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Fuemmeler BF, Glasgow TE, Schechter JC, Maguire R, Sheng Y, Bidopia T, Barsell DJ, Ksinan A, Zhang J, Lin Y, Hoyo C, Murphy S, Qin J, Wang X, Kollins S. Prenatal and Childhood Smoke Exposure Associations with Cognition, Language, and Attention-Deficit/Hyperactivity Disorder. J Pediatr 2023; 256:77-84.e1. [PMID: 36513211 PMCID: PMC10962780 DOI: 10.1016/j.jpeds.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/09/2022] [Accepted: 11/01/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess the relationships of prenatal and childhood smoke exposure with specific neurodevelopmental and behavioral problems during early childhood. STUDY DESIGN A subsample (n = 386) of mother-child dyads from the Newborn Epigenetic Study (NEST) prebirth cohort participated in the study. Cotinine concentrations were used to objectively measure prenatal and childhood smoke exposure when youth were aged 3-13 years. Multivariable regression models were used to estimate associations of prenatal and childhood cotinine concentrations with performance on the National Institutes of Health (NIH) Toolbox and attention-deficit/hyperactivity disorder and behavioral symptoms, measured using the Behavior Assessment System for Children, 2nd edition (BASC-2). RESULTS After adjusting for confounders, childhood cotinine concentrations were associated with poorer cognitive performance on tasks measuring cognitive flexibility (B = -1.29; P = .03), episodic memory (B = -0.97; P = .02), receptive language development (B = -0.58; P = .01), and inhibitory control and attention (B = -1.59; P = .006). Although childhood cotinine concentration was associated with higher levels of attention problems (B = 0.83; P = .004) on the BASC-2, after adjustment for confounders, the association is nonsignificant. Although associations for maternal cotinine concentrations were null, an interaction was detected between prenatal and childhood cotinine concentrations on the NIH Toolbox Picture Vocabulary Task (P = .02). CONCLUSIONS Our findings suggest that childhood tobacco smoke exposure may lead to poorer attention regulation and language acquisition, complex visual processing ability, and attention problems.
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Affiliation(s)
- Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA.
| | - Trevin E Glasgow
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Julia C Schechter
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Rachel Maguire
- Department of Biological Sciences, North Carolina State University, Raleigh, NC; Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, NC
| | | | - Tatyana Bidopia
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - D Jeremy Barsell
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, VA
| | - Albert Ksinan
- Research Center for Toxic Compounds in the Environment, Faculty of Science, Masaryk University, Brno, Czech Republic
| | - Junfeng Zhang
- Nicholas School of the Environment, Duke University, Durham, NC
| | - Yan Lin
- Nicholas School of the Environment, Duke University, Durham, NC
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC
| | - Susan Murphy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Jian Qin
- School of Public Health, Guangxi Medical University, Nanning, China
| | - Xiangtian Wang
- Nicholas School of the Environment, Duke University, Durham, NC
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Simon SG, Eiden RD, Molnar DS, Huestis MA, Riis JL. Associations between prenatal and postnatal substance exposure and salivary C-reactive protein in early childhood. Neurotoxicol Teratol 2023; 95:107134. [PMID: 36395973 PMCID: PMC10644259 DOI: 10.1016/j.ntt.2022.107134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exposure to tobacco and cannabis during developmental periods of enhanced vulnerability (e.g., in utero and early childhood) may have long-lasting effects on child health. One potential mechanism underlying these associations is the alteration of inflammatory pathways. Using data from a longitudinal study of mother/child dyads, we examined the adjusted and combined associations of prenatal and postnatal tobacco and cannabis exposure with inflammation in early childhood. Furthermore, we explored the relations between different measures of exposure, partly reflecting differences in timing, dose, and level of fetal exposure (e.g., self-report vs. biomarker), and inflammation. Finally, we explored child sex as a moderator of prenatal and postnatal tobacco and cannabis exposure and inflammation. METHOD Women were recruited from a local hospital during their first prenatal appointment. Repeated assessments were conducted at each trimester, at birth, and when children were 2, 9, 16, 24, 36, and 60 months old (N = 215; 112 female children). To evaluate associations with different measurement approaches, prenatal tobacco and cannabis exposure were assessed using: 1) continuous dose-response variables of maternal self-reported tobacco and cannabis use during each trimester to assess associations with timing and severity of exposure, 2) categorization of children into exposure groups based on drugs and metabolites present in infant meconium reflecting later pregnancy fetal exposure, and 3) categorization into exposure groups using a combination of maternal self-report data and biomarker data derived from maternal saliva samples and infant meconium taking advantage of multiple methods of assessment to examine group differences. Postnatal exposure to tobacco (assessed using child salivary cotinine) and cannabis (assessed using maternal self-reported average joints smoked per day) was measured at each infancy/early childhood assessment. Adjusted pre- and postnatal exposure associations with child inflammation were assessed by including both measures as predictor variables in linear regression models predicting child salivary C-reactive protein (CRP) concentrations at 60 months. Interactions between pre- and postnatal exposure variables were then modeled to investigate the combined relations between pre- and postnatal substance exposure with child salivary CRP concentrations at 60 months. RESULTS Adjusting for postnatal exposure variables, there was a significant interaction between the average daily cigarettes and the average daily cannabis joints smoked during the third trimester predicting salivary CRP concentrations in early childhood. At high tobacco exposure, the effect of cannabis on CRP concentrations was negligible, whereas at low tobacco exposure, the effect of cannabis exposure on CRP concentrations was positive. Adjusting for postnatal tobacco and cannabis exposure, children for whom meconium data indicated co-exposure to tobacco and cannabis showed approximately 43% lower CRP concentrations at age 60 months compared to children with no exposure. However, when mother/child dyads were categorized based on a combination of maternal self-report data and biomarker data from saliva samples and infant meconium, there were no differences in salivary CRP concentrations at age 60 months across the three groups (no prenatal exposure, prenatal tobacco exposure only, prenatal co-exposure to tobacco and cannabis), controlling for postnatal associations. Regardless of the measurement method used to assess prenatal exposures in adjusted analyses, prenatal tobacco exposure alone did not predict CRP concentrations in early childhood, nor did postnatal tobacco exposure. Among boys, postnatal cannabis exposure was associated with higher concentrations of CRP at age 60 months, controlling for prenatal exposure relations. There were no significant combined associations of pre- and postnatal exposure with CRP concentrations. CONCLUSION This study expands upon known relations between prenatal and postnatal substance exposure and immunological outcomes in early childhood, underscoring the importance of assessing cannabis exposure during gestation and early life in combination with tobacco exposure.
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Affiliation(s)
- Shauna G Simon
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, CA, USA.
| | - Rina D Eiden
- Department of Psychology & Consortium for Combating Substance Abuse, The Pennsylvania State University, University Park, PA, USA
| | - Danielle S Molnar
- Department of Child and Youth Studies, Brock University, St. Catharines, ON, Canada
| | - Marilyn A Huestis
- Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jenna L Riis
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, CA, USA; Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA, USA
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Nizamani S, McFarlane RA, Knight-Agarwal CR, Somerset S. Couples-based behaviour change interventions to reduce metabolic syndrome risk. A systematic review. Diabetes Metab Syndr 2022; 16:102662. [PMID: 36402071 DOI: 10.1016/j.dsx.2022.102662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 10/30/2022] [Accepted: 11/01/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND AIMS Metabolic Syndrome (MetS), is a major risk factor for non-communicable diseases including type 2 diabetes mellitus, cardiovascular disease, and cancer. Although MetS risk is transferred via the epigenome from both biological parents, periconceptional lifestyle interventions are generally directed towards mothers. There is a need for interventions to reflect the shared nature of epigenetic MetS risk between both biological parents. Couples-based lifestyle interventions have previously been used to improve adherence to behaviour change in conditions with shared risk responsibility such as sexually transmitted diseases. This systematic literature review sought to answer the research question: Are couples-based interventions more effective than individual interventions to address overweight and obesity as the primary modifiable risk for MetS in addition to other associated factors. METHODS Couples-based studies involving randomised controlled trials, published between 01/01/1990-31/12/2021, were identified in Medline, CINAHL, PsycINFO, Psychology and Behavioural Sciences Collection, Cochrane, and Scopus. RESULTS After screening 4742 articles, only five eligible trials remained. Statistically significant post-intervention maintenance of low glycaemic levels was observed in one study. Otherwise, no statistically significant group differences between couples' groups and control groups were observed in any of the five included studies. CONCLUSIONS The included studies concluded that couple-based interventions can lead to weight reduction, maintenance, and adherence to modified health behaviours similar to interventions that target individuals. Overall, the findings indicate that, notwithstanding the paucity of authentic couples-based interventions, there is potential for such approaches to moderate MetS risk factors likely to flow onto epigenetic transmission of risk.
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Affiliation(s)
- Sundus Nizamani
- Public Health, Faculty of Health, University of Canberra, Australia.
| | - R A McFarlane
- Public Health, Faculty of Health, University of Canberra, Australia
| | | | - Shawn Somerset
- Public Health, Faculty of Health, University of Canberra, Australia; Nutrition & Dietetics, Faculty of Health, University of Canberra, Australia
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Kheirallah KA, Shugaa Addin N, Alolimat MM. Trends of maternal waterpipe, cigarettes, and dual tobacco smoking in Jordan. A decade of lost opportunities. PLoS One 2021; 16:e0253655. [PMID: 34242237 PMCID: PMC8270187 DOI: 10.1371/journal.pone.0253655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Maternal tobacco use is a global public health problem. In the literature, the focus was mainly on cigarette smoking, minimally on waterpipe use, and totally ignored dual use among pregnant women. We estimated the prevalence of current maternal tobacco use by tobacco product (cigarette, waterpipe, and dual use) over a period of ten years (2007 to 2017), and examined the socio-demographic patterning of maternal tobacco use. Methods A secondary analysis of Jordan DHS four data waves was conducted for women who reported to be pregnant at the time of the survey. Current cigarette and waterpipe tobacco use were investigated. Prevalence estimates for cigarette-only, waterpipe-only, and dual use, as well as for cigarette, regardless of waterpipe, and waterpipe, regardless of cigarette, were reported. The effect of independent variables on cigarette smoking, waterpipe use, and dual use was assessed. Logistic regression models assessed the adjusted effects of socio-demographic variables on cigarette smoking, waterpipe use, and on dual use. For each outcome variable, a time-adjusted and a time-unadjusted logistic models were conducted. Results Over the last decade, the prevalence estimates of current cigarette-only smoking slightly decreased. The prevalence estimates of current waterpipe-only use exceeded those for cigarette-only after 2007 and showed a steady overall increase. Current dual use showed a continuous rise especially after 2009. Gradual increase in cigarette smoking (4.1%, in 2007, and 5.7% in 2017) and in waterpipe use (2.5% to 6.4%) were detected. Education showed an inverse relationship with cigarette and waterpipe smoking. Household wealth demonstrated a positive association with cigarette and waterpipe smoking. Conclusions Tobacco use epidemic is expanding its roots among pregnant women in Jordan through not only waterpipe use but also dual cigarette–waterpipe smoking. Maternal and child services should consider tobacco counseling and cessation.
