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Kelty E, Havard A, Preen DB. Trends in smoking during pregnancy stratified by the use of opioid agonist therapy and the contribution of smoking to poor outcome in neonates prenatally exposed to opioid agonist treatment. Arch Womens Ment Health 2023:10.1007/s00737-023-01342-z. [PMID: 37368055 DOI: 10.1007/s00737-023-01342-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/17/2023] [Indexed: 06/28/2023]
Abstract
High rates of cigarette smoking have been observed in pregnant women on opioid agonist therapy (OAT). However, it is unclear if these rates have changed overtime in line with the general population and the degree to which smoking contributes to poor outcomes in neonates born to women on OAT. Women who gave birth in Western Australia (WA) between 2003 and 2018 were identified from whole-population midwives records. Linked records were used to identify women who had been dispensed OAT during pregnancy and those who had smoking during pregnancy. Temporal changes in smoking during pregnancy were examined for women on OAT (n = 1059) and women not on OAT (n = 397,175) using Joinpoint regression. In women treated with OAT during pregnancy, neonatal outcomes were compared between smoking and non-smoking women using generalised linear models. During the study period, 76.3% of women on OAT smoked during pregnancy compared with 12.0% of the general population. There was a decrease in the prevalence of smoking during pregnancy among women not on OAT (APC: - 5.7, 95%CI: - 6.3, - 5.2), but not in women on OAT (APC: 0.8, 95%CI: - 0.4, 2.1). For women receiving OAT, smoking was associated with an increased odds of low birth weight (OR: 1.57, 95%CI: 1.06, 2.32) and neonatal abstinence syndrome (OR: 1.34, 95%CI: 1.01, 1.78) compared with non-smoking. Despite reductions in the prevalence of smoking during pregnancy in the general population, similar reductions have not occurred in pregnant women on OAT. The high prevalence of smoking in pregnant women on OAT is contributing to poor neonatal outcomes.
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Affiliation(s)
- Erin Kelty
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Nedlands, Western Australia, Australia.
| | - Alys Havard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
- School of Population Health, UNSW Sydney, Sydney, Australia
| | - David B Preen
- The School of Population and Global Health, The University of Western Australia, 35 Stirling Highway, Nedlands, Western Australia, Australia
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Development of a Blueprint for Integrated Care for Vulnerable Pregnant Women. Matern Child Health J 2022; 26:451-460. [PMID: 35000072 PMCID: PMC8917045 DOI: 10.1007/s10995-021-03340-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
Purpose There has been increasing awareness of perinatal health and organisation of maternal and child health care in the Netherlands as a result of poor perinatal outcomes. Vulnerable women have a higher risk of these poor perinatal outcomes and also have a higher chance of receiving less adequate care. Therefore, within a consortium, embracing 100 organisations among professionals, educators, researchers, and policymakers, a joint aim was defined to support maternal and child health care professionals and social care professionals in providing adequate, integrated care for vulnerable pregnant women. Description Within the consortium, vulnerability is defined as the presence of psychopathology, psychosocial problems, and/or substance use, combined with a lack of individual and/or social resources. Three studies focussing on population characteristics, organisation of care and knowledge, skills, and attitudes of professionals regarding vulnerable pregnant women, were carried out. Outcomes were discussed in three field consultations. Assessment The outcomes of the studies, followed by the field consultations, resulted in a blueprint that was subsequently adapted to local operational care pathways in seven obstetric collaborations (organisational structures that consist of obstetricians of a single hospital and collaborating midwifery practices) and their collaborative partners. We conducted 12 interviews to evaluate the adaptation of the blueprint to local operational care pathways and its’ embedding into the obstetric collaborations. Conclusion Practice-based research resulted in a blueprint tailored to the needs of maternal and child health care professionals and social care professionals and providing structure and uniformity to integrated care provision for vulnerable pregnant women.
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Castaldelli-Maia JM, Harutyunyan A, Herbec A, Kessel T, Odukoya O, Kemper KE, Hays J, Vardavas C. Tobacco dependence treatment for special populations: challenges and opportunities. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2021; 43:75-82. [PMID: 32491035 PMCID: PMC7861180 DOI: 10.1590/1516-4446-2019-0782] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 12/19/2022]
Abstract
Although smoking rates have declined in most of the countries in the world, there are population groups within these countries whose smoking rates remain significantly higher than the general population. These "forgotten groups" who have not been receiving the needed attention in tobacco control policies and tobacco cessation efforts include people with serious mental illness, substance use disorders, tuberculosis, people living with human immunodeficiency virus (HIV), lesbian-gay-bisexual-transgender-queer people, and pregnant women. A number of steps are needed at the national level in countries where these disparities exist, including modifications to national smoking cessation treatment guidelines that address the special needs of these populations, as well as targeted smoking cessation research, since these populations are often not included in clinical trials. Because of the higher smoking prevalence in these populations, as well as their lower smoking cessation treatment success rates than the general population, more resources are needed if we are to reduce health disparities in these vulnerable populations. Additionally, we believe that more effort should be focused on integrating smoking cessation treatment in the specialized care settings frequented by these subpopulations.
