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Roczen J, Bolte G, Reineke B, Kuhnert R, Starker A, Mena E. Gender equality and smoking among 15 to 25 year olds-a time-based ecological analysis of developments in Germany from 1960 to 2005. Front Public Health 2024; 12:1295050. [PMID: 38435291 PMCID: PMC10904588 DOI: 10.3389/fpubh.2024.1295050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Smoking is a major risk factor for premature death and health problems in which there are significant gender differences in the prevalence of smoking. This ecological study examines the correlation between changes in gender equality and prevalence of smoking among young adults (15-25 years old) in Germany over a period of 45 years (1960-2005). Methods Gender inequality was measured using the United Nations Gender Inequality Index (GII), which is composed of three dimensions; health, empowerment and labour market. It was calculated for the entire registered German population in five-year intervals with values between 0 and 1 (1 = highest inequality). The smoking prevalence of young women and men in Germany was established using a reconstruction method. A gender smoking ratio (GSR) with values between 0 and 1 was determined (1 = identical smoking prevalence among men and women). The smoking behaviour was illustrated and stratified by education. The correlation between the GII and the GSR was analysed. Results The GII decreased from 0.98 to 0.56 between 1960 and 2005. The GSR increased from 0.34 to 0.93. There was a strong negative correlation between the GII and the GSR (r = -0.71). The strength of the correlation fell slightly as the level of education decreased. An increase in gender equality as measured by the GII came along with similarities of smoking prevalence between young women and young men. Conclusion Successful tobacco prevention among young women and men may benefit from involving experts in gender-specific public health research to develop counter-advertising and gender-specific information as needed.
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Affiliation(s)
- Jana Roczen
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Birgit Reineke
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Ronny Kuhnert
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Anne Starker
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Emily Mena
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Prevention and Health Promotion, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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Olson RE, Wen EX, Staines Z, Goh F, Marshall HM. Imperatives of health or happiness: Narrative constructions of long-term smoking after undergoing lung screening. Health (London) 2023; 27:1115-1134. [PMID: 35668696 DOI: 10.1177/13634593221099108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tobacco control policies reinforce a health imperative that positions citizens as duty-bound to manage their health by abstaining from or quitting smoking. Limited attention is paid to the repercussions - especially for lung screening - of anti-smoking rhetoric emphasising individual responsibility. Drawing on interviews with 27 long-term smokers involved in an international lung screening trial, this study analysed Australian smokers' narratives of smoking. By attending to stigma and the use of public health rhetoric within personal narratives, we show how narratives underscoring individual responsibility for quitting were layered with conflicting explanations of biological responsibility and normative expectations. Ironically, narratives of individual responsibility potentially undermine smoking cessation. In positioning smokers as responsible for their own healthy choices, such rhetoric also positions smokers as responsible for managing their emotional health, which some did through smoking. Thus, anti-smoking campaigns pit the neoliberal imperative of health against the happiness imperative. These findings have implications for the design and delivery of lung screening campaigns. They also support calls to move beyond health messaging emphasising individual choice, towards acknowledging the moral power of structures and public health campaigns to discipline citizens in unintended ways.
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Taylor B, Mathers J, Parry J. A conceptual framework for understanding the mechanism of action of community health workers services: the centrality of social support. J Public Health (Oxf) 2019; 41:138-148. [PMID: 29228321 DOI: 10.1093/pubmed/fdx161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/18/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To propose an empirically derived and theoretically-informed mechanism to explain how Community Health Workers (CHWs) bring about health gain in clients in England. METHODS We undertook in-depth interviews (n = 43) with CHWs and service staff working in four case studies selected using maximum variation sampling. Interviewees were encouraged to talk about the service, how they had become involved with the service, the CHW role and relationship with clients. FINDINGS We identified the provision of social support to be central to the mechanism of CHW-mediated health gain. Appropriate social support provision comprised three inter-related elements; needs assessment, social support delivery and client engagement. This mechanism is dependent on the personal characteristics of CHWs and of the roles they are employed or volunteer to carry out. CONCLUSION A range of CHW characteristics can influence the social support process, but these are context-dependent and move beyond simple notions of CHW similarity to the client. This finding has important policy implications for the development and implementation of CHW services in high income countries with super-diverse populations.
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Affiliation(s)
- Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
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Cepeda-Benito A, Doogan NJ, Redner R, Roberts ME, Kurti AN, Villanti AC, Lopez AA, Quisenberry AJ, Stanton CA, Gaalema DE, Keith DR, Parker MA, Higgins ST. Trend differences in men and women in rural and urban U.S. settings. Prev Med 2018; 117:69-75. [PMID: 29627511 PMCID: PMC6173654 DOI: 10.1016/j.ypmed.2018.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/21/2018] [Accepted: 04/02/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Smoking prevalence is declining at a slower rate in rural than urban settings in the United States (U.S.), and known predictors of smoking do not readily account for this trend difference. Given that socioeconomic and psychosocial determinants of health disparities accumulate in rural settings and that life-course disadvantages are often greater in women than men, we examined whether smoking trends are different for rural and urban men and women. METHOD We used yearly cross-sectional data (n = 303,311) from the U.S. National Survey on Drug Use and Health (NSDUH) from 2007 through 2014 to compare cigarette smoking trends in men and women across rural and urban areas. Current smoking status was modelled using logistic regression controlling for confounding risk factors. RESULTS Regression derived graphs predicting unadjusted prevalence estimates and 95% confidence bands revealed that whereas the smoking trends of rural men, urban men, and urban women significantly declined from 2007 to 2014, the trend for rural women was flat. Controlling for demographic, socioeconomic and psychosocial predictors of smoking did not explain rural women's significantly different trend from those of the other three groups. CONCLUSION Rural women lag behind rural men, urban men and urban women in decreasing smoking, a health disparity finding that supports the need for tobacco control and regulatory policies and interventions that are more effective in reducing smoking among rural women.