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Affiliation(s)
- Khalid A. Kheirallah
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Nuha Shugaa Addin
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Maan M. Alolimat
- Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Beyene GM, Azale T, Gelaye KA, Ayele TA. The effect of antenatal depression on birth weight among newborns in South Gondar zone, Northwest Ethiopia: a population-based prospective cohort study. ACTA ACUST UNITED AC 2021; 79:121. [PMID: 34225799 PMCID: PMC8256480 DOI: 10.1186/s13690-021-00643-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/17/2021] [Indexed: 02/04/2023]
Abstract
Background There is a high prevalence of antenatal depression and low birth weight (LBW) (< 2.5 kg) in Ethiopia. Prior evidence revealed that the association between antenatal depression and LBW in high- and low-income countries is conflicting. The effect of antenatal depression on birth weight is under-researched in Ethiopia. We aimed to examine the independent effect of antenatal depression on newborn birth weight in an urban community in Northwest Ethiopia. Methods A total of 970 pregnant women were screened for antenatal depression in their second and third trimester of pregnancy through the use of the Edinburgh Postnatal Depression Scale (EPDS). A logistic regression model was used to adjust confounders and determine associations between antenatal depression and low birth weight. Information was collected on the birth weight of newborns and mother’s socio-demographic, anthropometric, obstetric, clinical, psychosocial, and behavioral factors. Results The cumulative incidence of LBW was found to be 27.76%. The cumulative incidence of LBW in those born from depressed pregnant women was 40% as compared to 21% in none depressed. While considering all other variables constant, mothers who had antenatal depression were 2.51 (COR = 2.51 (95 CI: 1.87, 3.37)) more likely to have a child with low birth weight. After adjusting for potential confounders, antenatal depression in the second and third trimester of pregnancy (AOR = 1.92 (95% CI: 1.31, 2.81)) remained significantly associated with LBW. Mid-Upper Arm Circumference (MUAC) ≤21, lack of ANC follow up, and preterm births were also associated with LBW. Conclusion This study showed that antenatal depression during the second and third trimester of pregnancy is associated with LBW of newborns and replicates results found in high-income countries. Linking early screening, detection, and treatment of antenatal depression into routine antenatal care could be essential to improve pregnancy outcomes.
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Affiliation(s)
- Getnet Mihretie Beyene
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia. .,Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Telake Azale
- Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu Gelaye
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Smoking and Smoking Relapse in Postpartum: A Systematic Review and Meta-analysis. ADDICTIVE DISORDERS & THEIR TREATMENT 2021. [DOI: 10.1097/adt.0000000000000282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Simoneau T, Hollenbach JP, Langton CR, Kuo CL, Cloutier MM. Smoking cessation and counseling: A mixed methods study of pediatricians and parents. PLoS One 2021; 16:e0246231. [PMID: 33561136 PMCID: PMC7872228 DOI: 10.1371/journal.pone.0246231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/02/2020] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Pediatric providers play an important role in parental and youth smoking cessation. The goal of this study was to understand smoking cessation attitudes of parents and the behaviors, confidence and self-efficacy of pediatricians related to providing smoking cessation counseling to parents and youth. METHODS A mixed methods study was conducted in a convenience sample of families (n = 1,549) and pediatric primary care clinicians (n = 95) in Connecticut using surveys and focus groups from April, 2016 to January, 2017. RESULTS The smoking rate (cigarettes or electronic cigarettes) among all households surveyed was 21%. Interest in quitting smoking was high (71%) and did not differ based on smoking amount, duration, type of community of residence (urban, rural, etc), or race/ethnicity. For example, compared to participants who smoked for <10 years, those who smoked ≥20 years had a similar interest in quitting (OR = 1.12; 95% CI: 0.85-1.48). Ninety percent of clinicians surveyed asked parents about their smoking behavior at least annually but 36% offered no smoking cessation counseling services or referral. Clinicians almost always reported counseling youth about the dangers of nicotine and tobacco use (99%), were more confident about counseling youth than parents (p<0.01) and reported low self-efficacy about smoking cessation and prevention counseling of parents and youth. Ninety-three percent of clinicians opined that electronic cigarettes were equally or more dangerous than cigarettes but 34% never counseled youth about the dangers of electronic cigarettes. CONCLUSIONS Clinicians frequently screen parents about their smoking behaviors, but rarely provide smoking cessation counseling and express low confidence in this activity. Clinicians are more confident counseling youth than parents. Clinicians also recognize the dangers of electronic cigarettes, yet they infrequently counsel youth about these dangers.
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Affiliation(s)
- Tregony Simoneau
- Department of Pediatrics, Division of Pulmonary Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Jessica P. Hollenbach
- Department of Pediatrics, UConn Health, Farmington, Connecticut, United States of America
- Asthma Center, Connecticut Children’s Medical Center, Hartford, Connecticut, United States of America
| | - Christine R. Langton
- Asthma Center, Connecticut Children’s Medical Center, Hartford, Connecticut, United States of America
| | - Chia-Ling Kuo
- Department of Community Medicine and Health Care, Connecticut Convergence Institute for Translation in Regenerative Engineering, UConn Health, Farmington, Connecticut, United States of America
| | - Michelle M. Cloutier
- Department of Pediatrics, UConn Health, Farmington, Connecticut, United States of America
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Görlitz K, Tamm M. Parenthood and smoking. ECONOMICS AND HUMAN BIOLOGY 2020; 38:100874. [PMID: 32603997 DOI: 10.1016/j.ehb.2020.100874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 01/12/2020] [Accepted: 03/27/2020] [Indexed: 06/11/2023]
Abstract
Parents' smoking is harmful to infants' health. While it is well established that the fraction of mothers smoking during pregnancy is non-negligible, it is an open question of how many parents actually quit smoking to account for the adverse health effects accruing to their offspring. It is also unknown for how long smoking is reduced after first childbirth. This paper investigates these questions in a longitudinal analysis. The analyzed time period covers smoking patterns several years before childbirth and up to twenty years afterwards. Women's smoking probability already drops several years before first childbirth and it remains reduced until the first child turns 18 years old. In the second and third trimester of pregnancy, the drop is largest by around 75 percent.
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Affiliation(s)
- Katja Görlitz
- HdBA, RWI, and IZA, Hochschule der Bundesagentur für Arbeit (HdBA), Seckenheimer Landstraße 16, 68163 Mannheim, Germany.
| | - Marcus Tamm
- HdBA, RWI, and IZA, Hochschule der Bundesagentur für Arbeit (HdBA), Seckenheimer Landstraße 16, 68163 Mannheim, Germany.
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Ueda K, Kitano N, Suzuki K. Description of Maternal Smoking Status Before and After Pregnancy: A Longitudinal, Community-Based Cohort Study. J Epidemiol 2020; 30:295-300. [PMID: 31474674 PMCID: PMC7280056 DOI: 10.2188/jea.je20180187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Maternal smoking during pregnancy is a major risk for adverse perinatal outcomes, as well as children’s health status. Thus, it is important to describe maternal smoking status during pregnancy and child-rearing to devise better intervention strategies. However, there have been no longitudinal studies to describe the status. Thus, in this study, we aimed to describe maternal smoking status during pregnancy and child-rearing based on population-based maternal and child health information. Moreover, we explored the factors associated with maternal smoking relapse after delivery. Methods We performed a survey of 1,220 mothers in a Japanese rural area who responded to a questionnaire upon registration of their pregnancies. When their children received health checkups at 4, 18, and 36 months of age, maternal smoking status was also surveyed. We then performed multiple logistic regression analysis to explore factors associated with maternal smoking relapse after delivery. Results Ultimately, the total number of mothers with data available for longitudinal analysis was 727 (59.6%). At the time of pregnancy registration, there were 74 current smokers (10.2%) and 176 former smokers (24.2%). Among them, 59 (33.5%) relapsed after delivery. Under 28 years of maternal age at pregnancy registration (OR 2.6; 95% CI, 1.2–5.4) was associated with maternal smoking relapse after delivery. Conclusions Longitudinal analyses showed that about 60% of mothers who smoked before and after delivery failed smoking cessation. In addition, younger mothers were significantly likely to relapse smoking after delivery.
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Affiliation(s)
| | - Naomi Kitano
- Research Center for Community Medicine and Department of Public Health, School of Medicine, Wakayama Medical University
| | - Kohta Suzuki
- Department of Health and Psychosocial Medicine, Aichi Medical University School of Medicine
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Oh K, Xu Y, Terrizzi BF, Lanphear B, Chen A, Kalkbrenner AE, Yolton K. Associations Between Early Low-Level Tobacco Smoke Exposure and Executive Function at Age 8 Years. J Pediatr 2020; 221:174-180.e1. [PMID: 31955878 PMCID: PMC7249348 DOI: 10.1016/j.jpeds.2019.11.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate whether exposure to tobacco smoke during early brain development is linked with later problems in behavior and executive function. STUDY DESIGN We studied 239 children in a prospective birth cohort. We measured tobacco exposures by caregiver report and serum cotinine 3 times during pregnancy and 4 times during childhood. We used linear regression to examine the association between prenatal and childhood serum cotinine concentrations and behavior (the Behavior Assessment System for Children-2) and executive function (the Behavior Rating Inventory of Executive Function) at age 8 years while adjusting for important covariates. RESULTS Neither prenatal nor child serum cotinine were associated with behavior problems measured by the Behavior Assessment System for Children-2. On the Behavior Rating Inventory of Executive Function, prenatal and childhood exposure was associated with poorer task initiation scores (B = 0.44; 95% CI, 0.03-0.85 and B = 0.69, 95% CI, 0.06-1.32 respectively). Additionally, in a subset of 208 children with nonsmoking mothers, prenatal exposure was associated with task initiation scores (B = 1.17; 95% CI, 0.47-1.87) and additional components of the metacognition index (eg, working memory, B = 1.20; 95% CI, 0.34-2.06), but not components of the behavioral regulation index. CONCLUSIONS Tobacco exposures during pregnancy (including low-level second-hand smoke) and childhood were associated with deficits in some domains of children's executive function, especially task initiation and metacognition. These results highlight that decreasing early exposure to tobacco smoke, even second-hand exposure, may support ideal brain functioning.
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Affiliation(s)
- Karin Oh
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH
| | - Yingying Xu
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH
| | - Brandon F Terrizzi
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH.
| | - Bruce Lanphear
- British Columbia Children's Hospital Research Institute and Faculty of Health Sciences, Simon Fraser University, British Columbia, Canada
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amy E Kalkbrenner
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI
| | - Kimberly Yolton
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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Rattay P, von der Lippe E. Association between Living with Children and the Health and Health Behavior of Women and Men. Are There Differences by Age? Results of the "German Health Update" (GEDA) Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3180. [PMID: 32370290 PMCID: PMC7246668 DOI: 10.3390/ijerph17093180] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 01/01/2023]
Abstract
Does the health of women and men living with and without minor children differ, and are age differences evident in the association? For self-rated general health, depression, back pain, overweight, smoking and sporting inactivity, the GEDA data 2009-2012 (18-54 years, n = 39,096) were used to calculate prevalence for women and men stratified by parental status (living with children: yes/no) and age. Moreover, we calculated odds ratios and predictive margins, performing logistic regressions with interaction terms of parental status and age. Women and men aged 45-54 living with children are healthier than those not living with children. Parents aged 18-24 smoke more frequently and do less sport; young mothers are also more likely to be overweight and suffer from back pain than women not living with children. In multivariable analysis, the interaction of living with children and age is significant for all outcomes (except depression and back pain in men). Living with children is an important social determinant of health, highly dependent on age. It is to be discussed whether the bio-psycho-social situation has an influence on becoming a parent, or whether parenthood in different phases of life strains or enhances health.
