Exposure to secondhand smoke in Iranian pregnant women at home and the related factors

Secondhand smoke prevention through the perceptions of pregnant women with smoking family members: a Thailand study

PURPOSE

Pregnant women with smoking family members are at risk of exposure to second-hand smoke, which leads to adverse pregnancy outcomes. Second-hand smoke prevention is thus important but remains less understood based on pregnant women's perceptions. This study aimed to describe the perceptions of pregnant women on second-hand smoke prevention.

METHODS

This study employed a qualitative descriptive approach. Data collection was performed between July and August 2023 through in-depth interviews with 17 pregnant women purposively selected from a province in central Thailand. The verbatim transcribed data were analysed using thematic analysis.

RESULTS

Five themes emerged: unclear understanding of second-hand smoke; influences shaping perceptions related to second-hand smoke; attempt to prevent second-hand smoke exposure; barriers to prevention of second-hand smoke exposure; and needs related to prevention of second-hand smoke exposure.

CONCLUSION

The findings provide insights into second-hand smoke prevention from the perception of pregnant women with smoking family members. Healthcare professionals need to design interventions tailored to pregnant women's needs and involve smoking family members. It is necessary to develop and incorporate clinical guidelines into standard prenatal care to support healthcare personnel in identifying, assessing, educating, and mitigating the issue of second-hand smoking exposure.

Predictive factors and adverse perinatal outcomes associated with maternal smoking status

To identify risk factors for smoking among pregnant women, and adverse perinatal outcomes among pregnant women. A case-control study of singleton full-term pregnant women who gave birth at a university hospital in Jordan in June 2020. Pregnant women were divided into three groups according to their smoking status, active, passive, and non-smokers. They were interviewed using a semi-structured questionnaire that included demographic data, current pregnancy history, and neonatal outcomes. Low-level maternal education, unemployment, secondary antenatal care, and having a smoking husband were identified as risk factors for smoke exposure among pregnant women. The risk for cesarean section was ninefold higher in nulliparous smoking women. Women with low family income, those who did not receive information about the hazards of smoking, unemployed passive smoking women, and multiparty raised the risk of neonatal intensive care unit admission among active smoking women. This risk increased in active and passive women with lower levels of education, and inactive smoking women with low family income by 25 times compared to women with a higher level of education. Smoking is associated with adverse perinatal outcomes. Appropriate preventive strategies should address modifiable risk factors for smoking during pregnancy.

The levels and trends of cancer incidence in the elderly population at national and sub-national scales in Iran from 1990 to 2016

BACKGROUND

Cancer is most commonly associated with aging. It is necessary to gain a better understanding of cancer's trend and distribution among elderlies and provide comprehensive cancer care for this population.

AIMS

The aim of the current study was to show the trends in cancer incidence focusing on the population aged 60+ from 1990 to 2016 in Iran.

MATERIAL AND RESULTS

We used the dataset of the Iran Cancer Registry to estimate cancer incidences by sex, age, province, and year. In order to account for incomplete data we used a two-stage spatiotemporal model along with random intercept mixed effect models. We calculated annual age-standardized incidence rates (ASIRs) for age groups 60+ and 5-interval age groups. There was an increasing trend of 25.3% to 936.9% (95% uncertainty interval: 769.6-1141.8) in ASIR in the elderly in 2016. ASIR of all cancers were 889.7 (731.3-1083.6) in women and 988.1 (811.1-1205) in men in 2016, per 100 000 respectively, which had an increasing trend comparing 1990. Skin, breast, and stomach cancers in women and prostate, skin, and stomach cancers in men were the most common types in 2016. All the most incident cancer subtypes underwent an increasing trend in both sexes, except for the bladder, esophageal, and skin cancers which almost had a similar level in 1990 and 2016. Most provinces had an increasing trend in ASIR in all cancers combined from 1990 to 2016 except Zanjan with a decreasing trend.

CONCLUSION

Regarding the persistent increasing trend of most elderly cancers' incidence, this is crucial for policymakers to establish preventive plans, determine proper resource allocation, and develop specific treatments for elderly cancer patients.

National and regional economic inequalities in first- and second-hand tobacco consumption among women of reproductive ages in Iran

INTRODUCTION

The epidemic of tobacco consumption is one of the major public health threats the world has been facing so far. This study was performed to investigate the economic inequalities in tobacco consumption among women of reproductive ages at national and regional levels in Iran.