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Affiliation(s)
- A Cepeda-Benito
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States.
| | - N J Doogan
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - R Redner
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Rehabilitation Institute, Southern Illinois University, United States
| | - M E Roberts
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - A N Kurti
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - A C Villanti
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - A A Lopez
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States
| | - A J Quisenberry
- Center of Excellence in Regulatory Tobacco Science, College of Public Health, The Ohio State University, United States
| | - C A Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Department of Oncology, Georgetown University Medical Center, United States; Department of Oncology, Georgetown University Medical Center / Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, United States
| | - D E Gaalema
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - D R Keith
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - M A Parker
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
| | - S T Higgins
- University of Vermont Center of Tobacco Regulatory Science, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States; Department of Psychiatry, University of Vermont, United States
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Nighbor TD, Doogan NJ, Roberts ME, Cepeda-Benito A, Kurti AN, Priest JS, Johnson HK, Lopez AA, Stanton CA, Gaalema DE, Redner R, Parker MA, Keith DR, Quisenberry AJ, Higgins ST. Smoking prevalence and trends among a U.S. national sample of women of reproductive age in rural versus urban settings. PLoS One 2018; 13:e0207818. [PMID: 30485376 PMCID: PMC6261597 DOI: 10.1371/journal.pone.0207818] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 11/06/2018] [Indexed: 11/19/2022] Open
Abstract
U.S. smoking prevalence is declining at a slower rate in rural than urban settings and contributing to regional health disparities. Cigarette smoking among women of reproductive age is particularly concerning due to the potential for serious maternal and infant adverse health effects should a smoker become pregnant. The aim of the present study was to examine whether this rural-urban disparity impacts women of reproductive age (ages 15-44) including pregnant women. Data came from the ten most recent years of the U.S. National Survey on Drug Use and Health (2007-2016). We estimated prevalence of current smoking and nicotine dependence among women categorized by rural-urban residence, pregnancy status, and trends using chi-square testing and multivariable modeling while adjusting for common risk factors for smoking. Despite overall decreasing trends in smoking prevalence, prevalence was higher among rural than urban women of reproductive age overall (χ2(1) = 579.33, p < .0001) and among non-pregnant (χ2(1) = 578.0, p < .0001) and pregnant (χ2(1) = 79.69, p < .0001) women examined separately. An interaction between residence and pregnancy status showed adjusted odds of smoking among urban pregnant compared to non-pregnant women (AOR = .58, [.53 -.63]) were lower than those among rural pregnant compared to non-pregnant women (AOR = 0.75, [.62 -.92]), consistent with greater pregnancy-related smoking cessation among urban pregnant women. Prevalence of nicotine dependence was also higher in rural than urban smokers overall (χ2(2) = 790.42, p < .0001) and among non-pregnant (χ2(2) = 790.58, p < .0001) and pregnant women examined separately (χ2(2) = 63.69, p < .0001), with no significant changes over time. Associations involving residence and pregnancy status remained significant in models adjusting for covariates (ps < 0.05). Results document greater prevalence of smoking and nicotine dependence and suggest less pregnancy-related quitting among rural compared to urban women, disparities that have potential for direct, multi-generational adverse health impacts.
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Affiliation(s)
- Tyler D. Nighbor
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Nathan J. Doogan
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, OH, United States of America
| | - Megan E. Roberts
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, Columbus, OH, United States of America
| | - Antonio Cepeda-Benito
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - Allison N. Kurti
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - Jeff S. Priest
- Medical Biostatistics, University of Vermont, Burlington, Vermont, United States of America
| | - Harley K. Johnson
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Alexa A. Lopez
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
| | - Cassandra A. Stanton
- Westat, Center for Evaluation and Coordination of Training and Research (CECTR) in Tobacco Regulatory Science, Rockville, Maryland, United States of America
- Department of Oncology, Georgetown University Medical Center, Washington District of Columbia, United States of America
| | - Diann E. Gaalema
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
| | - Ryan Redner
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Rehabilitation Institute, Southern Illinois University, Carbondale, Illinois, United States of America
| | - Maria A. Parker
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Diana R. Keith
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, United States of America
| | - Stephen T. Higgins
- Vermont Center on Behavior and Health, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychiatry, University of Vermont, Burlington, Vermont, United States of America
- Department of Psychological Science, University of Vermont, Burlington, Vermont, United States of America
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Wigginton B. Reimagining gender in psychology: What can critical psychology offer? SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2017. [DOI: 10.1111/spc3.12318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Disadvantaged Social Groups and the Cigarette Epidemic: Limits of the Diffusion of Innovations Vision. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13121230. [PMID: 27973442 PMCID: PMC5201371 DOI: 10.3390/ijerph13121230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/02/2016] [Accepted: 12/07/2016] [Indexed: 11/24/2022]
Abstract
The original four-stage model of the cigarette epidemic has been extended with diffusion of innovations theory to reflect socio-economic differences in cigarette use. Recently, two revisions of the model have been proposed: (1) separate analysis of the epidemic stages for men and women, in order to improve generalization to developing countries, and; (2) addition of a fifth stage to the smoking epidemic, in order to account for the persistence of smoking in disadvantaged social groups. By developing a cohort perspective spanning a 35-year time period in France and the USA, we uncover distinctive features which challenge the currently held vision on the evolution of smoking inequalities within the framework of the cigarette epidemic. We argue that the reason for which the model may not be fit to the lower educated is that the imitation mechanism underlying the diffusion of innovations works well with regard to adoption of the habit, but is much less relevant with regard to its rejection. Based on those observations, we support the idea that the nature and timing of the epidemic differs enough to treat the stages separately for high and low education groups, and discuss policy implications.
