1
|
Alemayehu M, Gebrehiwot TG, Medhanyie AA, Desta A, Alemu T, Abrha A, Godefy H. Utilization and factors associated with antenatal, delivery and postnatal Care Services in Tigray Region, Ethiopia: a community-based cross-sectional study. BMC Pregnancy Childbirth 2020; 20:334. [PMID: 32487069 PMCID: PMC7268454 DOI: 10.1186/s12884-020-03031-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 05/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background This study aimed to identify the utilization and factors associated with antenatal care, delivery, and postnatal care services in Tigray regional state, Ethiopia. Methods A community-based cross-sectional study was conducted among 667 women of reproductive age group who had children aged 45 days - 6 months in 13 districts (3 urban and 10 rural). Data were collected from May–June 2015. Multistage sampling technique was used. The data were analyzed using SPSS version 20. Multiple variable logistic regression analysis was used to identify the factors associated with the utilization of antenatal care, institutional delivery, and postnatal care services. Results Of the total, the proportion of women who visited a health facility for antenatal care four or more times (ANC 4+) was 58.2%, those who chose institutional delivery was 87.9%, and those who received postnatal care (PNC) within 42 days of birth at least once was 40.3%. Residing in an urban area, having an electronic media, and having 2–5 children were factors associated with an ANC 4+ visit. Whereas, partner involvement in ANC visit (AOR = 2.4, 95% of CI: 1.37, 4.35) and content of ANC discussed (AOR = 4.0, 95% of CI: 1.08, 14.93), having birth preparedness (AOR = 2.6, 95% of CI: 1.44, 4.97), residing within a distance of less than a 30-min walk to the nearest health facility (AOR = 2.0, 95% of CI: 1.16, 3.64), and having ANC 4+ visits (AOR = 2.4, 95% of CI: 1.39, 4.31) were the factors that were found to be associated with institutional delivery. As regards to PNC visits within 42 days of birth, age of 40–45 years, having 2–5 children, and ANC 4+ visits were found to be significant factors associated with it. Conclusion The proportion of women who attended antenatal care and gave birth in a health facility was high. However, the proportion of women who attended antenatal and postnatal care was low. Residing in urban areas, having an electronic media, living near a health facility, having partner involvement in decision making, receiving appropriate ANC counseling, having birth preparedness, age of the woman, and number of children could potentially influence maternal health services utilization.
Collapse
Affiliation(s)
- Mussie Alemayehu
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia.
| | | | - Araya Abrha Medhanyie
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia
| | - Alem Desta
- School of Public Health, Mekelle University, College of Health Sciences, Mekelle, Ethiopia
| | - Tesfu Alemu
- UNFPA-Ethiopia, Tigray Branch Office, Tigray, Ethiopia
| | | | - Hagos Godefy
- Tigray Regional Health Bureaus, Mekelle, Ethiopia
| |
Collapse
|
2
|
Myers V, Lev E, Guttman N, Tillinger E, Rosen L. "I can't stand it…but I do it sometimes" parental smoking around children: practices, beliefs, and conflicts - a qualitative study. BMC Public Health 2020; 20:693. [PMID: 32408872 PMCID: PMC7226982 DOI: 10.1186/s12889-020-08863-7] [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] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Many parents continue to smoke around their children despite the widely known risks of children's exposure to tobacco smoke. We sought to learn about parental smoking behavior around children from parents' perspective. METHODS Semi-structured interviews were conducted with 65 smoking parents or partners of smoking parents of children up to age 7, to learn about home smoking rules, behaviours performed to try to protect children, and smoking-related conflicts, from parents' perspective. Interviews were recorded and transcribed and thematic analysis performed. Recruitment was challenging due to the sensitive nature of the topic. RESULTS Many parents described smoking around their children in certain areas of the home, outdoors, and in what they consider to be open or ventilated areas. Participants emphasized efforts to protect their children and described various mitigating practices but held mixed views as to their effectiveness. Parents had different conceptions of which areas or distances were considered 'safe'. Many smoking parents described conflicts both internal and with other family members regarding the protection of children. Some parents who continue to smoke around their children despite understanding the health risks felt powerless to effect change, as well as being uncertain as to the effectiveness of their protective strategies; others were aware but reluctant to change. CONCLUSION Findings shed light on some of the difficulties faced by smoking parents and obstacles to maintaining a smoke-free environment for their children, providing insight for the type of information and support required to help parents better protect their children from exposure to tobacco smoke. Awareness of health risks associated with secondhand smoke was demonstrated, yet parents in smoking families were confused regarding which rules and behaviours best protect children from exposure to tobacco smoke. Parents were sometimes aware that their smoking 'rules' and mitigating practices were limited in their effectiveness. Guidelines should be provided explaining how and when exposure occurs and how to keep children safe.
