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Blair LM, Ickes M, McCubbin A, Ashford K. PATH to understanding cannabis and nicotine initiation and co-use among emerging adults. Public Health Nurs 2022; 39:973-981. [PMID: 35609183 DOI: 10.1111/phn.13094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/22/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this study was to describe the characteristics and age of initiation of nicotine and cannabis use, with a particular focus on the emerging adult period (ages 18-24 years) and concurrent use of nicotine with cannabis. DESIGN A secondary analysis of Population Assessment of Tobacco and Health (PATH). SAMPLE 32,078 participants from a nationally representative study of tobacco use and health outcomes. MEASUREMENT Variables of interest included ever use, regular use and age of initiation (first-time use) of nicotine (including tobacco) and/or cannabis and selected demographic factors. RESULTS Ever-use of nicotine was associated with a 13-fold increase in the likelihood of having ever used cannabis. Among those who reported cannabis use, 96.4% had also used nicotine. While initiation in adolescence was most common, 27.1% of those who use nicotine and 34.9% of those who use cannabis initiated during emerging adulthood. Among regular users of nicotine, 41.5% began regular use in emerging adulthood. CONCLUSIONS These findings underscore the continued susceptibility of emerging adults to initiation of these substances. Co-use of nicotine and cannabis is an understudied phenomenon in emerging adults with significant potential to cause harm and should be a public health priority.
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Affiliation(s)
- Lisa M Blair
- University of Kentucky College of Medicine, Lexington, Kentucky, USA.,University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, Kentucky, USA
| | - Melinda Ickes
- University of Kentucky College of Education, Lexington, Kentucky, USA
| | - Andrea McCubbin
- University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, Kentucky, USA
| | - Kristin Ashford
- University of Kentucky College of Nursing Perinatal Research and Wellness Center, Lexington, Kentucky, USA
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Kehler S, Kay Rayens M, Ashford K. Determining Psychological Distress During Pregnancy and Its Association with the Development of a Hypertensive Disorder. Pregnancy Hypertens 2022; 28:81-87. [DOI: 10.1016/j.preghy.2022.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 01/08/2023]
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Fallin-Bennett A, Smid M, Salvador JG, Coker J, McKinney K, Weitzen S, Bonham C, Ashford K. Perceived Effect of Research on Clinical Care for Women With Opioid Use Disorder. J Obstet Gynecol Neonatal Nurs 2022; 51:195-204. [DOI: 10.1016/j.jogn.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2021] [Indexed: 10/19/2022] Open
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Abstract
Opioid use in the perinatal period has escalated rapidly, with potentially devastating outcomes for perinatal persons and infants. Substance use treatment is effective and has the potential to greatly improve clinical outcomes; however, characteristics of care received from providers including nurses have been described as a barrier to treatment. Our purpose was to describe supportive perinatal care experiences of persons with opioid use disorder. A qualitative descriptive study design was used to examine experiences of 11 postpartum persons (ages 22-36 years) in medication-assisted treatment for opioid use disorder at an academic medical center in the southern region of the United States. Participants were interviewed about experiences with perinatal and neonatal care during the child's hospitalization for neonatal abstinence syndrome surveillance and/or treatment. Four themes of supportive care experiences emerged: informing, relating, accepting, and holistic supporting. Participants reported a range of positive and negative perinatal care experiences, with examples and counterexamples provided. This fuller understanding of perceptions and lived experiences of care can inform practice changes and educational/training priorities. Future research is needed to facilitate development of comprehensive care models geared to address perinatal care needs of persons with opioid use disorder.
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Affiliation(s)
- Lisa M Blair
- University of Kentucky College of Nursing, Lexington (Drs Blair, Ashford, and Fallin-Bennett and Mss Gentry and Bell); and Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington (Drs Blair, Ashford, and Fallin-Bennett). Ms Gentry is now with Baptist Hospital of Louisville, Kentucky
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Feld H, Barnhart S, Wiggins AT, Ashford K. Social support reduces the risk of unintended pregnancy in a low-income population. Public Health Nurs 2021; 38:801-809. [PMID: 33938034 PMCID: PMC8419072 DOI: 10.1111/phn.12920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 11/29/2022]
Abstract
Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health. PURPOSE To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. METHOD A cross-sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309). RESULTS Sixty-two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78-0.97, p = .011, OR = 0.86, 95% CI = 0.77-0.95, p = .005). A positive drug screen was associated with an almost three-fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49-5.58, p = .002). CONCLUSION Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs.
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Affiliation(s)
- Hartley Feld
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Sheila Barnhart
- College of Social Work, University of Kentucky, Lexington, KY, USA
| | | | - Kristin Ashford
- College of Nursing, University of Kentucky, Lexington, KY, USA
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Ashford K, McCubbin A, Barnett J, Blair LM, Lei F, Bush H, Breland A. Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use. Matern Child Health J 2021; 25:1175-1181. [PMID: 33973130 PMCID: PMC8314381 DOI: 10.1007/s10995-021-03161-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both. METHODS This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05. RESULTS At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters. DISCUSSION Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.
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Affiliation(s)
- Kristin Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA.
| | - Janine Barnett
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA
| | - Lisa M Blair
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 751 Rose Street, #447, Lexington, KY, 40536, USA
| | - Feitong Lei
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Heather Bush
- Department of Biostatistics, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Alison Breland
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
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Monroe M, Linares AM, Ashford K. Women's Perceptions of Hospital-Based Breastfeeding Care and the Association With Exclusive Breastfeeding. Nurs Womens Health 2021; 25:257-263. [PMID: 34181912 DOI: 10.1016/j.nwh.2021.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/18/2021] [Accepted: 05/01/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the differences in women's perceptions of hospital-based breastfeeding care and the association of these perceptions with exclusive breastfeeding. DESIGN Observational, mixed-methods study. SETTING/LOCAL PROBLEM A 932-bed, Baby-Friendly Hospital Initiative-designated, university hospital with approximately 2,000 births per year, where 50% of women who wanted to breastfeed were supplementing with formula before hospital discharge. PARTICIPANTS Thirty-four women who gave birth to a term, singleton newborn and had a desire to breastfeed exclusively. MEASUREMENTS Women's perceptions were assessed using a modified version of the Questionnaire for the Breastfeeding Mother. RESULTS Women's perceptions of breastfeeding care were positively associated with exclusive breastfeeding (p = .049). In addition, the influence of how a woman's own mother fed her as an infant was shown, because women who themselves were breastfed as infants were more likely to exclusively breastfeed their own newborns. Content analysis showed that women appreciated the care received in the hospital from lactation consultants and access to a hospital-administered breastfeeding clinic after discharge. CONCLUSION Creating a hospital environment supportive of breastfeeding could yield positive breastfeeding outcomes for women and newborns.