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Hendrick CE, Cohen AK, Deardorff J, Cance JD. Biological and Sociocultural Factors During the School Years Predicting Women's Lifetime Educational Attainment. THE JOURNAL OF SCHOOL HEALTH 2016; 86:215-224. [PMID: 26830508 PMCID: PMC4741106 DOI: 10.1111/josh.12368] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 07/14/2015] [Accepted: 04/03/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Lifetime educational attainment is an important predictor of health and well-being for women in the United States. In this study, we examine the roles of sociocultural factors in youth and an understudied biological life event, pubertal timing, in predicting women's lifetime educational attainment. METHODS Using data from the National Longitudinal Survey of Youth 1997 cohort (N = 3889), we conducted sequential multivariate linear regression analyses to investigate the influences of macro-level and family-level sociocultural contextual factors in youth (region of country, urbanicity, race/ethnicity, year of birth, household composition, mother's education, and mother's age at first birth) and early menarche, a marker of early pubertal development, on women's educational attainment after age 24. RESULTS Pubertal timing and all sociocultural factors in youth, other than year of birth, predicted women's lifetime educational attainment in bivariate models. Family factors had the strongest associations. When family factors were added to multivariate models, geographic region in youth, and pubertal timing were no longer significant. CONCLUSION Our findings provide additional evidence that family factors should be considered when developing comprehensive and inclusive interventions in childhood and adolescence to promote lifetime educational attainment among girls.
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Affiliation(s)
- C Emily Hendrick
- Department of Kinesiology and Health Education, Health Behavior Health Education Program, The University of Texas at Austin, 2109 San Jacinto Blvd., Austin, TX 78712.
| | - Alison K Cohen
- Division of Epidemiology, School of Public Health, University of California, Berkeley, 50 University Hall #7360 Berkeley, CA 94720-7360.
| | - Julianna Deardorff
- Division of Community Health and Human Development, School of Public Health, University of California, Berkeley, 50 University Hall #7360 Berkeley, CA 94720-7360.
| | - Jessica D Cance
- Department of Kinesiology and Health Education, Health Behavior Health Education Program, The University of Texas at Austin, 2109 San Jacinto Blvd., Austin, TX 78712-1415.
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Hemsing N, Greaves L, Poole N. Tobacco Cessation Interventions for Underserved Women. JOURNAL OF SOCIAL WORK PRACTICE IN THE ADDICTIONS 2015; 15:267-287. [PMID: 27226783 PMCID: PMC4867857 DOI: 10.1080/1533256x.2015.1054231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/09/2015] [Accepted: 05/14/2015] [Indexed: 06/05/2023]
Abstract
Despite high rates of smoking among some subgroups of women, there is a lack of tailored interventions to address smoking cessation among women. We identify components of a women-centered approach to tobacco cessation by analyzing 3 bodies of literature: sex and gender influences in tobacco use and addiction; evidence-based tobacco cessation guidelines; and best practices in delivery of women-centered care. Programming for underserved women should be tailored, build confidence and increase motivation, integrate social justice issues and address inequities, and be holistic and comprehensive. Addressing the complexity of women's smoking and tailoring appropriately could help address smoking among subpopulations of women.
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Affiliation(s)
- Natalie Hemsing
- Research Associate, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
| | - Lorraine Greaves
- Senior Investigator, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
| | - Nancy Poole
- Director, British Columbia Centre of Excellence for Women’s Health, Vancouver, British Columbia, Canada
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Bjerkaas E, Parajuli R, Engeland A, Maskarinec G, Weiderpass E, Gram IT. Social inequalities and smoking-associated breast cancer - Results from a prospective cohort study. Prev Med 2015; 73:125-9. [PMID: 25620729 DOI: 10.1016/j.ypmed.2015.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/15/2014] [Accepted: 01/05/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The association between smoking and breast cancer has been found in most recent, large cohort studies. We wanted to investigate how smoking-associated breast cancer varies by level of education, a well-established measure of socioeconomic status. METHODS We included 302,865 women with 7490 breast cancer cases. Participants were assigned to low, moderate or high level of education and analyzed by smoking status (ever/never), and stratified by birth cohorts (≤1950>). We used Cox proportional hazard to estimate hazard ratios (HRs) and confidence intervals (CIs), adjusting for age, number of children, age at first childbirth, BMI, age at enrollment and physical activity. RESULTS Women born ≤1950 with low and moderate levels of education had a 40% increase in smoking-associated breast cancer risk (HR=1.40, 95% CI 1.25-1.57 and HR=1.14, 95% CI 1.05-1.24, respectively). Women in the same age group with high level of education did not have an increase in risk. No increased breast cancer risk was found among women born after 1950 for any level of education, when analyzed by smoking status. Longer duration of smoking before first childbirth was consistently associated with increasing risk of breast cancer in all three categories of education (all p for trends<0.01). CONCLUSION Smoking for several years before first childbirth increases the risk of breast cancer, regardless of educational level.