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Affiliation(s)
- Petra Rattay
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, 12101 Berlin, Germany;
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Influence of Puerperal Health Literacy on Tobacco Use during Pregnancy among Spanish Women: A Transversal Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082910. [PMID: 32340128 PMCID: PMC7216153 DOI: 10.3390/ijerph17082910] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/18/2022]
Abstract
Background: Despite the fact that tobacco use during pregnancy produces adverse perinatal effects, some women continue to smoke. Health literacy (HL) is essential for health outcomes in adults. However, little is known about HL in pregnant women or postpartum women. The study aimed to analyse the relationship between the degree of HL of women during the early puerperium and tobacco use during pregnancy. Methods: A multicentre, descriptive, cross-sectional study was carried out with women in the early puerperium in a region of eastern Spain, between November 2017 and May 2018. Their HL level was obtained using the Newest Vital Sign (NVS) tool. Multivariate logistic models were adjusted to estimate the magnitude of association with tobacco use in pregnancy. Odds ratios (OR) were estimated with a 95% confidence interval. Results: 193 were included in the total. 29.5% (57) of pregnant women smoked tobacco during pregnancy, with a smoking cessation rate of 70.1% (40) while pregnant. 42.0% (81) of pregnant women had inadequate or limited HL. A low level of HL was strongly associated with tobacco use, adjusted by catchment area and age of first pregnancy (LRT p < 0.001; ROC curve = 0.71, 95% CI: 0.64–0.79). Conclusion: A low HL is associated with tobacco consumption during pregnancy. Whether low HL reflects the wide constellation of already-known socioeconomic, political and commercial determinants of tobacco use, or whether incorporating HL support interventions strengthens tobacco cessation activities in pregnancy, warrants further research. Still, it should be considered as essential to understanding the health disparities related to its consumption.
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Pollak KI, Gao X, Chung RJ, Farrell D, Bravender T. Feasibility of a clinic-delivered adolescent and pediatrician communication intervention on patient participatory behaviors and behavior change: TIC TAC pilot study. PATIENT EDUCATION AND COUNSELING 2020; 103:414-417. [PMID: 31455566 DOI: 10.1016/j.pec.2019.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/23/2019] [Accepted: 08/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Pediatrician-adolescent communication can improve adolescent health. We conducted a two-arm design to pilot-test an intervention that randomized adolescents to receive a Feedback Guide to promote engaged conversations. We hypothesized that adolescents who received the Guide would be more participatory. METHODS We recruited 12 pediatricians and 29 adolescents. Clinic staff enrolled adolescents using a tablet that enabled consenting, assessment of high-risk behaviors, and audio recording of encounters. We surveyed adolescents immediately and two months after the encounter. RESULTS Adolescents who received the intervention were more participatory than adolescents who did not. Pediatricians counseled on 20 of 32 high-risk behaviors with no significant arm differences. At follow-up, adolescents changed 9 of 32 behaviors; 6 were among 4 of adolescents in the intervention arm. Adolescents in the intervention arm were also more likely to report that counseling would help them change their behavior; these encounters were slightly longer than control arm encounters. CONCLUSIONS We confirmed feasibility of a streamlined approach to enrolling and audio recording encounters. The Feedback Guide improved adolescent participation and might have helped them adopt healthier behaviors. PRACTICE IMPLICATIONS Adolescents can be primed to be participatory and can change their behaviors after a meaningful encounter with their pediatrician.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA; Department of Population Health Sciences, Duke School of Medicine, Durham, USA.
| | - Xiaomei Gao
- Cancer Control and Populations Sciences, Duke Cancer Institute, Durham, USA
| | - Richard J Chung
- Department of Pediatrics, Duke School of Medicine, Durham, USA
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Collins BN, Nair US, DiSantis KI, Hovell MF, Davis SM, Rodriguez D, Audrain-McGovern J. Long-term Results From the FRESH RCT: Sustained Reduction of Children's Tobacco Smoke Exposure. Am J Prev Med 2020; 58:21-30. [PMID: 31759804 PMCID: PMC6960012 DOI: 10.1016/j.amepre.2019.08.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Standard care interventions to reduce children's tobacco smoke exposure (TSE) may not be sufficient to promote behavior change in underserved populations. A previous study demonstrated the short-term efficacy of an experimental counseling intervention, Family Rules for Establishing Smokefree Homes (FRESH) compared with standard care on boosting low-income children's TSE reduction and maternal smoking at 16-week end of treatment (EOT). This study tested long-term posttreatment efficacy of this treatment through a 12-month follow-up. STUDY DESIGN This study was a two-arm RCT. SETTING/PARTICIPANTS Maternal smokers (n=300) not seeking cessation treatment were recruited from low-income, urban communities. Participants exposed their <4-year-old children to tobacco smoke daily. Data collection and analyses occurred from 2006 to 2018. INTERVENTION The FRESH behavioral intervention included 2 home visits and 7 phone sessions. FRESH used cognitive behavioral skills training, support, problem-solving, and positive social reinforcement to facilitate the adoption of increasingly challenging TSE-protection behaviors. No nicotine-replacement therapy or medication was provided. MAIN OUTCOME MEASURES Primary outcomes were child cotinine (TSE biomarker) and reported TSE from EOT through 12 months after treatment. A secondary outcome was bioverified maternal smoking cessation. RESULTS Compared with controls, children in FRESH had significantly lower cotinine (β= -0.31, p<0.01) and lower maternal-reported TSE (β= -1.48, p=0.001) through the 12-month follow-up. A significant effect of time (β= -0.03, p=0.003) reflected a posttreatment decrease in cotinine. There was no treatment × time interaction, suggesting the treatment effect at EOT was sustained after treatment. Compared with controls, FRESH mothers maintained significantly higher odds of quitting smoking from EOT through 12-month follow-up (OR=8.87, 95% CI=2.33, 33.75). CONCLUSIONS Study results with a sample of underserved maternal smokers demonstrated that the short-term effect of FRESH counseling at 16-week EOT was maintained through 12 months after treatment-for both bioverified child TSE reduction and maternal smoking cessation. Smokers in low-income communities demonstrate elevated challenges to success in standard smoking treatment. FRESH follow-up results suggest the high potential value of more-intensive behavioral intervention for vulnerable smokers. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02117947.
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Affiliation(s)
- Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania.
| | - Uma S Nair
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, Arizona
| | - Katie I DiSantis
- Department of Public Health, Arcadia University, Philadelphia, Pennsylvania
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, California
| | - Samantha M Davis
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Daniel Rodriguez
- Department of Urban Public Health and Nutrition, School of Nursing and Health Sciences, La Salle University, Philadelphia, Pennsylvania
| | - Janet Audrain-McGovern
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Salminen LE, Wilcox RR, Zhu AH, Riedel BC, Ching CRK, Rashid F, Thomopoulos SI, Saremi A, Harrison MB, Ragothaman A, Knight V, Boyle CP, Medland SE, Thompson PM, Jahanshad N. Altered Cortical Brain Structure and Increased Risk for Disease Seen Decades After Perinatal Exposure to Maternal Smoking: A Study of 9000 Adults in the UK Biobank. Cereb Cortex 2019; 29:5217-5233. [PMID: 31271414 PMCID: PMC6918926 DOI: 10.1093/cercor/bhz060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 01/08/2023] Open
Abstract
Secondhand smoke exposure is a major public health risk that is especially harmful to the developing brain, but it is unclear if early exposure affects brain structure during middle age and older adulthood. Here we analyzed brain MRI data from the UK Biobank in a population-based sample of individuals (ages 44-80) who were exposed (n = 2510) or unexposed (n = 6079) to smoking around birth. We used robust statistical models, including quantile regressions, to test the effect of perinatal smoke exposure (PSE) on cortical surface area (SA), thickness, and subcortical volumes. We hypothesized that PSE would be associated with cortical disruption in primary sensory areas compared to unexposed (PSE-) adults. After adjusting for multiple comparisons, SA was significantly lower in the pericalcarine (PCAL), inferior parietal (IPL), and regions of the temporal and frontal cortex of PSE+ adults; these abnormalities were associated with increased risk for several diseases, including circulatory and endocrine conditions. Sensitivity analyses conducted in a hold-out group of healthy participants (exposed, n = 109, unexposed, n = 315) replicated the effect of PSE on SA in the PCAL and IPL. Collectively our results show a negative, long term effect of PSE on sensory cortices that may increase risk for disease later in life.
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Affiliation(s)
- Lauren E Salminen
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Rand R Wilcox
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Alyssa H Zhu
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Brandalyn C Riedel
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Christopher R K Ching
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Faisal Rashid
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Sophia I Thomopoulos
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Arvin Saremi
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Marc B Harrison
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Anjanibhargavi Ragothaman
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Victoria Knight
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Christina P Boyle
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Sarah E Medland
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Paul M Thompson
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
| | - Neda Jahanshad
- Imaging Genetics Center, USC Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine of the University of Southern California, Marina del Rey, CA USA
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Avery JC, Moran LJ, Moore V, Fernandez RC, Whitrow M, Stocks N, Gill TK, Musker M, Davies M, Rumbold A. Prevalence of Self-reported Polycystic Ovary Syndrome and Profiles of Health Among Women of Different Generations: A Cross Sectional Study. FERTILITY & REPRODUCTION 2019. [DOI: 10.1142/s2661318219500154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective: Although polycystic ovary syndrome (PCOS) is considered a lifelong disorder, very little is understood about the diagnosis and impact of this condition in women outside of the peak reproductive years. We examined the frequency of diagnosed PCOS and concurrent health conditions in women across the lifespan. Methods: Data were analysed from 1509 women aged 15–95 years participating in a cross-sectional, face-to-face population survey in South Australia, 2015. We assessed the prevalence of PCOS in 10-year age groups and the frequency of comorbidities in women with and without PCOS subgrouped by age (< 45, [Formula: see text] 45 years). The main outcome measures were Diagnosed PCOS and other chronic conditions; lifestyle factors. Logistic regression analyses determined the risk of comorbidities in women with PCOS adjusting for age and BMI. Results: Overall prevalence of PCOS was 5.6% (95% confidence interval (CI) 4.6–6.9%), peaking in the 35–44 year age group (9.1%), and lowest in those aged 15–24 (4.1%) or [Formula: see text] 65 (3.7%) years. Women with PCOS and aged <45 years were more likely to report diabetes (16.7% vs. 3.8%), cardiovascular disease (15.5% vs. 7.2%) and arthritis (15.5% vs. 7.2%) than their peers; these differences were diminished in the [Formula: see text] 45 year age group. The odds of diabetes and cardiovascular disease were more than doubled among women with PCOS (adjOR 2.23, 95% CI 1.49–4.31; adjOR 3.18, 95% CI 1.31–7.68). Conclusion: PCOS is underdiagnosed in young and post-menopausal women. Diabetes and cardiovascular disease are key comorbidities requiring greater attention in younger women with PCOS.
