1
|
Gregory EF, Maddox AI, Tindall A, Ibarra JL, Virudachalam S. Comparison of Cardiovascular Health Between Parents and Non-Parents in NHANES 2011-2018. FAMILY & COMMUNITY HEALTH 2024; 47:231-238. [PMID: 38713758 DOI: 10.1097/fch.0000000000000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND AND OBJECTIVES We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8). METHODS This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The exposure was parenting, defined as living with a child. Logistic regression assessed whether parenting was associated with odds of ideal LE8 total or sub-scores. Regression adjusted for age, sex, race and ethnicity, educational attainment, marital status, and income. Subgroups included female sex, male sex, income <150% federal poverty levels, and parents of younger children. RESULTS 6847 participants represented a weighted population of 79 120 285 (57% parents). Parenting was not associated with adjusted odds of ideal total LE8 (OR 0.91, 95% CI 0.76-1.09). Parenting was associated with decreased odds of ideal body mass index (BMI) (OR 0.81, 95% CI 0.72-0.91) and increased odds of smoking avoidance (OR 1.22, 95% CI 1.09-1.38). Associations varied by subgroup. Only the subgroup with lower incomes demonstrated reduced odds of ideal total LE8 for parents (OR 0.58, 95% CI 0.41-0.82). CONCLUSIONS Parents and non-parents differed in smoking and BMI, though not in LE8 total. Families with low incomes may particularly benefit from dual generation cardiovascular risk reduction.
Collapse
Affiliation(s)
- Emily F Gregory
- Author Affiliations: Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA (Drs Gregory and Tindall, Mr Ibarra, and Dr Virudachalam); Clinical Futures, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Gregory, Ms Maddox, and Drs Tindall and Virudachalam); PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA (Dr Gregory, Ms Maddox, and Drs Tindall and Virudachalam)
| | | | | | | | | |
Collapse
|
2
|
Morris RK, Johnstone E, Lees C, Morton V, Smith G. Investigation and Care of a Small-for-Gestational-Age Fetus and a Growth Restricted Fetus (Green-top Guideline No. 31). BJOG 2024. [PMID: 38740546 DOI: 10.1111/1471-0528.17814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Key recommendations
All women should be assessed at booking (by 14 weeks) for risk factors for fetal growth restriction (FGR) to identify those who require increased surveillance using an agreed pathway [Grade GPP]. Findings at the midtrimester anomaly scan should be incorporated into the fetal growth risk assessment and the risk assessment updated throughout pregnancy. [Grade GPP]
Reduce smoking in pregnancy by identifying women who smoke with the assistance of carbon monoxide (CO) testing and ensuring in‐house treatment from a trained tobacco dependence advisor is offered to all pregnant women who smoke, using an opt‐out referral process. [Grade GPP]
Women at risk of pre‐eclampsia and/or placental dysfunction should take aspirin 150 mg once daily at night from 12+0–36+0 weeks of pregnancy to reduce their chance of small‐for‐gestational‐age (SGA) and FGR. [Grade A]
Uterine artery Dopplers should be carried out between 18+0 and 23+6 weeks for women at high risk of fetal growth disorders [Grade B]. In a woman with normal uterine artery Doppler and normal fetal biometry at the midtrimester scan, serial ultrasound scans for fetal biometry can commence at 32 weeks. Women with an abnormal uterine artery Doppler (mean pulsatility index > 95th centile) should commence ultrasound scans at 24+0–28+6 weeks based on individual history. [Grade B]
Women who are at low risk of FGR should have serial measurement of symphysis fundal height (SFH) at each antenatal appointment after 24+0 weeks of pregnancy (no more frequently than every 2 weeks). The first measurement should be carried out by 28+6 weeks. [Grade C]
Women in the moderate risk category are at risk of late onset FGR so require serial ultrasound scan assessment of fetal growth commencing at 32+0 weeks. For the majority of women, a scan interval of four weeks until birth is appropriate. [Grade B]
Maternity providers should ensure that they clearly identify the reference charts to plot SFH, individual biometry and estimated fetal weight (EFW) measurements to calculate centiles. For individual biometry measurements the method used for measurement should be the same as those used in the development of the individual biometry and fetal growth chart [Grade GPP]. For EFW the Hadlock three parameter model should be used. [Grade C]
Maternity providers should ensure that they have guidance that promotes the use of standard planes of acquisition and calliper placement when performing ultrasound scanning for fetal growth assessment. Quality control of images and measurements should be undertaken. [Grade C]
Ultrasound biometry should be carried out every 2 weeks in fetuses identified to be SGA [Grade C]. Umbilical artery Doppler is the primary surveillance tool and should be carried out at the point of diagnosis of SGA and during follow‐up as a minimum every 2 weeks. [Grade B]
In fetuses with an EFW between the 3rd and 10th centile, other features must be present for birth to be recommended prior to 39+0 weeks, either maternal (maternal medical conditions or concerns regarding fetal movements) or fetal compromise (a diagnosis of FGR based on Doppler assessment, fetal growth velocity or a concern on cardiotocography [CTG]) [Grade C]. For fetuses with an EFW or abdominal circumference less than the 10th centile where FGR has been excluded, birth or the initiation of induction of labour should be considered at 39+0 weeks after discussion with the woman and her partner/family/support network. Birth should occur by 39+6 weeks. [Grade B]
Pregnancies with early FGR (prior to 32+0 weeks) should be monitored and managed with input from tertiary level units with the highest level neonatal care. Care should be multidisciplinary by neonatology and obstetricians with fetal medicine expertise, particularly when extremely preterm (before 28 weeks) [Grade GPP]. Fetal biometry in FGR should be repeated every 2 weeks [Grade B]. Assessment of fetal wellbeing can include multiple modalities but must include computerised CTG and/or ductus venous. [Grade B]
In pregnancies with late FGR, birth should be initiated from 37+0 weeks to be completed by 37+6 weeks [Grade A]. Decisions for birth should be based on fetal wellbeing assessments or maternal indication. [Grade GPP]
Collapse
|
3
|
Jao NC, Tan MM, Albanese A, Lee J, Stroud LR. Perceptions of family functioning impact smoking during pregnancy. J Addict Dis 2024:1-10. [PMID: 38619008 DOI: 10.1080/10550887.2024.2327732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Although socio-environmental factors are known to contribute to the maintenance of smoking behavior, few studies have examined the impact of family functioning on smoking during pregnancy. OBJECTIVE The current study examined the relationship between perceptions of family functioning and smoking during pregnancy. METHODS Pregnant women (N = 345, 59% ethnic/racial minority) completed the Family Assessment Device, a gold-standard assessment examining perceptions of family functioning in seven domains. Multinomial logistic regressions analyzed associations between clinically determined suboptimal levels of family functioning by domain and smoking status during pregnancy (smoking, ≥28 continuous days quit, nonsmoking), with stratified analyses exploring ethnic/racial differences (non-Hispanic/White vs. racial/ethnic minority). RESULTS Participants who reported suboptimal levels of family functioning in domains of Affective Involvement, Affective Responsiveness, Behavioral Control, and Roles were significantly more likely to have been smoking than nonsmoking during pregnancy. Stratified analyses revealed differing effects by ethnic/racial identity, with perceptions of Roles remaining the only significant effect on smoking outcomes for both groups. No significant effects were found regarding the impact of family functioning on whether participants were smoking vs. quit during pregnancy. CONCLUSIONS Suboptimal family functioning may contribute to smoking during pregnancy, but effects may differ based on domain of family functioning and by ethnic/racial identity.
Collapse
Affiliation(s)
- Nancy C Jao
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Marcia M Tan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
| | - Ariana Albanese
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Jacinda Lee
- Department of Psychology, College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Laura R Stroud
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, RI, USA
| |
Collapse
|
4
|
Woodrow N, Gillespie D, Kitchin L, O'Brien M, Chapman S, Chng NR, Passey A, Aquino MRJ, Clarke Z, Goyder E. Reintroducing face-to-face support alongside remote support to form a hybrid stop smoking service in England: a formative mixed methods evaluation. BMC Public Health 2024; 24:718. [PMID: 38448869 PMCID: PMC10916048 DOI: 10.1186/s12889-024-18235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, United Kingdom (UK) stop smoking services had to shift to remote delivery models due to social distancing regulations, later reintroducing face-to-face provision. The "Living Well Smokefree" service in North Yorkshire County Council adopted a hybrid model offering face-to-face, remote, or a mix of both. This evaluation aimed to assess the hybrid approach's strengths and weaknesses and explore potential improvements. METHODS Conducted from September 2022 to February 2023, the evaluation consisted of three components. First, qualitative interviews involved 11 staff and 16 service users, analysed thematically. Second, quantitative data from the QuitManager system that monitored the numbers and proportions of individuals selecting and successfully completing a 4-week quit via each service option. Third, face-to-face service expenses data was used to estimate the value for money of additional face-to-face provision. The qualitative findings were used to give context to the quantitative data via an "expansion" approach and complementary analysis. RESULTS Overall, a hybrid model was seen to provide convenience and flexible options for support. In the evaluation, 733 individuals accessed the service, with 91.3% selecting remote support, 6.1% face-to-face, and 2.6% mixed provision. Remote support was valued by service users and staff for promoting openness, privacy, and reducing stigma, and was noted as removing access barriers and improving service availability. However, the absence of carbon monoxide monitoring in remote support raised accountability concerns. The trade-off in "quantity vs. quality" of quits was debated, as remote support reached more users but produced fewer carbon monoxide-validated quits. Primarily offering remote support could lead to substantial workloads, as staff often extend their roles to include social/mental health support, which was sometimes emotionally challenging. Offering service users a choice of support options was considered more important than the "cost-per-quit". Improved dissemination of information to support service users in understanding their options for support was suggested. CONCLUSIONS The hybrid approach allows smoking cessation services to evaluate which groups benefit from remote, face-to-face, or mixed options and allocate resources accordingly. Providing choice, flexible provision, non-judgmental support, and clear information about available options could improve engagement and match support to individual needs, enhancing outcomes.
Collapse
Affiliation(s)
- Nicholas Woodrow
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK.
| | - Duncan Gillespie
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Liz Kitchin
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Mark O'Brien
- Living Well Smokefree Service, North Yorkshire Council, York, UK
| | - Scott Chapman
- Living Well Smokefree Service, North Yorkshire Council, York, UK
| | - Nai Rui Chng
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Andrew Passey
- School of Health, Leeds Beckett University, LS1 3HE, Leeds, UK
| | - Maria Raisa Jessica Aquino
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Clarke
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- Sheffield Centre for Health and Related Research (SCHARR), University of Sheffield, Sheffield, UK
| |
Collapse
|
5
|
Siersbaek R, Kavanagh P, Ford J, Burke S, Parker S. How and why do financial incentives contribute to helping people stop smoking? A realist review. BMC Public Health 2024; 24:500. [PMID: 38365629 PMCID: PMC10873947 DOI: 10.1186/s12889-024-17967-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Tobacco smoking remains a key cause of preventable illness and death globally. In response, many countries provide extensive services to help people to stop smoking by offering a variety of effective behavioural and pharmacological therapies. However, many people who wish to stop smoking do not have access to or use stop smoking supports, and new modes of support, including the use of financial incentives, are needed to address this issue. A realist review of published international literature was undertaken to understand how, why, for whom, and in which circumstances financial incentives contribute to success in stopping smoking for general population groups and among pregnant women. METHODS Systematic searches were undertaken from inception to February 2022 of five academic databases: MEDLINE (ovid), Embase.com, CIHAHL, Scopus and PsycINFO. Study selection was inclusive of all study designs. Twenty-two studies were included. Using Pawson and Tilley's iterative realist review approach, data collected were screened, selected, coded, analysed, and synthesised into a set of explanatory theoretical findings. RESULTS Data were synthesised into six Context-Mechanism-Outcome Configurations and one overarching programme theory after iterative rounds of analysis, team discussion, and expert panel feedback. Our programme theory shows that financial incentives are particularly useful to help people stop smoking if they have a financial need, are pregnant or recently post-partum, have a high threshold for behaviour change, and/or respond well to external rewards. The incentives work through a number of mechanisms including the role their direct monetary value can play in a person's life and through a process of reinforcement where they can help build confidence and self-esteem. CONCLUSION This is the first realist review to synthesise how, why, and for whom financial incentives work among those attempting to stop smoking, adding to the existing evidence demonstrating their efficacy. The findings will support the implementation of current knowledge into effective programmes which can enhance the impact of stop smoking care. PROSPERO REGISTRATION NUMBER CRD42022298941.
Collapse
Affiliation(s)
- Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, Ireland.
| | - Paul Kavanagh
- Health Intelligence, Strategic Planning and Transformation, 4th Floor, Jervis House, Jervis Street, Dublin, Ireland
| | - John Ford
- Wolfson Institute for Population Health, Queen Mary University, Charterhouse Square, EC1M 6BQ, London, UK
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, Ireland
| | - Sarah Parker
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, Ireland
| |
Collapse
|
6
|
Pierrot B, Legendre G, Riou J, Gentil A, Molle-Guiliani B, Petit A. Pregnancy and tobacco: Practice and knowledge of French midwives. Midwifery 2024; 129:103886. [PMID: 38041997 DOI: 10.1016/j.midw.2023.103886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/01/2023] [Accepted: 11/13/2023] [Indexed: 12/04/2023]
Abstract
OBJECTIVES Evaluate the midwives' practices and knowledges with regard to the management of the smoking cessation in pregnant women and analyse the profile of midwives prescribing nicotine replacement therapy (NRT). METHODS A national practice survey amongst 23,541 French midwives was conducted from 1 September 2020 to 15 September 2021 using an online self-administered questionnaire. RESULTS The analysis of the 1,216 usable questionnaires (97, 7% women, mostly aged 30 to 49 years and non-smokers) showed that 93.4% of midwives frequently questioned pregnant women about their smoking consumption during pregnancy. The minimal counselling was known and practiced by 91% of midwives, the Fagerström test by 26.9% and the measurement of exhaled CO by 27.1%. Concerning NRT, 60% of the midwives prescribed them in a usual way and 36.8% were aware of the possibility of prescribing them to the pregnant woman's entourage. The profile of midwives prescribing NRT was significantly more concerned with smoking cessation in pregnant women; worked more frequently in a hospital; carried out 25% or more of antenatal monitoring consultations; and had significantly better knowledge of the evaluation tools, without influence of sex or smoking status. CONCLUSIONS Improving the training of midwives in the screening and management of smoking cessation during pregnancy seems necessary.