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Affiliation(s)
- Eivind Bjerkaas
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - Ranjan Parajuli
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
| | - Anders Engeland
- Division of Epidemiology, Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Genetic Epidemiology, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland; Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Inger Torhild Gram
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037 Tromsø, Norway
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Gamble J, Grant J, Tsourtos G. Missed opportunities: a qualitative exploration of the experiences of smoking cessation interventions among socially disadvantaged pregnant women. Women Birth 2014; 28:8-15. [PMID: 25438715 DOI: 10.1016/j.wombi.2014.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 11/08/2014] [Accepted: 11/08/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Pregnant women who smoke are rarely consulted in the design and evaluation of the interventions that target them. In Australia, women will typically be counselled for smoking cessation as a part of routine antenatal care. However this approach achieves only modest rates of cessation. This study aimed to privilege the perspectives of women from low socioeconomic backgrounds who are most likely to smoke during pregnancy and who are less likely to quit spontaneously. METHODS Guided by feminist principles, in-depth interviews were undertaken with a purposive sample of six pregnant women, who resided in lower socioeconomic status areas in South Australia. Their experiences and views of being part of a smoking cessation intervention in metropolitan Adelaide were explored. Transcriptions were thematically analysed using an inductive approach and an open coding framework. FINDINGS An over-arching theme of 'missed opportunities' and four inter-related sub-themes encapsulated the predominantly negative experiences of the intervention for the women. The women's interest in quitting was hindered by a didactic communication style employed by maternity care professionals. The participants' information and support needs were reported as being superficially managed by maternity care professionals or Quitline workers who provided care in routine ways. CONCLUSIONS These findings indicate that smoking cessation interventions and associated Quitline support needs to become more personalised and sensitive to the needs of women who face barriers posed by complex socio-economic disadvantage. These findings have important policy and practice implications for Australian public maternity care settings where smoking cessation interventions are embedded.
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Affiliation(s)
- Jenni Gamble
- Public Health, School of Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia, Australia.
| | - Julian Grant
- School of Nursing and Midwifery, Flinders University, Sturt Road, Bedford Park, South Australia, Australia
| | - George Tsourtos
- Public Health, School of Health Sciences, Flinders University, Sturt Road, Bedford Park, South Australia, Australia
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Abstract
This Special Issue of Preventive Medicine (PM) focuses on behavior change, health, and health disparities, topics of fundamental importance to improving population health in the U.S. and other industrialized countries. While the U.S. health care system and those of other industrialized countries were developed to manage infectious disease and acute illnesses, it is chronic health conditions that most need to be understood and managed in the 21st century. The evidence is clear that personal behavior patterns like cigarette smoking and physical inactivity/obesity are critically important proximal causes of chronic disease (cardiovascular disease, site-specific cancers, type-2 diabetes) and as such behavior change will need to be a key component of their management. As the outstanding contributions to this Special Issue illustrate, substantial headway is being made in advancing knowledge including developing effective prevention and treatment strategies, with cigarette smoking being an excellent example that change is possible. That said, cigarette smoking continues to be responsible for approximately 480,000 premature deaths annually in the U.S. alone and 5 million globally. So more needs to be done, especially in economically disadvantaged populations. The same certainly applies to the challenges of the obesity epidemic, which of course is a more recent problem and understandably efforts to curtail it are in earlier stages of development.
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Affiliation(s)
- Stephen T. Higgins
- Vermont Center on Behavior and Health, Departments of Psychiatry & Psychology, University of Vermont, USA
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13
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Heil SH, Herrmann ES, Badger GJ, Solomon LJ, Bernstein IM, Higgins ST. Examining the timing of changes in cigarette smoking upon learning of pregnancy. Prev Med 2014; 68:58-61. [PMID: 25016042 PMCID: PMC4252916 DOI: 10.1016/j.ypmed.2014.06.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 06/28/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE AND METHOD Timeline Follow-back interviews were conducted with 107 pregnant women enrolling in smoking cessation and relapse prevention clinical trials in the Burlington, VT area between 2006 and 2009 to examine the time course of changes in smoking between learning of pregnancy and the first prenatal care visit. We know of no systematic studies of this topic. RESULTS Women reported learning of pregnancy at 5.1±2.2 weeks gestation and attending a first prenatal care visit at 10.1±3.6 weeks gestation. In the intervening five weeks, 22% of women became abstainers, 62% reduced their smoking, and 16% maintained or increased their smoking. Women who made changes typically reported doing so within the first 2 days after learning of pregnancy, with few changes occurring beyond the first week after learning of pregnancy. CONCLUSION In this first effort to systematically characterize the time course of changes in smoking upon learning of pregnancy, the majority of pregnant smokers who quit or made reductions reported doing so soon after receiving the news. Further research is needed to assess the reliability of these results and to examine whether devising strategies to provide early interventions for women who continue smoking after learning of pregnancy is warranted.
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Affiliation(s)
- Sarah H Heil
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA.