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Affiliation(s)
- Jodie C. Avery
- The University of Adelaide, Adelaide Medical School, Adelaide, SA 5005, Australia
| | - Lisa J. Moran
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, Adelaide, SA 5005, Australia
- Monash University, Monash Centre for Health Research & Implementation (MCHRI), Faculty of Medicine, Nursing and Health Sciences, School of Public Health & Preventive Medicine, Melbourne, VIC 3168, Australia
| | - Vivienne Moore
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, Adelaide, SA 5005, Australia
- The University of Adelaide, School of Public Health, Adelaide, SA 5005, Australia
| | - Renae C. Fernandez
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, Adelaide, SA 5005, Australia
| | - Melissa Whitrow
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, Adelaide, SA 5005, Australia
- The University of Adelaide, School of Public Health, Adelaide, SA 5005, Australia
| | - Nigel Stocks
- The University of Adelaide, Adelaide Medical School, Adelaide, SA 5005, Australia
| | - Tiffany K. Gill
- The University of Adelaide, Adelaide Medical School, Adelaide, SA 5005, Australia
- South Australian Health and Medical and Research Institute, Adelaide, SA 5000, Australia
| | - Michael Musker
- The University of Adelaide, Adelaide Nursing School, Adelaide, SA 5005, Australia
- South Australian Health and Medical and Research Institute, Adelaide, SA 5000, Australia
| | - Michael Davies
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, Adelaide, SA 5005, Australia
| | - Alice Rumbold
- The University of Adelaide, Robinson Research Institute, Adelaide Medical School, Adelaide, SA 5005, Australia
- South Australian Health and Medical and Research Institute, Adelaide, SA 5000, Australia
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Fairthorne JC, Hanley GE, Brant R, Oberlander TF. Risk factors for hospitalizations associated with depression among women during the years around a birth: a retrospective cohort study. Int J Popul Data Sci 2019; 4:453. [PMID: 34095525 PMCID: PMC8142953 DOI: 10.23889/ijpds.v4i1.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Socio-economic status (SES) is an important determinant of health. Low SES is associated with higher rates of prenatal and post-partum depression, and prenatal and post-partum depression are associated with sub-optimal maternal and infant health. Furthermore, increased negative effects of post-partum depression have been reported in children from low SES backgrounds. Objective To assess whether SES was related to the risk of a medical or psychiatric hospitalization associated with depression (HAWD) and the risk of a HAWD by anti-depressant (AD) use during the years around a birth. Methods This retrospective cohort study used linked birth, hospitalization, prescription and tax-file records of the study cohort. We linked registry data of 243,933 women delivering 348,273 live infants in British Columbia (1999-2009). The outcomes of interest were a HAWD and a HAWD with the associated patient AD use. Ranked area-based measures of equivalised, family disposable income were used to create income deciles, our proxy for SES. Decile-1 represented the lowest income areas, and mothers from Decile-6 (middle-income) were the comparator group. Anti-depressant use was defined as having a prescription for a selective serotonin reuptake inhibitor (SSRI) or other AD during the years around a birth, defined as the period beginning 12 months before conception and ending 12 months after the birth. We analysed by pregnancy using mixed effects logistic regression whilst adjusting for maternal age and parity. Results Compared to mothers from middle-income areas (Decile-6), mothers from low income areas (Decile-1, Decile-2) had increased odds of a HAWD [adjusted OR=1.77 (CI: 1.43, 2.19); adjusted OR=1.56 (CI: 1.26, 1.94)]. Mothers from low income areas with depression and no AD use had even higher odds of a HAWD [adjusted OR=1.83 (CI: 1.33, 2.20); adjusted OR=1.71(CI: 1.33, 2.20)]. Conclusions This study provides preliminary evidence to suggest that barriers to treating depression with ADs in mothers from low income areas during the years around a birth might contribute to their increased risk of a HAWD associated with non-pharmacologically treated depression. Further research is needed to understand the reasons for this increased risk. Disclaimer All inferences, opinions, and conclusions drawn in this manuscript are those of the authors and do not reflect the opinions or policies of the Data Stewards of Population Data BC.
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Affiliation(s)
- Jennifer Christine Fairthorne
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4.,Telethon Kids Institute, University of Western Australia
| | - Gillian E Hanley
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4.,Department of Obstetrics and Gynaecology, University of British Columbia, Faculty of Medicine, 1125 Howe Street, Vancouver, BC Canada V6Z 2K8
| | - Rollin Brant
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4.,Department of Statistics, University of British Columbia
| | - Tim F Oberlander
- British Columbia Children's Hospital Research Institute, 938 West 28th Avenue, Vancouver, BC Canada V5Z 4H4
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Scheffers-van Schayck T, Tuithof M, Otten R, Engels R, Kleinjan M. Smoking Behavior of Women Before, During, and after Pregnancy: Indicators of Smoking, Quitting, and Relapse. Eur Addict Res 2019; 25:132-144. [PMID: 30917383 PMCID: PMC6518863 DOI: 10.1159/000498988] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/15/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Smoking cessation during pregnancy and preventing relapse postpartum is a pivotal public health priority. OBJECTIVES This study examined the risk and protective indicators of women who (a) smoke before pregnancy, (b) smoke during the entire pregnancy, (c) successfully quit smoking during pregnancy, and (d) relapse postpartum. METHOD This paper reports secondary analyses of the Dutch population-based Monitor on Substance Use and Pregnancy (2016). A representative sample of mothers of young children (n = 1,858) completed questionnaires at youth health care centers. Bivariate and multivariate logistic regression analyses were conducted. RESULTS Main results showed that women's smoking around pregnancy was strongly associated with the partner's smoking status before pregnancy, partner's change in smoking during pregnancy, and partner's change in smoking postpartum. Women's educational level and cannabis use before pregnancy were also related with women's smoking before and during pregnancy. Women's intensity of alcohol use before pregnancy was ambiguously related with women's smoking before and during pregnancy. CONCLUSIONS One of the key findings of this study suggests that it is essential that partners quit smoking before pregnancy and do not smoke during pregnancy. If partners continue smoking during pregnancy, they should quit smoking postpartum. Health care professionals can play an important role in addressing partners' smoking and giving them evidence-based cessation support before, during, and after pregnancy.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands,Department of Developmental Psychology, Utrecht University, Utrecht, The Netherlands,*Tessa Scheffers-van Schayck, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Da Costakade 45, Utrecht, 3521 VS (The Netherlands), E-Mail
| | - Marlous Tuithof
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands
| | - Roy Otten
- Research and Development, Pluryn, Nijmegen, The Netherlands,ASU REACH Institute, Department of Psychology, Arizona State University, Tempe, Arizona, USA,Developmental Psychopathology, Radboud University, Nijmegen, The Netherlands
| | - Rutger Engels
- Executive Board, Erasmus University, Rotterdam, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Epidemiology and Research Support, Utrecht, The Netherlands,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
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Carswell AL, Ward KD, Vander Weg MW, Scarinci IC, Girsch L, Read M, Relyea G, Chen W. Prospective associations of breastfeeding and smoking cessation among low-income pregnant women. MATERNAL & CHILD NUTRITION 2018; 14:e12622. [PMID: 29797420 PMCID: PMC6865900 DOI: 10.1111/mcn.12622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 03/23/2018] [Accepted: 04/16/2018] [Indexed: 01/27/2023]
Abstract
Although low-income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast-feeding support programs in this population. We used a secondary analysis of 247 low-income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4 times (twice during pregnancy and twice through 6 months postpartum). Smoking cessation during prepartum and postpartum was defined as a self-report of not smoking for ≥1 week and an expired carbon monoxide level of <10 ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy-related, and smoking-related confounders. Thirty-nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2 times more likely to quit smoking prepartum (adjusted OR = 1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR = 1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR = 2.49, 95% CI [1.21, 5.11]). Low-income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high-risk population.
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Affiliation(s)
| | - Kenneth D. Ward
- School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | | | | | - Laura Girsch
- School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Mary Read
- School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - George Relyea
- School of Public HealthUniversity of MemphisMemphisTennesseeUSA
| | - Weiyu Chen
- School of Public HealthUniversity of MemphisMemphisTennesseeUSA
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Abstract
BACKGROUND While many cessation programmes are available to assist smokers in quitting, research suggests that support from individual partners, family members, or 'buddies' may encourage abstinence. OBJECTIVES To determine if an intervention to enhance one-to-one partner support for smokers attempting to quit improves smoking cessation outcomes, compared with cessation interventions lacking a partner-support component. SEARCH METHODS We limited the search to the Cochrane Tobacco Addiction Group Specialised Register, which was updated in April 2018. This includes the results of searches of the Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE (via OVID); Embase (via OVID); and PsycINFO (via OVID). The search terms used were smoking (prevention, control, therapy), smoking cessation and support (family, marriage, spouse, partner, sexual partner, buddy, friend, cohabitant and co-worker). We also reviewed the bibliographies of all included articles for additional trials. SELECTION CRITERIA We included randomised controlled trials recruiting people who smoked. Trials were eligible if they had at least one treatment arm that included a smoking cessation intervention with a partner-support component, compared to a control condition providing behavioural support of similar intensity, without a partner-support component. Trials were also required to report smoking cessation at six months follow-up or more. DATA COLLECTION AND ANALYSIS Two review authors independently identified the included studies from the search results, and extracted data using a structured form. A third review author helped resolve discrepancies, in line with standard methodological procedures expected by Cochrane. Smoking abstinence, biochemically verified where possible, was the primary outcome measure and was extracted at two post-treatment intervals where possible: at six to nine months and at 12 months or longer. We used a random-effects model to pool risk ratios from each study and estimate a summary effect. MAIN RESULTS Our update search identified 465 citations, which we assessed for eligibility. Three new studies met the criteria for inclusion, giving a total of 14 included studies (n = 3370). The definition of partner varied among the studies. We compared partner support versus control interventions at six- to nine-month follow-up and at 12 or more months follow-up. We also examined outcomes among three subgroups: interventions targeting relatives, friends or coworkers; interventions targeting spouses or cohabiting partners; and interventions targeting fellow cessation programme participants. All studies gave self-reported smoking cessation rates, with limited biochemical verification of abstinence. The pooled risk ratio (RR) for abstinence was 0.97 (95% confidence interval (CI) 0.83 to 1.14; 12 studies; 2818 participants) at six to nine months, and 1.04 (95% CI 0.88 to 1.22; 7 studies; 2573 participants) at 12 months or more post-treatment. Of the 11 studies that measured partner support at follow-up, only two reported a significant increase in partner support in the intervention groups. One of these studies reported a significant increase in partner support in the intervention group, but smokers' reports of partner support received did not differ significantly. We judged one of the included studies to be at high risk of selection bias, but a sensitivity analysis suggests that this did not have an impact on the results. There were also potential issues with detection bias due to a lack of validation of abstinence in five of the 14 studies; however, this is not apparent in the statistically homogeneous results across studies. Using the GRADE system we rated the overall quality of the evidence for the two primary outcomes as low. We downgraded due to the risk of bias, as we judged studies with a high weighting in analyses to be at a high risk of detection bias. In addition, a study in both analyses was insufficiently randomised. We also downgraded the quality of the evidence for indirectness, as very few studies provided any evidence that the interventions tested actually increased the amount of partner support received by participants in the relevant intervention group. AUTHORS' CONCLUSIONS Interventions that aim to enhance partner support appear to have no impact on increasing long-term abstinence from smoking. However, most interventions that assessed partner support showed no evidence that the interventions actually achieved their aim and increased support from partners for smoking cessation. Future research should therefore focus on developing behavioural interventions that actually increase partner support, and test this in small-scale studies, before large trials assessing the impact on smoking cessation can be justified.