Collapse
Affiliation(s)
- Béatrice Pierrot
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France; École de Sages-Femmes, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France; Unité de Coordination de Tabacologie, Département de Pneumologie, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France; Irset, Inserm UMR 1085, Equipe Ester, UFR Santé, Département de Médecine, Rue Haute de Reculée 49045 Angers Cedex, France.
| | - Guillaume Legendre
- Service de Gynécologie-Obstétrique, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France; École de Sages-Femmes, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France
| | - Jérémie Riou
- MINT, UMR INSERM 1066, UMR CNRS 6021, UNIV Angers, Micro Et Nano Médecines Translationnelles, Angers, France; Methodology and Biostatistics Department, Delegation to Clinical Research and Innovation, Angers University Hospital, 49100, Angers, France
| | - Alexandra Gentil
- Unité de Coordination de Tabacologie, Département de Pneumologie, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France
| | - Brigitte Molle-Guiliani
- Unité de Coordination de Tabacologie, Département de Pneumologie, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 ANGERS cedex 9, France
| | - Audrey Petit
- Irset, Inserm UMR 1085, Equipe Ester, UFR Santé, Département de Médecine, Rue Haute de Reculée 49045 Angers Cedex, France
| |
Collapse
|
7
|
Muza LC, Egenasi CK, Steinberg WJ, Benedict MO, Habib T, Mampuya F, van Rooyen C. Healthcare providers' knowledge, attitudes and practices on smoking cessation intervention in the Northern Cape. Health SA 2024; 29:2489. [PMID: 38322372 PMCID: PMC10839220 DOI: 10.4102/hsag.v29i0.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/12/2023] [Indexed: 02/08/2024] Open
Abstract
Background Clinicians are crucial in encouraging smokers to quit through behavioural or pharmacological smoking cessation interventions. Smokers quit better with professional help. The level of healthcare providers' (HCPs) knowledge, attitudes and counselling skills related to effective smoking cessation support in the study area remains uncertain. Aim The study aimed to determine HCPs' knowledge, attitudes and practices (KAP) on smoking cessation intervention strategies in the Sol Plaatje district, Northern Cape. Setting Sol Plaatje's 13 district municipality clinics, Kimberley, Northern Cape. Method A descriptive, cross-sectional analytical study involving healthcare workers in the above setting. Results A total of 165 HCPs, including medical officers, professional nurses, enrolled nurses and assistant-enrolled nurses working in primary healthcare clinics, were invited to participate in the study, with 156 completing the questionnaires. About 53.9% had no knowledge of South African tobacco smoking cessation guidelines, while 87.2% knew the importance of counselling patients about smoking and its impact on quitting. The majority of them did not know the medicines recommended for tobacco treatment in South Africa. About 89.7% expressed that smoking cessation counselling is an important part of their jobs. However, less than half indicated that they make follow-up arrangements for those attempting to quit. Conclusion The study revealed gaps in KAP regarding smoking cessation among the respondents, necessitating the need for continuing education on the existing smoking cessation guidelines among these HCPs. Contribution The results of this study will help to improve smoking cessation intervention knowledge among health providers.
Collapse
Affiliation(s)
- Lizwe C Muza
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Family Medicine, Robert Mangaliso Sobukwe Hospital, Kimberley, South Africa
| | - Chika K Egenasi
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Wilhelm J Steinberg
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Mathew O Benedict
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Talat Habib
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
- Department of Family Medicine, Robert Mangaliso Sobukwe Hospital, Kimberley, South Africa
| | - Ferdinand Mampuya
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Cornel van Rooyen
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
8
|
Hjern A, Brannstrom L, Vinnerljung B, Batty GD. WITHDRAWN: Cardiovascular disease in individuals with a history of out-of-home care: a Swedish national cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.20.23284828. [PMID: 36711699 PMCID: PMC9882626 DOI: 10.1101/2023.01.20.23284828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The authors have withdrawn their manuscript owing to errors apparent in the results. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
Collapse
|
9
|
Lisik F, Piketty-Desfeux M, Tchikladze C, Glowaczower É. The effectiveness of an intervention to reduce exposure to trace metals during or prior to pregnancy: A prospective study in urban and rural locations. Heliyon 2023; 9:e21293. [PMID: 37954379 PMCID: PMC10637957 DOI: 10.1016/j.heliyon.2023.e21293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/10/2023] [Accepted: 10/19/2023] [Indexed: 11/14/2023] Open
Abstract
Background Prenatal exposure to trace metals can have adverse effects on health and increase the risk of developing certain diseases. This study aimed to determine the effectiveness of giving women advice to reduce their exposure to trace metals during pregnancy or prior to conception. The study also examined differences in exposure between rural and urban environments in southern France. Methods In this prospective study, pregnant women or those intending to conceive were recruited from two medical centers for gynecology/obstetrics (rural location: Saint-Rémy-de-Provence; urban location: Marseille). Hair samples were collected and analyzed to determine the levels of exposure to trace metals. Participants with 'risky' levels were given corresponding advice sheets on how to reduce their exposure or, for certain metals, they were encouraged to find out about potential sources of exposure. A second hair sample was collected and analyzed 3 months later. Results It was found that 109 women had 'risky' levels of exposure to trace metals, out of a total of 184 women (59.2 %). Cerium was the most frequently identified metal (N = 26), followed by nickel (N = 23), and titanium (N = 19). There were more women at the urban center with 'risky' levels (56/86; 65.1 %) than at the rural center (53/98; 54.1 %), but this difference was not statistically significant (p = 0.13). Advice sheets were given to 64 of the 109 participants with 'risky' levels (58.7 %), but only 21 returned for the second hair analysis. Of these, 14 were found to have reduced their exposure, which corresponds to just 12.8 % (14/109) of the participants with 'risky' levels. Conclusions These results indicate that it would be helpful to develop new interventions to reduce trace metal exposure during or prior to pregnancy.
Collapse
Affiliation(s)
- François Lisik
- St Bernard Medical Center, 1 Avenue Maréchal de Lattre de Tassigny, 13210, Saint Remy de Provence, France
- Urbain V Polyclinic, Elsan, Chemin Du Pont des Deux Eaux, 84036, Avignon, France
| | - Mathilde Piketty-Desfeux
- St Bernard Medical Center, 1 Avenue Maréchal de Lattre de Tassigny, 13210, Saint Remy de Provence, France
| | | | - Éric Glowaczower
- Carré Saint-Giniez Medical Practice, 345 Avenue Du Prado, 13008, Marseille, France
- Bouchard Clinic, Elsan, 77 Rue Du Docteur Escat, 13006, Marseille, France
| |
Collapse
|
10
|
Wiles SD, Lee JW, Nelson A, Petersen AB, Singh PN. Racial/Ethnic Disparities Impact the Real-World Effectiveness of a Multicomponent Maternal Smoking Cessation Program: Findings from the CTTP Cohort. Matern Child Health J 2023; 27:2038-2047. [PMID: 37589829 PMCID: PMC10564824 DOI: 10.1007/s10995-023-03753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Smoking during pregnancy adversely affects perinatal outcomes for both women and infants. We conducted a retrospective cohort study of the state-funded Comprehensive Tobacco Treatment Program (CTTP) - the largest maternal tobacco cessation program in San Bernardino County, California - to determine the real-world program effectiveness and to identify variables that can potentially improve effectiveness. METHODS During 2012-2019, women who smoked during pregnancy were enrolled in CTTP's multicomponent behavioral smoking cessation program that implemented components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). RESULTS We found that 40.1% achieved prolonged abstinence by achieving weekly, cotinine-verified, 7-day abstinence during 6 to 8 weeks of enrollment. Using intention-to-treat analyses, we computed that the self-reported point prevalence abstinence rate (PPA) at the six-month telephone follow-up was 36.7%. Cohort members achieving prolonged abstinence during the CTTP were five times more likely to achieve PPA six months after CTTP. Several non-Hispanic ethnicities (Black, Native American, White, or More than one ethnicity) in the cohort were two-fold less likely (relative to Hispanics) to achieve prolonged abstinence during CTTP or PPA at six months after CTTP. This disparity was further investigated in mediation analysis. Variables such as quitting during the first trimester and smoking fewer cigarettes at enrollment were also associated with achieving PPA at six months. DISCUSSION Racial/ethnic health disparities that have long been linked to a higher rate of maternal smoking persist even when the pregnant smoker enrolls in a smoking cessation program.
Collapse
Affiliation(s)
- Stacey D Wiles
- Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Jerry W Lee
- Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Anna Nelson
- Health Promotion and Education, School of Public Health, Loma Linda University, Loma Linda, CA, USA
| | - Anne Berit Petersen
- Nursing and Global Health, Schools of Nursing and Public Health, Transdisciplinary Tobacco Research Program, Loma Linda University, Loma Linda University Cancer Center, Loma Linda, CA, USA.
| | - Pramil N Singh
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, Loma Linda, CA, USA
| |
Collapse
|
11
|
Dueñas-Garcia O, Lindsey R, Elly M, Kelly L, Janine B, Amna U, Catherine H, Christa L. Perinatal outcomes in women referred to the West Virginia University Assist Connect and Encourage (ACE) - A program of the Drug Free Moms and Babies Project (DFMB) for women with substance use during pregnancy. Prev Med Rep 2023; 35:102312. [PMID: 37455760 PMCID: PMC10339237 DOI: 10.1016/j.pmedr.2023.102312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
The main objective of this study was to analyze perinatal outcomes of women with substance use disorder in pregnancy who participated in the West Virginia University Medicine Drug Free Moms and Babies Assist Connect and Encourage program (DFMB/ACE) compared to women who were not enrolled in the program. This was a retrospective cohort study conducted in an l Academic Tertiary Care Center. Women who enrolled in DFMB/ACE services from 2018 to 2019 were termed as the intervention group. Their outcomes were compared to 734 women who delivered at the hospital between July 2015 and December 2019 with a positive urine drug screen on admission but were not enrolled in the DFMB/ACE program. Perinatal outcomes evaluated include low birth weight, preterm labor, neonatal intensive care unit (NICU) admission, preterm birth, neonatal abstinence syndrome (NAS), cesarean delivery, cord toxicology result, hepatitis c prevalence, and breastfeeding at the time of discharge. Participants of the DFMB/ACE group had a lower risk of having a preterm birth (OR = 0.56 95% CI 0.36-0.86) compared to the control group. The DFMB/ACE group had higher birth weight compared to the non-DFMB group (2865.7 g. vs. 2657.9 g, p = 0.004). NICU admission, NAS, mode of delivery, cord toxicology, and breastfeeding rates were not statistically different between the two groups. Hepatitis C rates were significantly higher in the intervention vs. non-intervention group (OR = 2.74 95 %CI 1.80 - 4.16). We concluded that the DFMB/ACE program interventions for women with substance use in pregnancy improves some perinatal outcomes for mothers and their newborns.
Collapse
Affiliation(s)
| | | | - Marshall Elly
- West Virginia University, Morgantown, USA
- West Virginia Perinatal Partnership, Charleston, WV, USA
| | | | - Breyel Janine
- West Virginia Perinatal Partnership, Charleston, WV, USA
| | - Umer Amna
- West Virginia University, Morgantown, USA
| | | | | |
Collapse
|
12
|
Khanal S, Miani C, Finne E, Zielke J, Boeckmann M. Effectiveness of behavior change interventions for smoking cessation among expectant and new fathers: findings from a systematic review. BMC Public Health 2023; 23:1812. [PMID: 37723506 PMCID: PMC10506219 DOI: 10.1186/s12889-023-16713-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 09/06/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Smoking cessation during pregnancy and the postpartum period by both women and their partners offers multiple health benefits. However, compared to pregnant/postpartum women, their partners are less likely to actively seek smoking cessation services. There is an increased recognition about the importance of tailored approaches to smoking cessation for expectant and new fathers. While Behavior Change Interventions (BCIs) are a promising approach for smoking cessation interventions, evidence on effectiveness exclusively among expectant and new fathers are fragmented and does not allow for many firm conclusions to be drawn. METHODS We conducted a systematic review on effectiveness of BCIs on smoking cessation outcomes of expectant and new fathers both through individual and/or couple-based interventions. Peer reviewed articles were identified from eight databases without any date or language restriction.Two independent reviewers screened studies for relevance, assessed methodological quality of relevant studies, and extracted data from studies using a predeveloped data extraction sheet. RESULTS We retrieved 1222 studies, of which 39 were considered for full text screening after reviewing the titles and abstracts. An additional eight studies were identified from reviewing the reference list of review articles picked up by the databases search. A total of nine Randomised Control Trials were included in the study. Six studies targeted expectant/new fathers, two targeted couples and one primarily targeted women with an intervention component to men. While the follow-up measurements for men varied across studies, the majority reported biochemically verified quit rates at 6 months. Most of the interventions showed positive effects on cessation outcomes. BCI were heterogenous across studies. Findings are suggestive of gender targeted interventions being more likely to have positive cessation outcomes. CONCLUSIONS This systematic review found limited evidence supporting the effectiveness of BCI among expectant and new fathers, although the majority of studies show positive effects of these interventions on smoking cessation outcomes. There remains a need for more research targeted at expectant and new fathers. Further, there is a need to identify how smoking cessation service delivery can better address the needs of (all) gender(s) during pregnancy.
Collapse
Affiliation(s)
- Sudeepa Khanal
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany.
| | - Céline Miani
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Emily Finne
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Julia Zielke
- Department of Epidemiology & International Public Health, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany
| | - Melanie Boeckmann
- Department of Global Health, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| |
Collapse
|
13
|
Notley C, Brown TJ, Bauld L, Clark AB, Duneclift S, Gilroy V, Harris T, Hardeman W, Holland R, Howard G, Man MS, Naughton F, Smith D, Turner D, Ussher M. BabyBreathe trial: protocol for a randomised controlled trial of a complex intervention to prevent postpartum return to smoking. BMJ Open 2023; 13:e076458. [PMID: 37666562 PMCID: PMC10481735 DOI: 10.1136/bmjopen-2023-076458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/04/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Many people quit smoking during pregnancy, but postpartum smoking relapse is common. Maintaining smoking abstinence achieved during pregnancy is key to improving maternal and child health. There are no evidence-based interventions for preventing postpartum smoking relapse. This trial aims to determine whether an intervention to prevent postpartum relapse is effective and cost-effective. METHODS AND ANALYSIS A randomised controlled trial of a complex intervention to prevent postpartum smoking relapse (BabyBreathe), with internal pilot, economic and process evaluations. Participants are adults who are pregnant and who report having quit smoking in the 12 months before, or during pregnancy. Participants are eligible if they read and understand English, and provide informed consent. Following consent and biochemical validation of smoking abstinence, participants are randomised to intervention or usual care/control (no specific relapse prevention support). The BabyBreathe intervention consists of manualised advice from a trained member of the health visiting service, health information leaflets for participants and partners, access to the BabyBreathe website and app. At the time of birth, participants are posted the BabyBreathe box and support is provided by text message for up to 12 months postpartum. Target sample size is 880, recruiting across midwifery services at four hubs in England and Scotland and through remote advertising in England, Scotland, Wales and Northern Ireland. Outcomes are collected at 6 and 12 months. The primary outcome is self-reported sustained smoking abstinence at 12 months, carbon monoxide verified. Secondary outcomes include self-reported abstinence, time to relapse, partner smoking status and quality of life. ETHICS AND DISSEMINATION The trial was approved by the North West Preston Research Ethics committee (21/NW/0017). Dissemination will include publication in peer-reviewed journals, presentation at academic and public conferences including patient and public involvement and to policymakers and practitioners. TRIAL REGISTRATION NUMBER ISRCTN70307341.
Collapse
Affiliation(s)
- Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Linda Bauld
- The Usher Institute, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinbugh, UK
| | - Allan B Clark
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | | | - Tess Harris
- Population Health Research Institute, St Georges, University of London, London, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Gregory Howard
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mei-See Man
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Dan Smith
- School of Computing Sciences, University of East Anglia, Norwich, UK
| | - David Turner
- Norwich Clinical Trials Unit, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michael Ussher
- Population Health Research Institute, St Georges, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| |
Collapse
|
14
|
Jackson MA, Brown AL, Baker AL, Bonevski B, Haber P, Bonomo Y, Blandthorn J, Attia J, Perry N, Barker D, Gould GS, Dunlop AJ. Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial. Front Psychiatry 2023; 14:1207955. [PMID: 37654991 PMCID: PMC10467262 DOI: 10.3389/fpsyt.2023.1207955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction Most pregnant women with substance use problems smoke, and few will quit during their pregnancy. Tobacco treatment is often overlooked, with the focus usually placed on other substance use. Additionally, few targeted effective treatments for this group exist. To address this, the feasibility of an intensive tobacco treatment incorporating contingency management (CM) that featured non-face-to-face delivery was examined. Methods A single-arm pre-post design feasibility trial was conducted in three antenatal services that support women who use substances in metropolitan Australia. Participants were over the age of 15, had <33-week gestation, and smoked tobacco daily. They received financial incentives for daily carbon monoxide-verified smoking abstinence or reduction through an internet-based CM programme, nicotine replacement therapy (NRT) posted to women and partners or household members who smoked and telephone-delivered behavioral counseling from study enrolment to birth. Results Of the 101 referrals, 46 women (46%) consented. The mean (SD) age was 31(±6) years, and the gestation period was 22(±6) weeks. Nineteen (41%) of those enrolled were retained for 12-week postpartum. Of 46 women, 32 (70%) utilized CM; 32 (70%) used NRT for ≥2 weeks; 23 (50%) attended ≥1 counseling session; and 15 (22%) received NRT for partners/household members. Fifteen (33%) were verified abstinent from tobacco at delivery after a median (IQR) period of abstinence of 65(36-128) days. All non-smokers at birth utilized NRT and financial incentives, and 9/15 (60%) utilized counseling. Four (9%) were abstinent at 12-week postpartum. Median cigarettes smoked/day reduced from baseline to delivery (10(6-20) to 1(0-6) p =< 0.001). Women who quit smoking had more education (72% vs. 33% p =< 0.02), completed more CO samples (median (IQR) 101(59-157) vs. 2(0-20) p =< 0.001), and received more incentives (median (IQR) $909($225-$1980) vs. $34($3-$64) p =< 0.001). Intervention acceptability was rated favorably by participants (9 items rated 0-10 with scores >5 considered favorable). Discussion This study demonstrated the feasibility and acceptability of a consumer-informed, non-face-to-face intensive tobacco treatment, highlighting the potential of remotely delivered technology-based CM to reduce the health impact of tobacco smoking in high-priority populations. The intervention demonstrates scale-up potential. Future studies should extend treatment into the postpartum period, utilizing new technologies to enhance CM delivery and improve counseling provision and partner support. Clinical trial registration https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374196, ACTRN1261800056224.
