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Ussher M, Best C, Lewis S, McKell J, Coleman T, Cooper S, Orton S, Bauld L. Effect of 3 months and 12 months of financial incentives on 12-month postpartum smoking cessation maintenance: A randomized controlled trial. Addiction 2024. [PMID: 38623627 DOI: 10.1111/add.16487] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/22/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND AND AIMS Offering financial incentives is effective for smoking cessation during pregnancy. We tested the effectiveness of financial incentives for maintaining postpartum cessation, comparing 12-month and 3-month incentives with each other and with usual care (UC). DESIGN, SETTING AND PARTICIPANTS This study was a pragmatic, multi-centre, three-arm randomized controlled trial involving four English, National Health Service, stop smoking services. A total of 462 postpartum women (aged ≥ 16 years) took part, who stopped smoking during pregnancy with financial incentives, validated as abstinent from smoking at end of pregnancy or early postpartum. INTERVENTIONS Interventions comprised (i) UC; (ii) UC plus up to £60 of financial voucher incentives offered to participants and £60 offered to an optional significant-other supporter, over 3 months postpartum, contingent upon validated abstinence ('3-month incentives'); or (iii) UC plus '3-month incentives' plus £180 of vouchers offered to participants over 9 months postpartum, contingent upon abstinence ('12-month incentives'). MEASUREMENTS Primary outcome: biochemically validated abstinence at 1 year postpartum. To adjust for testing all comparisons between groups with equal precision, P < 0.017 was necessary for significance. SECONDARY OUTCOMES self-reported and validated abstinence at 3 months postpartum; self-reported abstinence at 1 year postpartum. FINDINGS Primary outcome ascertainment: abstinence was 39.6% (63/159) 12 months incentives, 21.4% (33/154) 3 months incentives and 28.2% (42/149) UC. Adjusted odds ratios [95% confidence interval (CI)] = 12-month versus 3-month incentives OR = 2.41 (95% CI = 1.46-3.96), P = 0.001; 12 months versus UC 1.67 (1.04-2.70), P = 0.035; 3 months versus UC 0.69 (0.41-1.17), P = 0.174. Bayes factors indicated that for 12-month versus 3-month incentives and 12 months versus UC there was good evidence for the alternative hypothesis, and for 3 months versus UC there was good evidence for the null hypothesis. CONCLUSIONS This randomized controlled trial provides weak evidence that up to £300 of voucher incentives over 12 months is effective for maintaining smoking abstinence postpartum compared with usual care. There was good evidence that 12-month incentives are superior to those over only 3 months, for which there was no evidence of effectiveness relative to usual care.
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Affiliation(s)
- Michael Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Catherine Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sarah Lewis
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jennifer McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Tim Coleman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Bruce and John Usher Professor of Public Health, Usher Institute and SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
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Orton S, Karkia R, Mustafov D, Gharanei S, Braoudaki M, Filipe A, Panfilov S, Saravi S, Khan N, Kyrou I, Karteris E, Chatterjee J, Randeva HS. In Silico and In Vitro Mapping of Receptor-Type Protein Tyrosine Phosphatase Receptor Type D in Health and Disease: Implications for Asprosin Signalling in Endometrial Cancer and Neuroblastoma. Cancers (Basel) 2024; 16:582. [PMID: 38339334 PMCID: PMC10854520 DOI: 10.3390/cancers16030582] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Protein Tyrosine Phosphatase Receptor Type D (PTPRD) is involved in the regulation of cell growth, differentiation, and oncogenic transformation, as well as in brain development. PTPRD also mediates the effects of asprosin, which is a glucogenic hormone/adipokine derived following the cleavage of the C-terminal of fibrillin 1. Since the asprosin circulating levels are elevated in certain cancers, research is now focused on the potential role of this adipokine and its receptors in cancer. As such, in this study, we investigated the expression of PTPRD in endometrial cancer (EC) and the placenta, as well as in glioblastoma (GBM). METHODS An array of in silico tools, in vitro models, tissue microarrays (TMAs), and liquid biopsies were employed to determine the gene and protein expression of PTPRD in healthy tissues/organs and in patients with EC and GBM. RESULTS PTPRD exhibits high expression in the occipital lobe, parietal lobe, globus pallidus, ventral thalamus, and white matter, whereas in the human placenta, it is primarily localised around the tertiary villi. PTPRD is significantly upregulated at the mRNA and protein levels in patients with EC and GBM compared to healthy controls. In patients with EC, PTPRD is significantly downregulated with obesity, whilst it is also expressed in the peripheral leukocytes. The EC TMAs revealed abundant PTPRD expression in both low- and high-grade tumours. Asprosin treatment upregulated the expression of PTPRD only in syncytialised placental cells. CONCLUSIONS Our data indicate that PTPRD may have potential as a biomarker for malignancies such as EC and GBM, further implicating asprosin as a potential metabolic regulator in these cancers. Future studies are needed to explore the potential molecular mechanisms/signalling pathways that link PTPRD and asprosin in cancer.
