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O'Brien M, Dempsey B, Higgins MF. The experiences and outcomes of Gypsy, Roma, and Traveller pregnant people in pregnancy: A scoping review. Int J Gynaecol Obstet 2024. [PMID: 38887905 DOI: 10.1002/ijgo.15723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/26/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Within Europe, Roma, Gypsy, and Traveller groups have been marginalized and discriminated against by larger society. Persecution and displacement have resulted in high rates of unemployment, reduced access to education, and poorer health, with significantly increased risk of poverty compared with the general population. In pregnancy, there appears to be a gap in the literature surrounding the experiences and outcomes of pregnant people within these ethnic groups. OBJECTIVES The aim of this study was therefore to scope published research, specifically questioning "What is the experience of Roma Gypsy and Traveller pregnant people who access maternity care?" and "What are the obstetric outcomes within these groups?" SEARCH STRATEGY This review followed frameworks proposed by Arksey and O'Malley, Levac, and the Joanna Brigg's Institute. The PRISMA extension for Scoping Reviews (PRISMA-ScR) tool was used. The search strategy and specific terms were chosen using the population-concepts-context framework. SELECTION CRITERIA Titles and abstracts were reviewed independently by two reviewers. Inclusion and exclusion criteria were defined to set clear guidance for reviewers to identify appropriate studies. DATA COLLECTION AND ANALYSIS Five electronic databases were searched (CINAHL, EMBASE, MEDLINE [OVID] Web of Science and SCOPUS). A charting form was developed to record key characteristics systematically and uniformly from the studies. MAIN RESULTS Five themes were identified: systemic issues, antenatal care, complications of pregnancy, birth experience, and postnatal care. Systemic issues included racism, barriers to care, and adapted antenatal care. Antenatal issues included teenage pregnancy, smoking, risk of venous thrombus embolism, dietary issues, risk of communicable diseases, domestic violence, and mental health concerns. Increased risks of congenital abnormalities, growth restriction, premature labor, and perinatal and early childhood mortality were identified. For Roma women, negative birth experiences were reported, whereas the experiences of Traveller women varied. CONCLUSIONS The findings identified in this study serve to create a framework upon which healthcare providers can tailor the way in which pregnant people from a Roma, Gypsy, or Irish Traveller background are cared for. Using such a framework would hopefully begin to reduce the systematic marginalization and discrimination of these minorities.
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Affiliation(s)
- M O'Brien
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - B Dempsey
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
| | - M F Higgins
- UCD Perinatal Research Centre, National Maternity Hospital, Dublin, Ireland
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Ekezie W, Hopwood E, Czyznikowska B, Weidman S, Mackintosh N, Curtis F. Perinatal health outcomes of women from Gypsy, Roma and Traveller communities: A systematic review. Midwifery 2024; 129:103910. [PMID: 38113569 DOI: 10.1016/j.midw.2023.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/10/2023] [Accepted: 12/07/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND GRT communities are disadvantaged minority groups in Europe and experience some of the poorest health outcomes, including maternal and child health. This systematic review aimed to assess the maternal, perinatal and infant health outcomes of women from GRT communities and the factors associated with the reported outcomes. METHODS Database searches were conducted from inception to June 2023 in 4 bibliographic databases supplemented with an additional Google Scholar search. Studies with quantitative data on maternal outcomes published in English were considered. A narrative synthesis was performed, and data were presented in text, figures and tables. FINDINGS Forty-five studies from 13 European countries were included. Outcome factors related to mothers showing low healthcare engagement, high fertility rates and shorter gestation periods among GRT women. Child wantedness was also noted to influence pregnancy completeness, which included abortion and miscarriage. More negative infant outcomes were seen in GRT infants than non-GRT infants; this included higher preterm births, lower birth weight, higher rates of intrauterine growth restriction and infant mortality. Risk factors of poorer maternal outcomes were early reproduction, education, smoking, alcohol consumption, deprivation, poor nutrition and perinatal care. CONCLUSION This review provides evidence that GRT women and children experience more negative outcomes than general populations. It also highlights the gaps in ethnicity and health inequalities more broadly. The significant importance of this research is the need for increased focus on reducing health inequalities, especially among the GRT community.