Collapse
Affiliation(s)
- Melissa A. Jackson
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
| | - Amanda L. Brown
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Billie Bonevski
- College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Paul Haber
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
- Edith Collins Centre, Sydney Local Health District, Camperdown, NSW, Australia
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Yvonne Bonomo
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - Julie Blandthorn
- Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia
| | - John Attia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Natasha Perry
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
| | - Daniel Barker
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Gillian S. Gould
- Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia
| | - Adrian J. Dunlop
- Hunter New England Health Local Health District, Newcastle, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia
| |
Collapse
|
15
|
Bonello K, Figoni H, Blanchard E, Vignier N, Avenin G, Melchior M, Cadwallader JS, Chastang J, Ibanez G. Prevalence of smoking during pregnancy and associated social inequalities in developed countries over the 1995-2020 period: A systematic review. Paediatr Perinat Epidemiol 2023; 37:555-565. [PMID: 37427978 DOI: 10.1111/ppe.12989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 05/04/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Smoking during pregnancy (SDP) is an important source of preventable morbidity and mortality for both mother and child. OBJECTIVES The aim of this study was to describe changes in the prevalence of SDP over the last 25 years in developed countries (Human Development Index >0.8 in 2020) and associated social inequalities. DATA SOURCES A systematic review was conducted based on a search in PubMed, Embase and PsycInfo databases and government sources. STUDY SELECTION AND DATA EXTRACTION Published studies between January 1995 and March 2020, for which the primary outcome was to assess the national prevalence of SDP and the secondary outcome was to describe related socio-economic data were included in the analysis. The selected articles had to be written in English, Spanish, French or Italian. SYNTHESIS The articles were selected after successive reading of the titles, abstracts and full-length text. An independent double reading with intervention of a third reader in case of disagreement allowed including 35 articles from 14 countries in the analysis. RESULTS The prevalence of SDP differed across the countries studied despite comparable levels of development. After 2015, the prevalence of SDP ranged between 4.2% in Sweden and 16.6% in France. It was associated with socio-economic factors. The prevalence of SDP slowly decreased over time, but this overall trend masked inequalities within populations. In Canada, France and the United States, the prevalence decreased more rapidly in women of higher socio-economic status, and inequalities in maternal smoking were more marked in these countries. In the other countries, inequalities tended to decrease but remained significant. CONCLUSIONS During pregnancy, that is a period described as a window of opportunity, smoking and social vulnerability factors need to be detected to implement targeted prevention strategies aiming at reducing related social inequalities.
Collapse
Affiliation(s)
- Kim Bonello
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Hugo Figoni
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Estelle Blanchard
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Nicolas Vignier
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Guillaume Avenin
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
| | - Maria Melchior
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Jean-Sébastien Cadwallader
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Julie Chastang
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Gladys Ibanez
- Department of General Practice, School of Medicine, Sorbonne Université, Paris, France
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| |
Collapse
|
16
|
Cameron E, Bryant J, Cashmore A, Passmore E, Oldmeadow C, Neill S, Milat A, Mitchell J, Gatt N, Macoun E, Ioannides SJ, Murray C. A mixed methods evaluation of Quit for new life, a smoking cessation initiative for women having an Aboriginal baby. BMC Health Serv Res 2023; 23:532. [PMID: 37226175 DOI: 10.1186/s12913-023-09496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 05/03/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Quit for new life (QFNL) is a smoking cessation initiative developed to support mothers of Aboriginal babies to quit smoking during pregnancy. The state-wide initiative provides support for pregnant women and their households including free nicotine replacement therapy (NRT) and follow up cessation advice. Services are also supported to implement systems-level changes and integrate QFNL into routine care. This study aimed to evaluate: (1) models of implementation of QFNL; (2) the uptake of QFNL; (3) the impact of QFNL on smoking behaviours; and (4) stakeholder perceptions of the initiative. METHODS A mixed methods study was conducted comprising semi-structured interviews and analysis of routinely collected data. Interviews were conducted with 6 clients and 35 stakeholders involved in program implementation. Data were analysed using inductive content analysis. Aboriginal Maternal and Infant Health Service Data Collection (AMDC) records for the period July 2012-June 2015 were investigated to examine how many eligible women attended a service implementing QFNL and how many women took up a QFNL support. Smoking cessation rates were compared in women attending a service offering QFNL with women attending the same service prior to the implementation of QFNL to determine program impact. RESULTS QFNL was implemented in 70 services located in 13 LHDs across New South Wales. Over 430 staff attended QFNL training, including 101 staff in Aboriginal-identified roles. In the period July 2012-June 2015 27% (n = 1549) of eligible women attended a service implementing QFNL and 21% (n = 320) of these were recorded as taking up a QFNL support. While stakeholders shared stories of success, no statistically significant impact of QFNL on smoking cessation rates was identified (N = 3502; Odds ratio (OR) = 1.28; 95% Confidence Interval (CI) = 0.96-1.70; p-value = 0.0905). QFNL was acceptable to both clients and stakeholders, increased awareness about smoking cessation, and gave staff resources to support clients. CONCLUSION QFNL was perceived as acceptable by stakeholders and clients and provided care providers with knowledge and tangible support to offer women who presented at antenatal care as smokers, however, no statistically significant impact on rates of smoking cessation were found using the measures available.
Collapse
Affiliation(s)
- Emilie Cameron
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, College of Health and Wellbeing, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Aaron Cashmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Erin Passmore
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Christopher Oldmeadow
- Clinical Research Design, Information and Statistical Support, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Sarah Neill
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Andrew Milat
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
| | - Jo Mitchell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Sydney, NSW, 2006, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Nicole Gatt
- Drug Health Services, Aboriginal Health Education Officer, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Edwina Macoun
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| | - Sally J Ioannides
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
- The University of New South Wales School of Medicine, UNSW, Sydney, NSW, 2052, Australia
| | - Carolyn Murray
- Population and Public Health Division, NSW Ministry of Health, St Leonards, NSW, 2065, Australia
| |
Collapse
|
17
|
Wang X, Lee NL, Burstyn I. Smokers' utilization of quitting methods and vaping during pregnancy: an empirical cluster analysis of 2016-2018 Pregnancy Risk Assessment Monitoring System (PRAMS) data in seven US states. BMC Pregnancy Childbirth 2023; 23:306. [PMID: 37131124 PMCID: PMC10152601 DOI: 10.1186/s12884-023-05608-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 04/14/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Patterns of utilization of numerous smoking cessation methods among pregnant women amidst the increasing popularity of vaping (use of e-cigarettes) remains unknown. METHODS This study included 3,154 mothers who self-reported smoking around the time of conception and delivered live births in 2016-2018 in seven US states. Latent class analysis was used to identify subgroups of smoking women based on their utilization of 10 surveyed quitting methods and vaping during pregnancy. RESULTS We identified four subgroups of smoking mothers with different utilization patterns of quitting methods during pregnancy: 22.0% reported "not trying to quit"; 61.4% tried to "quit on my own" without any behavioral or pharmacological assistance; 3.7% belonged to the "vaping" subgroup; and 12.9% utilized "wide-ranging methods" with higher use rate of multiple approaches, such as quit line and nicotine patch. Compared to mothers "not trying to quit," the subgroup trying to "quit on my own" were more likely to be abstinent (adjusted OR 4.95, 95% CI 2.82-8.35) or to reduce the number of cigarettes smoked daily (adjusted OR 2.46, 95% CI 1.31-4.60) in late pregnancy, and these improvements lasted into early postpartum. We did not observe a measurable reduction in smoking among the "vaping" subgroup or women trying to quit with "wide-ranging methods". CONCLUSIONS We identified four subgroups of smoking mothers with different utilization patterns of eleven quitting methods during pregnancy. Pre-pregnancy smokers who tried to "quit on my own" were most likely to be abstinent or to reduce smoking amount.
Collapse
Affiliation(s)
- Xi Wang
- PolicyLab, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA.
| | - Nora L Lee
- Department of Epidemiology and Biostatistics, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| | - Igor Burstyn
- Department of Environmental and Occupational Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, USA
| |
Collapse
|
18
|
Kaur S, Manhungira W, Sankar A, Sarkar R. Women's Perspectives on Smoking During Pregnancy and Factors Influencing Their Willingness to Quit Smoking in Pregnancy: A Study From the United Kingdom. Cureus 2023; 15:e38890. [PMID: 37313110 PMCID: PMC10259749 DOI: 10.7759/cureus.38890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 06/15/2023] Open
Abstract
Objective This was a prospective questionnaire-based survey conducted in the Barnsley District of the United Kingdom among antenatal women smoking during pregnancy. The aim of the study was to assess the awareness of women regarding the risks with smoking during pregnancy, study their smoking behavior, their willingness to quit smoking during pregnancy, and the factors that could influence their intention to quit smoking. Methods A cohort of antenatal women smoking during pregnancy was surveyed prior to their contact with the maternity Stop Smoking Services. A well-structured, pre-tested, and validated questionnaire was used to assess their awareness regarding risks with smoking during pregnancy and their willingness to quit smoking during pregnancy. Descriptive statistics were used to analyze the results. Binomial logistic regression (univariate and multivariate) was used to identify the factors influencing the women's willingness to quit smoking during pregnancy. Results Among 66 women surveyed, 52 (79%) were multigravida and 14 (21%) were primigravida, with a mean age of 27.4 ± 5.7 years. Most women (68%) were in the first trimester of their pregnancy. Nearly two-thirds of women (64%) had low educational attainment, 53% were unemployed, 68% lived with family members who smoked, and 35% had mental health problems. One-third (33%) of women had an unsuccessful attempt at quitting smoking in the past. Around 44% of women had a low level of nicotine dependence, while 56% had a moderate level of nicotine dependence. More than three-fourths of women (77%) were aware that smoking during pregnancy is harmful for their baby, though most could not report the specific adverse effects. Nearly half of the women (51.5%) were willing to quit smoking during pregnancy with the rationality of having a healthy baby. On multivariate logistic regression analysis, awareness of the women that smoking during pregnancy has ill effects on the baby (adjusted odds ratio (aOR): 46.459, confidence interval (CI): 5.356-402.961, p value <0.001) was found to be the strongest predictor of willingness to quit smoking during pregnancy. Other determinants found to be significantly associated with willingness to quit smoking during pregnancy were unsuccessful quit attempts in the past (aOR: 0.048, CI: 0.007-0.309, p value 0.001) and the absence of any mental health concerns (aOR: 6.097, CI: 1.105-33.647, p value 0.038). Conclusion There is considerable room for raising awareness about the risks of smoking during pregnancy and providing effective smoking cessation and relapse prevention interventions in pregnancy. Obstetricians and midwives should actively participate in providing risk-focused information to pregnant women on smoking during pregnancy and support them in smoking cessation. Various factors such as employment status, nicotine dependence, previous failed attempts at quitting smoking, mental health issues, and awareness levels significantly influence the willingness to quit smoking during pregnancy. Hence, there is an imperative need to identify and address the barriers that could affect a woman's intention to quit smoking during pregnancy.
Collapse
Affiliation(s)
- Simar Kaur
- Department of Obstetrics and Gynaecology, Barnsley Hospital National Health Service Foundation Trust, Barnsley, GBR
| | - Walburgh Manhungira
- Department of Women's Services, Barnsley Hospital National Health Service Foundation Trust, Barnsley, GBR
| | - Ajesh Sankar
- Department of Obstetrics and Gynaecology, Barnsley Hospital National Health Service Foundation Trust, Barnsley, GBR
| | - Rupak Sarkar
- Department of Obstetrics and Gynaecology, Barnsley Hospital National Health Service Foundation Trust, Barnsley, GBR
| |
Collapse
|
19
|
Tahan C, Dobbins T, Hyslop F, Lingam R, Richmond R. Effect of digital health, biomarker feedback and nurse or midwife-led counselling interventions to assist pregnant smokers quit: a systematic review and meta-analysis. BMJ Open 2023; 13:e060549. [PMID: 36963792 PMCID: PMC10040078 DOI: 10.1136/bmjopen-2021-060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/03/2023] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To assess the effect of digital health (DH), biomarker feedback (BF) and nurse or midwife-led counselling (NoMC) interventions on abstinence in pregnant smokers during pregnancy and postpartum. SETTINGS Any healthcare setting servicing pregnant women, including any country globally. PARTICIPANTS Pregnant women of any social, ethnic or geographical background who smoke. METHODS We searched Embase, Medline, Web Of Science, Google Scholar, PsychINFO, CINAHL and PubMed between 2007 and November 2021. We included published original intervention studies in English with comparators (usual care or placebo). Two independent assessors screened and abstracted data. We performed a random-effects meta-analysis, assessed risk of bias with the Cochrane Tool and used Grading of Recommendations Assessment, Development and Evaluation to assess the quality of evidence. RESULTS We identified 57 studies and included 54 in the meta-analysis. Sixteen studies assessed DH (n=3961), 6 BF (n=1643), 32 NoMC (n=60 251), 1 assessed NoMC with BF (n=1120) and 2 NoMC with DH interventions (n=2107). DH interventions had moderate certainty evidence to achieve continuous abstinence (CA) at late pregnancy (4 studies; 2049 women; RR=1.98, 95% CI 1.08 to 3.64, p=0.03) and low certainty evidence to achieve point prevalence abstinence (PPA) postpartum (5 studies; 2238 women; RR=1.46, 95% CI 1.05 to 2.02, p=0.02). NoMC interventions had moderate certainty evidence to achieve PPA in late pregnancy (15 studies; 16 234 women; RR=1.54, 95% CI 1.16 to 2.06, p<0.01) and low certainty evidence to achieve PPA postpartum (13 studies; 5466 women; RR=1.79, 95% CI 1.14 to 2.83, p=0.01). Both DH and BF interventions did not achieve PPA at late pregnancy, nor NoMC interventions achieve CA postpartum. The certainty was reduced due to risk of bias, heterogeneity, inconsistency and/or imprecision. CONCLUSION NoMC interventions can assist pregnant smokers achieve PPA and DH interventions achieve CA in late pregnancy. These interventions may achieve other outcomes.