| | | | - Gary J Badger
- Department of Medical Biostatistics, University of Vermont, USA
| | | | - Ira M Bernstein
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont, USA
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, University of Vermont, USA; Department of Psychiatry, University of Vermont, USA; Department of Psychology, University of Vermont, USA
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White TJ, Redner R, Skelly JM, Higgins ST. Examining educational attainment, prepregnancy smoking rate, and delay discounting as predictors of spontaneous quitting among pregnant smokers. Exp Clin Psychopharmacol 2014; 22:384-91. [PMID: 25069014 PMCID: PMC4180793 DOI: 10.1037/a0037492] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We investigated three potential predictors (educational attainment, prepregnancy smoking rate, and delay discounting [DD]) of spontaneous quitting among pregnant smokers. These predictors were examined alone and in combination with other potential predictors using study-intake assessments from controlled clinical trials examining the efficacy of financial incentives for smoking cessation and relapse prevention. Data from 349 pregnant women (231 continuing smokers and 118 spontaneous quitters) recruited from the greater Burlington, VT, area contributed to this secondary analysis, including psychiatric/sociodemographic characteristics, smoking characteristics, and performance on a computerized DD task. Educational attainment, smoking rate, and DD values were each significant predictors of spontaneous quitting in univariate analyses. A model examining those three predictors together retained educational attainment as a main effect and revealed a significant interaction of DD and smoking rate (i.e., DD was a significant predictor at lower but not higher smoking rates). A final model considering all potential predictors, included education, the interaction of DD and smoking rate, and five additional predictors (i.e., stress ratings, the belief that smoking during pregnancy will "greatly harm my baby," age of smoking initiation, marital status, and prior quit attempts during pregnancy). The study presented here contributes new knowledge on predictors of spontaneous quitting among pregnant smokers with substantive practical implications for reducing smoking during pregnancy.
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Affiliation(s)
- Thomas J. White
- Vermont Center on Behavior & Health, University of Vermont
- Department of Psychiatry, University of Vermont
| | - Ryan Redner
- Vermont Center on Behavior & Health, University of Vermont
- Department of Psychiatry, University of Vermont
| | - Joan M. Skelly
- Department of Medical Biostatistics, University of Vermont
| | - Stephen T. Higgins
- Vermont Center on Behavior & Health, University of Vermont
- Department of Psychiatry, University of Vermont
- Department of Psychology University of Vermont
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Levis DM, Stone-Wiggins B, O'Hegarty M, Tong VT, Polen KND, Cassell CH, Council M. Women's perspectives on smoking and pregnancy and graphic warning labels. Am J Health Behav 2014; 38:755-64. [PMID: 24933145 DOI: 10.5993/ajhb.38.5.13] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To explore women's knowledge, attitudes, and beliefs about adverse outcomes associated with smoking during pregnancy and which outcomes might motivate cessation; to explore reactions to graphic warnings depicting 2 adverse outcomes. METHODS Twelve focus groups were conducted with women of childbearing age who were current smokers. RESULTS Participants had low to moderate awareness of many outcomes and believed it was acceptable to smoke in the first trimester before knowledge of pregnancy. Perceived susceptibility to outcomes was low. Motivators included risk-focused information, especially serious risks to the baby (eg, stillbirth, SIDS). Graphic warnings produced strong reactions, especially the warning with a real photo. CONCLUSIONS Despite barriers to reducing rates of smoking during pregnancy, educational information and photos depicting babies' risks could motivate women to quit.
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Affiliation(s)
- Denise M Levis
- Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, Atlanta, GA, USA.
| | - Brenda Stone-Wiggins
- RTI International, Public Health Research Division, Research Triangle Park, NC, USA
| | - Michelle O'Hegarty
- Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, GA, USA
| | - Van T Tong
- Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, GA, USA
| | - Kara N D Polen
- Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Cynthia H Cassell
- Centers for Disease Control and Prevention, Division of Birth Defects and Developmental Disabilities, Atlanta, GA, USA
| | - Mary Council
- RTI International, Public Health Research Division, Research Triangle Park, NC, USA
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Atari DO. Gender differences in the prevalence and determinants of tobacco use among school-aged adolescents (11-17 years) in Sudan and South Sudan. Pan Afr Med J 2014; 18:118. [PMID: 25404978 PMCID: PMC4232199 DOI: 10.11604/pamj.2014.18.118.3202] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 03/31/2014] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Tobacco use is one of the leading and preventable causes of global morbidities and premature mortalities. The study explores gender differences in the prevalence and determinants of tobacco use among school-aged adolescents (11-17 years) in Sudan and South Sudan. METHODS The study utilized the national Global Youth Tobacco Survey (GYTS) data collected in 2005 for Sudan (4,277 unweighted; 131,631 weighted). Univariate and bivariate analyses were conducted to examine the associations between the dependent (tobacco use status) and independent variables. Logistic regression analyses were performed to identify the key factors which influence tobacco consumption among adolescents in the 2 Sudans for ever cigarette users, current cigarette users, and users of noncigarette tobacco products. RESULTS There were significant gender differences in the prevalence of ever cigarette users (21.8%; male=13.1%, female=6.5%, p<0.05) and current cigarette users (6.9%; male=4.9%, female = 1.3%, p<0.05) but not among users of noncigarette tobacco products (14.7%; male=6.8%, female=6.1%). Adolescent tobacco use was significantly associated with availability of monthly income or allowance, exposure to tobacco industry promotions, and tobacco-use behavior of familial relations. Knowledge about the harmful effects of secondhand smoke was related with decreased likelihood of tobacco use. CONCLUSION School programs that focus on health messages alone may not work for the adolescent population. Legislations that ban all types of tobacco advertisements, promotions, and sponsorships among adolescents are needed in the 2 countries.
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Affiliation(s)
- Dominic Odwa Atari
- Department of Geography, Nipissing University, North Bay, Ontario, Canada
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17
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Brown T, Platt S, Amos A. Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review. Drug Alcohol Depend 2014; 138:7-16. [PMID: 24674707 DOI: 10.1016/j.drugalcdep.2014.03.001] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/21/2014] [Accepted: 03/02/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking. METHODS Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear. RESULTS 117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates. CONCLUSIONS Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies.