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Fallin-Bennett A, Lofwall M, Waters T, Nuzzo P, Barnett J, Ducas L, McCubbin A, Chavan N, Blair L, Ashford K. Behavioral and Enhanced Perinatal Intervention (B-EPIC): A randomized trial targeting tobacco use among opioid dependent pregnant women. Contemp Clin Trials Commun 2020; 20:100657. [PMID: 33294725 PMCID: PMC7689271 DOI: 10.1016/j.conctc.2020.100657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/11/2020] [Accepted: 09/29/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Opioid use during pregnancy is a significant public health issue. The standard of care for treating opioid use disorder during pregnancy includes medications for opioid disorder (MOUD). However, tobacco use often goes unaddressed among pregnant women on MOUD. In 2018, our team received a National Institute on Drug Abuse (NIDA) funded R34 to conduct a three year-randomized trial to test the feasibility of a novel tobacco intervention for pregnant women receiving MOUD. AIMS The aims of this study are: (1) to determine the impact of the B-EPIC intervention on maternal tobacco use and stage of change; (2) to determine the impact of B-EPIC on tobacco-related maternal and infant health outcomes including gestational age at birth, birthweight, NAS diagnosis and severity, and number of ear and respiratory infections during the first six months; (3) to compare healthcare utilization and costs incurred by pregnant patients that receive the B-EPIC intervention versus TAU. METHODS We plan to enroll 100 pregnant women on MOUD for this randomized controlled trial (B-EPIC intervention n = 50 and treatment as usual n = 50). A major strength of this study is its wide range of health and economic outcomes assessed on mother, neonate and the infant. CONCLUSIONS Despite the very high rates of smoking among pregnant women with OUD, there are few tobacco treatment interventions that have been tailored for this high - risk population. The overall goal of this study is to move towards a tobacco treatment standard for pregnant women receiving treatment for OUD.
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Affiliation(s)
- Amanda Fallin-Bennett
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Michelle Lofwall
- University of Kentucky Department of Behavioral Science & Psychiatry, Center on Drug and Alcohol Research, Kentucky (KY), USA
| | - Teresa Waters
- University of Kentucky College of Public Health, Kentucky (KY), USA
| | - Paul Nuzzo
- University of Kentucky Department of Behavioral Science & Psychiatry, Center on Drug and Alcohol Research, Kentucky (KY), USA
| | - Janine Barnett
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Letitia Ducas
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Andrea McCubbin
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Niraj Chavan
- University of Kentucky College of Medicine, Department of Obstetrics & Gynecology, Kentucky (KY), USA
| | - Lisa Blair
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
| | - Kristin Ashford
- University of Kentucky College of Nursing, Perinatal Research and Wellness Center, Kentucky (KY), USA
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Ashford K, McCubbin A, Rayens MK, Wiggins A, Dougherty K, Sturgill J, Ickes M. ENDS use among college students: Salivary biomarkers and persistent cough. Addict Behav 2020; 108:106462. [PMID: 32442871 DOI: 10.1016/j.addbeh.2020.106462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
Though e-cigarette aerosol has been associated with altered lung cell function, few studies have examined the effects of use on immune response and respiratory symptoms. The purpose of this study was to examine if recent persistent cough or cytokine levels are related to Electronic Nicotine Delivery Systems (ENDS) use in college students. In April 2019, 61 undergraduate students at the University of Kentucky completed surveys and provided a salivary sample to evaluate cytokine levels (Interleukin (IL-) 2, 4, 6, 8, 10, 12, 13 and TNFα, INFγ), using quota sampling to obtain comparable numbers of ENDS users and non-ENDS users. Data analysis included chi-square tests and multivariable logistic and linear regression. All ENDS users reported JUUL as their primary product. ENDS users were more likely to be younger, use cigarettes and marijuana, and report a persistent cough. Controlling for cigarette and marijuana use, there was a trend toward greater likelihood of persistent cough among ENDS users. Compared with nonusers, salivary IL-2 and INFγ were elevated and IL-4 was decreased, controlling for cigarette and marijuana use. There was a trend toward lower IL-12p70 values among ENDS users with these covariates. Findings reveal dysregulation of salivary immune profiles toward a TH1 phenotype in emerging adult ENDS users and short-term immune function may be dysregulated in young adult e-cigarette users.
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Linares AM, Bailey DF, Ashford K. Enabling Nursing Students to Achieve Their Breastfeeding Goals. Clin Lact (Amarillo) 2020; 11:65-73. [PMID: 34733581 DOI: 10.1891/clinlact-d-18-00021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction US workplace law requires employers to provide reasonable break time and space other than a bathroom for breastfeeding women to express their milk. However, this law does not include students in higher education institutions who choose to breastfeed, as students are typically not employed by their schools. The purpose of this report is to describe the joint efforts of faculty members and students to successfully operationalize a lactation room and develop college-specific lactation guidelines in a university in central Kentucky. Method Students from a college of nursing (CON) participated in a survey (N=135), of which 30% were parenting at that time (n=41). Results Responses from this subset were used to make the case to CON leadership and faculty to develop college-specific guidelines entitled, "Guidelines for Lactation Support," which was included in students' handbooks, and to the designated space for a lactation room in the CON building. Discussion The combined effort of faculty, administrators, and students was crucial to promote a breastfeeding-friendly environment in the CON.
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Breland A, McCubbin A, Ashford K. Electronic nicotine delivery systems and pregnancy: Recent research on perceptions, cessation, and toxicant delivery. Birth Defects Res 2019; 111:1284-1293. [PMID: 31364280 PMCID: PMC7121906 DOI: 10.1002/bdr2.1561] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 01/09/2023]
Abstract
Electronic nicotine delivery systems (ENDS), which includes e-cigarettes (ECIGs), are a rapidly-expanding class of products that heat a liquid (which may or may not contain nicotine) to produce an aerosol. The variation of ECIG components is extensive as are their effects on users. Epidemiological data show that while both adults and youth use ECIGs, use among youth has increased dramatically in recent years. Other epidemiological data show that women of reproductive age and some pregnant women are also using ECIGs. The goal of this article is to provide readers with background information about ECIGs, with a focus on recent findings about ECIG use in pregnancy and potential implications. Among pregnant women, correlates of ECIG use include current cigarette smoking, among other factors. Regarding pregnant women's perceptions of ECIG use in pregnancy, two themes emerge from the literature: many pregnant women perceive ECIGs to be safer than conventional cigarettes, and that ECIGs can aid with smoking cessation. In contrast to these perceptions, there is little concrete evidence that ECIGs help smokers quit. In addition, there are concerns about ECIG nicotine and other toxicant delivery. Nicotine is a toxicant of particular concern for pregnant women, as nicotine is known to harm a developing fetus. There are many limitations to existing research, and the literature is scant in this area. Further, new "pod mod"-style ECIGs such as JUUL present new challenges. Overall, with limited evidence of their effectiveness, and concerns about developmental toxicology, the authors do not recommend that pregnant women use ECIGs.