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Affiliation(s)
- Winifred Ekezie
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom; School of Social Sciences and Humanities, Aston University, Birmingham B4 7ET, United Kingdom.
| | - Ellen Hopwood
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Barbara Czyznikowska
- Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom
| | - Sarah Weidman
- Leicester Institute for Advanced Studies (LIAS), University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Nicola Mackintosh
- Department of Population Health Sciences, University of Leicester, Leicester LE1 7RH, United Kingdom
| | - Ffion Curtis
- Diabetes Research Centre, University of Leicester, Leicester LE5 4PW, United Kingdom; Centre for Ethnic Health Research, University of Leicester, Leicester LE5 4PW, United Kingdom; Institute of Population Health, Liverpool Reviews and Implementation Group (LRiG), University of Liverpool, Liverpool L69 3GF, United Kingdom
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Pike CK, Sofis MJ, Budney AJ. Correlates of continued cannabis use during pregnancy. Drug Alcohol Depend 2021; 227:108939. [PMID: 34358772 PMCID: PMC8464496 DOI: 10.1016/j.drugalcdep.2021.108939] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Cannabis use is increasingly common among pregnant women despite concern that it may be linked to adverse maternal and infant outcomes. Determining whether variables associated with cannabis use predict whether women continue or quit using during pregnancy may inform strategies to reduce prenatal use. METHODS Pregnant women who regularly used cannabis before pregnancy (n = 296) were recruited via Facebook. After finding out they were pregnant, 41 % reported quitting, 13 % quit then relapsed, 32 % reduced use, and 15 % continued use at the same rate. Differences among these four cannabis use status groups (quit, relapsed, reduced, continued) in sociodemographics, cannabis use, cigarette use, perceived risk/benefit, delay discounting, and communications about cannabis with their doctor were assessed. RESULTS Compared to those who quit, continuing use during pregnancy was associated with being unemployed (Relative Risk (RR) = .32, 95 %CI [.13, .78]), using cigarettes pre-pregnancy (RR = 3.43, 95 %CI [1.32, 8.94]), being in an earlier trimester (RR = 4.38, 95 %CI [1.18, 16.23]), less perceived risk (RR = .79, 95 %CI [.74, .85]), and more days per week of use pre-pregnancy (RR = .10, 95 %CI [.01, .84]). Unintended pregnancy, shorter time to cannabis use after waking pre-pregnancy, using cannabis more times per day pre-pregnancy, and greater perceived benefits of use had significant bivariate associations with continued use during pregnancy, but did not retain significance in a multinomial model. CONCLUSIONS Identification of these correlates provides potential targets for prevention of or intervention for prenatal cannabis use. However, much more research is needed to understand prenatal cannabis use and its effects in order to better educate women and healthcare providers, and to design optimal public health strategies.
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Affiliation(s)
- Chelsea K Pike
- Geisel School of Medicine, Dartmouth College, Center for Technology and Behavioral Health, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
| | - Michael J Sofis
- Advocates for Human Potential, Inc., Corporate Office, 490-B Boston Post Road, Sudbury, MA, USA.
| | - Alan J Budney
- Geisel School of Medicine, Dartmouth College, Center for Technology and Behavioral Health, 46 Centerra Parkway, Suite 315, Lebanon, NH, USA.