METHODS

We used data from 10,339 women of reproductive ages (18-49 years) who participated in Iran's 7th Non-Communicable Disease Risk Factor Surveillance (STEPS). Wagstaff normalized concentration index and decomposition method were applied to measure economic inequalities in first- and second-hand tobacco consumption and determine their corresponding contributory factors, respectively.

RESULTS

The prevalence of women's first-hand tobacco consumption, and their exposure to second-hand smoke in the home, and workplace were 3.6%, 28.3%, and 8.4%, respectively. First- and second-hand tobacco consumption was significantly more concentrated among low-economic women. Exposure to home second-hand smoke, education, and economic status had the largest contributions to the measured inequality in first-hand tobacco consumption (48.9%, 38.9%, and 30.8%, respectively). The measured inequality in women's secondhand smoke exposure at home was explained by their level of education (43.8%), economic status (30.3%), and residency in rural areas (18%), and at work by residency in rural areas (42.2%), economic status (38.8%), and level of education (32%). Our results also revealed diversity in the geographical distribution of inequalities in rural and urban areas and five regions of the country.

CONCLUSION

The present study highlighted the need for more enforcement of tobacco control rules and increasing tobacco taxes as general measures. Furthermore, there is a need for gender-sensitive initiatives at national and regional levels to educate, support, and empower low-economic women and households for tobacco cessation, and complying with restrictive smoking rules.

The Effect of Training Male Smokers About the Effects of Secondhand Smoke in Pregnant Wives on Their Self-Efficacy

Objective

Contact with second-hand cigarette smoke includes inhalation of cigarette smoke caused by the burning of the cigarette itself and inhalation of smoke exhaled by the smoker. Wife's pregnancy can be a motivating factor to change the behavior of men who smoke. Therefore, this study was conducted in order to determine the effect of training male smokers on the effects of secondhand smoke during pregnancy on their self-efficacy.

Materials and methods

The present study is an interventional type of pre-test and post-test. In this phase, random sampling was done from health centers in Isfahan, the participants were 140 smoking spouses of pregnant women, who referred to health centers to receive pregnancy care, and were divided into two intervention and control groups. The data collection tool was a researcher-made questionnaire on men's self-efficacy regarding second-hand cigarette smoke. The validity of the questionnaire was confirmed based on the opinion of the expert panel with content validity ratio (CVR)=0.87 and content validity index (CVI)=0.88, and its reliability was confirmed with Cronbach's alpha=0.97. All data were analyzed with SPSS18 software and Chi-score, Fisher, t-test.

Results

There was no significant difference between the comparison of demographic variables in the intervention and control groups (p>0.05). The results of the paired t-test to compare before and after the training showed that the average score of self-efficacy (p<0.001) in the intervention group had increased significantly after the training, and according to the independent t-test, the average score of self-efficacy After training, it was more in the intervention group than the control group (p<0.05).

Conclusion

Men's self-efficacy regarding second-hand smoke increased after training, so the current training package is effective in training and can be suggested for future studies.

Passive smoking as a risk factor among older adults: an ordered probability approach for Türkiye

Background/aim

Older adults represent a significant proportion of the population of many societies, and being one of the disadvantaged groups, they struggle with various difficulties in their social lives. Undoubtedly, passive smoking is one of these difficulties. Passive smoking among older adults, which is an important public health problem, is an issue that needs to be investigated. The aim of this study is to determine the relationship between the demographic and socio-economic characteristics of adults aged 60 and older in Türkiye and their exposure to secondhand smoke (SHS).

Methods

In this study, a microdata set of the 2016 and 2019 Turkey Health Survey conducted by the Turkish Statistical Institute (TUIK) was used. This survey was conducted by TUIK in the relevant years using a stratified sampling method to best represent the whole of Turkey. The study considered only demographic and socio-economic characteristics to investigate passive smoking. Since all the variables used in the study were categorical, the relationship between the dependent variable and the independent variables was first investigated using chi-square tests. In addition, since the dependent variable has an ordered-categorical probability form, the generalized ordinal logit model was used for the analysis of passive smoking and related factors.

Results

The rate of exposure to tobacco smoke of older adults who participated in the study in 2016 was 16%, while the rate of those who participated in the study in 2019 was 21%.

Conclusion

According to the findings of the study, older, uneducated, and uninsured smokers carry a more serious SHS risk. It may be beneficial for society for policy makers to carry out studies by considering these features a priority and focusing on policies in this context. Expanding smoke-free areas to cover older adult, increasing penalties as a deterrent, facilitating education, increasing state support for education, increasing education and public service announcements about tobacco harms, and facilitating social security are the main examples. This study's findings are crucial as a source of information for the development of policies and programs aimed at preventing the exposure of older adults to tobacco smoke.