Collapse
Affiliation(s)
- Vicki Myers
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Eimi Lev
- Department of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
- Department of Communications, Gordon College of Education, Haifa, Israel
| | - Nurit Guttman
- Department of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Tillinger
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Laura Rosen
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| |
Collapse
|
3
|
Secondhand tobacco smoke exposure of infants at home: A population based cross-sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
4
|
Small S, Porr C, Swab M, Murray C. Experiences and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2019; 16:385-452. [PMID: 29419622 DOI: 10.11124/jbisrir-2017-003377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this review was to identify and synthesize the best available evidence to address two questions: i) what is the experience of smoking during pregnancy for Indigenous women? and ii) what are the smoking cessation needs of Indigenous women who smoke during pregnancy? INTRODUCTION Smoking during pregnancy not only affects pregnant women's general health but also causes such serious problems as pre-term delivery, low birth weight, and sudden infant death. Rates of smoking during pregnancy are particularly high among Indigenous women. Learning about Indigenous women's experiences of smoking during pregnancy and associated smoking cessation needs is important to providing informed health care to them. INCLUSION CRITERIA The participants of interest were Indigenous women who smoked during a current or past pregnancy. The phenomena of interest were the experiences of smoking during pregnancy for Indigenous women and the smoking cessation needs of Indigenous women during pregnancy. The context was any community worldwide where pregnant Indigenous women live. Studies considered for this review were those in which qualitative data were gathered and analysed on the phenomena of interest, including mixed methods research. METHODS A comprehensive search was conducted for published studies in academic databases (i.e. PubMed, CINAHL, PsycINFO, Embase, Sociological Abstracts, SocINDEX, and Web of Science), unpublished studies in sources of gray literature (i.e. ProQuest Dissertations and Theses, OAIster, LILACS, MedNar, Google, Google Scholar, OpenGrey and relevant websites), and any additional studies in reference lists. Language and date limiters were not applied. The searches included all studies globally and were carried out on October 31, 2016. Studies that met the inclusion criteria were assessed for methodological quality by two reviewers independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Descriptive details of each study accepted for this review were extracted in accordance with the elements of the JBI Data Extraction Form for Qualitative Research. The research findings that were relevant to the phenomena of interest and had participant voice were extracted from each included study and synthesized using the JBI meta-aggregative approach. The synthesized findings were assigned confidence scores in accordance with the JBI ConQual approach. RESULTS Thirteen studies were included in this review following careful consideration of the methodological quality of each study. The studies yielded a total of 116 research findings, which were grouped into 19 categories and then aggregated to form five synthesized findings. Confidence in the findings was determined to be low to very low (see ConQual Summary of Findings). CONCLUSION There is a small body of research evidence on Indigenous women's experiences of smoking during pregnancy and their smoking cessation needs. Confidence in the synthesized findings is constrained due to methodological limitations in many of the primary studies included in this review, along with mixed credibility of the research findings from across primary studies.
Collapse
Affiliation(s)
- Sandra Small
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Caroline Porr
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Cynthia Murray
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| |
Collapse
|
5
|
Huang CM, Liao JY, Huang SF, Hsu YT, Hsu HP, Guo JL. Patterns of parents' perspectives on protecting young children from secondhand smoke exposure: A Q-methodology study. J Adv Nurs 2019; 75:2591-2602. [PMID: 30993733 DOI: 10.1111/jan.14029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/29/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Abstract
AIMS To identify and describe the various patterns of parents' perspectives on avoiding secondhand smoke exposure. DESIGN Q methodology was applied to investigate the parental perspectives of 50 parents. METHODS The study was implemented from September-December 2016. Forty-two Q-statements were constructed based on the literature related to parental attitudes and prevention practices regarding preventing young children from experiencing secondhand smoke exposure. A series of Q-sorts was performed by the participants to rank the statements into a Q-sort grid. PQMethod 2.35 software was used to perform principal component analysis to identify different patterns of parents' perspectives. RESULTS Five patterns of shared perspectives, which accounted for 62% of the total variance, were derived from the analysis: (a) lack of confidence to confront smokers in non-smoking areas; (b) awareness of health hazards but not ready to take preventive actions; (c) emphasis on parental responsibility and behavioural guidance; (d) awareness of health rights protected by legislation; and (e) strong willingness to take protective actions. CONCLUSION Our findings revealed the shared perspectives of five groups of parents. The exploration of clusters of parents could assist healthcare professionals in acknowledging parents' tendencies related to attitudes and responses towards secondhand smoke exposure. IMPACT Using a forced distribution through the Q-sorting technique, the particular perspective patterns of parents' experiences would be captured. These findings can serve as a useful guide for researchers and practitioners to develop tailored intervention programs for parents with the purpose of reducing secondhand smoke exposure in young children.
