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Tatton C, Lloyd J. Understanding for whom, under what conditions and how smoking cessation services for pregnant women in the United Kingdom work-a rapid realist review. BMC Public Health 2023; 23:2488. [PMID: 38087281 PMCID: PMC10717267 DOI: 10.1186/s12889-023-17378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal smoking in pregnancy is associated with several adverse maternal and infant health outcomes including increased risk of miscarriage, stillbirth, low birth weight, preterm birth, and asthma. Progress to reduce rates of smoking at time of delivery in England have been slow and over the last decade, less than half of pregnant women who accessed services went onto report having quit. This realist review was undertaken to improve the understanding of how smoking cessation services in pregnancy work and to understand the heterogeneity of outcomes observed. METHODS The initial programme theory was developed using the National Centre for Smoking Cession and Training Standard Treatment Programme for Pregnant Women and the National Institute for Health and Care Excellence guidance on treating tobacco dependency. A search strategy and inclusion criteria were developed. Four databases were searched to identify published papers and four websites were hand searched to identify any unpublished literature that could contribute to theory building. Realist logic was applied to the analysis of papers to identify the contexts in which the intended behaviour change mechanism(s) were triggered, or not, and towards what outcomes to develop context mechanism outcome configurations. RESULTS The review included 33 papers. The analysis produced 19 context mechanism outcome configurations structured under five closely interconnected domains (i) articulating harm, (ii) promoting support, (iii) managing cravings, (iv) maintaining commitment and (v) building self-efficacy. This review identifies two key processes involved in how services achieve their effects: how material resources are implemented and relationships. Of the two key processes identified, more existing literature was available evidencing how material resources are implemented. However, the review provides some evidence that non-judgemental and supportive relationships with healthcare workers where regular contact is provided can play an important role in interrupting the social cues and social practice of smoking, even where those around women continue to smoke. CONCLUSIONS This review clarifies the range of interconnected and bi-directional relationships between services and the personal and social factors in women's lives. It underscores the importance of aligning efforts across the models five domains to strengthen services' ability to achieve smoking cessation.
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Affiliation(s)
- Claire Tatton
- Faculty of Health and Life Sciences, Department of Health and Community Sciences, University of Exeter, Exeter, UK.
| | - Jenny Lloyd
- Faculty of Health and Life Sciences, Department of Health and Community Sciences, University of Exeter, Exeter, UK
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Pardavila-Belio MI, Moreno-Arroyo C, Romero-Clará O, Tricas-Sauras S, Barroso T, Duaso M, Vilaplana J, Agüera Z, Canga-Armayor N, Demedts D, Elliott R, Godin I, Fernández E, Hawkins S, Marques MID, Lavedan-Santamaria A, Pueyo-Garrigues M, Puig M, Roca J, Sancho R, Torne-Ruiz A, Martínez C. Adaptation, implementation, and evaluation of an online health sciences training program for brief smoking intervention: A pre-post study in four European countries. NURSE EDUCATION TODAY 2023; 130:105924. [PMID: 37677986 DOI: 10.1016/j.nedt.2023.105924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/01/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Tobacco cessation intervention has a positive impact on quality of care. For health professionals, limited competency in this area may be associated with poor training during their academic programs. There is a clear need to further develop and implement training programs to improve tobacco cessation knowledge, skills, and attitudes among healthcare students. OBJECTIVES The aim of this study was to assess the effectiveness of the innovative online training program "Brief Intervention in Smoking Cessation" for healthcare students to improve their knowledge, skills, and attitudes. DESIGN A pre-post evaluation study with a satisfaction assessment tool was used. SETTING Seven universities from four European countries, including Belgium, Portugal, Spain, and the United Kingdom, participated. PARTICIPANTS One thousand and seventy-two (1072) undergraduate students participated, with 851 completing the online program. METHODS All participants completed the "Brief Intervention in Smoking Cessation" online program, which consisted of five theoretical modules, five videos, and three virtual simulation cases between January 2020 and June 2022. Knowledge was assessed by a multiple-choice test, and practical skills were assessed by a simulation algorithm, both of which were developed by education and smoking cessation experts. Competency was achieved when students successfully completed both assessments. Satisfaction was measured using an ad hoc 16-item questionnaire. Pre-post changes in knowledge were assessed using a paired Student's t-test. RESULTS Eighty-six percent of the students achieved smoking cessation competency. Students significantly improved their knowledge score on a scale of 0 to 10 points, with a mean pre-program score of 3.79 vs a mean post-program score of 7.33 ([-3.7 - -3.4] p < 0.001), acquiring sufficient attitudes and skills (simulation mean of 7.4 out of 10 points). Students were highly satisfied with the program (8.2 out of 10) and recommended it to other students (8.4 out of 10). CONCLUSIONS The "Brief Intervention in Smoking Cessation" online training program is effective for the acquisition of smoking cessation competencies among European health profession students.