The effect of health education on second-hand smoke knowledge and exposure among pregnant women in Jordan: A quasi-experimental study

Second-Hand Smoke (SHS) is a significant health issue. For non-smoker pregnant women, SHS exposure can lead to harmful consequences on the fetus. This study aimed to examine the effectiveness of a health education program in decreasing SHS exposure and increasing pregnant women's knowledge of its harmful effects. A quasi-experimental (pretest-posttest control group) design and the second-hand exposure questionnaire (SS-A) were used. A convenience sample of 136 pregnant Jordanian women from the antenatal clinic was recruited and assigned to an intervention group (n = 70) and a control group (n = 66). The intervention group received a health education program, while the control group received the usual antenatal care. The data were collected from October to December 2018. The results revealed that the highest exposure to SHS was in the home setting, with an average of 8.7 ± 2.21 hours daily for both groups. After the educational program, there were significantly lower scores of exposure and a higher score of knowledge in the intervention group, compared to the control group (p < 0.001). There was also a significant decrease in the scores of exposure and a significant increase in the score of knowledge of the intervention group from pretest to posttest (p < 0.001). The study provides evidence about the importance of a program to educate pregnant women about the negative impact of SHS. Nurses need to assess SHS exposure and provide health education for pregnant women.

Estimates of incidence, prevalence, mortality, and disability-adjusted life years of lung cancer in Iran, 1990-2019: A systematic analysis from the global burden of disease study 2019

BACKGROUND

Lung cancer is one of the leading cancers, with a high burden worldwide. As a developing country, Iran is facing with population growth, widespread tobacco use, demographic and epidemiologic changes, and environmental exposures, which lead to cancers becoming a severe concern of public health in Iran. We aimed to examine the burden of lung cancer and its risk factors in Iran.

METHODS

We utilized the Global Burden of Disease 2019 data and analyzed the total burden of the lung cancer and seven related risk factors by sex, age at national and sub-national levels from 1990 to 2019.

RESULTS

The lung cancer age-standardized death rate increased from 11.8 (95% Uncertainty Interval: 9.7-14.4) to 12.9 (11.9-13.9) per 100,000 between 1990 and 2019. This increase was among women from 5 (4.2-7.1) to 8 (7.2-8.8) per 100,000; in contrast, there was a decline among men from 18.5 (14.8-22.6) to 17.8 (16.2-19.4) per 100,000. The burden of lung cancer is concentrated in the advanced age groups. Smoking with 53.5% of total attributable deaths (51.0%-55.9%) was the leading risk factor. At the provincial level, there was a wide range between the lowest and highest, from 8.3 (7.0-10.0) to 19.1 (16.4-22.0) per 100,000 population in the incidence rate and from 8.7 (7.3-10.3) to 20.6 (17.7-24.0) per 100,000 population in mortality rate, respectively in Tehran and West Azerbaijan provinces in 2019.

CONCLUSION

The increasing trend of lung cancer burden among the entire Iranian population, the inter-provincial disparities, and the significant rise in burden of this cancer in women necessitate the urgent implementation and development of policies to prevent and manage lung cancer burden and strategies to reduce exposure to risk factors.

Active and Passive Maternal Smoking During Pregnancy and Birth Outcomes: A Study From a Developing Country

Background:

Smoking is one of the modifiable risk factors for adverse maternal and neonatal outcomes and is associated with low birth weight, preterm birth, respiratory, antepartum and intrapartum stillbirth, and perinatal death as well as long-term morbidity in offspring and sudden unexpected infant death. The rate of smoking in low- and middle-income countries is still relevantly high, and Jordan is no exception.

Objective:

To investigate the effect of active and passive smoking during pregnancy on adverse pregnancy outcomes.

Methods:

The case-control study was conducted in Jordan in June 2020. Healthy women with full-term singleton pregnancy (n = 180) were interviewed and stratified into three groups: Group I, active smokers; Group II, passive smokers; and Group III, nonsmokers. The study variables included demographic data, current pregnancy history, cotinine level of mothers and newborns, and perinatal outcomes. Statistical analysis was performed using the application package IBM SPSS 25. Various algorithms of statistical analysis were used depending on the type of distribution of feature and data quality. The threshold for statistical significance was set at p < 0.05.