Collapse
Affiliation(s)
- Chiu-Mieh Huang
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Fei Huang
- Department of Senior Citizen Service, Mackay Junior College of Medicine, Taipei, Taiwan
| | | | - Hsiao-Pei Hsu
- Institute of Clinical Nursing, School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Jong-Long Guo
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| |
Collapse
|
6
|
"I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum. PLoS One 2016; 11:e0157525. [PMID: 27308829 PMCID: PMC4911111 DOI: 10.1371/journal.pone.0157525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 06/01/2016] [Indexed: 11/19/2022] Open
Abstract
Background Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children’s exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure. Methods Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum. Findings Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as ‘social’ or ‘occasional’ smokers rather than ‘regular’ smokers. Conclusions Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as ‘social’ or ‘occasional’ smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.
Collapse
|
7
|
Passey ME, Longman JM, Robinson J, Wiggers J, Jones LL. Smoke-free homes: what are the barriers, motivators and enablers? A qualitative systematic review and thematic synthesis. BMJ Open 2016; 6:e010260. [PMID: 26988351 PMCID: PMC4800143 DOI: 10.1136/bmjopen-2015-010260] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To thematically synthesise primary qualitative studies of the barriers, motivators and enablers of smoke-free homes (SFHs). DESIGN Systematic review and thematic synthesis. DATA SOURCES Searches of MEDLINE, EBM Reviews (Cochrane Database of Systematic Reviews), PsycINFO, Global Health, CINAHL, Web of Science, Informit and EMBASE, combining terms for families, households and vulnerable populations; SFH and secondhand smoke; and qualitative research, were supplemented by searches of PhD theses, key authors, specialist journals and reference lists. STUDY SELECTION We included 22 articles, reporting on 18 studies, involving 646 participants. INCLUSION CRITERIA peer-reviewed; English language; published from 1990 onwards (to week 3 of April 2014); used qualitative data collection methods; explored participants' perspectives of home smoking behaviours; and the barriers, motivators and enablers to initiating and/or maintaining a SFH. DATA EXTRACTION 1 of 3 authors extracted data with checking by a second. DATA SYNTHESIS A thematic synthesis was performed to develop 7 core analytic themes: (1) knowledge, awareness and risk perception; (2) agency and personal skills/attributes; (3) wider community norms and personal moral responsibilities; (4) social relationships and influence of others; (5) perceived benefits, preferences and priorities; (6) addiction and habit; (7) practicalities. CONCLUSIONS This synthesis highlights the complexity faced by many households in having a SFH, the practical, social, cultural and personal issues that need to be addressed and balanced by households, and that while some of these are common across study settings, specific social and cultural factors play a critical role in shaping household smoking behaviours. The findings can inform policy and practice and the development of interventions aimed at increasing SFHs. TRIAL REGISTRATION NUMBER CRD42014014115.