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Affiliation(s)
- Sophie Orton
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (S.O.); (S.G.); (I.K.)
| | - Rebecca Karkia
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
| | - Denis Mustafov
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9JA, UK;
| | - Seley Gharanei
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (S.O.); (S.G.); (I.K.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Maria Braoudaki
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9JA, UK;
| | - Alice Filipe
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
| | - Suzana Panfilov
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
| | - Sayeh Saravi
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
| | - Nabeel Khan
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
| | - Ioannis Kyrou
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (S.O.); (S.G.); (I.K.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Aston Medical School, College of Health and Life Sciences, Aston University, Birmingham B4 7ET, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
- College of Health, Psychology and Social Care, University of Derby, Derby DE22 1GB, UK
- Laboratory of Dietetics and Quality of Life, School of Food and Nutritional Sciences, Agricultural University of Athens, 11855 Athens, Greece
| | - Emmanouil Karteris
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
| | - Jayanta Chatterjee
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge UB8 3PH, UK; (R.K.); (D.M.); (A.F.); (S.P.); (S.S.); (N.K.); (E.K.)
- Academic Department of Gynaecological Oncology, Royal Surrey NHS Foundation Trust Hospital, Guildford GU2 7XX, UK
| | - Harpal S. Randeva
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK; (S.O.); (S.G.); (I.K.)
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
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Orton S, Szatkowski L, Naughton F, Coleman T. The Relationship Between Reported Daily Nicotine Dose from NRT and Daily Cigarette Consumption in Pregnant Women Who Smoke in an Observational Cohort Study. Nicotine Tob Res 2024; 26:212-219. [PMID: 37534909 PMCID: PMC10803113 DOI: 10.1093/ntr/ntad140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/02/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION For nonpregnant people unable to quit smoking, the NHS recommends nicotine replacement therapy (NRT) for smoking reduction. This is not recommended during pregnancy due to concerns about higher nicotine intake than smoking alone. We investigated the relationship between daily nicotine dose from NRT and cigarette consumption reported by pregnant women receiving smoking cessation support. METHODS We conducted secondary analysis of data from currently smoking pregnant women, recruited from antenatal clinics (Nottingham University Hospitals, UK) or online between June 2019-September 2020. Participants set a quit date, received a prototype NRT adherence intervention, and reported cigarettes per day (CPD) and daily NRT dose (mg) via smartphone app for 28 days. RESULTS 388 women were screened, 32 (8%) were eligible and joined the study. 24 (75%) submitted 510 app reports in total. 17 (71%) reported smoking and using NRT concurrently on at least one day, with concurrent use reported on 109 (21%) of app reports.The relationship between daily NRT dose and CPD followed an exponential decay curve of approximately 7%. In multilevel repeated measures modelling using 4 linear splines (knots 17, 40, and 85 mg/NRT), significant fixed effects of daily NRT dose on CPD were observed for splines 1, 3, and 4. The strongest association was spline 1 (0-17 mg/NRT), where each 10 mg NRT increase was associated with a 0.6 CPD reduction (24% on average). CONCLUSIONS Among women in a cessation study, many smoked and used NRT concurrently; within these women, daily nicotine dose and heaviness of smoking were inversely related. IMPLICATIONS Findings have implications for the design of future interventions intended to reduce harm associated with smoking in pregnancy. They suggest using NRT alongside smoking in pregnancy could help some women reduce the number of cigarettes they smoke per day.