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Affiliation(s)
- Babalola Faseru
- University of Kansas Medical CenterDepartment of Preventive Medicine and Public Health3901 Rainbow BoulevardKansas CityKSUSA66160
| | - Kimber P Richter
- University of Kansas Medical CenterDepartment of Preventive Medicine and Public Health3901 Rainbow BoulevardKansas CityKSUSA66160
| | - Taneisha S Scheuermann
- University of Kansas Medical CenterDepartment of Preventive Medicine and Public Health3901 Rainbow BoulevardKansas CityKSUSA66160
| | - Eal Whan Park
- Medical College of Dankook UniversityDepartment of Family Medicine16‐5 Anseo‐DongCheonanChungnamKorea, South330‐715
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Buchanan C, Nahhas GJ, Guille C, Cummings KM, Wheeler C, McClure EA. Tobacco Use Prevalence and Outcomes Among Perinatal Patients Assessed Through an "Opt-out" Cessation and Follow-Up Clinical Program. Matern Child Health J 2018; 21:1790-1797. [PMID: 28702864 DOI: 10.1007/s10995-017-2309-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Purpose Cigarette smoking in the perinatal period is associated with costly morbidity and mortality for mother and infant, yet many women continue to smoke throughout their pregnancy and following delivery. This report describes tobacco use prevalence among perinatal smokers identified through an "opt-out" inpatient smoking cessation clinical service. Description Adult women admitted to the peripartum, delivery, and postpartum units at a large academic hospital were screened for tobacco use. Smokers were identified through their medical record and referred to a bedside consult and follow-up using an interactive voice response (IVR) system to assess smoking up to 30 days post-discharge. Assessment Between February 2014 and March 2016, 533 (10%) current and 898 (16%) former smokers were identified out of 5649 women admitted to the perinatal units. Current smokers reported an average of 11 cigarettes per day for approximately 12 years. Only 10% reported having made a quit attempt in the past year. The majority of smokers (56%) were visited by a bedside tobacco cessation counselor during their stay and 27% were contacted through the IVR system. Those counselled in the hospital were twice as likely (RR 1.98, CI 1.04-3.78) to be abstinent from smoking using intent-to-treat analysis at any time during the 30 days post-discharge. Conclusions This opt-out service reached a highly nicotine-dependent perinatal population, many of whom were receptive to the service, and it appeared to improve abstinence rates post-discharge. Opt-out tobacco cessation services may have a significant impact on the health outcomes of this population and their children.
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Affiliation(s)
- Cole Buchanan
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Constance Guille
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Cameron Wheeler
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA.
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Morelli EL, Broadbent JM, Leichter JW, Thomson WM. Pregnancy, parity and periodontal disease. Aust Dent J 2018; 63:270-278. [PMID: 29770451 DOI: 10.1111/adj.12623] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 12/21/2022]
Abstract
Many women believe that their dental condition deteriorated during pregnancy or as a result of having children. Epidemiological studies have reported an association between higher parity and tooth loss, and higher parity and periodontal attachment loss. Several possible explanations for this association exist. First, hormonal changes during pregnancy affect the immune response to bacterial plaque and drive vascular and gingival changes that may contribute to heightened gingival inflammation. These changes are transient, without irreversible loss of periodontal attachment, and post-partum resolution can be expected for most women. For women with destructive periodontal disease, the effects of pregnancy and parity are unclear. Second, it is also plausible that parity and socioeconomic position (SEP) have shared risk factors, increasing the incidence of disease or influencing its management. Education, one aspect of SEP, is an important determining factor for women's fertility rate, with a gradient of fewer children with higher educational attainment. Higher levels of education are also favourably associated with behaviours conducive to oral health, and a lower incidence of damaging health behaviours. Thus, the potential for confounding is considerable. This review examines the literature on the association between pregnancy, parity and periodontal health, and explores sociobehavioural mechanisms for the observed association.
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Affiliation(s)
- E L Morelli
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
| | - J M Broadbent
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
| | - J W Leichter
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
| | - W M Thomson
- The University of Otago - Sir John Walsh Research Institute, Dunedin, New Zealand
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Riaz M, Lewis S, Naughton F, Ussher M. Predictors of smoking cessation during pregnancy: a systematic review and meta-analysis. Addiction 2018; 113:610-622. [PMID: 29235189 DOI: 10.1111/add.14135] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/09/2016] [Accepted: 12/05/2017] [Indexed: 01/10/2023]
Abstract
AIM To identify factors found in the research literature to be associated with smoking cessation in pregnancy. METHODS Electronic searches of the bibliographic databases of PubMed, EMBASE, PsycINFO, Elsevier, Scopus and ISI Web of Science were conducted to April 2017. All studies reporting factors associated with smoking cessation or continuing smoking during pregnancy were included and reviewed systematically, irrespective of study design. The Newcastle-Ottawa Quality Assessment Scale was used to assess the study quality. The DerSimonian & Laird random-effects model was used to conduct meta-analyses, and where effect estimates were reported for factors included in at least three studies. RESULTS Fifty-four studies, including 505 584 women globally who smoked before pregnancy, 15 clinical trials and 40 observational studies, were included in the review and 36 (65.5%) were considered to be of high quality. This review identified 11 socio-demographic, seven socially related, 19 smoking behaviour-related, five pregnancy-related, six health-related and six psychological factors that were associated significantly with smoking cessation during pregnancy. The most frequently observed significant factors associated with cessation were: higher level of education, pooled odds ratio (OR), 95% confidence interval (CI) = 2.16 (1.80-2.84), higher socio-economic status: 1.97 (1.20-3.24), overseas maternal birth: 2.00 (1.40-2.84), Medicaid coverage or private insurance: 1.54 (1.29-1.85), living with partner or married: 1.49 (1.38-1.61), partner/other members of the household do not smoke: 0.42 (0.35-0.50), lower heaviness of smoking index score: 0.45 (0.27-0.77, lower baseline cotinine level: 0.78 (0.64-0.94), low exposure to second-hand smoking: 0.45 (0.20-1.02), not consuming alcohol before and/or during pregnancy: 2.03 (1.47-2.80), primiparity: 1.85 (1.68-2.05), planned breastfeeding:1.99 (1.94-2.05), perceived adequate pre-natal care: 1.74 (1.38-2.19), no depression: 2.65 (1.62-4.30) and low stress during pregnancy: 0.58 (0.44-0.77). CONCLUSION A wide range of socio-demographics, relationship, social, smoking-related, pregnancy-related, health and psychological factors have been found to predict smoking cessation in pregnancy.
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Affiliation(s)
- Muhammad Riaz
- College of Medicine, Biological Sciences and Psychology, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
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The Health Behaviors of Ethnically Diverse Women at Increased Risk of Gestational Diabetes: The Behaviors Affecting Baby and You (B.A.B.Y.) Study. Matern Child Health J 2018; 22:735-744. [PMID: 29335906 DOI: 10.1007/s10995-018-2442-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives Cigarette smoking, low physical activity, and sedentary behavior are modifiable risk factors for adverse pregnancy outcomes. However, only one study has evaluated predictors of these health risk behaviors among women at high risk for gestational diabetes mellitus (GDM). Therefore, our goal was to examine predictors of smoking, low physical activity, and sedentary behavior during pregnancy in an ethnically diverse high risk cohort. Methods This cross-sectional analysis utilized baseline data from the Behaviors Affecting Baby and You (B.A.B.Y.) study conducted among prenatal care patients at high risk for GDM (personal history of GDM or family history of diabetes and body mass index [BMI] ≥ 25 kg/m2). Smoking was assessed using questions from the Pregnancy Risk Assessment Monitoring System questionnaire and sedentary behavior (top vs. lower quartiles) and moderate/vigorous physical activity (bottom vs. upper quartile) via the Pregnancy Physical Activity Questionnaire. Results Participants (n = 400) enrolled at a mean of 12.4 (SD 3.6) weeks gestation. A total of 150 (44.1%) engaged in one, 37 (10.9%) in two, and 4 (1.2%) in three risk behaviors. Lower household income and not having children at home were each associated with a 2-6 fold increased odds of smoking, high sedentary behavior, and engaging in at least one risk behavior. Being married, Hispanic or of younger age was associated with a 2-6 fold reduced odds of smoking. BMI and personal history of GDM were not associated with risk behaviors. Conclusions for Practice Findings help characterize high risk groups and inform prenatal interventions targeting these health risk behaviors.
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Tsakiridis I, Mamopoulos A, Papazisis G, Petousis S, Liozidou A, Athanasiadis A, Dagklis T. Prevalence of smoking during pregnancy and associated risk factors: a cross-sectional study in Northern Greece. Eur J Public Health 2018; 28:321-325. [DOI: 10.1093/eurpub/cky004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Ioannis Tsakiridis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Papazisis
- Department of Clinical Pharmacology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatios Petousis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Athanasia Liozidou
- Department of Psychology, Faculty of Human Sciences, Athens Metropolitan College, Athens, Greece
| | - Apostolos Athanasiadis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- 3rd Department of Obstetrics and Gynaecology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Verbiest S, Bonzon E, Handler A. Postpartum Health and Wellness: A Call for Quality Woman-Centered Care. Matern Child Health J 2017; 20:1-7. [PMID: 27757754 DOI: 10.1007/s10995-016-2188-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction The first 3 months after giving birth can be a challenging time for many women. The Postpartum Health and Wellness special issue explores this period, one that is often overlooked and under-researched. Methods This issue is designed to bring greater focus to the need for woman-centered care during the postpartum period. Articles in this issue focus on four key areas: (1) the postpartum visit and access to care, (2) the content of postpartum care and postpartum health concerns, (3) interconception care including contraception, and (4) policy, systems, and measurement. Results The submissions highlight deficits in the provision of comprehensive care and services during a critical period in women's lives. The research highlighted in this issue supports the recommendation that Maternal and Child Health leaders collaborate to create woman-centered postpartum services that are part of a coordinated system of care. Conclusion In order to achieve optimal health care in the postpartum period it is becoming more apparent that increased flexibility of services, cross-training of providers, a "no wrong door" approach, new insurance and work-place policy strategies, improved communication, and effective coordinated support within a system that values all women and families is required.