Collapse
Affiliation(s)
- Megan E Passey
- University Centre for Rural Health—North Coast, School of Public Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jo M Longman
- University Centre for Rural Health—North Coast, School of Public Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jude Robinson
- Department of Sociology, Social Policy and Criminology, School of Law and Social Justice, University of Liverpool, Liverpool, UK
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Laura L Jones
- UK Centre for Tobacco and Alcohol Studies & Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| |
Collapse
|
8
|
De Alwis D, Tandon M, Tillman R, Luby J. Nonverbal Reasoning in Preschool Children: Investigating the Putative Risk of Secondhand Smoke Exposure and Attention-Deficit/Hyperactivity Disorder as a Mediator. Scand J Child Adolesc Psychiatr Psychol 2016; 3:115-125. [PMID: 26726310 PMCID: PMC4696599 DOI: 10.21307/sjcapp-2015-012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Exposure to secondhand smoke (SHS) has been found to be associated with cognitive deficits in children. However, relatively little is known about the relationship between SHS exposure, cognitive deficits, and smoking-related psychopathology, specifically attention-deficit/hyperactivity disorder (ADHD) and externalizing disorders such as conduct disorder (CD) and oppositional defiant disorder (ODD) in preschool children. METHODS Children (n = 54) between the ages of 4 and 6 years from a comprehensive, longitudinal study of preschool emotional development were included in this study. Each child's primary caregiver completed questionnaires and interviews related to childhood psychopathology. SHS exposure was estimated with the use of saliva cotinine values. RESULTS After adjustment for sociodemographic factors (e.g., age, gender, an income-to-needs ratio) and for ADHD, CD, and ODD symptoms, exposure to SHS was found to be negatively associated with preschool children's nonverbal reasoning skills. Exposure to SHS continued to be negatively associated with nonverbal reasoning skills after adjustment for maternal education, maternal smoking during pregnancy, and maternal reports of exposure to SHS during pregnancy in separate models. CONCLUSIONS Children who grow up in an environment with adults who smoke are vulnerable to several social and environmental risk factors. The findings of this study suggest that exposure to SHS during early childhood should also be considered as a potential variable in the risk trajectory and as a marker of other associated risks when formulating public health intervention and prevention strategies.
Collapse
Affiliation(s)
- Duneesha De Alwis
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Mini Tandon
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine in St. Louis, Missouri, USA
| |
Collapse
|
9
|
Mao A, Robinson J. Home smoking restrictions before, during and after pregnancy-a qualitative study in rural China. Health Promot Int 2015; 31:606-13. [PMID: 26071606 DOI: 10.1093/heapro/dav050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Worldwide, many nonsmokers (often women and children) are exposed to second-hand smoke (SHS) in home settings, as men retain their traditional power and control within their family and women and children have limited agency to intervene. This study, set up to explore home smoking management in rural China, found that some women were able to positively intervene to restrict men's smoking at three key stages: prior to conception, during their pregnancy and at the early years of their children's lives. By utilizing dominant social, health and political narratives about the importance of raising a healthy child supported by the One-Child Policy in China, combined with the fear of health risks of SHS to young children, the women were able to use their elevated status as bearer and carers of the only children to subvert the pre-eminence of men in domestic environments, enabling them to positively influence home smoking. While this study highlights the possibility for future smoking cessation initiatives in China by incorporating family carers' elevated awareness of protection of children's health in key stages of childhood, there is also a need for further health education, as family members were unsure why they needed to keep children smoke-free, which may partially explain why few households were smoke-free.
Collapse
Affiliation(s)
- Aimei Mao
- Kiang Wu Nursing College of Macau, Est. Repouso No. 35, R/C, Macau, China
| | - Jude Robinson
- School of Law and Social Justice, University of Liverpool, Liverpool L69 7WW, UK
| |
Collapse
|
10
|
Fenton B, Thankappan KR, Champagne B, Lv J, Anthony D. Increased knowledge of the effects of smoking and second-hand smoke encourages smoke-free homes. J Res Nurs 2014. [DOI: 10.1177/1744987114525963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To establish the drivers for smoke-free homes among current daily smokers. Design A cross-sectional study employing interviews (adults) and self-completed surveys (schoolchildren). Sample Children aged 12 and 14 in schools in four cities in China, India, Mexico and England. Adults in the community. Measurements Knowledge, attitude, beliefs and behaviour relevant to second-hand smoke in home. Intervention None. Results A total of 8994 adults and 14,756 children were surveyed. Knowledge of some of the effects of tobacco is high, but other effects are poorly understood in all cities. In Thiruvananthapuram, there is a lack of awareness of the addictiveness of tobacco, and Hangzhou has poor knowledge in general. Conclusions Messages about reducing tobacco usage are effective in support of smoke-free homes in the city with poorest knowledge (Hangzhou) but other factors are more important where knowledge is high.