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Affiliation(s)
- Sophie Orton
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Lisa Szatkowski
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, NR4 7TJ, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Podlasek A, Claire R, Campbell KA, Orton S, Thomson R, Coleman T. Systematic review and meta-analysis investigating nicotine, cotinine and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy. Addiction 2023; 118:2076-2092. [PMID: 37394704 DOI: 10.1111/add.16279] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/16/2023] [Indexed: 07/04/2023]
Abstract
AIMS To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid and exhaled air carbon monoxide (CO) concentrations. METHODS Systematic review and meta-analysis of RCTs, which test interventions permitting concurrent NRT use and smoking and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. Measurements included reported number of cigarettes smoked per day (CPD), body fluid cotinine and expired air CO concentrations. RESULTS Twenty-nine studies were included in the review. Meta-analysis of nine showed that, compared with when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% CI = -3.06 to -1.07, P < 0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT used in the lead-up to quitting (i.e. as preloading), a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Eleven studies reported cotinine concentrations, but meta-analysis was not possible because of data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT use and smoking, four reported no differences, and none reported higher concentrations. CONCLUSIONS People who smoke and also use nicotine replacement therapy report smoking less heavily than people who solely smoke. When nicotine replacement therapy is used in the lead-up to quitting (preloading), this reported smoking reduction has been biochemically confirmed. There is no evidence that concurrent smoking and nicotine replacement therapy use result in greater nicotine exposure than solely smoking.
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Affiliation(s)
- Anna Podlasek
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
- Tayside Innovation and MedTech Ecosystem (TIME), University of Dundee, Dundee, Scotland, UK
| | - Ravinder Claire
- National Institute for Health and Care Excellence, London, London City, UK
| | - Katarzyna A Campbell
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Sophie Orton
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Ross Thomson
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham, Nottingham, Nottinghamshire, UK
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Podlasek A, Claire R, Campbell KA, Orton S, Thomson R, Coleman T. Systematic review and meta-analysis investigating nicotine, cotinine, and carbon monoxide exposures in people who both smoke and use nicotine replacement therapy. Br J Gen Pract 2023; 73:bjgp23X734241. [PMID: 37479301 DOI: 10.3399/bjgp23x734241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/23/2023] Open
Abstract
BACKGROUND Smoking is a major international public health problem. AIM To determine effects of concurrent smoking and nicotine replacement therapy (NRT) use on reported heaviness of smoking, nicotine (cotinine) body fluid, and exhaled air carbon monoxide (CO) concentrations. METHOD Systematic review and meta-analysis of randomised controlled trials (RCTs) that test interventions permitting concurrent NRT use and smoking, and comparing, within participants, outcomes when smoking with those when smoking and using NRT concurrently. RESULTS In total, 29 studies were included in the review. Meta-analysis of nine showed that, compared to when solely smoking, fewer cigarettes were smoked daily when NRT was used (mean difference during concurrent smoking and NRT use, -2.06 CPD [95% confidence interval {CI} = -3.06 to -1.07, P<0.0001]). Meta-analysis of seven studies revealed a non-significant reduction in exhaled CO during concurrent smoking and NRT use (mean difference, -0.58 ppm [95% CI = -2.18 to 1.03, P = 0.48]), but in the three studies that tested NRT 'preloading', a similar reduction in exhaled CO was statistically significant (mean difference, -2.54 ppm CO [95% CI = -4.14 to -0.95, P = 0.002]). Overall, 11 studies reported cotinine concentrations, but meta-analysis was not possible due to data reporting heterogeneity; of these, seven reported lower cotinine concentrations with concurrent NRT and smoking, four reported no differences, and none reported higher concentrations. CONCLUSION People who smoke but who also use NRT reported smoking less heavily than when solely smoking, and when NRT was used as 'preloading' this reported smoking reduction was biochemically confirmed. There was no evidence concurrent smoking and NRT use resulted in greater nicotine exposure than smoking.