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Affiliation(s)
- Alison Breland
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, College of Nursing, University of Kentucky, Lexington, Kentucky
| | - Kristin Ashford
- Perinatal Research and Wellness Center, College of Nursing, University of Kentucky, Lexington, Kentucky
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Fallin-Bennett A, Parker KA, Miller A, Ashford K, Hahn EJ. Smoking and Tobacco-Free Policies in Women's Residential Substance Use Disorder Treatment Facilities: A Community-Engaged Approach. Nicotine Tob Res 2019; 20:1386-1392. [PMID: 29059449 DOI: 10.1093/ntr/ntx211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023]
Abstract
Introduction The purpose of this study was to (1) describe the role of smoking in the lives of women in residential substance use disorder (SUD) treatment and (2) explore perceptions of the facilitators and barriers to tobacco-free policy among women in residential SUD treatment. Methods This was a community-engaged study using qualitative descriptive methods. We first recruited women in a residential SUD treatment facility to participate on a community research team. Interviews with staff (N = 10) and focus groups with clients (N = 42) were conducted using guides informed by the community research team. Interviews and focus groups were analyzed using content analysis. Results There were two themes related to the role of smoking in the women's lives: (1) smoking facilitates socialization and (2) smoking as a coping mechanism. There were three themes related to the benefits of tobacco-free policy: (1) improved health, (2) support for continued abstinence from a previous tobacco-free placement (eg, prison), and (3) less grounds up-keep. Barriers to tobacco-free policy included (1) lack of an alternative coping mechanism to smoking, (2) fear that a tobacco-free policy would drive clients away, and (3) anticipation of implementation challenges. Conclusions Many women in residential SUD treatment smoke, which they attribute to the fact that smoking is used to facilitate socialization and cope with stress. Future research is needed to develop and test messages to counter the misperception that smoking is an effective method to cope with stress. Ultimately, evidence-based tobacco-free policies are needed to reduce tobacco-related disease among women with SUDs. Implications To promote smoking cessation among women with substance use disorders through evidence-based tobacco policy, it is necessary to first understand the role of smoking in their lives as well as facilitators and barriers to tobacco-free policy in residential treatment facilities. Participants reported that smoking facilitated socialization and served as a coping mechanism. Tobacco-free policies have many benefits, including improved health, support for continued abstinence from a previous tobacco-free placement (eg, prison), and less grounds up-keep. Barriers include the lack of an alternative coping mechanism, fear that a tobacco-free policy would drive away clients and anticipation of implementation challenges. To reduce the burden of tobacco-related morbidity and mortality among women and their children, it is necessary to catalyze a culture change in behavioral health settings to prioritize the treatment of tobacco alongside treatment of other addictions.
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Affiliation(s)
| | - Kimberly A Parker
- College of Communication and Information, University of Kentucky, Lexington, KY
| | - Alana Miller
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
| | - Kristin Ashford
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
| | - Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
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Fallin-Bennett A, Scott T, Fallin-Bennett K, Ashford K. Call to Action to Reduce Tobacco Use During Pregnancy. J Obstet Gynecol Neonatal Nurs 2019; 48:563-567. [PMID: 30986372 DOI: 10.1016/j.jogn.2019.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/20/2022] Open
Abstract
Tobacco use is a leading preventable cause of adverse maternal and child health outcomes. However, many women in the United States still report smoking during the third trimester of pregnancy. Smoking rates during pregnancy are particularly high among vulnerable women, such as those who experience mental illness, substance use disorder, homelessness, or interpersonal violence. The Tobacco Control Vaccine is a model based on population-level, evidence-based practices to reduce tobacco use. The four elements of the Tobacco Control Vaccine are access to treatment for tobacco dependence, smoke-free policies, increased tobacco taxes, and media campaigns. The purpose of this commentary is a call to action for health care providers to advocate for increased access to treatment for tobacco dependence; stay up-to-date on innovative, tailored treatment practices; and advocate for comprehensive, smoke-free policies, higher tobacco taxes, and media campaigns to help pregnant women quit smoking and avoid relapse in the postpartum period.
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Ashford K, Fallin-Bennett A, McCubbin A, Wiggins A, Barnhart S, Lile J. Associations of first trimester co-use of tobacco and Cannabis with prenatal immune response and psychosocial well-being. Neurotoxicol Teratol 2019; 73:42-48. [PMID: 30936023 DOI: 10.1016/j.ntt.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 03/25/2019] [Accepted: 03/25/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aims to describe the association of first trimester co-use of tobacco and cannabis with maternal immune response and psychosocial well-being, relative to tobacco use only. METHODS A preliminary midpoint analysis included 138 pregnant women with biologically verified tobacco use, 38 of whom (28%) also tested positive for recent cannabis use. Maternal perceived stress (Perceived Stress Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and serum immune markers (IL-1β, IL-2, IL-6, IL-8, IL-10, TNFα, CRP, MMP8), were collected, although cytokine data were only available for 122 women. RESULTS Participant average age was 29.1 years, approximately half had a high school education or less, and half were unemployed. Compared to tobacco only users, co-users were more likely to be non-White, younger and more economically disadvantaged. In the adjusted linear regression models, TNF-α levels were significantly lower among co-users relative to tobacco only users, after adjusting for age, race/ethnicity, body mass index and tobacco use group (tobacco cigarettes, electronic nicotine delivery devices [ENDS] or both). TNF-α was the only immune marker found to be significant in this analysis. Measured stress levels (M = 5.9, SD = 3.3; potential range 0-16) and depression scores (M = 7.8, SD = 5.8; potential range 0-30) were low across all participants and did not differ as a function of co-use. CONCLUSION Preliminary results suggest women co-using during the first trimester exhibit decreased pro-inflammatory immune responsivity on one out of eight markers. Further research is needed to determine the impact of this immune modulation on fetal health outcomes and the unique contribution of cannabis.
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Affiliation(s)
- Kristin Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA.
| | - Amanda Fallin-Bennett
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Amanda Wiggins
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, 351 Rose Street, CON#447, Lexington, KY 40536-0232, USA
| | - Sheila Barnhart
- University of Kentucky College of Social Work, 653 Patterson Office Tower, Lexington, KY 40506, USA
| | - Josh Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA; Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA; Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
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Abstract
BACKGROUND Hypertensive disorders are common pregnancy complications in the United States. Although the exact mechanism underlying hypertensive disorders in pregnancy is unknown, there is evidence of involvement of a maladaptive maternal inflammatory response. Psychological maternal stress experienced during pregnancy can increase the risk of a hypertensive disorder by altering the maternal inflammatory response. OBJECTIVES The purpose of this analysis was to evaluate the relationships of hypertensive status and stress with inflammatory biomarkers throughout pregnancy. METHOD A 1:2 case-control design was used to analyze secondary data longitudinally with repeated measures of a multicenter, culturally and ethnically diverse pregnant population. Demographic data, psychological stress, and serum inflammatory data were analyzed. The sample consisted of 30 pregnant women with hypertension and 61 normotensive women. Measurements were taken once in each trimester of pregnancy. RESULTS Trimester-specific levels of inflammatory biomarkers varied based on stress and hypertensive status. IL-6 was elevated in the hypertensive, high-stress group, while IL-8 was greater among those with high stress, regardless of hypertensive status or trimester. For IL-1α and IL-1β, there was a significant stress-by-trimester interaction, while IL-10 was associated with a significant three-way interaction among stress level, hypertension status, and trimester. CONCLUSIONS The associations of stress and hypertensive status with inflammatory biomarkers are complex. Stress and hypertension were associated with changes in inflammatory response. Hypertensive women with high stress experienced a heightened anti-inflammatory response, potentially a compensatory mechanism. To better understand this relationship, further longitudinal studies are warranted.