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Affiliation(s)
- Tamara Brown
- UK Centre for Tobacco Control Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Stephen Platt
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Amanda Amos
- UK Centre for Tobacco Control Studies, Centre for Population Health Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
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Kulik MC, Menvielle G, Eikemo TA, Bopp M, Jasilionis D, Kulhánová I, Leinsalu M, Martikainen P, Östergren O, Mackenbach JP. Educational inequalities in three smoking-related causes of death in 18 European populations. Nicotine Tob Res 2013; 16:507-18. [PMID: 24212763 DOI: 10.1093/ntr/ntt175] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking is an important determinant of socioeconomic inequalities in mortality in many countries. As the smoking epidemic progresses, updates on the development of mortality inequalities attributable to smoking are needed. We provide estimates of relative and absolute educational inequalities in mortality from lung cancer, aerodigestive cancers, and chronic obstructive pulmonary disease (COPD)/asthma in Europe and assess the contribution of these smoking-related diseases to inequalities in all-cause mortality. METHODS We use data from 18 European populations covering the time period 1998-2007. We present age-adjusted mortality rates, relative indices of inequality, and slope indices of inequality. We also calculate the contribution of inequalities in smoking-related mortality to inequalities in overall mortality. RESULTS Among men, relative inequalities in mortality from the 3 smoking-related causes of death combined are largest in the Czech Republic and Hungary and smallest in Spain, Sweden, and Denmark. Among women, these inequalities are largest in Scotland and Norway and smallest in Italy and Spain. They are often larger among men and tend to be larger for COPD/asthma than for lung and aerodigestive cancers. Relative inequalities in mortality from these conditions are often larger in younger age groups, particularly among women, suggesting a possible further widening of inequalities in mortality in the coming decades. The combined contribution of these diseases to inequality in all-cause mortality varies between 13% and 32% among men and between -5% and 30% among women. CONCLUSION Our results underline the continuing need for tobacco control policies, which take into account socioeconomic position.
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Affiliation(s)
- Margarete C Kulik
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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Robinson J, Holdsworth C. 'They don't live in my house every day': How understanding lives can aid understandings of smoking. CONTEMPORARY DRUG PROBLEMS 2013; 40:47-70. [PMID: 27695141 PMCID: PMC5044980 DOI: 10.1177/009145091304000104] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While the prevalence of smoking in western countries has substantially reduced following the introduction of comprehensive tobacco control programs, reduction strategies such as the introduction of smokefree legislation, media campaigns and individual and group support for people trying to quit have been less successful with people living on low income, suggesting the need for new ways to engage with people who smoke. We argue that, rather than focusing solely on researching smoking behaviors to generate new understandings of why people smoke, people working in the broad area of public health should look more widely at peoples' lives in order to understand their smoking. Using a biographical, narrative perspective as part of a wider ethnographic study of 12 families living in one community within Liverpool in 2006, we argue that understandings that position smoking purely as a harmful, deviant behavior, fail to capture the cultural complexity of the lives of smokers and the changing place and meaning of cigarettes over a person's lifetime, and may explain why smokers fail to engage with smoking cessation services and continue to smoke.
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Keyes KM, March D, Link BG, Chilcoat HD, Susser E. Do socio-economic gradients in smoking emerge differently across time by gender? Implications for the tobacco epidemic from a pregnancy cohort in California, USA. Soc Sci Med 2012. [PMID: 23186639 DOI: 10.1016/j.socscimed.2012.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Understanding current patterns of population smoking by socioeconomic position (SEP) can be substantially enhanced by research that follows birth cohorts over long periods of time, yet such data in the US are rare. Information from birth cohorts followed during critical time periods when the health consequences of smoking became widely known can inform the ways in which current smoking prevalence has been shaped by the historical processes that preceded it. The present study utilizes data from a substudy of the Child Health and Development Study pregnancy cohort (N = 1612). Women were queried about smoking status in 1959-1962, 1971-1972 and 1977-1980. Women were divided into three cohorts based on date of birth. Offspring represented another birth cohort assessed for smoking in 1977-1980. Results indicated that the overall prevalence of smoking exhibited cohort-specific patterns that persisted across time. Notably, the youngest maternal cohort (born 1937-1946) had high smoking prevalence throughout and showed no appreciable decrease (44.7%, 41.4%, 40.1% for 1959-1962, 1971-1972, and 1977-1980). Results also indicated that the relation of smoking to SEP exhibited cohort-specific patterns over time. Among the oldest birth cohort (born 1914-1930), no inverse relation of SEP to smoking was observed at any time; in contrast, an inverse relation emerged by 1959-1962 among the youngest cohort of mothers. Among the adolescent offspring, there was a strong SEP gradient (OR = 2.0, 95% CI = 1.4-3.0) that was stronger than in any maternal birth cohort at any assessment (β = 0.40, SE = 0.1, p<0.01). We conclude that SEP gradients in smoking emerge across birth cohorts rather than time alone, with increasingly strong gradients across time especially among younger cohorts.
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Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Columbia University, 722 West 168th Street, #720E, New York, NY 10032, USA.