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Affiliation(s)
- Miren Idoia Pardavila-Belio
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research.
| | - Carmen Moreno-Arroyo
- Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Nursing, University of Barcelona, Barcelona, Spain; Department of Nursing Research Group (GRIN), Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain.
| | - Olga Romero-Clará
- E-oncologia Virtual Training Unit, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Spain.
| | - Sandra Tricas-Sauras
- Social Approaches to Health Research Center (CRISS-CR5), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Eurocare, The European Alcohol Policy Alliance, Brussels, Belgium.
| | - Tereza Barroso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - María Duaso
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | - Jordi Vilaplana
- Department of Computer Science, University of Lleida, Lleida, Spain.
| | - Zaida Agüera
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28015 Madrid, Spain.
| | - Navidad Canga-Armayor
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research.
| | - Dennis Demedts
- BRUCHI Expertise Center, Department of Health, Erasmus Brussels University of Applied Sciences and Arts, Brussels, Belgium.
| | - Rebecca Elliott
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | - Isabelle Godin
- Social Approaches to Health Research Center (CRISS-CR5), School of Public Health, Université Libre de Bruxelles, Brussels, Belgium.
| | - Esteve Fernández
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain; Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, L'Hospitalet del Llobregat, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
| | - Sian Hawkins
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom.
| | - Maria Isabel Dias Marques
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Coimbra, Portugal.
| | - Ana Lavedan-Santamaria
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain.
| | - María Pueyo-Garrigues
- University of Navarra, School of Nursing, Department of Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research.
| | - Montse Puig
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Judith Roca
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Lleida, Spain.
| | - Raúl Sancho
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Alba Torne-Ruiz
- Department of Public Health, Mental Health and Maternal-Child Nursing, School of Nursing, University of Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Cristina Martínez
- WHO Collaborating Centre for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Spain; Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing, University of Barcelona, L'Hospitalet del Llobregat, Spain; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States of America.
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Pueyo-Garrigues M, Agüera Z, Andrés A, Lluch-Canut MT, Tricas-Sauras S, Duaso MJ, Feliu A, Pardavila-Belio MI, Antón L, Cornejo-Ovalle M, Puig-Llobet M, Moreno-Arroyo C, Barroso T, Roca J, Martínez C. Knowledge, attitudes, behavioral and organizational factors of health professions students for a competent smoking cessation practice: An instrument adaptation and psychometric validation study in Spanish and English samples. Nurse Educ Pract 2023; 70:103647. [PMID: 37121026 DOI: 10.1016/j.nepr.2023.103647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND To improve smoking cessation, training of health professions students is essential. However, no specific instrument is available to assess factors that may affect students' learning about smoking cessation practice. AIM To adapt and validate the Knowledge, Attitudes, Behaviors and Organization questionnaire in the population of undergraduate health professions students. DESIGN Methodological research. METHODS The researchers conducted this study with 511 Spanish and 186 English health professions students from four different universities. We used a four-step approach: 1) adaptation of the items to the target population and validation of the content by a panel of experts; 2) a pilot study to test face validity; 3) linguistic adaptation of the Spanish version to English; and 4) the psychometric assessment based on construct validity, criterion validity and internal consistency. RESULTS Exploratory factor analysis revealed four subscales for the Spanish version, namely 'Individual knowledge and skills', 'Individual attitudes and beliefs', 'Organizational support' and 'Organizational resources', which accounted for 85.1% of the variance. Confirmatory factor analysis in the holdout Spanish and English samples revealed adequate goodness-of-fit values, supporting the factor structure. Hypotheses testing demonstrated significant differences by capacitation in smoking cessation interventions and degree courses, providing further evidence regarding construct validity. All the subscales correlated positively with the criterion variables (5 A's smoking cessation model), except for the 'Organizational resources' subscale, which was not significantly correlated with the 5 A's. The overall Cronbach's alpha was.83 for the Spanish version and.88 for the English one. CONCLUSIONS Our results provide empirical support for the use of the Knowledge, Attitudes, Behaviors and Organization questionnaire for Students as a reliable and valid instrument to assess knowledge, attitudes, behaviors and organization perceptions in health professions students, which is essential for competent smoking cessation practice. Interestingly, 'Organizational resources' subscale presented the lowest correlations among factors and did not correlate with any component of the 5 A's, suggesting the need of enhancing students' responsibility and involvement during their internships, as well as the interest of some organizations.