Collapse
Affiliation(s)
- Brenda Fenton
- Director, Community-based Research and Evaluation, MATRIX Public Health Solutions Inc., USA
| | - Kavumpurathu Raman Thankappan
- Professor, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
| | | | - Jun Lv
- Associate Professor, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Denis Anthony
- Statistical consultant, Oxford Health Alliance, UK; Chair in Applied Health Research, University of Leeds, UK
| |
Collapse
|
11
|
Mao A, Yang T, Bottorff JL, Sarbit G. Personal and social determinants sustaining smoking practices in rural China: a qualitative study. Int J Equity Health 2014; 13:12. [PMID: 24484610 PMCID: PMC3917907 DOI: 10.1186/1475-9276-13-12] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 01/31/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction Tobacco use in China is disproportionally distributed among rural and urban populations with rural people smoking more. While there is a wealth of evidence on the association between tobacco use among rural people and their lower socio-economic status (SES), how social structural factors contribute to rural smoking is not well understood. Guided by a socio-ecological model, the objective of this study was to explore the personal and social determinants that play a key role in sustaining smoking practices among Chinese rural people. Methods An ethnographic study was conducted in a rural area of Central Jiangsu, China. Participants (n = 29) were recruited from families where there was at least one smoking resident and there were young children. In-depth interviews and unstructured observations were used to collect data, which were then analyzed with an interpretive lens. Results Although individuals had limited knowledge about the risks of smoking and lack of motivation to quit, social factors were in effect the main barriers to quitting smoking. Cigarette exchange and cigarette gifting permeated every aspect of rural family life, from economic activities to leisure pastimes, in family and wider social interactions. Traditional familism and collectivism interplayed with the pro-smoking environment and supported rural people’s smoking practices at the community level. Living in the rural area was also a barrier to quitting smoking because of the lack of information on smoking cessation and the influence of courtyard-based leisure activities that facilitated smoking. Conclusion Development of comprehensive smoking cessation interventions in rural China needs to extend beyond an individual level to take into account the social determinants influencing smoking practices.
Collapse
Affiliation(s)
- Aimei Mao
- Faculty of Health and Social Development, University of British Columbia's Okanagan campus, Kelowna V1V 1 V7, Canada.
| | | | | | | |
Collapse
|
12
|
Butler KM, Rayens MK, Ashford K, Adkins S, Gombeski B, Britt J, Hahn EJ. Smoke-free homes, strength of smoke-free law, and children in the home. Nicotine Tob Res 2013; 16:485-90. [PMID: 24302637 DOI: 10.1093/ntr/ntt191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics. METHODS An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law. RESULTS Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers. CONCLUSIONS Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.
Collapse
Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY
| | | | | | | | | | | | | |
Collapse
|
13
|
Mak KK, Ho SY, Day JR. A Review of Life-Course Familial and Lifestyle Factors of Smoking Initiation and Cessation. CURRENT CARDIOVASCULAR RISK REPORTS 2013. [DOI: 10.1007/s12170-013-0341-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
14
|
Atkinson O, Coleman T, McNeill A, Lewis S, Jones LL. The role of nicotine replacement therapy for temporary abstinence in the home to protect children from environmental tobacco smoke exposure: a qualitative study with disadvantaged smokers. BMC Public Health 2013; 13:262. [PMID: 23521825 PMCID: PMC3620522 DOI: 10.1186/1471-2458-13-262] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/08/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Nicotine replacement therapy (NRT) has recently been licensed to help smokers to abstain from smoking for short time periods and recent studies have shown that 8-14% of smokers are regularly using NRT to cope when they cannot or are not allowed to smoke. These data suggest that, potentially, NRT for temporary abstinence might be an acceptable method to help smoking caregivers, who are not able to stop smoking completely, to avoid smoking whilst inside their home in order to protect their children from the harms of environmental tobacco smoke (ETS). The aim of this study was therefore to explore the concept of using NRT for temporary abstinence in the home, to protect children from exposure to ETS. METHODS Qualitative in-depth interviews were conducted with thirty six disadvantaged smoking parents who were currently, or had recently stopped smoking in the home with at least one child under the age of five. Parents were recruited from Children's Centres and Health Visitor Clinics in Nottingham, UK. Interviews were audio recorded and transcribed verbatim. Data were coded and analysed thematically to identify emergent main and subthemes. RESULTS Overall, participants responded negatively to the concept of attempting temporary abstinence in the home in general and more specifically to the use of NRT whilst at home to reduce children's exposure to ETS. Many parents would prefer to either attempt cutting down or quitting completely to make a substantial effort to change their smoking behaviour. There was limited interest in the use of NRT for temporary abstinence in the home as a first step to quitting, although some parents did express a willingness to use NRT to cut down as a first step to quitting. CONCLUSION Disadvantaged smoking parents were reluctant to initiate and maintain temporary abstinence with or without NRT as a way of making their homes smoke free to protect their children's health. More education about the specific risks of ETS to their children and the utility of NRT for use in the home might be needed to have a public health impact on children's health.