Collapse
Affiliation(s)
- Chadi Tahan
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Timothy Dobbins
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Fran Hyslop
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| | - Raghu Lingam
- Paediatric Population Health, School of Women's & Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Robyn Richmond
- School of Population Health, University of New South Wales - Kensington Campus, Sydney, New South Wales, Australia
| |
Collapse
|
20
|
Emery J, Huang Y, Naughton F, Cooper S, McDaid L, Dickinson A, Clark M, Kinahan-Goodwin D, Thomson R, Phillips L, Lewis S, Coleman T. Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study. JMIR Form Res 2023; 7:e35045. [PMID: 36881452 PMCID: PMC10031440 DOI: 10.2196/35045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 07/29/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. OBJECTIVE In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. METHODS Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. RESULTS Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. CONCLUSIONS Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants.
Collapse
Affiliation(s)
- Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Yue Huang
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Sue Cooper
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Anne Dickinson
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Miranda Clark
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Darren Kinahan-Goodwin
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
- Adult Social Care and Health, Derbyshire County Council, Matlock, United Kingdom
| | - Ross Thomson
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Lucy Phillips
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
21
|
Salameh TN, Hall LA, Hall MT. Cigarette Smoking Cessation Counselling in Pregnant Smokers with Mental Illness/Substance Use Disorders. West J Nurs Res 2023; 45:234-241. [PMID: 36196024 PMCID: PMC9902998 DOI: 10.1177/01939459221127803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our objective was to determine if past-year mental illness and substance use disorders (SUD) among pregnant smokers predicted the probability of receipt of counselling for cigarette smoking cessation. A secondary analysis of data from the National Survey on Drug Use and Health 2016-2019 was conducted. We found that approximately 83% of pregnant smokers (N = 373) received screening for cigarette smoking, and 65% received cessation counselling. Having mental illness predicted the probability of receipt of counselling for smoking cessation in pregnant smokers (adjusted odds ratio [AOR]: 3.75; 95% confidence interval [CI]: 1.25-11.27). However, having SUD (alcohol [AOR: 2.30; 95%CI: 0.57-9.26] or illicit drug use [AOR: 1.32; 95%CI: 0.26-6.82]) or comorbid mental illness and SUD (AOR: 0.23; 95%CI: 0.03-2.03) was not associated with receipt of counselling for smoking cessation. Practice guidelines and policy initiatives are needed to reduce cigarette use and its related adverse health outcomes in pregnant smokers with SUD.
Collapse
Affiliation(s)
| | - Lynne A Hall
- University of Louisville School of Nursing, Louisville, KY, USA
| | - Martin T Hall
- University of Louisville Kent School of Social Work, Louisville, KY, USA
| |
Collapse
|
22
|
Racial differences in the impact of maternal smoking on sudden unexpected infant death. J Perinatol 2023; 43:345-349. [PMID: 36271297 PMCID: PMC9589613 DOI: 10.1038/s41372-022-01516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prenatal smoking increases the risk of Sudden Unexpected Infant Death (SUID). Whether exposure patterns and associations differ by race requires further study. OBJECTIVES Determine if patterns of exposure and associations between SUID and maternal smoking before and during pregnancy differ by race. METHODS Using U.S. National Center for Health Statistics linked birth/infant death files 2012-2013, we documented SUID by smoking duration and race. Maternal smoking history: never, pre-pregnancy only, and pre-pregnancy plus first, first, second, or all trimesters. RESULTS Smoking was more common in non-Hispanic White (NHW) than non-Hispanic Black (NHB) mothers and more evident for both in SUID cases. The most common exposure duration is from before and throughout pregnancy (SUID: 78.3% NHW, 66.9% NHB; Survivors: 60.22% and 53.96%, respectively). NHB vs. NHW SUID rates per 1000 live births were 1.07 vs. 0.34 for non-smokers and 3.06 and 1.79 for smokers, ORs trended upward for both with increasing smoking duration. CONCLUSION Fewer NHB mothers smoked, but both NHB and NHW groups exhibited a dose-response relationship between smoking duration and SUID. The most common duration was from before to the end of pregnancy, suggesting difficulty in quitting and a need for effective interventions.
Collapse
|
23
|
Bandyopadhyay A, Jones H, Parker M, Marchant E, Evans J, Todd C, Rahman MA, Healy J, Win TL, Rowe B, Moore S, Jones A, Brophy S. Weighting of risk factors for low birth weight: a linked routine data cohort study in Wales, UK. BMJ Open 2023; 13:e063836. [PMID: 36764720 PMCID: PMC9923297 DOI: 10.1136/bmjopen-2022-063836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVE Globally, 20 million children are born with a birth weight below 2500 g every year, which is considered as a low birthweight (LBW) baby. This study investigates the contribution of modifiable risk factors in a nationally representative Welsh e-cohort of children and their mothers to inform opportunities to reduce LBW prevalence. DESIGN A longitudinal cohort study based on anonymously linked, routinely collected multiple administrative data sets. PARTICIPANTS The cohort, (N=693 377) comprising of children born between 1 January 1998 and 31 December 2018 in Wales, was selected from the National Community Child Health Database. OUTCOME MEASURES The risk factors associated with a binary LBW (outcome) variable were investigated with multivariable logistic regression (MLR) and decision tree (DT) models. RESULTS The MLR model showed that non-singleton children had the highest risk of LBW (adjusted OR 21.74 (95% CI 21.09 to 22.40)), followed by pregnancy interval less than 1 year (2.92 (95% CI 2.70 to 3.15)), maternal physical and mental health conditions including diabetes (2.03 (1.81 to 2.28)), anaemia (1.26 (95% CI 1.16 to 1.36)), depression (1.58 (95% CI 1.43 to 1.75)), serious mental illness (1.46 (95% CI 1.04 to 2.05)), anxiety (1.22 (95% CI 1.08 to 1.38)) and use of antidepressant medication during pregnancy (1.92 (95% CI 1.20 to 3.07)). Additional maternal risk factors include smoking (1.80 (95% CI 1.76 to 1.84)), alcohol-related hospital admission (1.60 (95% CI 1.30 to 1.97)), substance misuse (1.35 (95% CI 1.29 to 1.41)) and evidence of domestic abuse (1.98 (95% CI 1.39 to 2.81)). Living in less deprived area has lower risk of LBW (0.70 (95% CI 0.67 to 0.72)). The most important risk factors from the DT models include maternal factors such as smoking, maternal weight, substance misuse record, maternal age along with deprivation-Welsh Index of Multiple Deprivation score, pregnancy interval and birth order of the child. CONCLUSION Resources to reduce the prevalence of LBW should focus on improving maternal health, reducing preterm births, increasing awareness of what is a sufficient pregnancy interval, and to provide adequate support for mothers' mental health and well-being.
Collapse
Affiliation(s)
- Amrita Bandyopadhyay
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
| | - Hope Jones
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
| | - Michael Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
| | - Emily Marchant
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
| | - Julie Evans
- Keir Hardie University Health Park, Public Health Wales, Cardiff, UK
| | - Charlotte Todd
- Keir Hardie University Health Park, Public Health Wales, Cardiff, UK
| | - Muhammad A Rahman
- Cardiff School of Technologies, Cardiff Metropolitan University, Llandaff Campus, Cardiff, UK
| | - James Healy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
- Office for National Statistics, Government Buildings, Cardiff Road, Duffryn, Newport, UK
| | - Tint Lwin Win
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
| | - Ben Rowe
- National Police Chiefs' Council Lead for Mental Health and Age, London, UK
| | - Simon Moore
- Violence Research Group, School of Dentistry, Cardiff University, Cardiff, UK
- Security, Crime, Intelligence Institute, Cardiff University, SPARK, Maindy Road, Cardiff, UK
| | - Angela Jones
- Keir Hardie University Health Park, Public Health Wales, Cardiff, UK
| | - Sinead Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, West Glamorgan, UK
| |
Collapse
|
24
|
Piloting a complex intervention to promote a tobacco and alcohol-free pregnancy: the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pregnancy study. BMC Pregnancy Childbirth 2023; 23:19. [PMID: 36627569 PMCID: PMC9830616 DOI: 10.1186/s12884-022-05320-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Tobacco smoking and alcohol consumption before and during pregnancy increase the risk of adverse health outcomes for mother and child. Interventions to address smoking and drinking before and during pregnancy have the potential to reduce early-life health inequalities. In the Smoke and Alcohol Free with EHealth and Rewards (SAFER) pilot study we aimed to evaluate the acceptability, feasibility and effectiveness of a complex intervention supporting women in smoking and alcohol cessation before and during pregnancy. METHODS From February 2019 till March 2021, we piloted the SAFER pregnancy intervention among pregnant women and women planning pregnancy in South-West Netherlands in an uncontrolled before-after study. Participants were supported in smoking and alcohol cessation via up to six group sessions and an online platform. In addition, biochemically validated cessation was rewarded with incentives (i.e. shopping vouchers) amounting up to 185 euros. We aimed to include 66 women. The primary outcome was smoking and/or alcohol cessation at 34-38 weeks of gestation (if pregnant) or after six group sessions (if not pregnant). Quantitative data were analysed using descriptive statistics. Focus group interviews among those involved in the study were conducted at the end of the study to explore their experiences. Qualitative data was analysed using thematic analysis. RESULTS Thirty-nine women who smoked were included; no women who consumed alcohol were referred to the study. Unemployment (51%), financial problems (36%) and a smoking partner (72%) were common. Thirteen women (33%) dropped out, often due to other problems impeding smoking cessation or 'being too busy' to participate in the group sessions. Eleven women (28%) had quit smoking at the study's endpoint. The personal and positive approach was highly valued and biochemical validation was felt to be helpful. CONCLUSION The SAFER pregnancy intervention seems appropriate for women in need of extra support for smoking cessation before and during pregnancy. Its impact on alcohol cessation could not be studied due to recruitment issues. Recruitment and prevention of early dropout need attention in further development of this intervention. TRIAL REGISTRATION Netherlands Trial Register: NL7493. Date registered: 04/02/2019.
Collapse
|
25
|
Murakami K, Ishikuro M, Ueno F, Noda A, Onuma T, Obara T, Kuriyama S. Factors Associated With Postpartum Smoking Relapse Among Women Who Quit in Early Pregnancy: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. J Epidemiol 2023; 33:8-14. [PMID: 33907065 PMCID: PMC9727209 DOI: 10.2188/jea.je20200609] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND While a wide range of predictors of postpartum smoking relapse have been suggested, population-based studies have rarely examined these factors exclusively among women who quit in early pregnancy. Furthermore, workplace secondhand smoke (SHS) exposure has never been examined. METHODS We analyzed data from 10,466 pregnant women who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. Age, education, parity, breastfeeding, postpartum depression, SHS exposure at home, and SHS exposure at work (not working, working without SHS exposure, working with SHS exposure) were evaluated as possible predictors. Multiple logistic regression analyses were conducted to examine the associations between these factors and smoking relapse by 1 year postpartum among women who quit in early pregnancy. Analyses stratified by SHS exposure at home were also conducted. RESULTS About one-fourth of early-pregnancy quitters had relapsed into smoking by 1 year postpartum. Lower education, multiparity, not breastfeeding, postpartum depression, and SHS exposure at home were associated with increased risks of smoking relapse. Working with SHS exposure was associated with an increased risk of smoking relapse; the multivariate-adjusted odds ratios of working without SHS exposure and working with SHS exposure compared with not working were 1.14 (95% confidence interval [CI], 0.82-1.59) and 2.18 (95% CI, 1.37-3.46), respectively. The significant association of workplace SHS exposure was observed only among women without SHS exposure at home. CONCLUSION SHS exposure at work, as well as education, multiparity, breastfeeding, postpartum depression, and SHS exposure at home were associated with postpartum smoking relapse among early-pregnancy quitters.
Collapse
Affiliation(s)
- Keiko Murakami
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan,Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan,Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Fumihiko Ueno
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan,Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Aoi Noda
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan,Graduate School of Medicine, Tohoku University, Sendai, Japan,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Tomomi Onuma
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan,Graduate School of Medicine, Tohoku University, Sendai, Japan,Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan,Graduate School of Medicine, Tohoku University, Sendai, Japan,Department of Disaster Public Health, International Research Institute of Disaster Science, Tohoku University, Sendai, Japan
| |
Collapse
|
26
|
Smoking cessation Through Optimization of clinical care in Pregnancy: the STOP pragmatic randomized controlled trial. Am J Obstet Gynecol MFM 2023; 5:100763. [PMID: 36216314 DOI: 10.1016/j.ajogmf.2022.100763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Smoking cessation improves pregnancy outcomes, yet there is uncertainty around the efficacy of models of antenatal intervention for smoking cessation in pregnancy. OBJECTIVE This study aimed to test the Smoking cessation Through Optimization of clinical care in Pregnancy (STOP) clinic as an antenatal care pathway for smoking cessation in pregnancy. The STOP intervention is a smoking cessation clinic staffed by a dedicated multidisciplinary team of obstetricians, midwives, and smoking cessation practitioners, who provide motivational and psychological support and intensive clinical monitoring of pregnancy. STUDY DESIGN This was a pragmatic randomized controlled trial of the STOP clinic compared with routine antenatal care at a tertiary urban maternity hospital delivering >8000 infants per year. The primary outcome measured was continuous abstinence from smoking before 28+0 weeks' gestation, sustained throughout the duration of the pregnancy, and validated using biological measures. The secondary outcomes included maternal and fetal morbidity, delivery and neonatal outcomes, smoking outcomes, and qualitative measures. RESULTS A total of 436 women were randomized, with 430 women included in the primary outcome analysis. Women attending the STOP antenatal clinic were more likely to quit smoking compared with those in routine care (odds ratio, 3.62; 95% confidence interval, 1.43-9.17). In addition, women who continued to smoke in the STOP clinic smoked fewer cigarettes daily at the time of delivery compared with controls: 5±4 in the STOP clinic and 7±5 in the control group (odds ratio, 0.28; 95% confidence interval, 0.13-0.59). However, this intervention did not alter postpartum relapse rates (4.3% intervention arm vs 1.5% control arm, not significant) at 4 to 6 months following delivery. The mean birthweight was similar in the intervention and control arms; however, quitters in both groups had infants with significantly higher birthweights compared with those of continued smokers. CONCLUSION The STOP antenatal model of care leads to higher smoking cessation rates among pregnant smokers and lower daily cigarette consumption at time of delivery. Currently, there is no defined or dedicated antenatal pathway for pregnant smokers, despite the high-risk nature of their pregnancies. Our findings suggest that improved smoking cessation rates in pregnancy may be achieved using the holistic approach of the STOP model of care.
Collapse
|
27
|
Tong H, Piwoz E, Ruel MT, Brown KH, Black RE, Walker N. Maternal and child nutrition in the Lives Saved Tool: Results of a recent update. J Glob Health 2022; 12:08005. [PMID: 36583418 PMCID: PMC9801341 DOI: 10.7189/jogh.12.08005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background The Lives Saved Tool (LiST) is a mathematical modelling tool for estimating the survival, health, and nutritional impacts of scaling intervention coverage in low- and middle-income countries (LMICs). Various nutrition interventions are included in LiST and are regularly (and independently) reviewed and updated as new data emerge. This manuscript describes our latest in-depth review of nutrition evidence, focusing on intervention efficacy, appropriate population-affected fractions, and new interventions for potential inclusion in the LiST model. Methods An external advisory group (EAG) was assembled to review evidence from systematic reviews on intervention-outcome (I-O) pairs for women and children under five years of age. GRADE quality was assigned to each pair based on a LiST-specific checklist to facilitate consistent decisions during the consideration. For existing interventions with new information, the EAG was asked to recommend whether to update the default efficacy values and population-affected fractions. For the new interventions, the EAG decided whether there was sufficient evidence of benefit, and in affirmative cases, information on the efficacy and affected fraction values that could be used. Decisions were based on expert group consensus. Results Overall, the group reviewed 53 nutrition-related I-O pairs, including 25 existing and 28 new ones. Efficacy and population-affected fractions were updated for seven I-O pairs; three pairs were updated for efficacy estimates only, three were updated for population-affected fractions only; and nine new I-O pairs were added to the model, bringing the total of nutrition-related I-O pairs to 34. Included in the new I-O pairs were two new nutrition interventions added to LIST: zinc fortification and neonatal vitamin A supplementation. Conclusions For modelling tools like LiST to be useful, it is crucial to update interventions, efficacy and population-affected fractions as new evidence becomes available. The present updates will enable LiST users to better estimate the potential health, nutrition, and survival benefits of investing in nutrition.