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Affiliation(s)
- María Pueyo-Garrigues
- University of Navarra, School of Nursing, Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain
| | - Zaida Agüera
- Departament d'Infermeria de Salut Pública, Salut Mental i Materno-infantil, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08907 Barcelona, Spain; Psychoneurobiology of Eating and Addictive Behaviors Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain; CIBER Fisiopatología de la Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, 28015 Madrid, Spain.
| | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences, Ramon Llull University, Blanquerna, 08022 Barcelona, Spain
| | - Maria Teresa Lluch-Canut
- Departament d'Infermeria de Salut Pública, Salut Mental i Materno-infantil, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08907 Barcelona, Spain
| | - Sandra Tricas-Sauras
- Centre for Research in Social Approaches to Health, School of Public Health, Université Libre de Bruxelles, Brussels, Belgium; Erasmus Hogeschool Brussel, Departement Gezondheidszorg, Belgium
| | - Maria José Duaso
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, SE1 8WA London, United Kingdom
| | - Ariadna Feliu
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - Miren Idoia Pardavila-Belio
- University of Navarra, School of Nursing, Community, Maternity and Pediatric Nursing, Campus Universitario, 31008 Pamplona, Spain; IdiSNA, Navarra Institute for Health Research, Spain
| | - Laura Antón
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain
| | - Marco Cornejo-Ovalle
- Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Institute for Research in Dental Sciences, Faculty of Dentistry, Universidad de Chile, Santiago, Chile
| | - Montserrat Puig-Llobet
- Departament d'Infermeria de Salut Pública, Salut Mental i Materno-infantil, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08907 Barcelona, Spain
| | - Carmen Moreno-Arroyo
- Departament d'Infermeria Fonamental i Médico-Quirúrgica, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08907 Barcelona, Spain
| | - Tereza Barroso
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Portugal
| | - Judith Roca
- Department of Nursing and Physiotherapy. Faculty of Nursing and Physiotherapy, University of Lleida, Spain; Health Care Research Group (GRECS), Biomedical Research Institute of Lleida, Spain
| | - Cristina Martínez
- Departament d'Infermeria de Salut Pública, Salut Mental i Materno-infantil, Escola d'Infermeria, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), 08907 Barcelona, Spain; Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d'Oncologia-ICO, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, 08908 L'Hospitalet de Llobregat, Barcelona, Spain; Center for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, 490 Illinois St., 7th floor, San Francisco, CA 94158, United States.
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Martínez C, Castellano Y, Laroussy K, Fu M, Baena A, Margalef M, Feliu A, Aldazabal J, Tigova O, Galimany J, Puig-Llobet M, Moreno C, Bueno A, López A, Guydish J, Fernández E. Knowledge, Attitudes, and Training in Tobacco Dependence and Cessation Treatment Among Nursing Students in Catalonia (ECTEC Study): Cross-Sectional Study. Int J Ment Health Addict 2021. [PMID: 37261115 PMCID: PMC10229109 DOI: 10.1007/s11469-021-00640-w] [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] [Indexed: 11/24/2022] Open
Abstract
Nursing students are part of the future health labor force; thus, knowing their knowledge and participation in tobacco control is of importance. Multicentre cross-sectional study conducted to assess nursing students' knowledge, attitudes, and training in tobacco dependence and treatment at 15 nursing schools in Catalonia. We employed a self-administered questionnaire. 4,381 students participated. Few respondents (21.1%) knew how to assess smokers' nicotine dependence, and less than half (41.4%) knew about the smoking cessation therapies. Most (80%) had been educated on the health risks of smoking, 50% about the reasons why people smoke and, one third on how to provide cessation aid. Students in the last years of training were more likely to have received these two contents. Nursing students lack sufficient knowledge to assess and treat tobacco dependence and are rarely trained in such subjects. Nursing curricula in tobacco dependence and treatment should be strengthened to tackle the first preventable cause of disease worldwide.