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Affiliation(s)
- João M. Castaldelli-Maia
- Clínica Clima, São Paulo, SP, Brazil
- Departamento de Neurociência, Centro Universitário Saúde ABC, Faculdade de Medicina do ABC, Santo André, SP, Brazil
- Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
| | - Arusyak Harutyunyan
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aleksandra Herbec
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
- Research Department of Clinical Education and Health Psychology, University College London, London, UK
- Health Promotion Foundation, Warsaw, Poland
| | - Tzvia Kessel
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
- Meuhedet, Tel Aviv, Israel
| | - Oluwakemi Odukoya
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Idi-Araba, Lagos State, Nigeria
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Katherine E. Kemper
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
| | - J.T. Hays
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
| | - Constantine Vardavas
- Global Bridges Healthcare Alliance for Tobacco Dependence Treatment, Mayo Clinic, Rochester, MN, USA
- European Network for Smoking Prevention, Brussels, Belgium
- Institute of Public Health, The American College of Greece, Paraskevi, Grecce
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Gordon A, Chan L, Andrews C, Ludski K, Mead J, Brezler L, Foord C, Mansfield J, Middleton P, Flenady VJ, Bauman A. stillbirth prevention: Raising public awareness of stillbirth in Australia. Women Birth 2020; 33:526-530. [PMID: 33092702 DOI: 10.1016/j.wombi.2020.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/07/2020] [Accepted: 09/11/2020] [Indexed: 10/23/2022]
Abstract
Prevention of stillbirth remains one of the greatest challenges in modern maternity care. Despite this, public awareness is low and silence is common within families, the community and even healthcare professionals. Australian families and parent advocacy groups given a voice through the Senate Enquiry have made passionate and articulate calls for a national stillbirth awareness campaign. This fourth paper in the Stillbirth in Australia series outlines why stillbirth needs a national public awareness campaign; and provides an overview of good practice in the design, development and evaluation of public awareness campaigns. The cognitive and affective steps required to move from campaign awareness to action and eventually to stillbirth prevention are described. Using these best practice principles, learning from previous campaigns combined with close collaboration with aligned agencies and initiatives should assist a National Stillbirth Prevention Campaign to increase community awareness of stillbirth, help break the silence and contribute to stillbirth prevention across Australia.
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Affiliation(s)
- Adrienne Gordon
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; Sydney Institute of Women, Children and their Families, Sydney Local Health District, NSW Australia; Charles Perkins Centre, University of Sydney, NSW, Australia.
| | - Lillian Chan
- Charles Perkins Centre, University of Sydney, NSW, Australia; Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Australia
| | - Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | | | | | | | | | | | - Philippa Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia; SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Vicki J Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Australia
| | - Adrian Bauman
- Charles Perkins Centre, University of Sydney, NSW, Australia; Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Australia
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Smith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control 2020; 30:tobaccocontrol-2020-055874. [PMID: 32994297 PMCID: PMC8666809 DOI: 10.1136/tobaccocontrol-2020-055874] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND While price increases and targeted cessation support have been found to reduce inequalities in smoking by socioeconomic status (SES), evidence on other measures is mixed. We aimed to update the most recent (2014) previous review by identifying and appraising evidence published since 2013 on the equity impact of population tobacco control measures. METHODS Systematic searching of 10 electronic databases and hand-searching of four key journals identified 68 primary research articles published since 2013 that sought to examine the equity impact of population tobacco control measures in high-income countries with a negative socioeconomic gradient in smoking. Reported equity impacts were categorised as positive (greater impact among lower SES), neutral (no difference by SES), negative (greater impact among higher SES) or mixed/unclear. RESULTS There was substantial growth in research seeking to evaluate the equity impact of tobacco control interventions, but the majority of new studies showed mixed/unclear results. Findings for price increases and targeted cessation support continue to suggest an equity-positive impact, but limitations in the available evidence make further assessment difficult. Substantial differences in the context, scale and implementation of tobacco control policies make straightforward comparison of findings from the previous 2014 and current reviews problematic. CONCLUSION Researchers need to adopt more sophisticated, multidisciplinary approaches in evaluating the equity impact of tobacco control measures-developing robust measures of equity effect and using frameworks that take account of context, existing systems/processes and the likely mechanisms of action. Socioeconomic differences in intervention impact within low-income and middle-income countries require evaluation.
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Affiliation(s)
| | - Sarah E Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
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