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Affiliation(s)
- Stephanie Kehler
- 1 College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 1 College of Nursing, University of Kentucky, Lexington, KY, USA.,2 College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Kristin Ashford
- 3 Undergraduate Faculty & Interprofessional Education Affairs, College of Nursing, University of Kentucky, Lexington, KY, USA
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Kenner C, Ashford K, Badr LK, Black B, Bloch J, Mainous R, McGrath J, Premji S, Sinclair S, Terhaar M, Verklan MT, Walden M, Walker DS, Yeo S, Zekas LB, Kostas-Polston EA, Greenberg CS, Boykova M. Corrigendum to “Reducing Preterm Births in the United States” Nursing Outlook, Volume 66, Number 5, September/October 2018, 499-504. Nurs Outlook 2019; 67:132. [DOI: 10.1016/j.outlook.2019.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Fallin-Bennett A, Rademacher K, Dye H, Elswick A, Ashford K, Goodin A. Perinatal Navigator Approach to Smoking Cessation for Women With Prevalent Opioid Dependence. West J Nurs Res 2019; 41:1103-1120. [PMID: 30724661 DOI: 10.1177/0193945918825381] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Women who smoke during pregnancy face psychosocial barriers to cessation, and women with opioid use disorder (OUD) face amplified barriers. We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services. Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers. The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.
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Affiliation(s)
| | | | - Holly Dye
- 1 University of Kentucky College of Nursing, Lexington, USA
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18
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Fallin-Bennett A, Barnett J, Ducas L, Wiggins AT, McCubbin A, Ashford K. Pilot Tobacco Treatment Intervention for Women in Residential Treatment for Substance Use Disorder. J Obstet Gynecol Neonatal Nurs 2018; 47:749-759. [PMID: 30273555 DOI: 10.1016/j.jogn.2018.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To test the feasibility, acceptability, and efficacy of Get Fit and Quit (GFAQ), a community-engaged, holistic tobacco treatment program for women of childbearing age in a residential substance use disorder treatment facility. DESIGN A quasi-experimental, one-group, longitudinal design. SETTING A local Young Men's Christian Association (YMCA) location. PARTICIPANTS Twenty-three women of childbearing age were enrolled in the study. Nearly all (21/23) participants were White, and most were nonpartnered and unemployed. More than one third of participants had more than high school educations, and five (22%) were pregnant at enrollment. METHODS The program was conducted in 10 sessions over 6 months. For each 90-minute session, approximately 45 minutes were dedicated to smoking cessation, and 45 minutes were dedicated to group physical activity. Means and 95% confidence intervals were used to summarize nicotine dependence, expired carbon monoxide, urine cotinine, and exercise self-efficacy at baseline and 5-week, 8-week, and 6-month assessments. Cigarettes smoked per day were summarized using medians and interquartile ranges over time. Program satisfaction and regular exercise were presented as percentages with 95% confidence intervals. RESULTS Of the 23 women who enrolled in GFAQ, 7 (30%) completed the program. Compared with baseline results, participants who completed GFAQ had lower nicotine dependence and smoked fewer cigarettes per day. Additionally, at 5 weeks, more GFAQ participants exercised regularly (64%) compared with baseline (14%). Most participants viewed the program favorably. CONCLUSION Smoking in women of childbearing age with substance use disorders is an important public health issue. GFAQ is a promising intervention for tobacco treatment for this high-risk population, although the number of initial participants who completed the program was low.
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Aleshire ME, Ashford K, Fallin-Bennett A, Hatcher J. Primary Care Providers' Attitudes Related to LGBTQ People: A Narrative Literature Review. Health Promot Pract 2018; 20:173-187. [PMID: 29947564 DOI: 10.1177/1524839918778835] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this article is to review the current literature describing primary care providers' (PCPs) attitudes related to lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) people. LGBTQ individuals experience significant health disparities, and these inequities may be better understood via an ecological systems framework. PCPs' actual or perceived discriminatory attitudes can lead to suboptimal treatment or health outcomes for LGBTQ people. A review of the literature from 2005 through January 2017 was completed using the Cumulative Index for Nursing and Allied Health Literature and PubMed (Medline) databases. The purpose, sample, measure(s), design, findings, strengths, and weaknesses of each study were examined; and findings were synthesized, summarized, and critically appraised. Eight articles were eligible for review. There was significant heterogeneity in the studies' purposes, research questions, LGBTQ population(s) of focus, and findings. Many PCPs' attitudes toward LGBTQ people were positive, but a minority of each studies' participants had negative attitudes toward LGBTQ people. Stigma and health care barriers negatively affect LGBTQ health. Interventions must address LGBTQ health disparities at the individual, mesosytem, exosystem, and macrosystem levels. Research, education, and practice strategies all must be integrated across socioecological levels as components of a population-based approach to eliminate health disparities for LGBTQ persons.
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Affiliation(s)
| | - Kristin Ashford
- University of Kentucky College of Nursing, Lexington, KY, USA
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20
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Ashford K, Chavan NR, Wiggins AT, Sayre MM, McCubbin A, Critchfield AS, O'Brien J. Comparison of Serum and Cervical Cytokine Levels throughout Pregnancy between Preterm and Term Births. AJP Rep 2018; 8:e113-e120. [PMID: 29868246 PMCID: PMC5980496 DOI: 10.1055/s-0038-1656534] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/24/2018] [Indexed: 02/02/2023] Open
Abstract
Objective To assess differences in cytokine levels in cervicovaginal fluid (CVF) and serum across trimesters between women with preterm births (PTBs) and full-term births. Study Design This multicenter study enrolled 302 women with a singleton gestation. CVF and serum cytokines, interleukin 1α (IL-1α), IL-1β, IL-6, IL-8, IL-10, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and matrix metalloproteinase (MMP)-8, were measured. Women with at least one cytokine assessment and noted PTB status in their medical record were retained in the study ( N = 272). Data were analyzed using mixed modeling (main effects of PTBs and time/trimester). Results For the CVF values of IL-6, IL-8, IL-10, TNF-α, and CRP, and serum MMP-8, those who delivered preterm had significantly higher values than the full-term group regardless of trimester. For the serum values of IL-1β, IL-6, and TNF-α, those delivering preterm had significantly lower values than those delivering full-term regardless of trimester. For IL-1β in CVF, the cytokine was significantly higher in the PTB group for second and third trimesters only, relative to the full-term group. Conclusion For each CVF cytokine that differed by birth status, values were higher for PTB than term, averaged over trimester. Numerous cytokine profiles varied across trimesters in women delivering term versus preterm in both CVF and serum.