Results:

Active smokers had significantly lower gestational age at delivery compared to passive and nonsmoking women (p = 0.038 and p = 0.003, respectively). Neonates from active smoking mothers had significantly lower birth weight compared to neonates from passive and nonsmoking women (p = 0.016 and p = 0.019, respectively), significantly lower head and chest circumferences compared to babies from passive smokers (p < 0.001 and p = 0.036, respectively), and significantly lower first-minute Apgar score compared to those from nonsmoking women (p = 0.023). The urine cotinine level was significantly higher in both active and passive smoking women (both p < 0.01), and it was significantly higher in newborns who had been exposed to smoking in utero despite maternal active or passive smoking status (both p < 0.001). There was a weak negative correlation between urine cotinine level and birth weight: r = –0.14 for maternal cotinine level and r = –0.15 for neonate cotinine level.

Conclusions:

The current study illustrated that smoking during pregnancy leads to offspring with reduced birth weight, birth length, and head and chest circumference; reduces delivery gestational age; and lowers the first-minute Apgar score. Our study findings highlight the need for further research issued to smoking effects on perinatal outcomes, the implementation of actions to develop cessation interventions in the preconception period, and an evaluation of useful interventions to enhance a smoking-free environment during pregnancy.

Spatiotemporal variability of exposure to secondhand smoke in Iran during 2009-2020: a systematic review

The present study aimed to provide a systematic review of studies on the prevalence of secondhand smoke (SHS) exposure in the Iran population as a serious indoor health hazard. A literature review of studies that considered SHS exposure, available in multiple electronic databases including Web of Science, PubMed, and Scopus published 2009-2020 in English and two Persian databases (SID and Magiran), was carried out following the PRISMA recommendations. A total of 55 studies were included based on the inclusion and exclusion criteria and the quality assessment. The results showed no specific decrease in the prevalence of exposure to secondhand smoke in Iran; however, it appeared that the exposure has been increasing. Distribution of studies in terms of age group revealed that most studies (38%) investigated adults (more than 18 years old), while 34% of the studies considered less than 18 years of age group and a single article considered infants (6-24 months). Based on the present study results, a large population of Iran was exposed to SHS. Moreover, based on Iran's STEPs 2016 (Stepwise Non-communicable Diseases Risk Factors Survey in Iran) study, the overall prevalence of SHS exposure at home (57.5%) was higher than in workplaces (49.2%). The results of the present study recommended that protection measures should be comprehensive in terms of exposure places, and since the exposure prevalence in some provinces was higher than the others, it is especially important to consider the local measures and cultural aspects in SHS control programs.

Second hand smoking and tobacco use among pregnant women in Yatinuwara Medical Officer of Health (MOH) area in Sri Lanka

This study was aimed to assess the prevalence and factors associated with second hand smoking (SHS) and tobacco use among pregnant women in Yatinuwara Medical Officer of Health area in Kandy district, Sri Lanka. This was a descriptive cross-sectional study using 390 pregnant women. Data were collected through a pre-tested, self-administered questionnaire. Fifty-four-point four percent were exposed to the SHS. Prevalence of smoking during pregnancy was 0.5% and eight women used smokeless tobacco (SLT). SHS was significantly associated with the age of the mother and family income. Women's age, monthly income, husband's education, husband's occupation, women's age at marriage and trimester of pregnancy were significantly associated with tobacco use. In conclusions, prevalence of SHS was high but tobacco use was low in pregnant women. An effective training program should be designed to educate pregnant women as well as their husbands on adverse effects of tobacco use and SHS during pregnancy.

Exposure of second hand smoke in women and children: A narrative review

Second-hand smoke is a neglected public health issue. Every year 1.2 million people die due to this exposure. Second-hand smoke is also related to various other diseases like cardiovascular diseases, lung diseases, low birth weight, maternal depression, etc. The purpose of this review is to look over various studies and to gain an understanding of existing research about second-hand smoke and its adverse effects. In addition, we tried to identify the barriers behind creating a smoke-free environment at home and successful strategies employed and suggestion given in various studies. A comprehensive search of the recent literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications published since 2004 or later on Second-hand smoke exposure in pregnant women. Prevalence of SHS among pregnant women ranged from 24% 92%. Lack of knowledge, absence of comprehensive smoking ban, low status of women was among the main contributing factors. Community awareness and counseling by primary health-care physician was found to be successful strategies. There are various cultural and social barriers behind a smoke-free home for pregnant women. Interventional approaches like focused counseling by primary care physicians can help to overcome this issue. There is a need for behavioral interventions and community awareness to be done in this aspect.