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Affiliation(s)
- Sarah Verbiest
- School of Social Work, University of North Carolina at Chapel Hill, Campus Box 3550, Chapel Hill, NC, 27599-3550, USA. .,Center for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Campus Box 7181, Chapel Hill, NC, 27599-7181, USA.
| | - Erin Bonzon
- ZERO TO THREE, 1255 23rd St NW, Suite 350, Washington, DC, 20037, USA
| | - Arden Handler
- Community Health Sciences, University of Illinois School of Public Health Center of Excellence in Maternal and Child Health, 1603 W. Taylor, Chicago, IL, 60612, USA
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Chavkin U, Wainstock T, Sheiner E, Sergienko R, Walfisch A. Perinatal outcome of pregnancies complicated with extreme birth weights at term. J Matern Fetal Neonatal Med 2017; 32:198-202. [DOI: 10.1080/14767058.2017.1376048] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Uri Chavkin
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
| | - Tamar Wainstock
- Department of Public Health, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Soroka University Medical Center, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel
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Orton S, Coleman T, Coleman-Haynes T, Ussher M. Predictors of Postpartum Return to Smoking: A Systematic Review. Nicotine Tob Res 2017; 20:665-673. [DOI: 10.1093/ntr/ntx163] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Sophie Orton
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St. Georges, University of London, London, UK
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Bricard D, Legleye S, Khlat M. Changes in Smoking Behavior over Family Transitions: Evidence for Anticipation and Adaptation Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060610. [PMID: 28590412 PMCID: PMC5486296 DOI: 10.3390/ijerph14060610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/22/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
Abstract
The study of changes in smoking behaviors over the life course is a promising line of research. This paper aims to analyze the temporal relation between family transitions (partnership formation, first childbirth, separation) and changes in smoking initiation and cessation. We propose a discrete-time logistic model to explore the timing of changes in terms of leads and lags effects up to three years around the event in order to measure both anticipation and adaptation mechanisms. Retrospective biographical data from the Santé et Itinéraires Professionnels (SIP) survey conducted in France in 2006 are used. Partnership formation was followed for both genders by a fall in smoking initiation and an immediate rise in smoking cessation. Childbirth was associated with increased smoking cessation immediately around childbirth, and additionally, females showed an anticipatory increase in smoking cessation up to two years before childbirth. Couple separation was accompanied by an anticipatory increase in smoking initiation for females up to two years prior to the separation, but this effect only occurred in males during separation. Our findings highlight opportunities for more targeted interventions over the life course to reduce smoking, and therefore have relevance for general practitioners and public policy elaboration.
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Affiliation(s)
- Damien Bricard
- Institut de Recherche et Documentation en Économie de la Santé (Irdes), 117 bis rue Manin, 75019 Paris, France.
- Institut National d'Études Démographiques (Ined), 133 boulevard Davout, 75020 Paris, France.
| | - Stéphane Legleye
- Institut National de la Statistique et des Études Économiques (Insee), 6 Rue Legrand, 92240 Malakoff, France.
- Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Faculté de Médecine-Université Paris-Sud, Faculté de Médecine-UVSQ, INSERM, Université Paris-Saclay, 94805 Villejuif, France.
| | - Myriam Khlat
- Institut National d'Études Démographiques (Ined), 133 boulevard Davout, 75020 Paris, France.
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Buss C, Entringer S, Moog NK, Toepfer P, Fair DA, Simhan HN, Heim CM, Wadhwa PD. Intergenerational Transmission of Maternal Childhood Maltreatment Exposure: Implications for Fetal Brain Development. J Am Acad Child Adolesc Psychiatry 2017; 56:373-382. [PMID: 28433086 PMCID: PMC5402756 DOI: 10.1016/j.jaac.2017.03.001] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 03/01/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Growing evidence suggests the deleterious consequences of exposure to childhood maltreatment (CM) not only might endure over the exposed individual's lifespan but also might be transmitted across generations. The time windows, mechanisms, and targets of such intergenerational transmission are poorly understood. The prevailing paradigm posits that mother-to-child transmission of the effects of maternal CM likely occurs after her child's birth. The authors seek to extend this paradigm and advance a transdisciplinary framework that integrates the concepts of biological embedding of life experiences and fetal origins of health and disease risk. METHOD The authors posit that the period of embryonic and fetal life represents a particularly sensitive time for intergenerational transmission; that the developing brain represents a target of particular interest; and that stress-sensitive maternal-placental-fetal biological (endocrine, immune) pathways represent leading candidate mechanisms of interest. RESULTS The plausibility of this model is supported by theoretical considerations and empirical findings in humans and animals. The authors synthesize several research areas and identify important knowledge gaps that might warrant further study. CONCLUSION The scientific and public health relevance of this effort relates to achieving a better understanding of the "when," "what," and "how" of intergenerational transmission of CM, with implications for early identification of risk, prevention, and intervention.
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Affiliation(s)
- Claudia Buss
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH); the University of California-Irvine; and the University of California-Irvine Development, Health and Disease Research Program, Orange, CA.
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Misra DP, Slaughter-Acey J, Giurgescu C, Sealy-Jefferson S, Nowak A. Why Do Black Women Experience Higher Rates of Preterm Birth? CURR EPIDEMIOL REP 2017. [DOI: 10.1007/s40471-017-0102-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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McEvoy CT, Spindel ER. Pulmonary Effects of Maternal Smoking on the Fetus and Child: Effects on Lung Development, Respiratory Morbidities, and Life Long Lung Health. Paediatr Respir Rev 2017; 21:27-33. [PMID: 27639458 PMCID: PMC5303131 DOI: 10.1016/j.prrv.2016.08.005] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
Maternal smoking during pregnancy is the largest preventable cause of abnormal in-utero lung development. Despite well known risks, rates of smoking during pregnancy have only slightly decreased over the last ten years, with rates varying from 5-40% worldwide resulting in tens of millions of fetal exposures. Despite multiple approaches to smoking cessation about 50% of smokers will continue to smoke during pregnancy. Maternal genotype plays an important role in the likelihood of continued smoking during pregnancy and the degree to which maternal smoking will affect the fetus. The primary effects of maternal smoking on offspring lung function and health are decreases in forced expiratory flows, decreased passive respiratory compliance, increased hospitalization for respiratory infections, and an increased prevalence of childhood wheeze and asthma. Nicotine appears to be the responsible component of tobacco smoke that affects lung development, and some of the effects of maternal smoking on lung development can be prevented by supplemental vitamin C. Because nicotine is the key agent for affecting lung development, e-cigarette usage during pregnancy is likely to be as dangerous to fetal lung development as is maternal smoking.
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Affiliation(s)
- Cindy T. McEvoy
- Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St, CDRC-P, Portland, OR 97239
| | - Eliot R. Spindel
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR 97006, , 503-634-9364
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Hall ES, Venkatesh M, Greenberg JM. A population study of first and subsequent pregnancy smoking behaviors in Ohio. J Perinatol 2016; 36:948-953. [PMID: 27467563 DOI: 10.1038/jp.2016.119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/20/2016] [Accepted: 06/28/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The objective of this study is to identify maternal characteristics associated with non-smoking during a subsequent pregnancy after first pregnancy smoking. STUDY DESIGN We conducted a retrospective population-based analysis of Ohio vital birth records from 2007 to 2013. We used logistic regression to calculate adjusted odds ratios with 95% confidence intervals for detection of characteristics associated with non-smoking during a subsequent pregnancy after first pregnancy smoking. RESULTS Among 75 190 mothers, 75.6% were non-smokers and 13.7% were smokers during both pregnancies. During their first pregnancy, 49.7% of 15 075 smokers quit. Of them, 50.1% remained non-smokers during their subsequent pregnancy. Women who reduced, but continued smoking during their first pregnancy, were more than five times as likely to smoke during their subsequent pregnancy than women who quit (odds ratio (95% confidence interval): 2.85 (2.43 to 3.35) vs 0.55 (0.45 to 0.67)). CONCLUSION Interventions targeting complete cessation, rather than reduction in smoking among first-time mothers, may be the most effective at optimizing long-term health benefits.
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Affiliation(s)
- E S Hall
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Cradle Cincinnati, Cincinnati, OH, USA
| | | | - J M Greenberg
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Cradle Cincinnati, Cincinnati, OH, USA
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Abstract
Reductions in substance use tend to coincide with marriage, as both may occur during emerging adulthood. During the transition to marriage, it is possible that one's spouse may be the influence that causes the reduction in substance use. Data on participants (N = 471 couples) for this report are taken from a longitudinal study of early marriage. The objective of the current analysis is to determine if having a spouse who uses marijuana is associated with a greater likelihood of one's own use. Additionally, we are interested in spousal influence and cessation. The findings support spousal influence. Husbands are more likely to start using marijuana if their wives use marijuana, but the reverse is not true. Husbands also are more likely to stop using if their spouses do not use. During the transition into marriage, the drug use of one spouse does affect the other. However, this influence appears to be unidirectional, with wives influencing their husbands more often.
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Affiliation(s)
- Kenneth E Leonard
- Senior research scientist at the Research Institute on Addictions, and research professor of psychiatry at the University at Buffalo School of Medicine, The State University of New York (SUNY)
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Shenassa ED, Wen X, Braid S. Exposure to Tobacco Metabolites via Breast Milk and Infant Weight Gain: A Population-Based Study. J Hum Lact 2016; 32:462-71. [PMID: 26644421 DOI: 10.1177/0890334415619154] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although the immutable benefits of breastfeeding are well documented, information on the potential consequences of exposure to tobacco metabolites specifically via breastfeeding is sparse. OBJECTIVE The aim was to conduct the first study of the association between exposure to tobacco metabolites specifically through breastfeeding and infant weight gain. METHODS We used historical data from the US Collaborative Perinatal Project. Mothers were classified as nonsmokers, light smokers (1-19 cigarettes/day), and heavy (20+ cigarettes/day) smokers. In-hospital feeding type was observed during a nursery stay after delivery. We conducted stratified analyses among average-for-gestational-age (AGA; N = 23 571) and small-for-gestational-age (SGA; N = 2552) infants. We isolated the effect of exposure to tobacco metabolites specifically through breastfeeding. RESULTS Overall, maternal smoking was associated with change in weight-for-length z-score in a dose-response manner. Change in weight z-score was most pronounced among SGA infants of heavy smokers (breastfed: 0.53; 95% confidence interval [CI], 0.12-0.94; formula fed: 0.17; 95% CI, 0.03-0.30). Exposure to tobacco metabolites specifically through breastfeeding was not associated with additional weight gain among AGA infants. Among the much smaller sample of SGA infants, exposure specifically through breastfeeding was associated with marginally significant additional weight gain (0.46; 95% CI, 0.00-0.91) among infants of heavy smokers. CONCLUSION Our findings are in accord with recommendations by health agencies for smokers to breastfeed. However, SGA infants exposed to tobacco metabolites via breastfeeding by heavy smokers appear to gain weight more rapidly than other infants. Practical implications of our findings are discussed.