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Affiliation(s)
- Kristin Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, Kentucky
| | - Niraj R Chavan
- Department of Obstetrics & Gynecology, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Amanda T Wiggins
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, Kentucky
| | - Molly Malany Sayre
- Department of Sociology, Anthropology, and Social Work, University of Dayton, Dayton, Ohio
| | - Andrea McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, Kentucky
| | - Agatha S Critchfield
- Division of Maternal-Fetal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
| | - John O'Brien
- Division of Maternal-Fetal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky
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21
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Butler KM, Ickes MJ, Rayens MK, Wiggins AT, Ashford K, Hahn EJ. Intention to quit smoking and polytobacco use among college student smokers. Prev Med Rep 2018; 10:72-75. [PMID: 29560301 PMCID: PMC5856666 DOI: 10.1016/j.pmedr.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 11/28/2022] Open
Abstract
Little is known about polytobacco use in college students. One nationally representative survey indicated 51.3% of tobacco-using college students used more than one product, which may increase risk of tobacco-related disease and premature death. The purpose of this study was to examine the association of intention to quit smoking (ITQS) cigarettes with polytobacco use status, controlling for frequency of tobacco product use and cigarette smoking intensity as measured by cigarettes per day (CPD). Data are from a larger quasi-experimental study conducted at a large state university in the Southeastern United States. Analysis is based on the combined sample of current smokers from two randomly selected cohorts surveyed two months apart. Polytobacco users (n = 52) were as likely as cigarette-only users (n = 81) to intend to quit smoking. Compared to students who used tobacco products 1–9 days per month, students using 10–29 days per month or daily reported higher ITQS. Higher intensity smokers (>10 CPD) were 71% less likely to indicate ITQS, compared to lower intensity smokers (≤10 CPD) (p = .025). College student polytobacco users were as likely as those using only cigarettes to intend to quit smoking. Interventions are needed to target college student polytobacco users as well as cigarette smokers as both groups may intend to quit. Smokers using 10 or fewer CPD and those who use tobacco products daily or 10–29 days per month may be more motivated to quit than college students who smoke with more intensity but who use tobacco products less frequently. 44.4% of the sample reported using at least one form of tobacco in addition to cigarettes. Polytobacco users were as likely as cigarette-only users to intend to quit smoking (ITQS). Significant ITQS predictors were sex, academic status, use frequency, cigarettes per day (CPD). Higher intensity smokers (>10 CPD) were 71% less likely than lower intensity (≤10 CPD) to ITQS. Students using tobacco 10–29 days/month or daily (vs. 1–9 days/month) reported greater ITQS.
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Affiliation(s)
- Karen M Butler
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Melinda J Ickes
- University of Kentucky Department of Kinesiology and Health Promotion, College of Education, 111 Seaton, Lexington, KY 40506-0219, United States
| | - Mary Kay Rayens
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Amanda T Wiggins
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Kristin Ashford
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Ellen J Hahn
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
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Ashford K, Rayens E, Wiggins AT, Kay Rayens M, Sayre MM, O’Brien J. Associations of Demographic Factors and Tobacco Use With Progesterone and Estradiol During Pregnancy. SAGE Open Nurs 2018; 4:2377960818806285. [PMID: 33415210 PMCID: PMC7774417 DOI: 10.1177/2377960818806285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 09/18/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the association of biochemically validated prenatal tobacco use with serum progesterone and estradiol in the second trimester of pregnancy, controlling for demographic and personal factors. STUDY DESIGN This secondary analysis of a multicenter longitudinal study included 114 women with singleton pregnancies. Multiple regression analysis assessed whether prenatal tobacco use was related to hormone levels during the second trimester, controlling for covariates (age, body mass index, and race or ethnicity, with gestational age added to subsequent models). RESULT In the initial regressions, tobacco users had significantly lower progesterone level compared with nonsmokers (p = .037), while estradiol was unrelated to prenatal tobacco use. Women with greater body mass index also had significantly lower progesterone (p = .028), but body mass index was unrelated to estradiol. With gestational age as an additional covariate, prenatal tobacco use was no longer a significant predictor of progesterone, but both body mass index and gestational age were significant (F = 10.6, p < .001, R 2 = 0.35). For estradiol, the overall regression of estradiol on age, body mass index, and race or ethnicity was not significant (F = 1.2, p = .31). With gestational age added to the model, the overall model was significant (F = 7.2, p < .001, R 2 = 0.27). CONCLUSION This study provides additional evidence that prenatal tobacco use may influence lower serum progesterone during the second trimester. This is of particular concern given the link between depressed progesterone activity and risk for preterm birth.
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Affiliation(s)
- Kristin Ashford
- University of Kentucky Perinatal
Research and Wellness Center, College of Nursing, Lexington, KY, USA
| | - Emily Rayens
- Department of Infectious Disease,
University of Georgia, Athens, GA, USA
| | - Amanda T. Wiggins
- University of Kentucky Perinatal
Research and Wellness Center, College of Nursing, Lexington, KY, USA
| | - Mary Kay Rayens
- University of Kentucky Perinatal
Research and Wellness Center, College of Nursing, Lexington, KY, USA
- University of Kentucky College of Public
Health, Lexington, KY, USA
| | | | - John O’Brien
- Maternal Fetal Medicine Division,
University of Kentucky College of Medicine, Lexington, KY, USA
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Fallin-Bennett A, Ashford K. Tailoring a NICU-Based Tobacco Treatment Program for Mothers Who Are Dependent on Opioids. J Obstet Gynecol Neonatal Nurs 2017; 46:660-668. [PMID: 28754255 DOI: 10.1016/j.jogn.2017.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To collect formative information to design a tailored tobacco treatment intervention for women with newborns treated or evaluated for neonatal abstinence syndrome and to explore current tobacco use behaviors and facilitators and barriers to smoking cessation. DESIGN Qualitative descriptive study. SETTING An academic medical center in the southern United States. PARTICIPANTS Mothers (N = 11) of newborns who were treated or evaluated for neonatal abstinence syndrome at birth within the preceding 3 months. Women recruited were older than 18 years and reported opioid dependence and smoking during pregnancy. METHODS Participants took part in semistructured individual interviews that lasted approximately 1 hour. Interviews were professionally transcribed and analyzed in MAXQDA using content analysis. RESULTS Five themes emerged from the data: Strategizing to Reduce Risk, Desire to Quit Smoking in the Future, Holding on to Smoking While Working Through Recovery, Feeling Judged by Nurses, and Feeling Supported and Empowered by Nurses. Participants reported that they to reduce risk to their newborns by avoiding second- and thirdhand smoke exposure. Participants wanted to stop smoking but reported many barriers, including multiple life stressors compounded by their newborns' extended stays in the hospital. However, most participants described overall positive experiences and the support of health care providers. CONCLUSION Holistic tobacco treatment programs that incorporate stress relief and social support and are led by trusted health care providers have the potential to be effective to reduce smoking in new mothers with histories of opioid dependence disorders and smoking and whose newborns are in the NICU.