Collapse
Affiliation(s)
- Hannah Tong
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ellen Piwoz
- Independent Consultant, Annapolis, Maryland, USA
| | - Marie T Ruel
- Poverty, Health, and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, California, USA
| | - Robert E Black
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Neff Walker
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| |
Collapse
|
28
|
Larrea-Schiavon S, Vázquez-Quesada LM, Bartlett LR, Lam-Cervantes N, Sripad P, Vieitez I, Coutiño-Escamilla L. Interventions to Improve the Reproductive Health of Undocumented Female Migrants and Refugees in Protracted Situations: A Systematic Review. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100418. [PMID: 36562449 PMCID: PMC9771456 DOI: 10.9745/ghsp-d-21-00418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 11/08/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Limited evidence exists on interventions aimed at enabling reproductive health (RH) services access for undocumented female migrants and refugee women. We aimed to identify intervention characteristics and impacts on RH outcomes among migrants and refugee women in protracted situations. METHODS We conducted a systematic literature review of RH intervention studies that reported on migrants and refugee women in protracted situations. We applied 2 search strategies across 6 databases to identify peer-reviewed articles in English, Spanish, and Portuguese. Eligible studies were assessed for content and quality. RESULTS Of the 21,453 screened studies, we included 10 (all observational) for final data extraction. Interventions implemented among migrant and refugee women included financial support (n=2), health service delivery structure strengthening (n=4), and educational interventions (n=4). Financial support intervention studies showed that enabling women to obtain RH services for free or at a low cost promoted utilization (e.g., increased use of contraception). Interventions that established or strengthened health service delivery structures and linkage demonstrated increased prenatal visits, decreased maternal mortality, and facilitated access to safe abortion through referral services or access to medical abortion. Educational interventions indicated positive effects on RH knowledge and the importance of involving peers and meeting the unique needs of a mobile population. All intervention studies emphasized the need to accommodate migrant security concerns and cultural and linguistic needs. CONCLUSION Interventions in protracted situations reported positive outcomes when they were migrant or refugee-centered and complementary, culturally acceptable, geographically proximate, and cost-sensitive, as well as recognized the concerns around legality and involved opportunities for peer learning. Free or low-cost RH services and greater availability of basic and emergency maternal and neonatal care showed the most promise but required further community outreach, education, and stronger referral mechanisms. We recommend further participatory implementation research linked to policy and programming.
Collapse
|
29
|
Strobel NA, Chamberlain C, Campbell SK, Shields L, Bainbridge RG, Adams C, Edmond KM, Marriott R, McCalman J. Family-centred interventions for Indigenous early childhood well-being by primary healthcare services. Cochrane Database Syst Rev 2022; 12:CD012463. [PMID: 36511823 PMCID: PMC9746601 DOI: 10.1002/14651858.cd012463.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary healthcare, particularly Indigenous-led services, are well placed to deliver services that reflect the needs of Indigenous children and their families. Important characteristics identified by families for primary health care include services that support families, accommodate sociocultural needs, recognise extended family child-rearing practices, and Indigenous ways of knowing and doing business. Indigenous family-centred care interventions have been developed and implemented within primary healthcare services to plan, implement, and support the care of children, immediate and extended family and the home environment. The delivery of family-centred interventions can be through environmental, communication, educational, counselling, and family support approaches. OBJECTIVES To evaluate the benefits and harms of family-centred interventions delivered by primary healthcare services in Canada, Australia, New Zealand, and the USA on a range of physical, psychosocial, and behavioural outcomes of Indigenous children (aged from conception to less than five years), parents, and families. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was 22 September 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, controlled before-after studies, and interrupted time series of family-centred care interventions that included Indigenous children aged less than five years from Canada, Australia, New Zealand, and the USA. Interventions were included if they met the assessment criteria for family-centred interventions and were delivered in primary health care. Comparison interventions could include usual maternal and child health care or one form of family-centred intervention versus another. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. overall health and well-being, 2. psychological health and emotional behaviour of children, 3. physical health and developmental health outcomes of children, 4. family health-enhancing lifestyle or behaviour outcomes, 5. psychological health of parent/carer. 6. adverse events or harms. Our secondary outcomes were 7. parenting knowledge and awareness, 8. family evaluation of care, 9. service access and utilisation, 10. family-centredness of consultation processes, and 11. economic costs and outcomes associated with the interventions. We used GRADE to assess the certainty of the evidence for our primary outcomes. MAIN RESULTS We included nine RCTs and two cluster-RCTs that investigated the effect of family-centred care interventions delivered by primary healthcare services for Indigenous early child well-being. There were 1270 mother-child dyads and 1924 children aged less than five years recruited. Seven studies were from the USA, two from New Zealand, one from Canada, and one delivered in both Australia and New Zealand. The focus of interventions varied and included three studies focused on early childhood caries; three on childhood obesity; two on child behavioural problems; and one each on negative parenting patterns, child acute respiratory illness, and sudden unexpected death in infancy. Family-centred education was the most common type of intervention delivered. Three studies compared family-centred care to usual care and seven studies provided some 'minimal' intervention to families such as education in the form of pamphlets or newsletters. One study provided a minimal intervention during the child's first 24 months and then the family-centred care intervention for one year. No studies had low or unclear risk of bias across all domains. All studies had a high risk of bias for the blinding of participants and personnel domain. Family-centred care may improve overall health and well-being of Indigenous children and their families, but the evidence was very uncertain. The pooled effect estimate from 11 studies suggests that family-centred care improved the overall health and well-being of Indigenous children and their families compared no family-centred care (standardised mean difference (SMD) 0.14, 95% confidence interval (CI) 0.03 to 0.24; 2386 participants). We are very uncertain whether family-centred care compared to no family-centred care improves the psychological health and emotional behaviour of children as measured by the Infant Toddler Social Emotional Assessment (ITSEA) (Competence domain) (mean difference (MD) 0.04, 95% CI -0.03 to 0.11; 2 studies, 384 participants). We assessed the evidence as being very uncertain about the effect of family-centred care on physical health and developmental health outcomes of children. Pooled data from eight trials on physical health and developmental outcomes found there was little to no difference between the intervention and the control groups (SMD 0.13, 95% CI -0.00 to 0.26; 1961 participants). The evidence is also very unclear whether family-centred care improved family-enhancing lifestyle and behaviours outcomes. Nine studies measured family health-enhancing lifestyle and behaviours and pooled analysis found there was little to no difference between groups (SMD 0.16, 95% CI -0.06 to 0.39; 1969 participants; very low-certainty evidence). There was very low-certainty evidence of little to no difference for the psychological health of parents and carers when they participated in family-centred care compared to any control group (SMD 0.10, 95% CI -0.03 to 0.22; 5 studies, 975 parents/carers). Two studies stated that there were no adverse events as a result of the intervention. No additional data were provided. No studies reported from the health service providers perspective or on outcomes for family's evaluation of care or family-centredness of consultation processes. AUTHORS' CONCLUSIONS There is some evidence to suggest that family-centred care delivered by primary healthcare services improves the overall health and well-being of Indigenous children, parents, and families. However, due to lack of data, there was not enough evidence to determine whether specific outcomes such as child health and development improved as a result of family-centred interventions. Seven of the 11 studies delivered family-centred education interventions. Seven studies were from the USA and centred on two particular trials, the 'Healthy Children, Strong Families' and 'Family Spirit' trials. As the evidence is very low certainty for all outcomes, further high-quality trials are needed to provide robust evidence for the use of family-centred care interventions for Indigenous children aged less than five years.
Collapse
Affiliation(s)
- Natalie A Strobel
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
- Medical School, The University of Western Australia, Perth, Australia
| | - Catherine Chamberlain
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Australia
| | - Sandra K Campbell
- College of Nursing & Midwifery, Charles Darwin University, Darwin, Australia
| | - Linda Shields
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Roxanne G Bainbridge
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| | - Claire Adams
- Kurongkurl Katitjin, Edith Cowan University, Mount Lawley, Australia
| | - Karen M Edmond
- Department of Women and Children's Health, King's College London, London, UK
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia
| | - Janya McCalman
- School of Human Health and Social Sciences, Central Queensland University, Cairns, Australia
| |
Collapse
|
30
|
Barnes LAJ, Longman J, Adams C, Paul C, Atkins L, Bonevski B, Cashmore A, Twyman L, Bailie R, Pearce A, Barker D, Milat AJ, Dorling J, Nicholl M, Passey M. The MOHMQuit (Midwives and Obstetricians Helping Mothers to Quit Smoking) Trial: protocol for a stepped-wedge implementation trial to improve best practice smoking cessation support in public antenatal care services. Implement Sci 2022; 17:79. [PMID: 36494723 PMCID: PMC9734467 DOI: 10.1186/s13012-022-01250-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/04/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Smoking during pregnancy is the most important preventable cause of adverse pregnancy outcomes, yet smoking cessation support (SCS) is inconsistently provided. The MOMHQUIT intervention was developed to address this evidence-practice gap, using the Behaviour Change Wheel method by mapping barriers to intervention strategies. MOHMQuit includes systems, leadership and clinician elements. This implementation trial will determine the effectiveness and cost-effectiveness of MOHMQuit in improving smoking cessation rates in pregnant women in public maternity care services in Australia; test the mechanisms of action of the intervention strategies; and examine implementation outcomes. METHODS A stepped-wedge cluster-randomised design will be used. Implementation of MOHMQuit will include reinforcing leadership investment in SCS as a clinical priority, strengthening maternity care clinicians' knowledge, skills, confidence and attitudes towards the provision of SCS, and clinicians' documentation of guideline-recommended SCS provided during antenatal care. Approximately, 4000 women who report smoking during pregnancy will be recruited across nine sites. The intervention and its implementation will be evaluated using a mixed methods approach. The primary outcome will be 7-day point prevalence abstinence at the end of pregnancy, among pregnant smokers, verified by salivary cotinine testing. Continuous data collection from electronic medical records and telephone interviews with postpartum women will occur throughout 32 months of the trial to assess changes in cessation rates reported by women, and SCS documented by clinicians and reported by women. Data collection to assess changes in clinicians' knowledge, skills, confidence and attitudes will occur prior to and immediately after the intervention at each site, and again 6 months later. Questionnaires at 3 months following the intervention, and semi-structured interviews at 6 months with maternity service leaders will explore leaders' perceptions of acceptability, adoption, appropriateness, feasibility, adaptations and fidelity of delivery of the MOHMQuit intervention. Structural equation modelling will examine causal linkages between the strategies, mediators and outcomes. Cost-effectiveness analyses will also be undertaken. DISCUSSION This study will provide evidence of the effectiveness of a multi-level implementation intervention to support policy decisions; and evidence regarding mechanisms of action of the intervention strategies (how the strategies effected outcomes) to support further theoretical developments in implementation science. TRIAL REGISTRATION ACTRN12622000167763, registered February 2nd 2022.
Collapse
Affiliation(s)
- Larisa Ariadne Justine Barnes
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Jo Longman
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Catherine Adams
- Northern New South Wales Local Health District, Byron Central Hospital, Ewingsdale Rd, Byron Bay, NSW 2480 Australia
| | - Christine Paul
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
| | - Lou Atkins
- grid.83440.3b0000000121901201University College London, Centre for Behaviour Change, Gower Street, London, WC1E 6BT UK
| | - Billie Bonevski
- grid.1014.40000 0004 0367 2697Flinders University, College of Medicine & Public Health, Flinders Health and Medical Research Institute, Sturt Road, Bedford Park, SA 5042 Australia
| | - Aaron Cashmore
- grid.416088.30000 0001 0753 1056NSW Ministry of Health, Centre for Epidemiology and Evidence, 1 Reserve Road, St Leonards, NSW 2065 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, NSW 2006 Australia
| | - Laura Twyman
- grid.266842.c0000 0000 8831 109XTobacco Control Unit, Cancer Prevention and Advocacy Division, Cancer Council NSW, and Conjoint Fellow, School of Medicine and Public Health, University of Newcastle, 153 Dowling St., Woolloomooloo, NSW 2011 Australia
| | - Ross Bailie
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| | - Alison Pearce
- grid.1013.30000 0004 1936 834XThe Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, and Sydney School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Camperdown, NSW 2006 Australia
| | - Daniel Barker
- grid.266842.c0000 0000 8831 109XUniversity of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, NSW 2308 Australia
| | - Andrew J. Milat
- grid.416088.30000 0001 0753 1056NSW Ministry of Health, Centre for Epidemiology and Evidence, 1 Reserve Road, St Leonards, NSW 2065 Australia ,grid.1013.30000 0004 1936 834XThe University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Camperdown, NSW 2006 Australia
| | - Julie Dorling
- grid.492318.50000 0004 0619 0853Western NSW Local Health District, 7 Commercial Avenue, Dubbo, NSW 2830 Australia
| | - Michael Nicholl
- grid.1013.30000 0004 1936 834XClinical Excellence Commission-NSW Health and The University of Sydney Faculty of Medicine and Health, 1 Reserve Road, St. Leonards, NSW 2065 Australia
| | - Megan Passey
- grid.1013.30000 0004 1936 834XThe University of Sydney, The University Centre for Rural Health, 61 Uralba St., Lismore, NSW 2480 Australia
| |
Collapse
|
31
|
Avşar TS, Jackson L, Barton P, Jones M, McLeod H. Supporting pregnant women not ready to quit smoking: an economic evaluation. BMC Pregnancy Childbirth 2022; 22:865. [PMID: 36419041 PMCID: PMC9686103 DOI: 10.1186/s12884-022-05150-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/25/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Some pregnant women are not ready or do not want to quit smoking completely, and currently there is no support provided for these women in the UK. Offering help to reduce smoking could reduce the health risks associated with smoking and increase the limited reach of the NHS Stop Smoking Services (SSS) for pregnant women. This study aimed to design and evaluate a hypothetical intervention aimed at pregnant women who are not yet ready or do not want to quit smoking entirely. METHODS A hypothetical intervention, the Reduced Smoking During Pregnancy (RSDP) intervention, was conceptualised based on the best available evidence. The intervention was evaluated, using a decision-analytic model developed for SDP interventions. Two different scenarios, a base-case and a cautious-case were developed, and a cost-utility analysis and return on investment analysis were conducted. The uncertainty around the estimates was assessed, using deterministic and probabilistic sensitivity analyses. RESULTS The RSDP intervention could prevent the loss of 13 foetuses and generate 43 quitters 1 year after delivery per 1000 women. In the lifetime analysis, the intervention was cost-effective in both scenarios, with an incremental cost of £363 (95% CI £29 to £672) and 0.44 (95% CI 0.32 to 0.53) QALYs gained in the base-case. CONCLUSIONS The study found that the hypothetical reduction intervention would produce significant health benefits, reduce smoking and be cost-effective. Offering pregnant smokers help to reduce smoking could reduce health inequalities, widen the reach of SSS and improve health. This economic evaluation of a novel, intensive intervention could inform the piloting of such interventions.