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Chanie ES, Alemu AY, Mekonen DK, Melese BD, Minuye B, Hailemeskel HS, Asferie WN, Bayih WA, Munye T, Birlie TA, Amare AT, Tibebu NS, Tiruneh CM, Legas G, Gebre Eyesus FA, Belay DM. Impact of respiratory distress syndrome and birth asphyxia exposure on the survival of preterm neonates in East Africa continent: systematic review and meta-analysis. Heliyon 2021; 7:e07256. [PMID: 34189307 PMCID: PMC8215220 DOI: 10.1016/j.heliyon.2021.e07256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 04/21/2021] [Accepted: 06/03/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Several kinds of researches are available on preterm mortality in the East Africa continent; however, it is inconsistent and inconclusive, which requires the pooled evidence to recognize the burden in general. PURPOSE To collect and synthesis evidence on preterm mortality and identify factors in the East Africa continent. METHODS PubMed, Google Scholar, Hinary, Cochrane library, research gate, and institutional repositories were retrieved to identity eligible articles through Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The articles were selected if the publication period is between 2010-2021 G.C. Data were extracted by a standardized JBI data extraction format for mortality rate and stratified the associated factors. Then exported to STATA 14 for further analysis. I2 and Egger's tests were employed to estimate the heterogeneity and publication bias respectively. Subgroup analysis based on country, study design, year of publication, and the sample size was also examined. RESULT This meta-analysis included 32 articles with a total of 21,405 study participants. The pooled mortality rate among preterm in the East Africa continent was found to be 19.2% (95% CI (confidence interval (16.0-22.4)). Regarding the study design, the mortality rate was found to be 18.1%, 19.4%, and 19.7% concerning the prospective cohort, retrospective cohort, and cross-sectional studies. The pooled odds of mortality among preterm with respiratory distress syndrome decreased survival by nearly three folds [AOR (Adjusted odds ratio = 3.2; 95% CI: 22, 4.6)] as compared to their counterparts. Similarly, preterm neonates presented with birth asphyxia were nearly three times higher in death as compared with preterm without birth asphyxia [AOR = 2.6; 95% CI: 1.9, 3.4]. CONCLUSION Preterm mortality was found to be unacceptably high in Eastern Africa continent.Fortunately, the main causes of death were found to be respiratory distress syndrome and birth asphyxia which are preventable and treatable hence early detection and timely management of this problem are highly recommended to improve preterm survival.
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Affiliation(s)
- Ermias Sisay Chanie
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abebew Yeshambel Alemu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoze Kefale Mekonen
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Biruk Demissie Melese
- Department of Environmental Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Binyam Minuye
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Habtamu Shimels Hailemeskel
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Worku Necho Asferie
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Maternity and Neonatal Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tigabu Munye
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Tekalign Amera Birlie
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Abraham Tsedalu Amare
- Department of Adult Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Chalie Marew Tiruneh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Getasew Legas
- Department of Psychiatric, School of Medicine, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Demeke Mesfin Belay
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Hajdu T, Hajdu G. Smoking ban and health at birth: Evidence from Hungary. ECONOMICS AND HUMAN BIOLOGY 2018; 30:37-47. [PMID: 29908431 DOI: 10.1016/j.ehb.2018.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/20/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
In 2012, smoking restrictions were extended to hospitality venues in Hungary. Women working in bars and restaurants were primarily affected by the intervention. In this research, we analyze the effect of this smoking ban on the outcomes of their pregnancies. Using individual live birth, fetal loss, and infant mortality registry data, we examine the probability of live birth, indicators of health at birth, and the probability of death in the first year of life. We apply a difference-in-differences framework and show that the smoking ban has improved health at birth. We observed birth weight to increase by 56 g (95% CI: 4.2 to 106.8) and gestation length by 0.19 weeks (95% CI: 0.02 to 0.36). Due to the ban, the probability of being born with very low and low birth weight has decreased by 1.2 and 2.2 percentage points, respectively (95% CI: -0.2 to -2.2 and 0.06 to -4.4), and we see a 0.9 percentage points reduction in the chance of being born very preterm (95% CI: -0.03 to -1.9). We also observe a decrease in the probability of being born with a low Ponderal index (decrease of 4.1 percentage points, 95% CI: -0.7 to -7.5). Performing a series of robustness and placebo tests, we provide evidence that supports the causal interpretation of our results. We also show that the ban was more beneficial for newborns of parents with low educational attainment and at the bottom of the fetal health endowment distribution.
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Affiliation(s)
- Tamás Hajdu
- Institute of Economics, Centre for Economic and Regional Studies, Hungarian Academy of Sciences, Tóth Kálmán u. 4., 1097 Budapest, Hungary.
| | - Gábor Hajdu
- Institute for Sociology, Centre for Social Sciences, Hungarian Academy of Sciences, Tóth Kálmán u. 4., 1097 Budapest, Hungary; MTA-ELTE Peripato Comparative Social Dynamics Research Group, Pázmány Péter sétány 1/A, 1117 Budapest, Hungary.