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Hunter A, Yargawa J, Notley C, Ussher M, Bobak A, Murray RL, Nath S, Cooper S. Healthcare Professionals' Beliefs, Attitudes, Knowledge, and Behavior Around Vaping in Pregnancy and Postpartum: A Qualitative Study. Nicotine Tob Res 2021; 23:471-478. [PMID: 32621745 PMCID: PMC7885779 DOI: 10.1093/ntr/ntaa126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/02/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Finding effective ways to help pregnant women quit smoking and maintain long-term abstinence is a public health priority. Electronic cigarettes (ie, vaping) could be a suitable cessation tool in pregnancy for those who struggle to quit; however, healthcare professionals (HCP) must be informed about these devices to offer appropriate advice. This study used the Capability, Opportunity, Motivation, and Behavior (COM-B) model and Theoretical Domains Framework (TDF) to explore HCP attitudes towards vaping in pregnancy and postpartum; beliefs about the health risks of vaping; perceived barriers and facilitators of vaping in pregnancy; knowledge of current guidelines and policies; and training needs. METHODS Interviews (n = 60) were conducted with midwives (n = 17), health visitors (n = 10), general practitioners (n = 15) and stop smoking specialists (n = 18) across the United Kingdom. Interview transcriptions were analyzed thematically using the framework approach and the COM-B. RESULTS Discussing vaping as a tool for quitting smoking in pregnancy was prevented by a lack of capability (limited knowledge of vaping, lack of training in smoking cessation); lack of opportunity (restricted by organizational policies and guidelines, lack of time and financial issues impacting on training), and negative social influences (sensationalist media and stigma associated with vaping in pregnancy); and lack of motivation (fear of future litigation and comebacks should adverse effects from vaping arise). CONCLUSIONS Factors related to capability, opportunity, and motivation were identified that influence HCPs attitudes and behaviors towards vaping in pregnancy. Gaps in knowledge and training needs were identified, which could inform the development of targeted vaping training. IMPLICATIONS Vaping could be suitable in pregnancy for those struggling to quit smoking. However, HCPs must be informed about these devices to offer appropriate advice. These data extend our knowledge of factors influencing HCP attitudes and behaviors towards vaping in pregnancy. Generally, vaping was perceived as safer than cigarettes, but a perceived lack of evidence, health and safety risks, dependency, and regulation issues were concerning. Considering our findings, greater efforts are needed to ensure HCPs are sufficiently informed about vaping and guidelines available. More importance should be placed on training for all HCPs who have contact with pregnant women.
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Affiliation(s)
- Abby Hunter
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Judith Yargawa
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Caitlin Notley
- Addiction Research Group, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Michael Ussher
- Institute of Social Marketing and Health, University of Stirling, Stirling and Population Health Research Institute, St George’s, University of London, London, UK
| | - Alex Bobak
- Alex Bobak, GP Specialist in Smoking Cessation, Wandsworth Medical Centre, London, UK
| | - Rachael L Murray
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Srabani Nath
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, University Park, Nottingham, UK
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Diamanti A, Papadakis S, Schoretsaniti S, Rovina N, Vivilaki V, Gratziou C, Katsaounou PA. Smoking cessation in pregnancy: An update for maternity care practitioners. Tob Induc Dis 2019; 17:57. [PMID: 31582946 PMCID: PMC6770622 DOI: 10.18332/tid/109906] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/10/2019] [Accepted: 06/06/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION This paper provides an up-to-date summary of the effects of smoking in pregnancy as well as challenges and best practices for supporting smoking cessation in maternity care settings. METHODS We conducted a qualitative review of published peer reviewed and grey literature. RESULTS There is strong evidence of the effects of maternal tobacco use and secondhand smoke exposure on adverse pregnancy outcomes. Tobacco use is the leading preventable cause of miscarriage, stillbirth and neonatal deaths, and evidence has shown that health effects extend into childhood. Women who smoke should be supported with quitting as early as possible in pregnancy and there are benefits of quitting before the 15th week of pregnancy. There are a variety of factors that are associated with tobacco use in pregnancy (socioeconomic status, nicotine addiction, unsupportive partner, stress, mental health illness etc.). Clinical-trial evidence has found counseling, when delivered in sufficient intensity, significantly increases cessation rates among pregnant women. There is evidence that the use of nicotine replacement therapy (NRT) may increase cessation rates, and, relative to continued smoking, the use of NRT is considered safer than continued smoking. The majority of women who smoke during pregnancy will require support throughout their pregnancy, delivered either by a trained maternity care provider or via referral to a specialized hospital or community quit-smoking service. The 5As (Ask, Advise, Assess, Assist, Arrange) approach is recommended for organizing screening and treatment in maternity care settings. Additionally, supporting smoking cessation in the postpartum period should also be a priority as relapse rates are high. CONCLUSIONS There have been several recent updates to clinical practice regarding the treatment of tobacco use in pregnancy. It is important for the latest guidance to be put into practice, in all maternity care settings, in order to decrease rates of smoking in pregnancy and improve pregnancy outcomes.
