were selected as the main intervention functions. For health providers, the delivery mode was webinar, to accommodate time and location constraints, bringing the training to the services; for patients, face-to-face consultations were supported by a booklet embedded with videos to improve patients' capability, opportunity and motivation. CONCLUSIONS The ICAN QUIT in Pregnancy was an intervention to train health providers at Aboriginal Medical Services in how to implement culturally competent evidence-based practice including counselling and nicotine replacement therapy for pregnant patients who smoke. The BCW aided in scientifically and systematically informing this targeted implementation intervention based on the identified gaps in SCC by health providers. Multiple factors impact at systemic, provider, community and individual levels. This process was therefore important for defining the design and intervention components, prior to a conducting a pilot feasibility trial, then leading on to a full clinical trial.
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Affiliation(s)
- Gillian S Gould
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
| | - Yael Bar-Zeev
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Michelle Bovill
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Lou Atkins
- University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Maree Gruppetta
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Marilyn J Clarke
- Clarence Specialist Clinic, 86 Through Street, South Grafton, NSW, 2460, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
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McConnachie A, Haig C, Sinclair L, Bauld L, Tappin DM. Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis. Trials 2017; 18:337. [PMID: 28728583 PMCID: PMC5520300 DOI: 10.1186/s13063-017-2053-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 06/19/2017] [Indexed: 11/26/2022] Open
Abstract
Background The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis. Methods CPIT offered financial incentives up to £400 to pregnant smokers to quit. With incentives, 68 women (23.1%) were confirmed non-smokers at primary outcome, compared to 25 (8.7%) without incentives, a difference of 14.3% (Fisher test, p < 0.0001). For this analysis, randomised groups were split into three theoretical sub-groups: independent quitters - quit without incentives, hardened smokers - could not quit even with incentives and potential quitters - required the addition of financial incentives to quit. Viewed in this way, the overall birth weight gain with incentives is attributable only to potential quitters. We compared an intuitive approach to a CACE analysis. Results Mean birth weight of potential quitters in the incentives intervention group (who therefore quit) was 3338 g compared with potential quitters in the control group (who did not quit) 3193 g. The difference attributable to incentives, was 3338 – 3193 = 145 g (95% CI −617, +803). The mean difference in birth weight between the intervention and control groups was 21 g, and the difference in the proportion who managed to quit was 14.3%. Since the intervention consisted of the offer of incentives to quit smoking, the intervention was received by all women in the intervention group. However, “compliance” was successfully quitting with incentives, and the CACE analysis yielded an identical result, causal birth weight increase 21 g ÷ 0.143 = 145 g. Conclusions Policy makers have great difficulty giving pregnant women money to stop smoking. This study indicates that a small clinically insignificant improvement in average birth weight is likely to hide an important clinically significant increase in infants born to pregnant smokers who want to stop but cannot achieve smoking cessation without the addition of financial voucher incentives. Trial Registration ISRCTN Registry, ISRCTN87508788. Registered on 1 September 2011. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2053-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alex McConnachie
- Robertson Centre, Level 11, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Caroline Haig
- Robertson Centre, Level 11, Boyd Orr Building, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Lesley Sinclair
- Institute for Social Marketing, Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - Linda Bauld
- Institute for Social Marketing, Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences & Sport, University of Stirling, Stirling, FK9 4LA, UK
| | - David M Tappin
- Section of Child Health, School of Medicine, Glasgow University, Scottish Cot Death Trust, 5th floor, West Glasgow Ambulatory Care Hospital, Yorkhill, Glasgow, G3 8SJ, UK.
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