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Passey ME, D'Este CA, Stirling JM, Sanson-Fisher RW. Factors associated with antenatal smoking among Aboriginal and Torres Strait Islander women in two jurisdictions. Drug Alcohol Rev 2012; 31:608-16. [PMID: 22487020 DOI: 10.1111/j.1465-3362.2012.00448.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Smoking rates are three times as high for pregnant Indigenous women relative to non-Indigenous women, in Australia. This paper describes Indigenous women's self-reported antenatal smoking behaviour and compares knowledge and attitudes of those who: (i) smoke and don't smoke during pregnancy; and (ii) quit or continued to smoke since the beginning of pregnancy. DESIGN AND METHODS Cross-sectional surveys with 264 pregnant Indigenous women in two states collected data on smoking status, antenatal changes, risk knowledge, attitudes to smoking and sociodemographic characteristics. Multivariable logistic regression analyses assessed associations between knowledge and attitude variables and smoking status and antenatal changes in smoking status. RESULTS Forty-six per cent of the women (n = 121) reported currently smoking. The majority (68%) who smoked at the beginning of pregnancy reported quitting (21%) or reducing (47%). Relative to smokers, non-smokers had more schooling (P = 0.002), more post-secondary education (P = 0.023), lower parity (P = 0.003), better understanding of smoking-related risks (miscarriage P = 0.01; low birth weight P = 0.003; infant illness P < 0.001; childhood behavioural problems P = 0.007), and less frequently expressed attitudes indicating that quitting was very difficult given other problems they faced. Similar patterns were found for women who quit during pregnancy compared to those who continued smoking. DISCUSSION AND CONCLUSIONS Increasing awareness of antenatal smoking risks and the benefits of quitting may motivate women to attempt to quit. However, knowledge alone is unlikely to be sufficient considering the life circumstances of many Indigenous women. Addressing the social environment and daily stressors, particularly those exacerbated by pregnancy, may be critical to supporting quit attempts.
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Affiliation(s)
- Megan E Passey
- University Centre for Rural Health-North Coast, School of Public Health, University of Sydney, Lismore, Australia.
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Hollowell J, Kurinczuk JJ, Brocklehurst P, Gray R. Social and ethnic inequalities in infant mortality: a perspective from the United kingdom. Semin Perinatol 2011; 35:240-4. [PMID: 21798404 DOI: 10.1053/j.semperi.2011.02.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Social inequalities in infant mortality can be clearly demonstrated in the countries of the United Kingdom with a social gradient between different groups. Marked variations in infant mortality between ethnic groups are also evident in England and Wales, with the highest rates seen in Pakistani and Caribbean infants and the lowest rates in the white and Bangladeshi groups. Although individual risk factors for infant mortality are well understood, the reasons why certain social and ethnic groups have higher rates remain to be fully elucidated. Policies and interventions to tackle these inequalities are likely to be most effective if they have both universal and targeted components to "level-up" rates to the rate of the most advantaged in society.
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Murphy JG, MacKillop J, Tidey JW, Brazil LA, Colby SM. Validity of a demand curve measure of nicotine reinforcement with adolescent smokers. Drug Alcohol Depend 2011; 113:207-14. [PMID: 20832200 PMCID: PMC3025087 DOI: 10.1016/j.drugalcdep.2010.08.004] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 08/03/2010] [Accepted: 08/06/2010] [Indexed: 11/27/2022]
Abstract
High or inelastic demand for drugs is central to many laboratory and theoretical models of drug abuse, but it has not been widely measured with human substance abusers. The authors used a simulated cigarette purchase task to generate a demand curve measure of nicotine reinforcement in a sample of 138 adolescent smokers. Participants reported the number of cigarettes they would purchase and smoke in a hypothetical day across a range of prices, and their responses were well-described by a regression equation that has been used to construct demand curves in drug self-administration studies. Several demand curve measures were generated, including breakpoint, intensity, elasticity, P(max), and O(max). Although simulated cigarette smoking was price sensitive, smoking levels were high (8+ cigarettes/day) at prices up to 50¢ per cigarette, and the majority of the sample reported that they would purchase at least 1 cigarette at prices as high as $2.50 per cigarette. Higher scores on the demand indices O(max) (maximum cigarette purchase expenditure), intensity (reported smoking level when cigarettes were free), and breakpoint (the first price to completely suppress consumption), and lower elasticity (sensitivity of cigarette consumption to increases in cost), were associated with greater levels of naturalistic smoking and nicotine dependence. Greater demand intensity was associated with lower motivation to change smoking. These results provide initial support for the validity of a self-report cigarette purchase task as a measure of economic demand for nicotine with adolescent smokers.
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Affiliation(s)
- James G Murphy
- Department of Psychology, University of Memphis, Memphis, TN 38152, United States.
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24
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Inequalities in smoking in the Czech Republic: Societal or individual effects? Health Place 2011; 17:215-21. [DOI: 10.1016/j.healthplace.2010.10.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 09/17/2010] [Accepted: 10/02/2010] [Indexed: 11/24/2022]
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Heil SH, Jones HE, Arria A, Kaltenbach K, Coyle M, Fischer G, Stine S, Selby P, Martin PR. Unintended pregnancy in opioid-abusing women. J Subst Abuse Treat 2010; 40:199-202. [PMID: 21036512 DOI: 10.1016/j.jsat.2010.08.011] [Citation(s) in RCA: 190] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 08/25/2010] [Indexed: 11/26/2022]
Abstract
The aim of this study was to estimate the prevalence of unintended pregnancy and its three subtypes (mistimed, unwanted, and ambivalent) among opioid-abusing women. In the general population, 31%-47% of pregnancies are unintended; data on unintended pregnancy in opioid- and other drug-abusing women are lacking. Pregnant opioid-abusing women (N = 946) screened for possible enrollment in a multisite randomized controlled trial comparing opioid maintenance medications completed a standardized interview assessing sociodemographic characteristics, current and past drug use, and pregnancy intention. Almost 9 of every 10 pregnancies were unintended (86%), with comparable percentages mistimed (34%), unwanted (27%), and ambivalent (26%). Irrespective of pregnancy intention, more than 90% of the total sample had a history of drug abuse treatment, averaging more than three treatment episodes. Interventions are sorely needed to address the extremely high rate of unintended pregnancy among opioid-abusing women. Drug treatment programs are likely to be an important setting for such interventions.