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Affiliation(s)
- Edmond D Shenassa
- Maternal and Child Health Program, School of Public Health, University of Maryland, College Park, MD, USA Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, MD, USA Department of Epidemiology, School of Medicine, University of Maryland, Baltimore, MD, USA Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, State University of New York at Buffalo, Buffalo, NY, USA
| | - Susan Braid
- Department of Family and Community Health, University of Maryland, Baltimore, MD, USA
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Spindel ER, McEvoy CT. The Role of Nicotine in the Effects of Maternal Smoking during Pregnancy on Lung Development and Childhood Respiratory Disease. Implications for Dangers of E-Cigarettes. Am J Respir Crit Care Med 2016; 193:486-94. [PMID: 26756937 DOI: 10.1164/rccm.201510-2013pp] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Use of e-cigarettes, especially among the young, is increasing at near-exponential rates. This is coupled with a perception that e-cigarettes are safe and with unlimited advertising geared toward vulnerable populations, the groups most likely to smoke or vape during pregnancy. There is now wide appreciation of the dangers of maternal smoking during pregnancy and the lifelong consequences this has on offspring lung function, including the increased risk of childhood wheezing and subsequent asthma. Recent evidence strongly supports that much of the effect of smoking during pregnancy on offspring lung function is mediated by nicotine, making it highly likely that e-cigarette use during pregnancy will have the same harmful effects on offspring lung function and health as do conventional cigarettes. In fact, the evidence for nicotine being the mediator of harm of conventional cigarettes may be most compelling for its effects on lung development. This raises concerns about both the combined use of e-cigarettes plus conventional cigarettes by smokers during pregnancy as well as the use of e-cigarettes by e-cigarette-only users who think them safe or by those sufficiently addicted to nicotine to not be able to quit e-cigarette usage during pregnancy. Thus, it is important for health professionals to be aware of the risks of e-cigarette usage during pregnancy, particularly as it pertains to offspring respiratory health.
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Affiliation(s)
- Eliot R Spindel
- 1 Division of Neuroscience, Oregon National Primate Research Center, and
| | - Cindy T McEvoy
- 2 Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
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"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.
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Rockhill KM, Tong VT, Farr SL, Robbins CL, D'Angelo DV, England LJ. Postpartum Smoking Relapse After Quitting During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2000–2011. J Womens Health (Larchmt) 2016; 25:480-8. [DOI: 10.1089/jwh.2015.5244] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karilynn M. Rockhill
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Van T. Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry L. Farr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl L. Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denise V. D'Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucinda J. England
- Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Fitzpatrick KE, Gray R, Quigley MA. Women's Longitudinal Patterns of Smoking during the Pre-Conception, Pregnancy and Postnatal Period: Evidence from the UK Infant Feeding Survey. PLoS One 2016; 11:e0153447. [PMID: 27111661 PMCID: PMC4844127 DOI: 10.1371/journal.pone.0153447] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/29/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND An understanding of women's longitudinal patterns of smoking during the pre-conception, pregnancy and postnatal period and the factors associated with these patterns could help better inform smoking cessation services and interventions. METHODS Latent class analysis (LCA) was used to empirically identify women's smoking patterns in a sample of 10,768 mothers from the 2010 UK Infant Feeding Survey. Multinomial logistic regression was used to identify characteristics associated with these patterns. RESULTS LCA identified five distinct smoking patterns during the pre-conception, pregnancy and postnatal period: "non-smokers" (74.1% of women); "pregnancy-inspired quitters" (10.2%); "persistent smokers" (10.1%); "temporary quitters" (4.4%); and postnatal quitters (1.1%). Smoking patterns varied markedly according to socio-demographic variables and parity. After adjusting for these variables, mothers who lived during pregnancy with a partner who smoked were more likely to be temporary quitters (aOR 2.64, 95% CI 1.74-3.99) or persistent smokers (aOR 3.32, 95% CI 2.34-4.72) than pregnancy-inspired quitters. Mothers who lived during pregnancy with someone else other than a partner who smoked were more likely to be persistent smokers (aOR 2.34, 95% CI 1.38-3.97) or postnatal quitters (aOR 2.97, 95% CI 1.07-8.24) than pregnancy-inspired quitters. Mothers given information on how their partner could stop smoking if they lived during pregnancy with a smoking partner were less likely to be persistent smokers (aOR 0.42, 95% CI 0.27-0.65) than pregnancy-inspired quitters. CONCLUSION Health professionals should ask about smoking at every opportunity, and refer women who self-report as current smokers to an evidence based smoking cessation service.
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Affiliation(s)
- Kate E. Fitzpatrick
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Ron Gray
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Maria A. Quigley
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Pollak KI, Fish LJ, Lyna P, Peterson BL, Myers ER, Gao X, Swamy GK, Brown-Johnson A, Whitecar P, Bilheimer AK, Pletsch PK. Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial. Nicotine Tob Res 2016; 18:1960-6. [PMID: 27091830 DOI: 10.1093/ntr/ntw108] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/08/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). METHODS We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. RESULTS Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( CONTROL 36% [95% confidence interval [CI]: 29-43] vs. INTERVENTION 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). CONCLUSIONS Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. IMPLICATIONS Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention.
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Affiliation(s)
- Kathryn I Pollak
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC; Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC;
| | - Laura J Fish
- Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC
| | - Pauline Lyna
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | | | - Evan R Myers
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Xiaomei Gao
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
| | - Geeta K Swamy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Angela Brown-Johnson
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC
| | - Paul Whitecar
- Department of Obstetrics and Gynecology, Womack Army Medical Center, Ft Bragg, NC
| | - Alicia K Bilheimer
- Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC
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Correa JB, Simmons VN, Sutton SK, Meltzer LR, Brandon TH. A content analysis of attributions for resuming smoking or maintaining abstinence in the post-partum period. Matern Child Health J 2016; 19:664-74. [PMID: 24996953 DOI: 10.1007/s10995-014-1556-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A significant proportion of women who self-quit smoking during pregnancy subsequently relapse to smoking post-partum. This study examined free-text responses describing attributions of smoking relapse or maintained abstinence at 1, 8, and 12 months post-partum. This study reports secondary analyses from a randomized clinical trial (N = 504) for preventing post-partum smoking relapse. At each follow-up, one survey item asked the participant to describe why she resumed smoking or what helped her maintain abstinence. A thematic content analysis was conducted on responses from the 472 participants (94.0 % of the original sample) who returned at least 1 survey. Content analyses revealed several themes for participants' reasons for relapse and abstinence. Stress was the most frequently cited reason for smoking relapse across all follow-ups. Health concerns for children and family was the most common reason provided for remaining abstinent. Chi square analyses revealed differences in written responses related to income, age, and depressive symptoms. Overall, these findings suggest that during the post-partum period, stress and familial health concerns are perceived contributors to smoking relapse and abstinence, respectively. These results confirmed key risk and protective factors that have been identified through other assessment modalities (e.g., quantitative surveys and focus groups). They also provide support for targeting these variables in the development, content, and delivery of future post-partum smoking relapse-prevention interventions. The high response rate to these open-ended attribution questions suggests that future studies would benefit from including these and similar items to allow for additional insight into participant perspectives.
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Affiliation(s)
- John B Correa
- Department of Psychology, University of South Florida, 4202 East Fowler Avenue, PCD4118G, Tampa, FL, 33620, USA
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Chesnokova A, French B, Weibe D, Camenga DR, Yun K. Association Between Neighborhood-Level Smoking and Individual Smoking Risk: Maternal Smoking Among Latina Women in Pennsylvania. Public Health Rep 2016; 130:672-83. [PMID: 26556939 DOI: 10.1177/003335491513000617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We examined whether or not high maternal smoking rates at the neighborhood level increase the likelihood of individual smoking by Latina women in the three months prior to and during pregnancy, independent of other individual and neighborhood factors. METHODS This study was observational in nature, using linked vital statistics records for 24,443 Latina women in Pennsylvania (2009-2010) and U.S. Census data for 2,398 census tracts. We used multilevel logistic regression models to determine the individual odds of self-reported maternal smoking given different census tract-level rates of maternal smoking in the previous three years (2006-2008), adjusting for maternal and census-tract characteristics, including ethnic density, population density, and poverty. RESULTS Higher levels of maternal smoking at the census-tract level were associated with increased individual odds of smoking among Latina mothers. In the fully adjusted model, a 10% increase in the neighborhood smoking rate was associated with a 1.28 (95% confidence interval 1.22, 1.34) increase in the individual odds of smoking. CONCLUSION Latina women living in census tracts where more women have smoked during or immediately prior to pregnancy are themselves at higher risk of smoking during this period.
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Affiliation(s)
- Arina Chesnokova
- The Children's Hospital of Philadelphia PolicyLab, Division of General Pediatrics, Philadelphia, PA ; Current affiliation: Baylor College of Medicine, Houston, TX
| | - Benjamin French
- University of Pennsylvania Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA
| | - Douglas Weibe
- University of Pennsylvania Perelman School of Medicine, Center for Clinical Epidemiology and Biostatistics, Philadelphia, PA
| | - Deepa R Camenga
- Yale School of Medicine, Department of Pediatrics, New Haven, CT
| | - Katherine Yun
- The Children's Hospital of Philadelphia PolicyLab, Division of General Pediatrics, Philadelphia, PA ; University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA
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Snodgrass AM, Tan PT, Soh SE, Goh A, Shek LP, van Bever HP, Gluckman PD, Godfrey KM, Chong YS, Saw SM, Kwek K, Teoh OH. Tobacco smoke exposure and respiratory morbidity in young children. Tob Control 2015; 25:e75-e82. [DOI: 10.1136/tobaccocontrol-2015-052383] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 10/07/2015] [Indexed: 11/04/2022]
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Collins BN, Nair US, Hovell MF, DiSantis KI, Jaffe K, Tolley NM, Wileyto EP, Audrain-McGovern J. Reducing Underserved Children's Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers. Am J Prev Med 2015; 49:534-44. [PMID: 26028355 PMCID: PMC4575825 DOI: 10.1016/j.amepre.2015.03.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 03/06/2015] [Accepted: 03/13/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure. DESIGN A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded. SETTING/PARTICIPANTS Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline. INTERVENTION Philadelphia Family Rules for Establishing Smoke-free Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smoke-free home. MAIN OUTCOME MEASURES Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status. RESULTS Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ(2)=10.56, p<0.01). There was no moderating effect of other smokers living at home. CONCLUSIONS FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02117947.