Collapse
Affiliation(s)
- Tuba Saygın Avşar
- grid.83440.3b0000000121901201Department of Applied Health Research, NIHR ARC North Thames and UCLPartners Academic Health Science Partnership, University College London, London, WC1E 7HB UK
| | - Louise Jackson
- grid.6572.60000 0004 1936 7486Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Pelham Barton
- grid.6572.60000 0004 1936 7486Health Economics Unit, University of Birmingham, Birmingham, UK
| | - Matthew Jones
- grid.4563.40000 0004 1936 8868Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Hugh McLeod
- grid.5337.20000 0004 1936 7603Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK ,grid.410421.20000 0004 0380 7336NIHR ARC West at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|
32
|
Doherty E, Kingsland M, Wiggers J, Wolfenden L, Hall A, McCrabb S, Tremain D, Hollis J, Licata M, Wynne O, Dilworth S, Daly JB, Tully B, Dray J, Bailey KA, Elliott EJ, Hodder RK. The effectiveness of implementation strategies in improving preconception and antenatal preventive care: a systematic review. Implement Sci Commun 2022; 3:121. [PMID: 36419177 PMCID: PMC9682815 DOI: 10.1186/s43058-022-00368-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 11/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical guideline recommendations for addressing modifiable risk factors are not routinely implemented into preconception and antenatal care. This review assessed the effectiveness of implementation strategies in improving health professional provision of preconception and antenatal care addressing tobacco smoking, weight management and alcohol consumption. METHODS A systematic review of randomised and non-randomised studies with a parallel comparison group was conducted. Eligible studies used implementation strategy/ies targeted at health professionals to improve at least one element of preconception and/or antenatal care (smoking: ask, advise, assess, assist, arrange; weight/alcohol: assess, advise, refer) compared to usual practice/control or alternative strategies. Eligible studies were identified via CENTRAL, MEDLINE, EMBASE, Maternity and Infant Care, CINAHL and other sources. Random-effects meta-analyses were conducted where appropriate, with other findings summarised using the direction of effect. The certainty of the pooled evidence was assessed using the GRADE approach. RESULTS Fourteen studies were included in the review. Thirteen were in the antenatal period and 12 tested multiple implementation strategies (median: three). Meta-analyses of RCTs found that implementation strategies compared to usual practice/control probably increase asking (OR: 2.52; 95% CI: 1.13, 5.59; 3 studies; moderate-certainty evidence) and advising (OR: 4.32; 95% CI: 3.06, 6.11; 4 studies; moderate-certainty evidence) about smoking and assessing weight gain (OR: 57.56; 95% CI: 41.78, 79.29; 2 studies; moderate-certainty evidence), and may increase assessing (OR: 2.55; 95% CI: 0.24, 27.06; 2 studies; low-certainty evidence), assisting (OR: 6.34; 95% CI: 1.51, 26.63; 3 studies; low-certainty evidence) and arranging support (OR: 3.55; 95% CI: 0.50, 25.34; 2 studies; low-certainty evidence) for smoking. The true effect of implementation strategies in increasing advice about weight gain (OR: 3.37; 95% CI: 2.34, 4.84; 2 non-randomised studies; very low-certainty evidence) and alcohol consumption (OR: 10.36; 95% CI: 2.37, 41.20; 2 non-randomised studies; very low-certainty evidence) is uncertain due to the quality of evidence to date. CONCLUSIONS Review findings provide some evidence to support the effectiveness of implementation strategies in improving health professional delivery of antenatal care addressing smoking and weight management. Rigorous research is needed to build certainty in the evidence for improving alcohol and weight gain advice, and in preconception care. TRIAL REGISTRATION PROSPERO-CRD42019131691.
Collapse
Affiliation(s)
- Emma Doherty
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Melanie Kingsland
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Luke Wolfenden
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| | - Alix Hall
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sam McCrabb
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Danika Tremain
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Jenna Hollis
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Milly Licata
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Olivia Wynne
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Sophie Dilworth
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Justine B. Daly
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia
| | - Belinda Tully
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia
| | - Kylie A. Bailey
- grid.266842.c0000 0000 8831 109XSchool of Psychological Sciences, College of Engineering, Science and Environment, The University of Newcastle, Callaghan, NSW Australia
| | - Elizabeth J. Elliott
- grid.1013.30000 0004 1936 834XFaculty of Medicine and Health and Discipline of Child and Adolescent Health, The University of Sydney, Camperdown, NSW 2006 Australia ,grid.413973.b0000 0000 9690 854XSydney Children’s Hospital Network, Kids’ Research Institute, Westmead, NSW 2145 Australia
| | - Rebecca K. Hodder
- grid.3006.50000 0004 0438 2042Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW 2287 Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW Australia ,grid.413648.cPopulation Health Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW 2305 Australia ,National Centre of Implementation Science, Wallsend, NSW 2287 Australia
| |
Collapse
|
33
|
Affiliation(s)
- Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jasper V Been
- Division of Neonatology, Department of Paediatrics, Erasmus MC Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
| |
Collapse
|
34
|
Jackson MA, Buykx P, Brown AL, Baker AL, Dunlop AJ, Gould GS. Using mixed methods to establish tobacco treatment acceptability from the perspective of clients and clinicians of antenatal substance use services. Addict Sci Clin Pract 2022; 17:56. [PMID: 36195932 PMCID: PMC9531520 DOI: 10.1186/s13722-022-00337-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Background Up to 95% of pregnant women with alcohol and other drug (AOD) problems also smoke tobacco. Challenging psychosocial circumstances and a lack of targeted tobacco interventions contribute to low rates of prenatal abstinence and more effective treatment strategies are required. This study explores smoking in pregnant clients of AOD treatment services from a consumer and healthcare provider perspective to examine characteristics of behaviour change and the acceptability of evidence-based tobacco treatment strategies. Outcomes will support the design and implementation of a comprehensive tobacco intervention. Methods A mixed methods triangulated design was used. Thirteen women who smoked and attended antenatal AOD services in New South Wales, Australia, were interviewed and 28 clinicians from the same services were surveyed. Domains including experiences of tobacco smoking in pregnancy, motivators and barriers to cessation and evidence-based strategies to assist cessation during pregnancy were explored. Interviews were analysed using Iterative Categorization, with interpretation guided by Qualitative Description. Online surveys were analysed descriptively. A convergent-parallel mixed methods analysis was performed. Results Women and clinicians agreed that improving baby’s health outcomes was the primary motivation to stop smoking. Negative experiences with nicotine replacement therapy (NRT), financial constraints and maternal contraindications restricted its uptake and effectiveness during pregnancy. Both groups agreed that other AOD use, stopping multiple substances concurrently, difficulty coping with stress and the influence of partners who smoke had the biggest impacts on cessation efforts. Clinicians favoured harm-reduction rather than abstinence-based tobacco interventions and women appeared satisfied with reduction efforts. Both views may influence the attainment of prenatal abstinence-based goals. Although previous evidence suggested the contrary, clinicians were willing to encourage simultaneous cessation of tobacco and other substances. Non-judgmental treatment approaches that provide extra support, education and motivation were important for women. Women and clinicians supported use of NRT despite concerns. Financial incentives, counselling, partner support and offering tobacco treatment with antenatal AOD care were considered acceptable treatment options. Conclusions NRT, incentives, counselling and partner support could be utilized in a tobacco intervention for pregnant women with substance use concerns. Non-judgmental education, motivation, and provision of NRT including instruction for correct use are important considerations. Supplementary Information The online version contains supplementary material available at 10.1186/s13722-022-00337-y.
Collapse
Affiliation(s)
- Melissa A Jackson
- Hunter New England Local Health District Drug and Alcohol Clinical Services, Level 3, 670 Hunter Street, Newcastle, NSW, 2290, Australia.
| | - Penny Buykx
- School of Humanities, Creative Industries and Social Sciences, University of Newcastle, Callaghan, NSW, Australia
| | - Amanda L Brown
- Hunter New England Local Health District Drug and Alcohol Clinical Services, Level 3, 670 Hunter Street, Newcastle, NSW, 2290, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Adrian J Dunlop
- Hunter New England Local Health District Drug and Alcohol Clinical Services, Level 3, 670 Hunter Street, Newcastle, NSW, 2290, Australia
| | - Gillian S Gould
- Faculty of Health, Southern Cross University, Lismore, NSW, Australia
| |
Collapse
|
35
|
Cortés Rico O, Esparza Olcina MJ, Sánchez-Ventura JG, Gallego Iborra A, Pallás Alonso CR, Garcia Soto L, Rando Diego Á, Colomer Revuelta J, Garach Gómez A, Martí Martí L, Mengual Gil JM. [Summary PAPPS Childhood and Adolescence 2022]. Aten Primaria 2022; 54 Suppl 1:102441. [PMID: 36435589 PMCID: PMC9705216 DOI: 10.1016/j.aprim.2022.102441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/24/2022] Open
Abstract
Two important topics about children and adolescents in our primary care activity are presented in this update document: tobacco smoking prevention in adolescence and prophylaxis with vitamin K to prevent the hemorrhagic disease of the newborn.
Collapse
|
36
|
Silva-Jose C, Sánchez-Polán M, Barakat R, Díaz-Blanco Á, Mottola MF, Refoyo I. A Virtual Exercise Program throughout Pregnancy during the COVID-19 Pandemic Modifies Maternal Weight Gain, Smoking Habits and Birth Weight—Randomized Clinical Trial. J Clin Med 2022; 11:jcm11144045. [PMID: 35887809 PMCID: PMC9321470 DOI: 10.3390/jcm11144045] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/11/2022] [Indexed: 02/01/2023] Open
Abstract
The intrauterine environment is key to health from a short- and long-term perspective. Birth weight is an important indicator that may influence the fetal environment due to epigenetics. Considering physical inactivity, in parallel with higher levels of stress, affecting smoking patterns and the physical and emotional health of the pregnant population, maintaining the health of future generations is crucial. A randomized clinical trial (NCT04563065) was conducted. One-hundred and ninety-two healthy pregnant individuals were assigned to the intervention (IG) or control (CG) group. Overall, significant differences were found between groups when stratified by birth weight (χ2 (1) = 6.610; p = 0.037) with low birth weight and macrosomia found more often in the CG (4% vs. 14% and 3% vs. 9%, respectively) and higher admissions to the neonatal intensive care unit (χ2 (1) = 5.075; p = 0.024) in the CG (20/28.6%) compared to the IG (9/13.0). Smoking during pregnancy was also found more often in the CG (12/17.1%) compared to the IG (3/4.4%) (p = 0.016). A virtual program of supervised exercise throughout pregnancy during the ongoing pandemic could help to maintain adequate birth weights, modify maternal smoking habits, and lower admissions to the neonatal intensive care unit.
Collapse
Affiliation(s)
- Cristina Silva-Jose
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (R.B.)
| | - Miguel Sánchez-Polán
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (R.B.)
- Correspondence: ; Tel.: +34-913364120
| | - Ruben Barakat
- AFIPE Research Group, Faculty of Physical Activity and Sport Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain; (C.S.-J.); (R.B.)
| | - Ángeles Díaz-Blanco
- Gynecology and Obstetrics Department, Hospital Universitario Severo Ochoa de Leganés, 28911 Leganés, Spain;
| | - Michelle F. Mottola
- R. Samuel McLaughlin Foundation-Exercise and Pregnancy Lab, School of Kinesiology, Faculty of Health Sciences, Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Children’s Health Research Institute, The University of Western Ontario London, London, ON N6A 3K7, Canada;
| | - Ignacio Refoyo
- Sports Department, Faculty of Physical Activity and Sports Sciences-INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| |
Collapse
|
37
|
Littman D, Sherman SE, Troxel AB, Stevens ER. Behavioral Economics and Tobacco Control: Current Practices and Future Opportunities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8174. [PMID: 35805833 PMCID: PMC9266334 DOI: 10.3390/ijerph19138174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/21/2022] [Accepted: 07/02/2022] [Indexed: 11/17/2022]
Abstract
Despite considerable progress, smoking remains the leading preventable cause of death in the United States. To address the considerable health and economic burden of tobacco use, the development of improved tobacco control and treatment interventions is critical. By combining elements of economics and psychology, behavioral economics provides a framework for novel solutions to treat smokers who have failed to quit with traditional smoking cessation interventions. The full range of behavioral economic principles, however, have not been widely utilized in the realm of tobacco control and treatment. Given the need for improved tobacco control and treatment, the limited use of other behavioral economic principles represents a substantial missed opportunity. For this reason, we sought to describe the principles of behavioral economics as they relate to tobacco control, highlight potential gaps in the behavioral economics tobacco research literature, and provide examples of potential interventions that use each principle.
Collapse
Affiliation(s)
- Dalia Littman
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| | - Scott E. Sherman
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY 10010, USA
| | - Andrea B. Troxel
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| | - Elizabeth R. Stevens
- Department of Population Health, NYU Langone Health, New York, NY 10016, USA; (D.L.); (S.E.S.); (A.B.T.)
| |
Collapse
|
38
|
Turner S, Posthumus AG, Steegers EAP, AlMakoshi A, Sallout B, Rifas-Shiman SL, Oken E, Kumwenda B, Alostad F, Wright-Corker C, Watson L, Mak D, Cheung HC, Judge A, Aucott L, Jaddoe VWV, Annesi Maesano I, Soomro MH, Hindmarsh P, Jacobsen G, Vik T, Riaño-Galan I, Rodríguez-Dehli AC, Lertxundi A, Rodriguez LSM, Vrijheid M, Julvez J, Esplugues A, Iñiguez C. Household income, fetal size and birth weight: an analysis of eight populations. J Epidemiol Community Health 2022; 76:629-636. [PMID: 35414519 DOI: 10.1136/jech-2021-218112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/12/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The age at onset of the association between poverty and poor health is not understood. Our hypothesis was that individuals from highest household income (HI), compared to those with lowest HI, will have increased fetal size in the second and third trimester and birth. METHODS Second and third trimester fetal ultrasound measurements and birth measurements were obtained from eight cohorts. Results were analysed in cross-sectional two-stage individual patient data (IPD) analyses and also a longitudinal one-stage IPD analysis. RESULTS The eight cohorts included 21 714 individuals. In the two-stage (cross-sectional) IPD analysis, individuals from the highest HI category compared with those from the lowest HI category had larger head size at birth (mean difference 0.22 z score (0.07, 0.36)), in the third trimester (0.25 (0.16, 0.33)) and second trimester (0.11 (0.02, 0.19)). Weight was higher at birth in the highest HI category. In the one-stage (longitudinal) IPD analysis which included data from six cohorts (n=11 062), head size was larger (mean difference 0.13 (0.03, 0.23)) for individuals in the highest HI compared with lowest category, and this difference became greater between the second trimester and birth. Similarly, in the one-stage IPD, weight was heavier in second highest HI category compared with the lowest (mean difference 0.10 (0 .00, 0.20)) and the difference widened as pregnancy progressed. Length was not linked to HI category in the longitudinal model. CONCLUSIONS The association between HI, an index of poverty, and fetal size is already present in the second trimester.