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Affiliation(s)
- Sarah H Heil
- Department of Psychiatry and Psychology, University of Vermont, Burlington, VT 05401, USA.
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26
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Kahila H, Gissler M, Sarkola T, Autti-Rämö I, Halmesmäki E. Maternal welfare, morbidity and mortality 6-15 years after a pregnancy complicated by alcohol and substance abuse: a register-based case-control follow-up study of 524 women. Drug Alcohol Depend 2010; 111:215-21. [PMID: 20627617 DOI: 10.1016/j.drugalcdep.2010.04.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Revised: 04/23/2010] [Accepted: 04/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND A register-based retrospective case-control study to investigate the long-term morbidity, mortality, and welfare among women with alcohol and/or substance misuse identified during pregnancy. METHODS Cohort of 524 women followed-up ante- and perinatally 1992-2001 at special out-patient clinics of maternity hospitals in the capital area of Finland. The control group of 1792 women with no evidence of alcohol or substance misuse was matched for maternal age, parity, date of birth and hospital of index delivery. Both groups were followed-up until end of 2007. RESULTS 7.9% (42/524) of the cases and 0.2% (4/1792) of the controls had died by the end of the median follow-up of 9 years (OR 38, 95% CI 14-108). The cases displayed significant morbidity requiring in-patient care in the areas of mental disorders (AOR 8.8, 95% CI 6.5-11.9), viral (AOR 23.5, 95% CI 8.8-62.7) and bacterial (AOR 6.1, 95% CI 3.5-10.4) infections, skin diseases (AOR 3.9, 95% CI 2.0-7.8) and injury and poisoning (AOR 4.2, 95% CI 3.1-5.6). The cases displayed more out-patient visits (OR 2.7, 95% CI 2.7-2.8). Their mean length of hospital stay was longer compared to controls (10.3 vs. 4.4 days, p<0.001). The risk of pension granted due to a disorder, disease or disability (OR 8.8, 95% CI 6.0-13.0) and the risk for minimum unemployment benefit were higher compared to controls (OR 2.1, 95% CI 1.8-2.5). CONCLUSIONS These women display significant long-term morbidity, mortality and loss of productivity after delivery. The results emphasize the importance of adequate postnatal follow-up and treatment for misuse.
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Affiliation(s)
- Hanna Kahila
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, POB 140, FIN-00029 HUCH, Helsinki, Finland.
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Chilcoat HD. An overview of the emergence of disparities in smoking prevalence, cessation, and adverse consequences among women. Drug Alcohol Depend 2009; 104 Suppl 1:S17-23. [PMID: 19632070 DOI: 10.1016/j.drugalcdep.2009.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 06/03/2009] [Accepted: 06/08/2009] [Indexed: 11/24/2022]
Abstract
This report reviews epidemiologic findings demonstrating the emergence of disparities in smoking prevalence against the backdrop of general declines in smoking over time among women in the United States. In addition to socioeconomic differences in overall smoking prevalence, this report examines evidence of emerging disparities for specific stages of smoking, including progression to heavy smoking, smoking cessation, and lung cancer mortality. Findings from population-based studies indicate that social disadvantage signals higher likelihood of involvement with each stage of smoking and the gap by level of disadvantage is increasing over time. Disparities in smoking outcomes have been observed for both men and women but in many cases appear to be greater for women. This pattern of results in which disparities emerge in a dynamic system of change in smoking are consistent with Link and Phelan's theory of social conditions as a fundamental cause of disease, and has important implications for approaches to reduce the public health burden of smoking.
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Affiliation(s)
- Howard D Chilcoat
- Worldwide Epidemiology, GlaxoSmithKline, Research Triangle Park, NC 27709, USA.
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28
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Higgins ST, Heil SH, Badger GJ, Skelly JM, Solomon LJ, Bernstein IM. Educational disadvantage and cigarette smoking during pregnancy. Drug Alcohol Depend 2009; 104 Suppl 1:S100-5. [PMID: 19442460 PMCID: PMC2763386 DOI: 10.1016/j.drugalcdep.2009.03.013] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 03/11/2009] [Accepted: 03/23/2009] [Indexed: 11/28/2022]
Abstract
This study examined the influence of education on smoking status in a cohort (n=316) of pregnant women who were smokers at the time they learned of the current pregnancy. Subjects were participants in clinical trials examining the efficacy of monetary-based incentives for smoking-cessation and relapse prevention. In multivariate analyses, educational achievement was a robust predictor of smoking status upon entering prenatal care, of achieving abstinence antepartum among those still smoking at entry into prenatal care, and of smoking status at 6-month postpartum in the entire cohort and the subsample who received smoking-cessation treatment. In addition to educational attainment, other predictors of smoking status included smoking-related characteristics (e.g., number of cigarettes/day smoked pre-pregnancy), treatment, maternal age, and stress ratings. We suggest that strategies to increase educational attainment be included with more conventional tobacco-control policies in efforts to reduce smoking among girls and young women.
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Affiliation(s)
- Stephen T Higgins
- Department of Psychiatry, University of Vermont, Burlington, VT 05401, USA.
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Higgins ST, Chilcoat HD. Women and smoking: an interdisciplinary examination of socioeconomic influences. Drug Alcohol Depend 2009; 104 Suppl 1:S1-5. [PMID: 19586726 PMCID: PMC2805006 DOI: 10.1016/j.drugalcdep.2009.06.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Accepted: 06/03/2009] [Indexed: 10/20/2022]
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