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Affiliation(s)
- Bradley N Collins
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
| | - Uma S Nair
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California
| | - Katie I DiSantis
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - Karen Jaffe
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - Natalie M Tolley
- Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania
| | - E Paul Wileyto
- Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Janet Audrain-McGovern
- Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Salimi S, Terplan M, Cheng D, Chisolm MS. The Relationship Between Postpartum Depression and Perinatal Cigarette Smoking: An Analysis of PRAMS Data. J Subst Abuse Treat 2015; 56:34-8. [PMID: 25841705 PMCID: PMC4841998 DOI: 10.1016/j.jsat.2015.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 03/05/2015] [Accepted: 03/16/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study examines the relationship between postpartum depression (PPD) and cigarette smoking from prior to pregnancy to postpartum. METHODS The study sample consisted of 29,654 U.S. women who reported smoking in the 3months prior to pregnancy and for whom data on PPD were available from the Pregnancy Risk Assessment Monitoring System (PRAMS). Two sets of analyses were conducted. The first compared smoking at 2 time points (prior to pregnancy and postpartum) and the second at 3 time points (prior to pregnancy, during pregnancy, and postpartum). PPD was defined as responses of "often" or "always" to 2 questions: "Since your baby was born, how often have you felt down, depressed, or sad?" and "Since your new baby was born, how often have you had little interest or little pleasure in doing things?" RESULTS Overall, 22% of the sample endorsed PPD symptoms. In the 2 time-point analysis, controlling for known confounders, participants whose smoking was reduced or unchanged postpartum were about 30% more likely to have PPD compared to those who quit (OR: 1.34; 95% CI=1.10-1.60, p=0.001; OR:1.32; 95% CI: 1.10-1.50, p<0.001 respectively). Participants who increased smoking postpartum were 80% more likely to have PPD compared those who quit (OR: 1.80; 95% CI: 1.50-2.30, p<0.001). In the 3 time-point analysis, participants who continued smoking at any level during pregnancy and postpartum had 1.48 times the odds of reporting PPD (95% CI: 1.26, 1.73) compared to those who quit during pregnancy and remained quit postpartum. Participants who quit during pregnancy but resumed postpartum had 1.28 times the odds of reporting PPD (95% CI: 1.06, 1.53) compared to those who quit during pregnancy and remained quit postpartum. CONCLUSION Results suggest an association among women who smoke cigarettes prior to pregnancy between PPD and continued smoking during pregnancy and postpartum.
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Affiliation(s)
- Shabnam Salimi
- University of Maryland, Baltimore, Department of Epidemiology and Public Health
| | - Mishka Terplan
- University of Maryland School of Medicine, Department of Epidemiology and Public Health; Behavioral Health System Baltimore
| | - Diana Cheng
- Maryland Department of Health and Mental Hygiene, Maternal and Child Health Bureau
| | - Margaret S Chisolm
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences.
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LaChance H, Cioe PA, Tooley E, Colby SM, O'Farrell TJ, Kahler CW. Behavioral couples therapy for smoking cessation: A pilot randomized clinical trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2015; 29:643-52. [PMID: 25642582 PMCID: PMC4768739 DOI: 10.1037/adb0000051] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Behavioral couples therapy (BCT) has been found to improve long-term abstinence rates in alcohol- and substance-dependent populations but has not been tested for smoking cessation. This pilot study examined the feasibility and acceptability of BCT for smoking-discordant couples. Forty-nine smokers (smoking >10 cigarettes/day) with nonsmoking partners were randomized to receive a couples social support (BCT-S) intervention or an individually delivered, standard smoking cessation treatment (ST). The couples were married or had been cohabiting for at least 1 year, with partners who had never smoked or had not used tobacco in 1 year. Both treatments included 7 weekly sessions and 8 weeks of nicotine replacement therapy. Participants were followed for 6 months posttreatment. The Partner Interaction Questionnaire was used to measure perceived smoking-specific partner support. Participants were 67% male and 88% White. Biochemically verified cessation rates were 40.9%, 50%, and 45% in BCT-S and 59.1%, 50%, and 55% in ST at end of treatment, after 3 month, and after 6 months, respectively, and did not differ significantly between treatment conditions at any time point. Perceived smoking-specific partner support at posttreatment did not significantly differ between treatment groups. Results of this pilot study do not provide support for the efficacy of BCT in smoking-discordant couples.
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Affiliation(s)
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University
| | - Erin Tooley
- Center for Behavioral and Preventative Medicine, Warren Alpert Medical School, Brown University
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University
| | | | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University
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Torres ET, Guido J, de Monegro ZQ, Diaz S, Dozier AM, McInstosh S, Ossip DJ. Understanding sociodemographic and sociocultural factors that characterize tobacco use and cessation during pregnancy among women in the Dominican Republic. Matern Child Health J 2015; 18:2275-83. [PMID: 24043558 DOI: 10.1007/s10995-013-1354-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Tobacco use and exposure are serious public health problems that threaten to undermine improvements in maternal and child health, and add to already existing poor pregnancy outcomes in many low- and middle-income countries. The purpose of this study is to explore factors that characterize tobacco use and cessation during pregnancy among women in the Dominican Republic. This study was part of a larger trial and includes a sample of women who participated in baseline surveillance and community assessments (n = 613). Descriptive, bivariate, and multivariable analyses were conducted. Overall, 93.31 % (n = 572) of women experienced a past/current pregnancy and 22.44 % (n = 127) smoked during a past or current pregnancy. Among women who had smoked, 34.13 % (n = 43) stopped smoking due to a pregnancy, and 46.03 % (n = 58) were advised by a health care provider to quit smoking because of pregnancy. Women who were older, Catholic, and had a mother who used tobacco were three times more likely to smoke during a past or current pregnancy. Inability to read or write was also significantly associated with smoking during pregnancy. Women who were able to read and write and were from a tobacco growing community were three times more likely to quit smoking during pregnancy. This study provides a preliminary understanding of factors influencing tobacco use and cessation among pregnant women in the Dominican Republic. It also informs a critical area for public health research and intervention, indicating opportunities to engage the health care provider community in intervening with pregnant women and their families.
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Affiliation(s)
- Essie T Torres
- Department of Health Education and Promotion, East Carolina University, 3202 Belk Building, Greenville, NC, 27858, USA,
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Khati I, Menvielle G, Chollet A, Younès N, Metadieu B, Melchior M. What distinguishes successful from unsuccessful tobacco smoking cessation? Data from a study of young adults (TEMPO). Prev Med Rep 2015; 2:679-85. [PMID: 26844137 PMCID: PMC4721354 DOI: 10.1016/j.pmedr.2015.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
INTRODUCTION Smoking prevalence rates among young people are high in many countries. Although attempts to quit smoking increasingly occur in young adulthood, many former smokers relapse. We compared individuals who successfully quit smoking from those who relapsed on socio-demographic, psychological and health factors. METHODS Data come from telephone interviews conducted in 2011 with participants of the TEMPO community-based study (ages 18-37 years, France). To study the likelihood of successful cessation vs. smoking relapse, we restricted the study sample to current or former smokers (n = 600) and conducted multinomial logistic regression analyses. RESULTS 43% of participants were current smokers who never quit for an extended period and, 33% former smokers and 24% current smokers who relapsed after extended cessation. In multivariate analyses female sex, parental status and illegal drug use were associated with both successful and unsuccessful smoking cessation. Factors specifically associated with a low probability of smoking cessation were job strain and symptoms of hyperactivity/inattention, while occupational grade was associated with smoking relapse. CONCLUSIONS Work and family circumstances, co-occurring substance use and psychological difficulties may influence smoking cessation in young adults. These characteristics should be considered by individual and collective interventions aiming to help young smokers quit successfully.
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Affiliation(s)
- Inès Khati
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France; Sorbonne University, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France
| | - Gwenn Menvielle
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France; Sorbonne University, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France
| | - Aude Chollet
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France; Sorbonne University, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France
| | - Nadia Younès
- EA 40-47 University of Versailles Saint-Quentin, F-78047 Guyancourt, France; Academic Unit of Psychiatry, Versailles Hospital, F-78157 Le Chesnay, France
| | | | - Maria Melchior
- INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France; Sorbonne University, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Social Epidemiology Research Team, F-75013 Paris, France
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Goletiani NV, Siegel AJ, Lukas SE, Hudson JI. The effects of smoked nicotine on measures of subjective states and hypothalamic-pituitary-adrenal axis hormones in women during the follicular and luteal phases of the menstrual cycle. J Addict Med 2015; 9:195-203. [PMID: 25783522 PMCID: PMC4449300 DOI: 10.1097/adm.0000000000000117] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the acute effects of cigarette smoking on hypothalamic-pituitary-adrenal (HPA) axis hormones and subjective states as a function of the menstrual cycle in nicotine-dependent women. METHODS Seventeen healthy nicotine-dependent women were studied during the follicular and/or luteal phase of the menstrual cycle. Because of observation of a possible bimodal distribution of progesterone levels within the luteal phase group, we performed a set of a posteriori analyses. Therefore, we divided the luteal group into a low progesterone and a high progesterone groups. RESULTS Smoked nicotine activated HPA, measured by adrenocorticotropin hormone (ACTH), cortisol, and dehydroepiandrosterone (DHEA) response and affected subjective states in both follicular and luteal phases, with increased "High," "Rush," and decreased "Craving." The HPA stimulation revealed a blunting of ACTH response. There was only modest evidence for a blunting of subjective state responses in the luteal phase. However, upon post hoc analyses, the high progesterone luteal group showed a marked blunting of measures of subjective states and a blunted ACTH response. Examining the association between hormone and measures of subjective states revealed tentative associations of ACTH stimulation with increased "Rush" and "Craving," and DHEA stimulation with increased "Craving." CONCLUSIONS This pilot study suggests that menstrual cycle phase differences in progesterone levels may attenuate nicotine's addictive effects via diminution of its reinforcing properties and augmentation of its aversive effects interfering with the pleasure associated with cigarette smoking.
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Affiliation(s)
- Nathalie V Goletiani
- From the McLean Imaging Center (NVG, SEL) and Biological Psychiatry Laboratory (JIH), McLean Hospital, Belmont, MA; Department of Psychiatry (NVG, SEL, JIH), Harvard Medical School, Boston, MA; and Department of Internal Medicine (AJS), McLean Hospital and Harvard Medical School, Boston, MA
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Margolis R, Wright L. Better Off Alone Than With a Smoker: The Influence of Partner's Smoking Behavior in Later Life. J Gerontol B Psychol Sci Soc Sci 2015; 71:687-97. [PMID: 25693998 DOI: 10.1093/geronb/gbu220] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/23/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We examine how the likelihood of smoking cessation among smokers and patterns of adherence to smoking cessation differ by partnership status, partnership changes, and partners' smoking behavior. The data are a nationally representative sample of smokers in middle and older age from the Health and Retirement Study (1992-2010). METHOD We use multivariate logistic regression models to analyze the likelihood of smoking cessation among smokers and then estimate adherence to smoking cessation using discrete-time event history models. RESULTS Those partnered with smokers and those whose partners relapse into smoking are much less likely than the unpartnered to quit smoking and adhere to smoking cessation. Respondents partnered with non-smokers and those whose partners quit smoking are more likely to quit smoking than the unpartnered. Those recently widowed, divorced, and repartnered have similar smoking changes to the consistently unpartnered. DISCUSSION Being partnered does not always mean healthier behavior changes. Rather, the association between partnership status and smoking changes depends greatly on the health behavior changes of the partner. The partnership context at the time of smoking cessation sets the stage for longer term patterns of adherence, shaping health in older age.
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Affiliation(s)
- Rachel Margolis
- Department of Sociology, University of Western Ontario, London, Canada.
| | - Laura Wright
- Department of Sociology, University of Western Ontario, London, Canada
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