Collapse
Affiliation(s)
- Steve Turner
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Anke G Posthumus
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Eric A P Steegers
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, The Netherlands
| | - Amel AlMakoshi
- Child Health, University of Aberdeen, Aberdeen, UK.,Maternal-Fetal medicine, Women's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Bahauddin Sallout
- Medical Service Directorate, Ministry of Defence, Riyadh, Saudi Arabia
| | - Sheryl L Rifas-Shiman
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Emily Oken
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Ben Kumwenda
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | | | - Laura Watson
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Diane Mak
- Child Health, University of Aberdeen, Aberdeen, UK
| | | | - Alice Judge
- Child Health, University of Aberdeen, Aberdeen, UK
| | - Lorna Aucott
- Centre for Healthcare Randomised Trial, University of Aberdeen, Aberdeen, UK
| | - Vincent W V Jaddoe
- The Generation R Study Group, Erasmus MC, Rotterdam, The Netherlands.,Department of Paediatrics, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Annesi Maesano
- Debrest Institute of Epidemiology and Public Health, Montpellier University and INSERM, Montpellier, France
| | - Munawar Hussain Soomro
- Debrest Institute of Epidemiology and Public Health, Montpellier University and INSERM, Montpellier, France
| | | | - Geir Jacobsen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Torstein Vik
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Isolina Riaño-Galan
- AGC de Pediatría, Hospital Universitario Central de Asturias, Asturias, Oviedo, Spain.,IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ana Cristina Rodríguez-Dehli
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Pediatrics Service, Hospital Universitario San Agustín, Avilés, Spain.,Servicio de Salud del Principado de Asturias (SESPA), IUOPA-Departamento de Medicina-ISPA, Universidad de Oviedo, Oviedo, Spain
| | - Aitana Lertxundi
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Department of Preventive Medicine and Public Health, Faculty of Medicine, University of the Basque Country, (UPV/EHU), Spain
| | - Loreto Santa Marina Rodriguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Biodonostia Health Research Institute, San Sebastian, Spain.,Health Department of Basque Government, Subdirectorate of Public Health of Gipuzkoa, San Sebastian, Spain
| | - Martine Vrijheid
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,ISGlobal- Instituto de Salud Global de Barcelona-Campus MAR, PRBB, Barcelona, Catalonia, Spain.,Universitat Pompeau Fabra (UPF), Barcelona, Spain
| | - Jordi Julvez
- Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Reus, Spain.,Instituto de Salud Global, Barcelona, Spain.,Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Ana Esplugues
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Joint Research Unit of Epidemiology and Environmental Health, FISABIO, Valencia, Spain
| | - Carmen Iñiguez
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Department of Statistics and Operational Research, Universitat de València, València, Spain
| |
Collapse
|
39
|
Crume TL, Powers S, Dufford AJ, Kim P. Cannabis and Pregnancy: Factors Associated with Cannabis Use Among Pregnant Women and the Consequences for Offspring Neurodevelopment and Early Postpartum Parenting Behavior. CURRENT ADDICTION REPORTS 2022. [DOI: 10.1007/s40429-022-00419-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
40
|
Siersbaek R, Parker S, Kavanagh P, Ford JA, Burke S. How and why do financial incentives contribute to helping people stop smoking? A realist review protocol. BMJ Open 2022; 12:e060457. [PMID: 35705352 PMCID: PMC9204444 DOI: 10.1136/bmjopen-2021-060457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Smoking is harmful to human health and programmes to help people stop smoking are key public health efforts that improve individual and population health outcomes. Research shows that financial incentives improve the success of stop smoking programmes. However, a better understanding of how they work is needed to better inform policy and to support building capability for implementation.The aims of this study: (1) To review the international literature to understand: How, why, in what circumstances and for whom financial incentives improve the success of stop smoking interventions among general population groups and among pregnant women. (2) To provide recommendations for how to best use financial incentives in efforts to promote smoking cessation. METHODS AND ANALYSIS A realist review of published international literature will be undertaken to understand how, why, for whom and in which circumstances financial incentives contribute to success in stopping smoking for general population groups and among pregnant women. Systematic searches were undertaken on 16 February 2022 of five academic databases: MEDLINE (ovid), Embase.com, CIHAHL, Scopus and PsycINFO. Iterative searching using citation tracking and of grey literature will be undertaken as needed. Using Pawson and Tilley's iterative realist review approach, data collected will be screened, selected, coded, analysed and synthesised into a set of explanatory theoretical findings. ETHICS AND DISSEMINATION Ethical approval is not required for this review as data sources to be included are previously published. The study will provide important findings for policy-makers and health system leaders to guide the development of stop smoking services which use incentives, for example, as part of the Health Service Executive's Tobacco Free Programme in Ireland. Understanding how contextual factors impact implementation and programmatic success is key to developing a more effective public health approach to stop smoking. Our dissemination strategy will be developed with our stakeholders. PROSPERO REGISTRATION NUMBER CRD42022298941.
Collapse
Affiliation(s)
- Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin School of Medicine, Dublin 2, Ireland
| | - Sarah Parker
- Centre for Health Policy and Management, Trinity College Dublin School of Medicine, Dublin 2, Ireland
| | - Paul Kavanagh
- National Health Intelligence Unit, Strategy and Research, Jervis House, Jervis St, Health Service Executive, Dublin 1, Ireland
- Department of Public Health and Epidemiology, Centre for Population Health and Health Services Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin School of Medicine, Dublin 2, Ireland
| |
Collapse
|
41
|
Fletcher C, Hoon E, Gialamas A, Dekker G, Lynch J, Smithers L. Isolation, marginalisation and disempowerment - understanding how interactions with health providers can influence smoking cessation in pregnancy. BMC Pregnancy Childbirth 2022; 22:396. [PMID: 35538450 PMCID: PMC9086664 DOI: 10.1186/s12884-022-04720-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Maternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. Aim This study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey. Methods Women (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. Findings Four interconnected themes were identified: 1) smoking embedded in women’s challenging lives and pregnancies, 2) cyclic isolation and marginalisation, 3) feeling disempowered, and 4) autonomy and self-determination. Themes 3 and 4 are characterised as being two sides of a single coin in that they coexist simultaneously and are inseparable. A key finding is a strong unanimous desire for smoking cessation in pregnancy but women felt they did not have the necessary support from health providers or confidence and self-efficacy to be successful. Conclusion Women would like improvements to antenatal care that increase health practitioners’ understanding of the social and contextual healthcare barriers faced by women who smoke in pregnancy. They seek improved interventions from health providers to make informed choices about smoking cessation and would like women-centred care. Women feel that with greater support, more options for cessation strategies and consistency and encouragement from health providers they could be more successful at antenatal smoking cessation. If such changes were made, then South Australian practice could align more with best practice international guidelines for addressing smoking cessation in pregnancy, and potentially improve outcomes for women and their children. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04720-0.
Collapse
Affiliation(s)
- Cherise Fletcher
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia
| | - Elizabeth Hoon
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,Discipline of General Practice, Faculty of Health & Medical Sciences, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Angela Gialamas
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia
| | - Gustaaf Dekker
- The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia.,Obstetrics and Gynaecology Department, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - John Lynch
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia.,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Lisa Smithers
- School of Public Health, Faculty of Health & Medical Sciences, University of Adelaide, Level 5, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, SA, 5005, Australia. .,The Robinson Research Institute, Norwich Centre, Ground Floor, 55 King William Road, North Adelaide, SA, 5006, Australia. .,School of Health & Society, Faculty of Arts, Social Sciences & Humanities, University of Wollongong, Wollongong, NSW, 2522, Australia. .,The Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia.
| |
Collapse
|
42
|
Kurti AN, Nighbor TD, Tang K, Bolívar HA, Evemy CG, Skelly J, Higgins ST. Effect of Smartphone-Based Financial Incentives on Peripartum Smoking Among Pregnant Individuals: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2211889. [PMID: 35560055 PMCID: PMC9107025 DOI: 10.1001/jamanetworkopen.2022.11889] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This randomized clinical trial assesses the effect of a smartphone-based intervention with financial incentive on peripartum smoking among pregnant individuals.
Collapse
|
43
|
Abstract
BACKGROUND Mindfulness-based smoking cessation interventions may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal. Types of mindfulness-based interventions include mindfulness training, which involves training in meditation; acceptance and commitment therapy (ACT); distress tolerance training; and yoga. OBJECTIVES To assess the efficacy of mindfulness-based interventions for smoking cessation among people who smoke, and whether these interventions have an effect on mental health outcomes. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, and trial registries to 15 April 2021. We also employed an automated search strategy, developed as part of the Human Behaviour Change Project, using Microsoft Academic. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs that compared a mindfulness-based intervention for smoking cessation with another smoking cessation programme or no treatment, and assessed smoking cessation at six months or longer. We excluded studies that solely recruited pregnant women. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methods. We measured smoking cessation at the longest time point, using the most rigorous definition available, on an intention-to-treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of intervention and type of comparator. We carried out meta-analyses where appropriate, using Mantel-Haenszel random-effects models. We summarised mental health outcomes narratively. MAIN RESULTS We included 21 studies, with 8186 participants. Most recruited adults from the community, and the majority (15 studies) were conducted in the USA. We judged four of the studies to be at low risk of bias, nine at unclear risk, and eight at high risk. Mindfulness-based interventions varied considerably in design and content, as did comparators, therefore, we pooled small groups of relatively comparable studies. We did not detect a clear benefit or harm of mindfulness training interventions on quit rates compared with intensity-matched smoking cessation treatment (RR 0.99, 95% CI 0.67 to 1.46; I2 = 0%; 3 studies, 542 participants; low-certainty evidence), less intensive smoking cessation treatment (RR 1.19, 95% CI 0.65 to 2.19; I2 = 60%; 5 studies, 813 participants; very low-certainty evidence), or no treatment (RR 0.81, 95% CI 0.43 to 1.53; 1 study, 325 participants; low-certainty evidence). In each comparison, the 95% CI encompassed benefit (i.e. higher quit rates), harm (i.e. lower quit rates) and no difference. In one study of mindfulness-based relapse prevention, we did not detect a clear benefit or harm of the intervention over no treatment (RR 1.43, 95% CI 0.56 to 3.67; 86 participants; very low-certainty evidence). We did not detect a clear benefit or harm of ACT on quit rates compared with less intensive behavioural treatments, including nicotine replacement therapy alone (RR 1.27, 95% CI 0.53 to 3.02; 1 study, 102 participants; low-certainty evidence), brief advice (RR 1.27, 95% CI 0.59 to 2.75; 1 study, 144 participants; very low-certainty evidence), or less intensive ACT (RR 1.00, 95% CI 0.50 to 2.01; 1 study, 100 participants; low-certainty evidence). There was a high level of heterogeneity (I2 = 82%) across studies comparing ACT with intensity-matched smoking cessation treatments, meaning it was not appropriate to report a pooled result. We did not detect a clear benefit or harm of distress tolerance training on quit rates compared with intensity-matched smoking cessation treatment (RR 0.87, 95% CI 0.26 to 2.98; 1 study, 69 participants; low-certainty evidence) or less intensive smoking cessation treatment (RR 1.63, 95% CI 0.33 to 8.08; 1 study, 49 participants; low-certainty evidence). We did not detect a clear benefit or harm of yoga on quit rates compared with intensity-matched smoking cessation treatment (RR 1.44, 95% CI 0.40 to 5.16; 1 study, 55 participants; very low-certainty evidence). Excluding studies at high risk of bias did not substantially alter the results, nor did using complete case data as opposed to using data from all participants randomised. Nine studies reported on changes in mental health and well-being, including depression, anxiety, perceived stress, and negative and positive affect. Variation in measures and methodological differences between studies meant we could not meta-analyse these data. One study found a greater reduction in perceived stress in participants who received a face-to-face mindfulness training programme versus an intensity-matched programme. However, the remaining eight studies found no clinically meaningful differences in mental health and well-being between participants who received mindfulness-based treatments and participants who received another treatment or no treatment (very low-certainty evidence). AUTHORS' CONCLUSIONS We did not detect a clear benefit of mindfulness-based smoking cessation interventions for increasing smoking quit rates or changing mental health and well-being. This was the case when compared with intensity-matched smoking cessation treatment, less intensive smoking cessation treatment, or no treatment. However, the evidence was of low and very low certainty due to risk of bias, inconsistency, and imprecision, meaning future evidence may very likely change our interpretation of the results. Further RCTs of mindfulness-based interventions for smoking cessation compared with active comparators are needed. There is also a need for more consistent reporting of mental health and well-being outcomes in studies of mindfulness-based interventions for smoking cessation.
Collapse
Affiliation(s)
- Sarah Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
| | - Emma Norris
- Health Behaviour Change Research Group, Brunel University London, London, UK
| | | | - Emily Hayes
- Centre for Behaviour Change, University College London, London, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
44
|
Petersen AB, Ogunrinu T, Wallace S, Yun J, Belliard JC, Singh PN. Implementation and Outcomes of a Maternal Smoking Cessation Program for a Multi-ethnic Cohort in California, USA, 2012-2019. J Community Health 2022; 47:257-265. [PMID: 34739686 PMCID: PMC8569845 DOI: 10.1007/s10900-021-01042-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
Smoking during pregnancy remains one of the most significant risk factors for poor birth outcomes. During 2012-2019, the Loma Linda University Health Comprehensive Tobacco Treatment Program (CTTP) used a multicomponent behavioral intervention for tobacco cessation for 1402 pregnant smokers with components of known efficacy (i.e., incentives, biomarker testing, feedback, and motivational interviewing). The CTTP cohort includes a multi-ethnic sample of pregnant women with a mean age of 27 years referred by collaborating community-based healthcare providers in San Bernardino county. Evaluation of program outcomes from 7 years of follow-up (2012-2019) creates a rich cohort dataset for implementation science research to examine the real-world effectiveness of the program. In this report, we provide a cohort profile, and 8-week prolonged abstinence (8-week PA) and relapse findings from the first year of follow-up (n = 233). We found: (1) 28.4% achieved 8-week PA, (2) At a median of 6.2 months of follow-up after achieving 8-week PA, 23.2% of enrolled subjects reported tobacco cessation, and (3) a high rate of loss to follow-up (44%). In addition, our modeling indicated that the odds of relapse/smoking after enrollment was significantly higher in young mothers, non-Hispanic mothers (White, Black/African-American), mothers in the first and third trimester, and rural mothers. Formative quantitative and qualitative research on the CTTP cohort will consider the effects of a range of implementation science (number of intervention sessions, addition of a mHealth component, distance to care) and individual (partner/household smoking, birth outcomes, NICU) outcome measures for the purpose of scaling up the CTTP model.
Collapse
Affiliation(s)
- Anne Berit Petersen
- Loma Linda University School of Nursing, 11262 Campus Street, Loma Linda, CA, 92350, USA.
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA, 92354, USA.
| | - Temidayo Ogunrinu
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Shane Wallace
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Jane Yun
- Loma Linda University Health SACHS Clinic, 250 S G St, San Bernardino, CA, 92410, USA
| | - Juan Carlos Belliard
- Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Institute for Community Partnerships, Loma Linda University, 11234 Anderson St, Loma Linda, CA, 92354, USA
| | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Loma Linda University School of Public Health, 11234 Anderson St, Loma Linda, CA, 92354, USA
- Transdisciplinary Tobacco Research Program, Loma Linda University Cancer Center, 11234 Anderson St, Loma Linda, CA, 92354, USA
| |
Collapse
|
45
|
Barros H, Baia I, Monjardino T, Pimenta P, Alfredo A, Sorokina A, Domingues R. Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW). BMJ Open 2022; 12:e052964. [PMID: 35292492 PMCID: PMC8928251 DOI: 10.1136/bmjopen-2021-052964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Low birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is to estimate the effect of implementing fast-track referral for early intervention on psychosocial and behavioural risk factors-smoking, alcohol consumption, depression and physical violence-in reducing the incidence of LBW. METHODS AND ANALYSIS Parallel superiority pragmatic clinical trial randomised by clusters. Primary healthcare units (PHCU) located in Portugal will be randomised (1:1) to intervention or control groups. Pregnant women over 18 years of age attending these PHCU will be eligible to the study. Risk factors will be assessed through face-to-face interviews. In the intervention group, women who report at least one risk factor will have immediate access to referral services. The comparison group will be the local standard of care for these risk factors. We will use intention-to-treat analyses to compare intervention and control groups. We estimated a sample size of 2832 pregnant women to detect a 30% reduction in the incidence rate of LBW between the control and intervention groups. Secondary outcomes are the reduction of preterm births, reduction of the four risk factors and acceptance of the intervention. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the Public Health Institute of the University of Porto (no CE20140). The findings will be disseminated to the public, the funders, health professionals, health managers and other researchers. TRIAL REGISTRATION NUMBER NCT04866277.