Collapse
Affiliation(s)
- Olesya Atkinson
- UKCTCS and Division of Primary Care, University of Nottingham, Nottingham, UK
| | | | | | | | | |
Collapse
|
15
|
Mao A, Bristow K, Robinson J. Caught in a dilemma: why do non-smoking women in China support the smoking behaviors of men in their families? HEALTH EDUCATION RESEARCH 2013; 28:153-164. [PMID: 22843329 DOI: 10.1093/her/cys078] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Intimate relationships influence family members' health practices. Although cigarette smoking in China is predominantly a male behavior, (non-smoking) women's roles should be taken into account for the development of home-smoking interventions. Drawing on ethnographic interviews with 22 families in a rural area of China, this article explores non-smoking women's attitudes towards male smoking. The findings suggest that women's ability to influence male behavior is largely determined by culturally defined gender roles, underpinned by ideologies of familism and collectivism. Despite concerns about the adverse results of smoking to their family members and households, non-smoking women ultimately maintain the (male) smokers' argument that smoking plays an important role in construction and maintenance of intra- and extra-family relationships. By accepting male smoking and men's engagement in the social practice of smoking and cigarette exchanges, women maintain their identities as supportive wives, filial daughters/in-law and responsible family members who pursue family collective interests at the expense of their own personal beliefs. Future smoking control initiatives that target non-smoking women to influence male smoking should take into account the women's overarching need to maintain the status and harmony of their families.
Collapse
Affiliation(s)
- Aimei Mao
- School of Law and Social Justice, University of Liverpool, Liverpool L69 7WW, UK.
| | | | | |
Collapse
|
16
|
McEwen A, Hackshaw L, Jones L, Laverty L, Amos A, Robinson J. Evaluation of a programme to increase referrals to stop-smoking services using Children's Centres and smoke-free families schemes. Addiction 2012; 107 Suppl 2:8-17. [PMID: 23121355 DOI: 10.1111/j.1360-0443.2012.04081.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIMS To assess the feasibility and effectiveness of a new service using referral liaison advisers to increase the number of referrals of parents/carers at selected Children's Centres to National Health Service (NHS) Stop Smoking Services (SSS) and/or smoke-free families schemes (SFS). DESIGN This mixed-methods pilot study collected numerical data on indicators of smoking behaviours and carried out face-to-face and telephone interviews. SETTINGS Thirteen Children's Centres in Liverpool and Nottingham using local providers of smoking cessation services, from September 2010 to April 2011. PARTICIPANTS Parents and carers registered with, and staff working for, Children's Centres. MEASURES Number of smokers referred to smoking cessation services and/or smoke-free family schemes and the views of service providers and users on the new service. FINDINGS In Liverpool, 181 referrals to NHS SSS were made from 331 identified smokers (54.7%); extrapolated to 12 months, this represents a 182% increase in referrals from baseline and a similar extrapolation indicates a 643% increase from baseline of referrals to smoke-free families schemes. There were no reliable baseline data for Nottingham; 31 referrals were made (30.7% of smokers) to SSS and 44 referrals to SFS from 52 contacts (84.6%). The interviews highlighted the need for sustained personal contact with parents/carers to discuss smoking behaviours and concerns and their willingness to be referred to SFS as part of caring for their child. CONCLUSIONS Routine recording of smoking status and appropriate follow-up by trained staff in Children's Centres can lead to significant numbers of clients attending stop-smoking services, although relatively few stop smoking.
Collapse
Affiliation(s)
- Andy McEwen
- Cancer Research UK Health Behaviour Research Centre, University College London, London, UK.
| | | | | | | | | | | |
Collapse
|
17
|
Exploration of parental smokers' experience, perceptions, and family's influences on their smoking in the presence of children. ANS Adv Nurs Sci 2012; 35:E1-13. [PMID: 22293613 DOI: 10.1097/ans.0b013e3182445525] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to explore parents' experience and perceptions of smoking in the presence of children. Findings regarding patterns of parents' smoking in the presence of children were situation specific. When thinking of smoking with children around, parents engaged in a process of weighing the importance of the need to smoke and adverse effects from exposure to environmental tobacco smoke, a consideration based mostly on their experience. A pattern of correspondence was identified between family's level of concern and promoting change among smokers. Many strategies participants used to prevent children's environmental tobacco smoke exposure were relatively ineffective and needed to be addressed.