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Jankovic J, Stamenkovic Z, Stojanovski K, Goodwin RD, Janevic T. Predictors of prenatal smoking and attempted smoking cessation during pregnancy: a community-based study of Romani women in Southeastern Europe. J Public Health (Oxf) 2017; 39:e186-e193. [PMID: 27899475 DOI: 10.1093/pubmed/fdw123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The objective of this study was to examine predictors of prenatal smoking, and attempted smoking cessation during pregnancy among Romani women. Methods A community-based, cross-sectional study (November 2012 to February 2013) of 410 Romani women in Roma settlements in Serbia and Macedonia was conducted. Logistic regression was used to identify predictors of prenatal smoking and attempted smoking cessation during pregnancy. Results Romani women older than 30 years and those who were living with a man were over twice as likely (adjusted odds ratio (aOR) 2.48, 95% confidence interval (CI) 1.12-5.46; aOR 2.09, 95% CI 1.27-3.43) to smoke during pregnancy, compared to women <20 and married women, respectively. An inverse relationship between education and prenatal smoking was observed (for primary education versus no education, aOR 0.56, 95% CI 0.32-0.98; for secondary or higher education versus no education, aOR 0.38, 95% CI 0.16-0.90). Having a husband/partner who smokes was associated with significantly increased likelihood of prenatal smoking (aOR 3.71, 95% CI 2.20-6.25) and decreased likelihood of attempting to quit (aOR 0.51, 95% CI 0.24-1.06). Conclusions Culturally sensitive and comprehensive prevention strategies and intervention programs are needed to reduce smoking during pregnancy among Romani women, including interventions targeting male partners.
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Affiliation(s)
- Janko Jankovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia
| | - Zeljka Stamenkovic
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Dr Subotica 15, 11000 Belgrade, Serbia
| | - Kristefer Stojanovski
- Center for Regional Policy Research and Cooperation, Studiorum, Nikola Parapunov br. 41, PO Box 24, 1020 Skopje, Macedonia
| | - Renee D Goodwin
- Department of Psychology, Queens College and The Graduate Center, City University of New York (CUNY), 65-30 Kissena Boulevard, Queens, NY 11367, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Teresa Janevic
- Department of Population Health Science and Health Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, New York, NY 10029, USA
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Ruta F, Avram C, Voidăzan S, Mărginean C, Bacârea V, Ábrám Z, Foley K, Fogarasi-Grenczer A, Pénzes M, Tarcea M. Active Smoking and Associated Behavioural Risk Factors before and during Pregnancy - Prevalence and Attitudes among Newborns' Mothers in Mures County, Romania. Cent Eur J Public Health 2017; 24:276-280. [PMID: 28095282 DOI: 10.21101/cejph.a4559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 02/09/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIM Smoking before, during and after pregnancy leads to detrimental outcomes on maternal and foetal health and represents an important public health issue. This study aims to evaluate the prevalence and correlates of smoking before and during pregnancy in a sample of Romanian women. METHODS A cross-sectional survey was conducted among mothers (N=1,278) in three maternity hospitals in Tirgu-Mures, Romania, immediately after childbirth, in 2014. We evaluated the prevalence of smoking before and during pregnancy and used binary logistic regression to assess the influence of socio-demographics and other health behaviour factors in three groups of women: non-smoking pregnant women, women who continued smoking during pregnancy, and smokers who quit during pregnancy. RESULTS 30% of the interviewed mothers were smokers prior to pregnancy, of whom 43.3% continued smoking during pregnancy. Women with a family income of less than 100 Euro/month (OR=3.01, 95% CI: 1.02-8.83) and those who were unemployed (OR=13.2, 95% CI: 3.90-44.79) had increased odds of continued smoking versus quitting during pregancy in multivariable analyses. Women who continued smoking during pregnancy were also more likley to be of lower socioeconomic status than never smokers (OR=14.1, 95% CI: 4.97-39.6). CONCLUSIONS A high percentage of women of reproductive age smoke and continue to smoke despite their knowledge about risks of smoking during pregnancy. Smoking prior to and during pregnancy is predominantly associated with lower socioeconomic status. Women with limited economic means should be a high priority target group for smoking cessation interventions.