Collapse
Affiliation(s)
- Henrique Barros
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto, Porto, Portugal
| | - Ines Baia
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Teresa Monjardino
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Pedro Pimenta
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Ana Alfredo
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Anzhela Sorokina
- Instituto de Saúde Pública da Universidade do Porto, Universidade do Porto, Porto, Portugal
| | - Rosa Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| |
Collapse
|
46
|
Sequí-Canet JM, Sequí-Sabater JM, Marco-Sabater A, Corpas-Burgos F, Collar del Castillo JI, Orta-Sibú N. Maternal factors associated with smoking during gestation and consequences in newborns: Results of an 18-year study. J Clin Transl Res 2022; 8:6-19. [PMID: 35097236 PMCID: PMC8791242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/06/2021] [Accepted: 11/12/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Tobacco use is one of the most important causes of obstetric and perinatal pathologies. Its frequency during pregnancy is high and could be related to various socioeconomic and cultural characteristics of the mothers. AIM The aim of this study is to determine the trend and prevalence of smoking in pregnant mothers in our area over the years and the socio-cultural or obstetric factors associated with smoking as well as the repercussions on the newborns related to its consumption. METHODS Retrospective study of 18,959 mothers of healthy newborns in the maternity ward of the regional hospital during the years 2002-2019. The variable under study was maternal smoking during pregnancy compared with various maternal, obstetric, and perinatal factors. RESULTS A mean percentage of 20.4% of the mothers smoked, with significantly decreasing percentages over the years. There was a significant association between smoking and mothers' age, origin, level of education, the occurrence of previous abortions, parity, type of breastfeeding at discharge, type of delivery, low birth weight, and need for neonatal resuscitation. CONCLUSIONS This defines a profile of pregnant smokers on whom it is important to act: young, Spanish, with a low level of education, multiparous, and with previous miscarriages. Its repercussions are also evident with a lower birth weight in newborns. Knowledge of these factors will make it possible to design more effective intervention strategies to reduce smoking during pregnancy. RELEVANCE FOR PATIENTS Any effort that reduces smoking habits can improve the health status of mothers and newborns and the first step is to know who are risk pregnants.
Collapse
Affiliation(s)
- Jose Miguel Sequí-Canet
- 1Department of Paediatrics, University Hospital “Francisco de Borja”, Gandía, Spain,
Corresponding author: Jose Miguel Sequí-Canet Department of Paediatrics, University Hospital “Francisco de Borja”, Av. de la Medicina 646702-Gandia, Spain. Tel: +34 962849732
| | | | - Ana Marco-Sabater
- 1Department of Paediatrics, University Hospital “Francisco de Borja”, Gandía, Spain
| | - Francisca Corpas-Burgos
- 3Department of Statistics, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Área de Desigualdades en Salud, Spain
| | | | - Nelson Orta-Sibú
- 1Department of Paediatrics, University Hospital “Francisco de Borja”, Gandía, Spain
| |
Collapse
|
47
|
Wang K, Qi Y, Wei Q, Shi Y, Zhang Y, Shi H. Responsive Caregiving and Opportunities for Early Learning Associated With Infant Development: Results From a Prospective Birth Cohort in China. Front Pediatr 2022; 10:857107. [PMID: 35813393 PMCID: PMC9260074 DOI: 10.3389/fped.2022.857107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/01/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infant development shapes children's health into adulthood. Although providing responsive caregiving and opportunities regarding early learning for infants have received increasing attention from the international community, few studies have been published on these topics thus far. The purpose of the present study, then, was to explore the influences of responsive caregiving and the opportunities for early learning on infant development. METHODS Mother-child dyads (3,714 pairs) were recruited from the Shanghai Maternal-Child Pairs Cohort (Shanghai MCPC) for the present study, and the development of infants, responsive caregiving and opportunities for early learning were collected from three waves of follow-up (2-, 6-, and 12-month old) We used the cross-lagged model to analyze the longitudinal correlation between responsive caregiving or opportunities for early learning and development of infants. We used the generalized estimation equation (GEE) to evaluate the effect of responsive caregiving and opportunities for early learning on suspected developmental delay; we also conducted a hierarchical analysis to investigate the interaction between responsive caregiving or opportunities for early learning and annual family income. RESULTS There was a mutual prediction between responsive caregiving or opportunities for early learning and some developmental domains of the Ages and Stages Questionnaires, third edition (ASQ-3). Sustained high-exposure to responsive caregiving or opportunities for early learning significantly decreased the risk of suspected developmental delay in most domains of the ASQ-3. And For infants whose annual family income was < ¥200,000, sustained high-exposure (Adjusted Odds Ratio = 0.456, 95% CI, 0.325-0.638) and fluctuating-exposure (Adjusted Odds Ratio = 0.510, 95% CI, 0.414-0.627) to responsive caregiving significantly reduced the risk for suspected developmental delay. CONCLUSION Responsive caregiving or opportunities for early learning interacted with infant development. Infants' early access to adequate responsive caregiving and opportunities for early learning exerted a sustained and positive impact on infant development, and this effect is more pronounced in relative low-income families.
Collapse
Affiliation(s)
- Ke Wang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yue Qi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Qian Wei
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yuyang Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| | - Yunhui Zhang
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Huijing Shi
- Key Laboratory of Public Health Safety, Ministry of Education, Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
| |
Collapse
|
48
|
Sartore GM, Pourliakas A, Lagioia V. Peer support interventions for parents and carers of children with complex needs. Cochrane Database Syst Rev 2021; 12:CD010618. [PMID: 34923624 PMCID: PMC8684823 DOI: 10.1002/14651858.cd010618.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Parents and family carers of children with complex needs experience a high level of pressure to meet children's needs while maintaining family functioning and, as a consequence, often experience reduced well-being and elevated psychological distress. Peer support interventions are intended to improve parent and carer well-being by enhancing the social support available to them. Support may be delivered via peer mentoring or through support groups (peer or facilitator led). Peer support interventions are widely available, but the potential benefits and risks of such interventions are not well established. OBJECTIVES To assess the effects of peer support interventions (compared to usual care or alternate interventions) on psychological and psychosocial outcomes, including adverse outcomes, for parents and other family carers of children with complex needs in any setting. SEARCH METHODS We searched the following resources. • Cochrane Central Register of Controlled Trials (CENTRAL; latest issue: April 2014), in the Cochrane Library. • MEDLINE (OvidSP) (1966 to 19 March 2014). • Embase (OvidSP) (1974 to 18 March 2014). • Journals@OVID (22 April 2014). • PsycINFO (OvidSP) (1887 to 19 March 2014). • BiblioMap (EPPI-Centre, Health Promotion Research database) (22 April 2014). • ProQuest Dissertations and Theses (26 May 2014). • metaRegister of Controlled Trials (13 May 2014). We conducted a search update of the following databases. • MEDLINE (OvidSP) (2013 to 20 February 2018) (search overlapped to 2013). • PsycINFO (ProQuest) (2013 to 20 February 2018). • Embase (Elsevier) (2013 to 21 February 2018). We handsearched the reference lists of included studies and four key journals (European Child and Adolescent Psychiatry: 31 March 2015; Journal of Autism and Developmental Disorders: 30 March 2015; Diabetes Educator: 7 April 2015; Journal of Intellectual Disability Research: 13 April 2015). We contacted key investigators and consulted key advocacy groups for advice on identifying unpublished data. We ran updated searches on 14 August 2019 and on 25 May 2021. Studies identified in these searches as eligible for full-text review are listed as "Studies awaiting classification" and will be assessed in a future update. SELECTION CRITERIA Randomised and cluster randomised controlled trials (RCTs and cluster RCTs) and quasi-RCTs were eligible for inclusion. Controlled before-and-after and interrupted time series studies were eligible for inclusion if they met criteria set by the Cochrane Effective Practice and Organisation of Care Review Group. The comparator could be usual care or an alternative intervention. The population eligible for inclusion consisted of parents and other family carers of children with any complex needs. We applied no restriction on setting. DATA COLLECTION AND ANALYSIS Inclusion decisions were made independently by two authors, with differences resolved by a third author. Extraction to data extraction templates was conducted independently by two authors and cross-checked. Risk of bias assessments were made independently by two authors and were reported according to Cochrane guidelines. All measures of treatment effect were continuous and were analysed in Review Manager version 5.3. GRADE assessments were undertaken independently by two review authors, with differences resolved by discussion. MAIN RESULTS We included 22 studies (21 RCTs, 1 quasi-RCT) of 2404 participants. Sixteen studies compared peer support to usual care; three studies compared peer support to an alternative intervention and to usual care but only data from the usual care arm contributed to results; and three studies compared peer support to an alternative intervention only. We judged risk of bias as moderate to high across all studies, particularly for selection, performance, and detection bias. Included studies contributed data to seven effect estimates compared to usual care: psychological distress (standardised mean difference (SMD) -0.10, 95% confidence interval (CI) -0.32 to 0.11; 8 studies, 864 participants), confidence and self-efficacy (SMD 0.04, 95% CI -0.14 to 0.21; 8 studies, 542 participants), perception of coping (SMD -0.08, 95% CI -0.38 to 0.21; 3 studies, 293 participants), quality of life and life satisfaction (SMD 0.03, 95% CI -0.32 to 0.38; 2 studies, 143 participants), family functioning (SMD 0.15, 95% CI -0.09 to 0.38; 4 studies, 272 participants), perceived social support (SMD 0.31, 95% CI -0.15 to 0.77; 4 studies, 191 participants), and confidence and skill in navigating medical services (SMD 0.05, 95% CI -0.17 to 0.28; 4 studies, 304 participants). In comparisons to alternative interventions, one pooled effect estimate was possible: psychological distress (SMD 0.2, 95% CI -0.38 to 0.79; 2 studies, 95 participants). No studies reported on adverse outcomes. All narratively synthesised data for psychological distress (compared to usual care - 2 studies), family functioning (compared to usual care - 1 study; compared to an alternative intervention - 1 study), perceived social support (compared to usual care - 2 studies), and self-efficacy (compared to alternative interventions - 1 study) were equivocal. Comparisons with usual care showed no difference between intervention and control groups (perceived social support), some effect over time for both groups but more effect for intervention (distress), or mixed effects for intervention (family function). Comparisons with alternative interventions showed no difference between the intervention of interest and the alternative. This may indicate similar effects to the intervention of interest or lack of effect of both, and we are uncertain which option is likely. We found no clear evidence of effects of peer support interventions on any parent outcome, for any comparator; however, the certainty of evidence for each outcome was low to very low, and true effects may differ substantially from those reported here. We found no evidence of adverse events such as mood contagion, negative group interactions, or worsened psychological health. Qualitative data suggest that parents and carers value peer support interventions and appreciate emotional support. AUTHORS' CONCLUSIONS Parents and carers of children with complex needs perceive peer support interventions as valuable, but this review found no evidence of either benefit or harm. Currently, there is uncertainty about the effects of peer support interventions for parents and carers of children with complex needs. However, given the overall low to very low certainty of available evidence, our estimates showing no effects of interventions may very well change with further research of higher quality.
Collapse
Affiliation(s)
| | - Anastasia Pourliakas
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Australia
| | - Vince Lagioia
- Parenting Research Centre, East Melbourne, Australia
| |
Collapse
|
49
|
Murff HJ, Greevy RA, Sanghani RS, Hartmann KE, Hartert TV, Graves CR, Lee SS, Tindle HA. Investigating N-3 Fatty Acids to prevent Neonatal Tobacco-related outcomeS (INFANTS): study protocol for a double-blind, randomized, placebo-controlled parallel clinical trial of n-3 polyunsaturated fatty acids in pregnant smokers. Trials 2021; 22:922. [PMID: 34906201 PMCID: PMC8669400 DOI: 10.1186/s13063-021-05865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco use during pregnancy is the most important modifiable risk factor associated with adverse pregnancy outcomes, increasing the risk of preterm birth, intrauterine growth restriction and sudden infant death syndrome. Fewer than half of pregnant smokers can quit on their own. Identifying safe and effective therapies to prevent tobacco-related adverse pregnancy outcomes and/or increase smoking cessation in pregnant women would have a substantial public health impact. Cigarette smoking is associated with a relative deficiency in circulating n-3 long-chain polyunsaturated fatty acid (n-3 LCPUFA) levels. A recent analysis found that smokers taking n-3 LCPUFAs during pregnancy had a reduction in preterm labor risk when compared to non-smokers. Studies have shown that supplemental n-3 LCPUFAs may also reduce nicotine cravings and daily cigarette use. Thus, smokers may benefit from supplemental n-3 LCPUFAs by lowering the risk of preterm labor and/or increased smoking cessation. To address important remaining knowledge gaps, we propose the Investigating N-3 Fatty Acids to prevent Neonatal Tobacco related outcomeS (INFANTS). METHODS The INFANTS study is a multicenter, randomized, double-blind, placebo-controlled study that will randomize 400 pregnant smokers to either supplemental n-3 LCPUFAs or placebo. Participants will be enrolled between 12 and 24 weeks' gestation and followed until 6 weeks after delivery. We will recruit from clinical centers throughout Middle Tennessee. We will assess smoking behavior after 12 weeks of supplementation using self-report and validated biomarkers of tobacco exposure. We will measure response to supplementation using biological markers of n-3 LCPUFA status. Our primary endpoint will be preterm labor as reflected by gestational age at delivery. Our secondary endpoint will be change from baseline in cigarettes per day at 12 weeks. DISCUSSION This study tests the hypothesis that smoking-induced n-3 LCPUFA deficiencies contribute to tobacco-related adverse pregnancy outcomes and that supplementation of n-3 LCPUFAs in pregnant smokers may prevent these complications. If our study demonstrates that supplemental n-3 LCPUFAs are effective at reducing the risk of tobacco-related adverse neonatal outcomes and/or reducing tobacco use during pregnancy, our results could have an immediate and major impact on pregnancy care and neonatal outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT04417595. Registered on April 21, 2020.
Collapse
Affiliation(s)
- Harvey J Murff
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37232, USA.
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, USA
| | - Reesha S Sanghani
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, USA
| | - Katherine E Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, USA
| | - Tina V Hartert
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, USA
| | | | - Scott S Lee
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37232, USA
| | - Hilary A Tindle
- Division of General Internal Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 450, Nashville, TN, 37232, USA
- Geriatric Research, Education and Clinical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| |
Collapse
|
50
|
Saygın Avşar T, Jackson L, McLeod H. Potential for health economics to influence policies on tobacco use during pregnancy in low-income and middle-income countries: a qualitative case study. BMJ Open 2021; 11:e045624. [PMID: 34880008 PMCID: PMC8655542 DOI: 10.1136/bmjopen-2020-045624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Tobacco control during pregnancy is a policy priority in high-income countries (HICs) because of the significant health and inequality consequences. However, little evidence exists on interventions to reduce tobacco use in low-income and middle-income countries (LMICs), especially for pregnant women. This study aimed to assess how health economics evidence, which is mainly produced in HICs, could be adopted for tobacco cessation policies for pregnant women in LMICs. METHODS A qualitative case study was conducted in an international public health organisation. The organisation was chosen due to its capacity to influence health policies around the world. Tobacco control experts working in the organisation were identified through purposeful sampling and snowballing. Semistructured interviews were conducted with 18 informants with relevant experience of countries from all of the regions covered by the organisation. Data were analysed using the framework method. RESULTS In practice, tobacco cessation during pregnancy was not viewed as a priority in LMICs despite international recognition of the issue. In LMICs, factors including the recorded country-specific prevalence of tobacco use during pregnancy, availability of healthcare resources and the characteristics of potential interventions all affected the use of health economics evidence for policy making. CONCLUSION The scale of tobacco use among pregnant women might be greater than reported in LMICs. Health economics evidence produced in HICs has the potential to inform health policies in LMICs around tobacco cessation interventions if the country-specific circumstances are addressed. Economic evaluations of cessation interventions integrated into antenatal care with a household perspective would be especially relevant in LMICs.
Collapse
Affiliation(s)
- Tuba Saygın Avşar
- National Institute for Health Research Applied Research Collaboration (NIHR ARC) North Thames, Department of Applied Health Research, University College London, London, UK
| | - Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Hugh McLeod
- Population Health Sciences, Medical School, University of Bristol, Bristol, UK
- NIHR ARC West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| |
Collapse
|