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Affiliation(s)
- Athina Diamanti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Midwifery, University of West Attica, Athens, Greece
| | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
| | - Sotiria Schoretsaniti
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Center for Health Services Research, Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- 1st Department of Respiratory Medicine, ‘Sotiria’ Chest Disease Hospital, Athens, Greece
| | | | - Christina Gratziou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Evgenidio Hospital, Athens, Greece
| | - Paraskevi A. Katsaounou
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- First ICU, Evangelismos Hospital, Athens, Greece
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Fullerton J, Butler M, Aman C, Reid T. Global competencies for midwives: external cephalic version; ultrasonography, and tobacco cessation intervention. Women Birth 2018; 32:e413-e420. [PMID: 30174206 DOI: 10.1016/j.wombi.2018.08.166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
PROBLEM AND BACKGROUND The International Confederation of Midwives (ICM) conducts regular updates to the Essential Competencies for Basic Midwifery Practice to determine the introduction or retention of items in the global scope of midwifery practice guidance document. AIM This article presents the review process that underpinned the deliberation about three specific clinical practices: external cephalic version, prenatal ultrasonography, and tobacco cessation interventions that occurred during the 2016-2017 global update study. METHODS A brief outline of the research methodology used in the 2016-2017 study is provided. Literature summaries about safety and effectiveness of three clinical skills are offered. Data addressing global and regional variations in support of each practice and final disposition of the items are documented. FINDINGS External cephalic version did not receive sufficient document support for inclusion in the initial list of items to be tested in the study. Prenatal ultrasonography was supported as an advanced (76.6%) or country-specific (18.8%) skill that midwives could acquire, to promote wider global access for pregnant women. Midwives' participation in tobacco cessation counselling was supported (≥85%) in each of ICM's regions. Knowledge about World Health Organization recommendations for nicotine replacement therapy was endorsed as an additional (62.4%) or country-specific (29.3%) skill. DISCUSSION AND CONCLUSION The current evidence of safety of midwives performing external cephalic version led to the recommendation that it be considered in the next document update. Conflicting views of midwives' role in acquiring skills to conduct prenatal ultrasound were evident. There was strong support for participation in smoking cessation counselling, but knowledge of World Health Organization recommendations was not highly endorsed.
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Affiliation(s)
| | - Michelle Butler
- Faculty of Science and Health, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - Cheryl Aman
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
| | - Tobi Reid
- Midwifery Program, Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
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Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings. J Smok Cessat 2018. [DOI: 10.1017/jsc.2017.25] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Although the hospital inpatient setting arguably provides an ideal opportunity to engage patients in smoking cessation interventions, this is done infrequently. We therefore aimed to systematically review the perceived barriers to the implementation of smoking cessation interventions in the hospital inpatient setting.Methods: A systematic literature search was conducted specific to hospital-based healthcare workers’ perceived barriers to implementing smoking cessation interventions. Reported barriers were categorised using the capability, opportunity and motivation (COM-B) framework.Results: Eighteen studies were selected for inclusion, which consisted of cross-sectional surveys and interviews. The most commonly identified barrier in capability was lack of knowledge (56% of studies); in Opportunity, it was a lack of time (78%); while in Motivation, a lack of perceived patient motivation to quit smoking (44%). Seventeen other barriers were also endorsed, but less frequently.Conclusion: Healthcare workers report a plethora of barriers to providing smoking cessation interventions in hospital settings, which cover all aspects of the COM-B framework. These impediments need to be addressed in a multidisciplinary approach, at clinical, educational, and administrative levels, to improve intervention provision.
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Bauld L, Oncken C. Smoking in Pregnancy: An Ongoing Challenge. Nicotine Tob Res 2017; 19:495-496. [PMID: 28403476 DOI: 10.1093/ntr/ntx034] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 02/15/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Linda Bauld
- UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, UK
| | - Cheryl Oncken
- Department of Medicine and Obstetrics & Gynecology, UConn School of Medicine, Farmington, CT, USA
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