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Affiliation(s)
- Anna Podlasek
- Centre for Academic Primary Care, University of Nottingham
| | | | | | - Sophie Orton
- Centre for Academic Primary Care, University of Nottingham
| | - Ross Thomson
- Centre for Academic Primary Care, University of Nottingham
| | - Tim Coleman
- Centre for Academic Primary Care, University of Nottingham
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Foulkes M, Hunt P, Orton S, Sharma N, Cox L. CN55 The testing times project: Collaboration in action. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.379] [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: 11/01/2022] Open
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Orton S, Taylor L, Laing L, Lewis S, Ussher M, Coleman T, Cooper S. Are E-cigarettes associated with postpartum return to smoking? Secondary analyses of a UK pregnancy longitudinal cohort. BMJ Open 2022; 12:e061028. [PMID: 35414565 PMCID: PMC9006833 DOI: 10.1136/bmjopen-2022-061028] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/17/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Postpartum return to smoking (PPRS) is an important public health problem. E-cigarette (EC) use has increased in recent years, and in a contemporary UK pregnancy cohort, we investigated factors, including ECs use, associated with PPRS. DESIGN Secondary analyses of a longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING 17 hospitals in England and Scotland in 2017. PARTICIPANTS The cohort recruited 750 women who were current or recent ex-smokers and/or EC users. A subgroup of women reported being abstinent from smoking in late pregnancy (n=162, 21.6%), and of these 137 (84.6%) completed the postpartum questionnaire and were included in analyses. OUTCOME MEASURES Demographics, smoking behaviours and beliefs, views and experience of ECs and infant feeding. RESULTS 35.8% (95% CI 28% to 44%) of women reported PPRS. EC use in pregnancy (adjusted OR 0.34, 95% CI 0.13 to 0.85) and breast feeding (adjusted OR 0.06, 95% CI 0.02 to 0.24) were inversely associated with PPRS, while household member smoking at 3 months post partum was positively associated with PPRS (adjusted OR 11.1, 95% CI 2.47 to 50.2). CONCLUSION EC use in pregnancy could influence PPRS. Further research is needed to confirm this and investigate whether ECs could be used to prevent PPRS.
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Affiliation(s)
- Sophie Orton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Lauren Taylor
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Libby Laing
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Division of Population Health Sciences and Education, St George's University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- School of Medicine, University of Nottingham, Nottingham, UK
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Notley C, Brown TJ, Bauld L, Boyle EM, Clarke P, Hardeman W, Holland R, Hubbard M, Naughton F, Nichols A, Orton S, Ussher M, Ward E. Development of a Smoke-Free Home Intervention for Families of Babies Admitted to Neonatal Intensive Care. IJERPH 2022; 19:ijerph19063670. [PMID: 35329355 PMCID: PMC8949360 DOI: 10.3390/ijerph19063670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 02/05/2023]
Abstract
Neonatal intensive care units (NICUs) have a disproportionately higher number of parents who smoke tobacco compared to the general population. A baby’s NICU admission offers a unique time to prompt behaviour change, and to emphasise the dangerous health risks of environmental tobacco smoke exposure to vulnerable infants. We sought to explore the views of mothers, fathers, wider family members, and healthcare professionals to develop an intervention to promote smoke-free homes, delivered on NICU. This article reports findings of a qualitative interview and focus group study with parents whose infants were in NICU (n = 42) and NICU healthcare professionals (n = 23). Thematic analysis was conducted to deductively explore aspects of intervention development including initiation, timing, components and delivery. Analysis of inductively occurring themes was also undertaken. Findings demonstrated that both parents and healthcare professionals supported the need for intervention. They felt it should be positioned around the promotion of smoke-free homes, but to achieve that end goal might incorporate direct cessation support during the NICU stay, support to stay smoke free (relapse prevention), and support and guidance for discussing smoking with family and household visitors. Qualitative analysis mapped well to an intervention based around the ‘3As’ approach (ask, advise, act). This informed a logic model and intervention pathway.