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Ashford K, Wiggins A, Rayens E, Assef S, Fallin A, Rayens MK. Perinatal Biochemical Confirmation of Smoking Status by Trimester. Nicotine Tob Res 2017; 19:631-635. [PMID: 28403470 PMCID: PMC7450522 DOI: 10.1093/ntr/ntw332] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 01/01/2017] [Indexed: 11/13/2022]
Abstract
Introduction: Tobacco use during pregnancy is the most modifiable risk factor associated with poor pregnancy outcomes. Self-reported tobacco use has been demonstrated to have high misclassification rates. The aims were to examine misclassification rates of perinatal tobacco use during each trimester of pregnancy and 8 weeks postpartum, and to evaluate characteristics associated with misclassification of tobacco use status. Methods: This is secondary analysis of a prospective, multicenter trial of pregnant women, and it includes participants who were biochemically identified as tobacco users during their first trimester (N = 103). Each trimester and once postpartum, tobacco use was assessed via self-report and validated using a cutoff of 100 ng/mL for urine cotinine via NicAlert test strips to indicate current use. Those who self-reported as nonusers but were identified as users via urine cotinine were considered misclassified; misclassification rates were determined for each time period. Logistic regression assessed maternal factors associated with misclassification status. Results: Misclassification rates declined from 35.0% at first trimester to 31.9% and 26.6% at the second and third; the postpartum rate was 30.4%. These rates did not differ significantly from each other at the 0.05 level. Race/ethnicity was associated with misclassification status; white/non-Hispanic women were 87% less likely to be misclassified (p < .001). Conclusion: Misclassification of prenatal smoking status decreases as pregnancy progresses, though the observed rate change was not significant. Minority women may be at particular risk for non-disclosure of tobacco use. Biochemical validation should be considered when assessing perinatal tobacco use via self-report, given high misclassification rates throughout the perinatal period. Implications: These results demonstrate that regardless of trimester, more than one-quarter of tobacco-using pregnant women may not disclose tobacco use throughout pregnancy and early postpartum. Although the rate of misclassification decreased from first to third trimester and then increased in the immediate postpartum, these changes in misclassification rates were not significant. Minority groups may be at particular risk of misclassification compared with white/non-Hispanic women. Biochemical validation is warranted throughout pregnancy to encourage cessation as tobacco use is one of the most easily-modified risk factors for poor birth outcomes.
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Affiliation(s)
| | - Amanda Wiggins
- University of Kentucky, College of Nursing, Lexington, KY
| | - Emily Rayens
- University of Georgia, Department of Infectious Diseases, Athens, GA
| | - Sara Assef
- University of Kentucky, College of Nursing, Lexington, KY
| | - Amanda Fallin
- University of Kentucky, College of Nursing, Lexington, KY
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Ashford K, Rayens E, Wiggins AT, Rayens MK, Fallin A, Sayre MM. Advertising exposure and use of e-cigarettes among female current and former tobacco users of childbearing age. Public Health Nurs 2017; 34:430-436. [PMID: 28485553 DOI: 10.1111/phn.12334] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The study examined the relationship between exposure to e-cigarette advertising and e-cigarette use by pregnancy status, including use of flavored e-cigarette products, among women of childbearing age. DESIGN A cross-sectional, correlational design was used. SUBJECTS Female current or former tobacco users in Central and Eastern Kentucky, 18-45 years old (N = 194, 52% pregnant). MEASURES Demographics, pregnancy status, cigarette and e-cigarette use, and exposure to e-cigarette advertising. RESULTS Younger age, white non-Hispanic race, and greater exposure to e-cigarette advertising were associated with a higher likelihood of ever using e-cigarettes (p < .05 for each variable). Pregnancy was not associated with ever use (p = .11). Younger age was associated with use of flavored e-cigarettes (p = .0027). Among e-cigarette users, those who used flavored products were more likely to have seen advertisements or information about e-cigarettes on social media, compared to those who used unflavored e-cigarettes only (p = .016). CONCLUSION There is a link between advertising exposure and ever use of e-cigarettes. Pregnancy status is not significantly associated with ever use. Use of flavored e-cigarettes is associated with younger age. E-cigarette users with greater exposure to advertising on social media were more likely to use flavored products.
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Affiliation(s)
- Kristin Ashford
- University of Kentucky College of Nursing, Lexington, KY, USA
| | | | | | - Mary Kay Rayens
- University of Kentucky College of Nursing, Lexington, KY, USA.,University of Kentucky College of Public Health, Lexington, KY, USA
| | - Amanda Fallin
- University of Kentucky College of Nursing, Lexington, KY, USA
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McCubbin A, Fallin-Bennett A, Barnett J, Ashford K. Perceptions and use of electronic cigarettes in pregnancy. Health Educ Res 2017; 32:22-32. [PMID: 28158490 PMCID: PMC5914445 DOI: 10.1093/her/cyw059] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 12/21/2016] [Indexed: 05/19/2023]
Abstract
Use of electronic cigarettes (e-cigs) is quickly growing in the United States, despite the unknown health implications and unregulated device contents. Although research is emerging around e-cigs in general, there continues to be a lack of scientific evidence regarding the safety and risks of e-cig use on maternal and fetal health, even though adverse health effects of nicotine on maternal and fetal outcomes are documented. This review summarizes existing perceptions of e-cig use in pregnancy, based on the limited number of publications available, and highlights the necessity of conducting additional research in this field of public health. Authors conducted a literature search of scientific peer-reviewed articles published from January 2006 to October 2016, comprising more than a decade of research. Search keywords include ‘tobacco use’, ‘electronic cigarette(s)’ and ‘pregnancy’. Fifty-seven publications were identified, narrowed to fifteen by screening title/abstract for potential relevance, with seven articles chosen for final inclusion. Of these seven studies, most participants not only believed e-cigs pose risks to maternal and child health but also perceived e-cigs as a safer and potentially healthier alternative to traditional cigarettes, and may assist with smoking cessation. Further research is needed to determine health implications and provide clinical guidelines for e-cig use in pregnancy.
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Affiliation(s)
- Andrea McCubbin
- College of Nursing, Office for Nursing Research, University of Kentucky,
Lexington, KY 40536, USA
- Correspondence to: A. McCubbin. E-mail:
| | - Amanda Fallin-Bennett
- College of Nursing, Office for Nursing Research, University of Kentucky,
Lexington, KY 40536, USA
| | - Janine Barnett
- College of Nursing, Office for Nursing Research, University of Kentucky,
Lexington, KY 40536, USA
| | - Kristin Ashford
- College of Nursing, Office for Nursing Research, University of Kentucky,
Lexington, KY 40536, USA
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Abstract
Preeclampsia is a major cause of maternal and fetal morbidity and mortality affecting 5-10% of pregnancies. Mental health issues are often exhibited in this vulnerable population partly due to the rigid management of this condition including prolonged bed rest. The purpose of this qualitative study is to describe women's experience with preeclampsia and being placed on bed rest. Six themes emerged including: negative feelings and thoughts, lack of guidelines about their diagnosis, family stressors, lack of social support, not being heard, loss of normal pregnancy, and physical symptoms. The identified categories provide insight into improving care for these women.