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Affiliation(s)
- Florina Ruta
- Department of Community Nutrition and Food safety, University of Medicine and Pharmacy, Tirgu-Mures, Romania
| | - Calin Avram
- Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tirgu-Mures, Romania
| | - Septimiu Voidăzan
- Department of Epidemiology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynaecology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
| | - Vladimir Bacârea
- Department of Research Methodology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
| | - Zoltán Ábrám
- Department of Hygiene, University of Medicine and Pharmacy, Tirgu-Mures, Romania
| | - Kristie Foley
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Andrea Fogarasi-Grenczer
- Department of Family Care and Methodology, Faculty of Health Sciences, Institute of Public Health, Semmelweis University, Budapest, Hungary
| | - Melinda Pénzes
- Faculty of Medicine, Institute of Public Health, Semmelweis University, Budapest, Hungary
| | - Monica Tarcea
- Department of Community Nutrition and Food safety, University of Medicine and Pharmacy, Tirgu-Mures, Romania
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Fiatal S, Tóth R, Moravcsik-Kornyicki Á, Kósa Z, Sándor J, McKee M, Ádány R. High Prevalence of Smoking in the Roma Population Seems to Have No Genetic Background. Nicotine Tob Res 2016; 18:2260-2267. [PMID: 27613936 DOI: 10.1093/ntr/ntw161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 06/16/2016] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The prevalence of smoking in Romani of both genders is significantly higher than in the general population. Our aim was to determine whether a genetic susceptibility contributes to the high prevalence of smoking among Roma in a study based on data collected from cross-sectional surveys. METHODS Twenty single nucleotide polymorphisms known to be closely related to smoking behavior were investigated in DNA samples of Hungarian Roma (N = 1273) and general (N = 2388) populations. Differences in genotype and allele distribution were investigated. Genetic risk scores (GRSs) were generated to estimate the joint effect of single nucleotide polymorphisms in genes COMT, CHRNA3/4/5, CYP2A6, CTNNA3, DRD2, MAOA, KCNJ6, AGPHD1, ANKK1, TRPC7, GABRA4, and NRXN1. The distribution of scores in study populations was compared. Age, gender, and body mass index were considered as confounding factors. RESULTS Difference in allele frequencies between the study populations remained significant for 16 polymorphisms after multiple test correction (p < .003). Unexpectedly, the susceptible alleles were more common in the general population, although the protective alleles were more prevalent among Roma. The distribution of unweighted GRS in Roma population was left shifted compared to general population (p < .001). Furthermore, the median weighted GRS was lower among the subjects of Roma population compared to the subjects of general population (p < .001) even after adjustment for confounding factors. CONCLUSIONS The harmful smoking behavior of the Roma population could not be accounted for by genetic susceptibility; therefore, interventions aimed at smoking prevention and cessation should focus on cultural and environmental factors. IMPLICATIONS This is the first study designed to determine whether genetic background exists behind the harmful behavior of the smoking of the Roma population. Although the frequencies of susceptible and protective alleles strongly differ between the Hungarian Roma and general populations, it is shown that calculated GRSs being significantly higher in the general population, which do not support the hypothesis on the genetic susceptibility of the Roma population. Interventions aimed at smoking cessation in the Roma population should preferentially target cultural and environmental factors.
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Affiliation(s)
- Szilvia Fiatal
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Réka Tóth
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Ágota Moravcsik-Kornyicki
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zsigmond Kósa
- Department of Health Visitor Methodology and Public Health, Faculty of Health, University of Debrecen, Nyíregyháza, Hungary
| | - János Sándor
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Martin McKee
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,WHO Collaborating Centre on Vulnerability and Health, Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.,MTA-DE Public Health Research Group of the Hungarian Academy of Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Balázs P, Rákóczi I, Grenczer A, Foley KL. Birth-weight differences of Roma and non-Roma neonates--public health implications from a population-based study in Hungary. Cent Eur J Public Health 2014; 22:24-8. [PMID: 24844102 DOI: 10.21101/cejph.a3841] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study analyses the role of ethnicity-based birth weight differences at term (37-42 weeks) between neonates of Roma and non-Roma populations in Hungary, controlling for socio-demographic and biological characteristics of the mothers. METHODS A cross-sectional survey among 9,040 mothers coupled with biometric data of the neonates was conducted in 2010. Inclusion criteria were: at term (37-42 weeks gestation) non-pathological pregnancies, and self-reported ethnicity. Birth weight was based on mothers' ethnicity, age, body mass index, education, marital and employment status, poverty level, household amenities, dietary and smoking habits using multiple linear regression. RESULTS The mean difference between Roma and non-Roma neonates measured without controlling for possible confounding factors was -288.7 gram (p < 0.001, 95% CI = -313.4-263.9). In the linear regression model Roma neonates weighed on average 69.67 grams less than non-Roma neonates (p < 0.001, 95% CI = 30.51-108.83). The mother's underweight BMI, low education and smoking during pregnancy (p < 0.001), age under 18 years, no amenities of housing and insufficient consumption of fruits and dairy products also significantly influenced (p < 0.05) the neonates' birth weight. CONCLUSION Roma ethnicity was independently correlated with lower birth-weight among at term neonates, controlling for known risk factors. Roma ethnicity may serve as a proxy for other unmeasured social or biological factors and should be considered an important covariate for measurement among neonates.