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Affiliation(s)
- Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
- Correspondence: ; Tel.: +44-1603-591275
| | - Tracey J. Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Elaine M. Boyle
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
- Neonatal Unit, Leicester Royal Infirmary, Leicester LE5 4PW, UK;
| | - Paul Clarke
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK;
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester LE1 7HA, UK;
| | - Marie Hubbard
- Neonatal Unit, Leicester Royal Infirmary, Leicester LE5 4PW, UK;
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Amy Nichols
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK;
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London SW17 0RE, UK;
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Emma Ward
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
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Huang Y, Emery J, Naughton F, Cooper S, McDaid L, Dickinson A, Clark M, Kinahan-Goodwin D, Thomson R, Phillips L, Lewis S, Orton S, Coleman T. The development and acceptability testing of an app-based smart survey system to record smoking behaviour, use of nicotine replacement therapy (NRT) and e-cigarettes. BMC Res Notes 2022; 15:100. [PMID: 35272684 PMCID: PMC8908557 DOI: 10.1186/s13104-022-05983-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 10/04/2021] [Accepted: 02/22/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Nicotine replacement therapy (NRT) helps people stop smoking. Monitoring treatment adherence is important as poor adherence to NRT limits its effectiveness. As e-cigarettes contain nicotine, their use (‘vaping’) is likely to affect both NRT use and smoking. We wished to measure adherence to NRT, and to investigate relationships between NRT, vaping and smoking so we developed ‘NicUse’, a smartphone App linked to a cloud database for collecting data relevant to NRT adherence. We report user-acceptability and investigate data validity among pregnant people by comparing heaviness of smoking reported to NicUse surveys with contemporaneous exhaled carbon monoxide readings. Results Thirty five pregnant women participating in a pilot study were asked to install and use NicUse on their smartphones. 32/35 (91%) logged into NicUse, 31 (89%) completed one or more surveys, and 22 (63%) completed these on ≥ 20 of 28 study days. Twenty-four gave end-of-study user acceptability ratings; 23 (96%) agreed or strongly agreed NicUse was ‘Easy to use’ and ‘Instructions were clear’. There was a strong correlation between the number of daily cigarettes reported on NicUse and exhaled CO readings taken on study Day 7 (Pearson’s r = 0.95, p < 0.001). NicUse appears highly acceptable, and smoking data reported to it shows validity. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-05983-8.
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Affiliation(s)
- Yue Huang
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich, NR4 7UL, UK
| | - Anne Dickinson
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Miranda Clark
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | | | - Ross Thomson
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, NG7 2RD, UK
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Bowker K, Lewis S, Ussher M, Naughton F, Phillips L, Coleman T, Orton S, McRobbie H, Bauld L, Cooper S. Smoking and vaping patterns during pregnancy and the postpartum: A longitudinal UK cohort survey. Addict Behav 2021; 123:107050. [PMID: 34343923 PMCID: PMC8434421 DOI: 10.1016/j.addbeh.2021.107050] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/09/2021] [Accepted: 07/12/2021] [Indexed: 12/03/2022]
Abstract
INTRODUCTION There is limited information about longitudinal patterns of vaping during pregnancy and the postpartum. We describe the prevalence, frequency, and reasons for vaping throughout pregnancy and postpartum. We also describe temporal patterns in pregnant women's vaping. METHODS A longitudinal cohort study across England and Scotland, with questionnaires in early pregnancy (8-24 weeks gestation), late pregnancy (34-38 weeks) and 3 months postpartum. A total of 750 women, aged 16 years or over, who were either current smokers, vapers or had smoked in the 3 months before pregnancy, were recruited between June and November 2017. RESULTS Vaping prevalence was 15.9% (n = 119/750) in early pregnancy: 12.4% (n = 93/750) were dual users and 3.5% (n = 26/750) exclusive vapers. Late pregnancy vaping prevalence was 17.8% (n = 68/383): 12.5% (n = 48/383) were dual users and 5.2% (n = 20/383) exclusive vapers. Postpartum vaping prevalence was 23.1% (n = 95/411): 14.6% (n = 60/411) were dual users and 8.5% (n = 35/411) exclusive vapers. The most frequently reported reason to vape among all vapers was to quit smoking. A total of 316 women completed all three surveys: 2.6% (n = 8/316) were exclusive vapers in early pregnancy with most remaining exclusive vapers postpartum (n = 6/8, 75%). Of the 11.5% (n = 35/316) dual users in early pregnancy, 31.4% (n = 11/35) were exclusive smokers by the postpartum. CONCLUSION Vaping prevalence was between 15.9% and 23.1% during pregnancy and the postpartum period, and the majority were dual users. Vaping habits of exclusive vapers remains stable throughout pregnancy and the postpartum. However, the vaping habits of dual users varies, with a third exclusively smoking in the postpartum.