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Affiliation(s)
- Stephanie Kehler
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
| | - Kristin Ashford
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
| | - Mary Cho
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
| | - Rebecca L Dekker
- a University of Kentucky , College of Nursing , Lexington , Kentucky , USA
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Affiliation(s)
- Laura Hieronymus
- Education & Quality Services, University of Kentucky HealthCare Barnstable Brown Diabetes Center, Lexington, KY
| | - Liz Combs
- Education & Quality Services, University of Kentucky HealthCare Barnstable Brown Diabetes Center, Lexington, KY
| | - Elizabeth Coleman
- Education & Quality Services, University of Kentucky HealthCare Barnstable Brown Diabetes Center, Lexington, KY
| | - Kristin Ashford
- Education & Quality Services, University of Kentucky HealthCare Barnstable Brown Diabetes Center, Lexington, KY
| | - Amanda Wiggins
- Education & Quality Services, University of Kentucky HealthCare Barnstable Brown Diabetes Center, Lexington, KY
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Fallin A, Miller A, Assef S, Ashford K. Perceptions of Electronic Cigarettes Among Medicaid-Eligible Pregnant and Postpartum Women. J Obstet Gynecol Neonatal Nurs 2016; 45:320-5. [PMID: 27083420 DOI: 10.1016/j.jogn.2016.02.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2016] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe perceptions and beliefs about electronic cigarette (e-cigarette) use during pregnancy among pregnant and newly postpartum women. DESIGN An exploratory, qualitative descriptive study. SETTING University-affiliated prenatal clinics. PARTICIPANTS Twelve pregnant or recently postpartum women who reported use of tobacco and electronic cigarettes. METHODS Semistructured focus groups were audio recorded and professionally transcribed. The transcripts were coded to consensus and analyzed with MAXQDA software (version 11) using content analysis. RESULTS Four overarching themes emerged: (a) Attraction to E-Cigarettes as a Harm Reduction Strategy, (b) Uncertainty Regarding the Health Effects of E-Cigarettes; (c) Ambivalence Regarding Novel Product Characteristics; and (d) Behaviors Reflected Dual Use and Often Complete Relapse to Traditional Cigarettes. CONCLUSION Pregnant women are initially attracted to e-cigarettes as a harm reduction strategy, but they often return to traditional cigarettes in the postpartum period. Nurses should counsel pregnant women on the adverse effects of fetal exposure to nicotine. Evidence-based nursing interventions are needed to prevent relapse during the postpartum period.
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Fallin A, Miller A, Ashford K. Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry. Nicotine Tob Res 2016; 18:1727-32. [PMID: 26817489 DOI: 10.1093/ntr/ntw023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/15/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoking during pregnancy is a major public health issue, contributing to adverse health outcomes. The vast majority of women with substance use disorders smoke during the perinatal period. Medication Assisted Treatment (MAT) is the standard of care for women using opioids during pregnancy. The majority of women engaged in MAT (88%-95%) report smoking. The purposes of this study were to describe: (1) facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT; and (2) strategies to tailor tobacco treatment interventions with this population. METHODS Two semi-structured focus groups lasting approximately 45 minutes each were conducted with 22 women engaged in MAT. Focus groups were recorded, transcribed and analyzed in MAXQDA using content analysis. RESULTS Participants reported: (1) desire to quit smoking for themselves and their children; (2) aversion to smoking; (3) a turning point in their lives from being pregnant and entering MAT; (4) nicotine dependence; (5) smoking as a way to cope with stress; (6) coping with dual dependencies; (7) past experiences with stopping smoking due to smoking restrictions; (8) perceived lack of success with nicotine replacement therapy or other tobacco treatment medications; and (9) the need for intensive environmental support for quit attempts. CONCLUSIONS Participants were motivated to quit smoking, but faced multiple complex barriers. Integrating tobacco treatment into the psychosocial services offered in conjunction with MAT would allow a healthcare provider to offer tailored tobacco treatment in a supportive environment. IMPLICATIONS Results of this qualitative study include facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT, as well as strategies to tailor tobacco treatment interventions for this population. In-depth knowledge of the complex barriers facing this patient population can be used to inform tailored tobacco treatment services that can be integrated into clinics providing MAT.
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Affiliation(s)
- Amanda Fallin
- College of Nursing, University of Kentucky, Lexington, KY
| | - Alana Miller
- College of Nursing, University of Kentucky, Lexington, KY
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Gómez ML, Ashford K, Linares AM, Hall LA. A Pilot Test of the Everyday Stressors Index-Spanish Version in a Sample of Hispanic Women Attending Prenatal Care. J Nurs Meas 2016; 23:519-31. [PMID: 26673774 DOI: 10.1891/1061-3749.23.3.519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Prenatal and postpartum psychosocial stress are associated with adverse pregnancy outcomes. Hispanic women experience higher levels of stress during pregnancy. This pilot study assessed the psychometric characteristics of the Everyday Stressors Index-Spanish (ESI-S) version. METHODS Secondary analysis in a convenience sample, n = 51 women. RESULTS The ESI-S showed adequate internal consistency (Cronbach's alpha = .86). Two factors accounted for 40% of the item variance. The greatest sources of stress were "having too many responsibilities" and "not enough money for basics". Higher levels of stressors were associated with older age, living without a partner, and working part or full time. The ESI-S was positively correlated with measures of perinatal depression. CONCLUSIONS Findings support the reliability and validity of the newly translated ESI-S.
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Chavan N, Ashford K, Wiggins A, McCubbin A, Barnett J, O'Brien JM. 146: The early bioinflammatory milieu in gestational diabetes mellitus (GDM). Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chavan N, Ashford K, Wiggins A, McCubbin A, Barnett J, O'Brien JM. 790: The early pregnancy bioinflammatory milieu and hypertensive disorders of pregnancy. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Background and Purpose: The Hispanic population is the fastest growing ethnic group in the United States. There is a lack of validated health-related tools culturally and linguistically appropriate. The purpose of this study was to evaluate the psychometric properties of the Autonomy and Relatedness Inventory–Spanish version (ARI-S). Methods: We recruited a convenience sample of 100 pregnant Hispanic women. Results: Cronbach's alpha for the ARI-S total scale was .92. Factor analysis yielded a similar factor structure as reported with the ARI-English version. As hypothesized, the ARI-S was inversely correlated with depressive symptoms and positively correlated with social support. Conclusions: ARI-S provides a psychometrically sound method for measuring the quality of intimate relationships. This is particularly important considering the limited inclusion of Hispanic women in current research.
