Understanding sociodemographic and sociocultural factors that characterize tobacco use and cessation during pregnancy among women in the Dominican Republic

Predictors of Secondhand Smoke Exposure During Pregnancy in Costa Rica, the Dominican Republic, and Honduras

INTRODUCTION

Secondhand smoke (SHS) exposure poses risks to pregnant women and children. Though smoking among pregnant women in many low- and middle-income countries is low, exposure to SHS might be higher. We examined the prevalence and predictors of SHS among pregnant women from Costa Rica, the Dominican Republic, and Honduras.

METHODS

Postpartum women 18+ years old who completed pregnancy in past 5 years were surveyed in health care and community settings.

RESULTS

Data for 1,081 women indicated low tobacco use (1.0%-3.7%), frequent exposure to active smokers (29.0%-34.0%), often being close enough to breathe others' smoke (49.4%-66.5%), and most having smoke-free home policies (70.8%-76.2%). Women reporting unintended pregnancy (adjusted odds ratio [aOR]: 1.44, 95% confidence interval [CI] 1.03, 2.00) and alcohol consumption (aOR: 1.92, 95% CI 1.34, 2.77) were more likely to be close enough to breathe others' smoke. Women with health problems during pregnancy (aOR: 1.48 95% CI 1.07, 2.06) were more likely to have home smoking policies. Tobacco use was associated with all SHS exposure outcomes.

CONCLUSIONS

SHS exposure was high during pregnancy; women with higher risk variables, that is, tobacco use, alcohol consumption, and unintended pregnancy were more likely to be exposed. Addressing SHS exposure in pregnancy in low- and middle-income countries can improve maternal health outcomes in vulnerable populations.

IMPLICATIONS

The study results suggest a cluster of multiple risk factors associated with a high prevalence of exposure to SHS among pregnant women in LIMCs from Latin America and Caribbean Region. Interventions, regulations, and policies need to address specific high-risk factors to change behaviors and improve maternal and child health outcomes especially in vulnerable populations.

Tobacco Cessation in Economically Disadvantaged Dominican Republic Communities: Who are the Ex-Users?

INTRODUCTION

Tobacco use and harm continue to increase in low- and middle income countries (LMICs) globally. Smoking cessation is the most effective means of reducing morbidity and mortality from tobacco use. Increasing the prevalence of ex-users is an indicator of population cessation.

AIMS

This study provides the first examination of factors associated with ex-tobacco use status in the Dominican Republic (DR), a LMIC in the Latin America and Caribbean region.

METHODS

Baseline surveillance was conducted for 1177 randomly selected households in 7 economically disadvantaged DR communities (total N=2680 adult household members).

RESULTS

Ex-user prevalence was 10.6% (1.0%-18.5% across communities), 14.8% were current users (9.1-20.4), and quit ratios were 41.7% (9.7%-52.7%). Among ever-users, females (OR 2.02, 95% CI 1.41, 2.90), older adults (45-64: OR 1.75, 95% CI 1.12, 2.74; 65+: OR 2.09, 95% CI 1.29, 3.39), and those who could read/write (OR 1.64, 95% CI 1.08, 2.50), had health conditions (OR 1.63, 95% CI 1.11, 2.41), and lived with ex-users (OR 1.70, 95% CI 1.12, 2.58) were over 60% to two times as likely to be ex-users. Those from remote communities (OR 0.52, 95% CI 0.36, 0.74), using chewed tobacco (OR 0.14, 95% CI 0.04, 0.48) and living with tobacco users (OR 0.55, 95% CI 0.37, 0.81) were less likely to be ex-users.

CONCLUSIONS

Ex-user prevalence and quit ratios were lower than for high income countries. Implementing broad tobacco control measures, combined with clinically targeting vulnerable groups, may increase tobacco cessation to most effectively reduce this public health crisis.

Development and Implementation of Culturally Tailored Offline Mobile Health Surveys

Background

In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings.

Objective

The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs.

Methods

In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets.

Results

Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners.

Conclusions

Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs.

Lessons Learned from Twelve Years of Partnered Tobacco Cessation Research in the Dominican Republic

Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.