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Smoking and pregnancy--a review on the first major environmental risk factor of the unborn. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:6485-99. [PMID: 24351784 PMCID: PMC3881126 DOI: 10.3390/ijerph10126485] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/12/2013] [Accepted: 11/13/2013] [Indexed: 12/23/2022]
Abstract
Smoking cigarettes throughout pregnancy is one of the single most important avoidable causes of adverse pregnancy outcomes and it represents the first major environmental risk of the unborn. If compared with other risk factors in the perinatal period, exposure to tobacco smoke is considered to be amongst the most harmful and it is associated with high rates of long and short term morbidity and mortality for mother and child. A variety of adverse pregnancy outcomes are linked with cigarette consumption before and during pregnancy. Maternal prenatal cigarette smoke disturbs the equilibrium among the oxidant and antioxidant system, has negative impact on the genetic and cellular level of both mother and fetus and causes a large quantity of diseases in the unborn child. These smoking-induced damages for the unborn offspring manifest themselves at various times in life and for most only a very limited range of causal treatment exists. Education, support and assistance are of high importance to decrease maternal and fetal morbidity and mortality, as there are few other avoidable factors which influence a child's health that profoundly throughout its life. It is imperative that smoking control should be seen as a public health priority.
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Stanković A, Nikolić M, Arandelović M. Exposure to environmental tobacco smoke and absence from work in women in Nis, Serbia. Cent Eur J Public Health 2012; 20:24-8. [PMID: 22571012 DOI: 10.21101/cejph.a3701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to environmental tobacco smoke leads to very serious health effects, especially on the respiratory system. The objective of this paper was to estimate the influence of passive smoking on absence from work because of respiratory problems in women. The study sample consisted of 497 women aged 40-56 who live in an area with identical outdoor air pollution. Environmental tobacco smoke exposure was recorded in 346 women. Data about respiratory symptoms in women were entered into a structured questionnaire. Statistics tests showed no significant difference of living conditions, keeping pets, hereditary predisposition among women. The occurrence of congested nose (OR = 3.47; 95% Cl = 1.38-9.01), nasal secretion (OR = 3.48; 95% Cl = 1.38-9.02) and sinusitis (OR = 2.88; 95% Cl = 1.22-6.89) was significantly higher in women who were exposed to environmental tobacco smoke. Primary health care need for respiratory symptoms due to the effect of passive smoking is higher in the exposed women. Passive smoking can be a risk factor for the appearance of respiratory symptoms and illness in women that causes absence from work.
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Fogarasi-Grenczer A, Balázs P. [The correlation between smoking, environmental tobacco smoke and preterm birth]. Orv Hetil 2012; 153:690-4. [PMID: 22547463 DOI: 10.1556/oh.2012.29325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The rate of preterm births is very high in Hungary; it was 8.9% of the total livebirths in 2010. Preterm birth (<37 weeks) has a considerable health impact, because it is responsible for 85% of infant mortality and morbidity as well as for numerous chronic diseses in the long-term. Many maternal and fetal diseases can be identified in the background, but in a number of cases, preterm labor begins unexpectedly, without any prodrome. Presumably, the socioeconomic background and the presence of harmful lifestyle factors are related to preterm birth in these cases. Tobacco smoking is the most frequent harmful health behavior. At national level, the rate of smoking during pregnancy was 14.4% in the last 13 years, but in some counties, this proportion mounted to 25%. In these counties, the prevalence of preterm births also exceeds the national average. This summary highlights the factors related to disadvantaged socio-economic status that can be responsible for the higher number of preterm birth cases.
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Affiliation(s)
- Andrea Fogarasi-Grenczer
- Semmelweis Egyetem, Egészségtudományi Kar Egészségfejlesztési és Klinikai Módszertani Intézet, Családgondozási Módszertani Tanszék, Budapest.
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