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Mast S, O'Brien J, Ashford K, Curry T. 865: Omentin is significantly lower in pregnancies affected by preeclampsia than in normotensive gestations. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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O'Brien J, Ashford K, Barnett J, McCubbin A, McQuerry K, Stromberg A. 812: The relationship of second trimester serum progesterone, cytokine levels, and pregnancy outcome. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ashford K, O'Brien J, McQuerry K, Barnett J, McCubbin A, Ferguson J, Ebersole J. 499: Cytokine concentrations and their association with preterm birth: comparison between serum and cervicovaginal measurements. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Chavan N, Ashford K, McQuerry K, McCubbin A, Barnett J, O'Brien J. 569: Smoking cessation in pregnancy: impact on the bio-inflammatory milieu. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ashford K, O'Brien J, Barnett J, McCubbin A, McQuerry K, Curry T. 500: Tobacco use alters pregnancy biomarkers reflecting tissue function. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ashford K, Westneat S, Ferguson J, Barnett J, McCubbin A, O'Brien J. 729: A longitudinal assessment of systemic immunologic change in women with objective evidence of tobacco use. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Meints L, Saunders R, Agboola R, Ashford K, Stromberg A, O'Brien J. 16: MMP-8 correlates with an increase in anxiety and depression during early pregnancy and the postpartum period. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Butler KM, Rayens MK, Ashford K, Adkins S, Gombeski B, Britt J, Hahn EJ. Smoke-free homes, strength of smoke-free law, and children in the home. Nicotine Tob Res 2013; 16:485-90. [PMID: 24302637 DOI: 10.1093/ntr/ntt191] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is a leading cause of childhood illness and premature death, especially in rural areas. The study examined the relationship of having a smoke-free home, strength of smoke-free law (SFL) in the county of residence, having one or more minor children in the home, rural/urban location, and demographics. METHODS An Internet-based panel survey was administered to Kentucky residents from 2007 to 2012. Sample size ranged from 400 to 513 per year; N = 2,653 total. Most were female, aged 35-54, had at least some college education, and lived in a smoke-free home. Almost half lived in a county with a comprehensive SFL; 14% lived in a county with a moderate or weak law. RESULTS Multivariate logistic regression revealed that the significant predictors of a smoke-free home included having education beyond high school, being a nonsmoker, living in an urban county, and having a year of participation in the survey. Controlling for smoking status and other personal characteristics, those who responded to the survey in the last 2 years of administration were more likely to have a smoke-free home compared to the reference year of 2007. Respondents living in urban counties were nearly 2 times more likely to report a smoke-free home than rural dwellers. CONCLUSIONS Smoke-free homes in urban areas, where SFLs may be the norm, may be more typical than in rural communities. Public awareness campaigns and education about the benefits of smoke-free homes is needed, especially in rural areas, targeting smokers, those with less education, and those with children living in the home.
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Affiliation(s)
- Karen M Butler
- Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY
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Ashford K, Barnett J, Mccubbin A, Kehler S, Westneat S. Prenatal Systemic Immune Response in Smoking and Nonsmoking Women. J Obstet Gynecol Neonatal Nurs 2013. [DOI: 10.1111/1552-6909.12172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Horlacher L, Newberry Y, Ashford K. Comparison of Stress, Social Support, and Depression Across the Trimesters in a Multiethnic Population. J Obstet Gynecol Neonatal Nurs 2013. [DOI: 10.1111/1552-6909.12173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Ashford K, O'Brien J, McCubbin A, Westneat S, Barnett J. 15: The influence of prenatal smoking status on cervical cytokine distribution. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Prenatal exposure to secondhand smoke (SHS) is responsible for adverse perinatal outcomes, including preterm birth. Smoking at home is the primary source of exposure to women during pregnancy. Hair nicotine analysis of mothers and infants was used to describe the relationship between prenatal SHS exposure and number of household smokers. Maternal hair nicotine was strongly correlated with the number of household smokers and was a more sensitive measure of household smoking than infant hair. Home smoking bans and focused public media campaigns on the harmful effects of SHS exposure are necessary prevention strategies to avoid adverse perinatal outcomes.
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Affiliation(s)
- Kristin Ashford
- University of Kentucky, College of Nursing, #417 College of Nursing Building, Lexington, KY 40536-0232, USA.
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Abstract
The purpose of this exploratory study was to describe factors that contribute to successful postpartum smoking abstinence among women who quit smoking during pregnancy. Research questions addressed the primary motivators and lifestyle characteristics of women who do not return to postpartum smoking. Participants were recruited from a feasibility study (N = 16) based on their ability to remain smoke free for at least 6 months following delivery. Individual interviews were analyzed using content analysis strategies. Women’s narratives described the process of postpartum smoking abstinence. Four themes emerged: (a) child’s health as the primary motivator, (b) demanding a smoke-free home or environment, (c) smoking perception changes from one of primarily comfort to one of disgust, and (d) viewing abstinence as a lifelong change. Clinical implications include educating families about the effects of smoke-free environments on the health of their children while redirecting smoking habits with healthy behaviors.
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Affiliation(s)
- Kristin Ashford
- College of Nursing at the University of Kentucky in Lexington, Kentucky,
| | - Ellen Hahn
- Tobacco Policy Research Program at the University of Kentucky
| | - Lynne Hall
- University of Kentucky College of Nursing
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Neal K, Newlands M, Ashford K, Baker M, Wale M, Nguyen-Van-Tam J, Ala'Aldeen D. Carriage of neisseria meningitidis in a village community after mass antibiotic and vaccine programmes. J Infect 1999. [DOI: 10.1016/s0163-4453(99)90158-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Crowe M, Ashford K, Ispahani P. Clinical features and antibiotic treatment of septic arthritis and osteomyelitis due to Yersinia enterocolitica. J Med Microbiol 1996; 45:302-9. [PMID: 8849705 DOI: 10.1099/00222615-45-4-302] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Yersinia enterocolitica bone and joint infections are rare. Over a period of 7 months four patients with deep-seated skeletal infections due to Y. enterocolitica were seen at the University Hospital, Nottingham. Sites of infection included the knee (one patient) the hip (one) and the spine (two). None of the patients had major underlying disease or risk factors for developing invasive Y. enterocolitica infection. The organisms were sensitive to the second- and third-generation cephalosporins, gentamicin and fluoroquinolones. A literature search covering the period 1970-1994 revealed 20 other cases of skeletal infections due to Y. enterocolitica; there was no uniformity in the choice of antimicrobial agent for treating these infections. Oral ciprofloxacin was used as the principal antimicrobial agent in the patients described here and therapeutic success was achieved in three of these patients. Ciprofloxacin should be considered as first line therapy for invasive infections due to Y enterocolitica.
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Affiliation(s)
- M Crowe
- Department of Microbiology and Public Health Laboratory, Queens Medical Centre, University Hospital, Nottingham, United Kingdom
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