Collapse
|
18
|
Temple B, Johnson J. Provision of smoke-free homes and vehicles for kindergarten children: associated factors. J Pediatr Nurs 2011; 26:e69-78. [PMID: 22055386 DOI: 10.1016/j.pedn.2011.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Revised: 12/31/2010] [Accepted: 01/06/2011] [Indexed: 11/16/2022]
Abstract
Many children continue to be exposed to environmental tobacco smoke (ETS) each day. To describe the factors associated with providing a smoke-free home (PSFH) and vehicle (PSFV) for kindergarten children, a cross-sectional descriptive study was conducted in Manitoba, Canada, with 551 mothers and primary caregivers responding. A social-ecologic model of health behavior guided the study. In the bivariate analysis, being better educated, living with a partner, and having a higher income were associated with PSFH. In the multivariable logistic regression analysis, the variables most predictive for PSFH were living with a partner and the mother's self-efficacy, and for PSFV, the most predictive variables were the mother's self-efficacy and ETS knowledge. Smoking behaviors are complex and must be considered broadly within all levels of influence if nurses are to assist parents in protecting their children.
Collapse
Affiliation(s)
- Beverley Temple
- Faculty of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | |
Collapse
|
19
|
|
20
|
Jones LL, Atkinson O, Longman J, Coleman T, McNeill A, Lewis SA. The motivators and barriers to a smoke-free home among disadvantaged caregivers: identifying the positive levers for change. Nicotine Tob Res 2011; 13:479-86. [PMID: 21447837 DOI: 10.1093/ntr/ntr030] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The aims of this study were to explore home smoking behaviors and the motivators and barriers to smoke-free homes among a group of disadvantaged caregivers for young children and to identify the positive levers that health care professionals can utilize when supporting smoking behavior change. METHODS In-depth qualitative interviews were conducted between July and September 2009, with 22 disadvantaged smoking caregivers, accessing Children's Centre Services in Nottingham, UK. Interviews were audiorecorded and transcribed verbatim. Data were coded and analyzed thematically to identify emergent main and subthemes. RESULTS Caregivers had some general understanding of the dangers of secondhand smoke (SHS), but their knowledge appeared incomplete and confused. All interviewees described rules around smoking in the home; however, these tended to be transient and fluid and unlikely to be effective. Caregivers were often living in difficult and complex circumstances and experienced significant barriers to creating a smoke-free home. The motivators for change were more strongly linked to house decor and smell than children's health, suggesting that visible evidence of the harm done by SHS to children might help promote smoke-free homes. CONCLUSIONS Findings suggest that further tailored information on the effect of SHS is required, but to instigate caregiver behavior change, providing demonstrable evidence of the impact that their smoking is having on their children's health is more likely to be effective.
Collapse
Affiliation(s)
- Laura L Jones
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | | | | | | | | | | |
Collapse
|
21
|
Wen LM, Rissel C, Lee E. Smoke-free home status and parents' smoking status among first-time mothers. Aust N Z J Public Health 2010; 34:532-3. [PMID: 21040186 DOI: 10.1111/j.1753-6405.2010.00604.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
22
|
Advising parents with asthmatic children. J Emerg Nurs 2009; 36:97-8. [PMID: 20211393 DOI: 10.1016/j.jen.2009.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/01/2009] [Indexed: 11/21/2022]
|
23
|
Greaves L, Hemsing N. Women and tobacco control policies: social-structural and psychosocial contributions to vulnerability to tobacco use and exposure. Drug Alcohol Depend 2009; 104 Suppl 1:S121-30. [PMID: 19520523 DOI: 10.1016/j.drugalcdep.2009.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Revised: 05/01/2009] [Accepted: 05/04/2009] [Indexed: 10/20/2022]
Abstract
This article explores the psychosocial and social-structural vulnerability in relation to women's tobacco use, smoke exposure and responses to policy, and examines these issues in the context of women's lives and roles, describing forward looking strategies that could improve research and equity in outcomes for women. Various literatures on smoking among women and girls, and how women and sub-populations of women respond to tobacco control policies are reviewed. Specific sub-populations exhibiting more tobacco use and exposure are described, such as young pregnant and mothering women and low-income women. Emerging evidence also reveals links between smoking and experiences such as childhood sexual abuse, interpersonal violence, post-traumatic stress disorder, mental health issues and alcohol and drug dependence. Varied sub-populations of women respond in different ways to price and taxation, sales restrictions and location restrictions. However, tobacco control policies have, to date, been fashioned as broad instruments, not taking into account social context, trauma backgrounds, gendered roles such as mothering, unequal power relations affecting women in relationships and workplaces, and differences in access to resources and social support. When these issues are considered, the implications for tobacco policy development include: widening the policy purview, accounting for uneven and differential responses to policies, committing to an ethical framework, extending sex, gender and diversity based analyses, and improving research methods and approaches.
Collapse
Affiliation(s)
- Lorraine Greaves
- British Columbia Centre of Excellence for Women's Health, BC, Canada
| | | |
Collapse
|
24
|
Sex, gender, and secondhand smoke policies: implications for disadvantaged women. Am J Prev Med 2009; 37:S131-7. [PMID: 19591752 DOI: 10.1016/j.amepre.2009.05.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 03/03/2009] [Accepted: 05/05/2009] [Indexed: 11/24/2022]
Abstract
CONTEXT Although implementation of secondhand smoke policies is increasing, little research has examined the unintended consequences of these policies for disadvantaged women. EVIDENCE ACQUISITION Macro-, meso-, and micro-level issues connected to secondhand smoke and women are considered to illustrate the range of ways in which sex, gender, and disadvantage affect women's exposure to secondhand smoke. A review of current literature, primarily published between 2000 and 2008, on sex- and gender-based issues related to secondhand smoke exposure and the effects of secondhand smoke policies for various subpopulations of women, including low-income girls and women, nonwhite minority women, and pregnant women, was conducted in 2008. These materials were critically analyzed using a sex and gender analysis, allowing for the drawing of inferences and reflections on the unintended effects of secondhand smoke policies on disadvantaged women. EVIDENCE SYNTHESIS Smoke-free policies do not always have equal or even desired effects on low-income girls and women. Low-income women are more likely to be exposed to secondhand smoke, may have limited capacity to manage their exposure to secondhand smoke both at home and in the workplace, and may experience heightened stigmatization as a result of secondhand smoke policies. CONCLUSIONS Various sex- and gender-related factors, such as gendered roles, unequal power differences between men and women, child-caring roles, and unequal earning power, affect exposure and responses to secondhand smoke, women's capacity to control exposure, and their responses to protective policies. In sum, a much more nuanced gender- and diversity-sensitive framework is needed to develop research and tobacco control policies that address these issues.
Collapse
|
25
|
Abstract
Smoking during pregnancy and exposure to environmental tobacco smoke have harmful and sometimes devastating effects on the health of the newborn. Although interventions for smoking cessation during pregnancy demonstrate effectiveness for increasing smoking abstinence, the majority of women relapse in the postpartum period. However, modifying contributing factors for relapse may improve the success of sustained abstinence. Many parents are eager to quit smoking and willing to participate in smoking cessation interventions. Through a population-based approach to healthcare, neonatal nurses are in an ideal position to prevent relapse and to promote smoking abstinence; they can coordinate and lead efforts for establishing smoking cessation strategies that integrate obstetric, newborn, and pediatric services.
Collapse
|
26
|
Ritchie D, Amos A, Phillips R, Cunningham-Burley S, Martin C. Action to achieve smoke-free homes: an exploration of experts' views. BMC Public Health 2009; 9:112. [PMID: 19386111 PMCID: PMC2679738 DOI: 10.1186/1471-2458-9-112] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 04/22/2009] [Indexed: 11/10/2022] Open
Abstract
Background Smoking in the home is the major cause of exposure to second-hand smoke in children in the UK, particularly those living in low income households which have fewer restrictions on smoking in the home. Reducing children's exposure to second-hand smoke is an important public health and inequalities issue. Drawing on findings from a qualitative Scottish study, this paper identifies key issues and challenges that need to be considered when developing action to promote smoke-free homes at the national and local level. Methods Two panels of tobacco control experts (local and national) from Scotland considered the implications of the findings from a qualitative study of smokers and non-smokers (who were interviewed about smoking in the home), for future action on reducing smoking in the home. Results Several key themes emerged through the expert panel discussions. These related to: improving knowledge about SHS among carers and professionals; the goal and approach of future interventions (incremental/harm reduction or total restrictions); the complexity of the interventions; and issues around protecting children. Conclusion The expert panels were very aware of the sensitivities around the boundary between the 'private' home and public health interventions; but also the lack of evidence on the relative effectiveness of specific individual and community approaches on increasing restrictions on smoking in the home. Future action on smoke-free homes needs to consider and address these complexities. In particular health professionals and other key stakeholders need appropriate training on the issues around smoking in the home and how to address these, as well as for more research to evaluate interventions and develop a more robust evidence base to inform effective action on this issue.
Collapse
Affiliation(s)
- Deborah Ritchie
- Nursing Studies, School of Health in Social Science, University of Edinburgh, Medical School, Teviot Place, Edinburgh, UK.
| | | | | | | | | |
Collapse
|