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Affiliation(s)
- Katharine Bowker
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Sarah Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Clinical Sciences Building 2, Nottingham City Hospital Hucknall Road, Nottingham NG5 1PB, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK; Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Felix Naughton
- University of East Anglia, Faculty of Medicine and Health Sciences, Edith Cavell Building, Norwich NR4 7TJ, UK
| | - Lucy Phillips
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Tim Coleman
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Sophie Orton
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
| | - Hayden McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2031, Australia
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, EH16 4UX, UK
| | - Sue Cooper
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Phillips L, Campbell KA, Coleman T, Ussher M, Cooper S, Lewis S, Orton S. Barriers and Facilitators to Staying Smoke-Free after Having a Baby, a Qualitative Study: Women's Views on Support Needed to Prevent Returning to Smoking Postpartum. Int J Environ Res Public Health 2021; 18:ijerph182111358. [PMID: 34769875 PMCID: PMC8583693 DOI: 10.3390/ijerph182111358] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 11/30/2022]
Abstract
Background: Postpartum return to smoking (PPRS) is a common and important public health problem. Interventions to prevent PPRS have not been shown to be effective. We aimed to qualitatively explore the barriers and facilitators to staying smoke-free after having a baby, and women’s views on the support needed to avoid PPRS to inform future intervention development. Methods: We conducted semi-structured telephone interviews (n = 26) with pregnant women who quit smoking (n = 9), and postpartum women who were abstinent at delivery and returned to smoking (n = 7) or stayed smoke-free (n = 10). Inductive thematic analysis was used. Results: Five overarching themes were identified: (i) smoking intentions; (ii) facilitators to staying smoke-free; (iii) barriers to staying smoke-free; (iv) support to avoid relapse; and (v) e-cigarettes, nicotine replacement therapy, and varenicline. Facilitators to staying smoke-free were the health benefits to their baby, whilst barriers included stress, cravings, and being in environments where they would previously have smoked. Women wanted continuous offers of support to stay smoke-free throughout the extended postpartum period, with a particular interest in support for partners to quit smoking and self-help support. Women expressed safety concerns for e-cigarettes, nicotine replacement therapy, and varenicline. Conclusions: Offers of support to stay smoke-free should continue throughout the postpartum and engage with partners or other household members who smoke. Reassuring women about the relative safety of nicotine replacement therapy and e-cigarettes by a health professional, particularly for those who are breastfeeding, could be beneficial.
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Affiliation(s)
- Lucy Phillips
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Katarzyna Anna Campbell
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Michael Ussher
- Population Health Research Institute, St. George’s University of London, London SW17 0RE, UK;
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Sue Cooper
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
| | - Sophie Orton
- School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (L.P.); (K.A.C.); (T.C.); (S.C.); (S.L.)
- Correspondence:
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Ussher M, Best C, Lewis S, McKell J, Coleman T, Cooper S, Orton S, Bauld L. Financial Incentives for Preventing Postpartum return to Smoking (FIPPS): study protocol for a three-arm randomised controlled trial. Trials 2021; 22:512. [PMID: 34340694 PMCID: PMC8327045 DOI: 10.1186/s13063-021-05480-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/22/2021] [Indexed: 02/08/2023] Open
Abstract
Background Financial incentives are an effective way of helping women to stop smoking during pregnancy. Unfortunately, most women who stop smoking at this time return to smoking within 12 months of the infant’s birth. There is no evidence for interventions that are effective at preventing postpartum smoking relapse. Financial incentives provided after the birth may help women to sustain cessation. This randomised controlled trial will assess the effectiveness and cost-effectiveness of financial incentives to help women who are abstinent from smoking at end-of-pregnancy to avoid return to smoking up to 12 months postpartum. Methods This is a UK-based, multi-centre, three-arm, superiority, parallel group, individually randomised controlled trial, with 1:1:1 allocation. It will compare the effectiveness of two financial incentive interventions with each other (one intervention for up to 3 months postpartum offering up to £120 of incentives (£60 for the participant and £60 for a significant other support); the other for up to 12 months postpartum with up to £300 of incentives (£240 for the participant and £60 for a significant other support) and with a no incentives/usual care control group. Eligible women will be between 34 weeks gestation and 2 weeks postpartum, abstinent from smoking for at least 4 weeks, have an expired carbon monoxide (CO) reading < 4 parts per million (ppm), aged at least 16 years, intend remaining abstinent from smoking after the birth and able to speak and read English. The primary outcome is self-reported, lapse-free, smoking abstinence from the last quit attempt in pregnancy until 12 months postpartum, biochemically validated by expired CO and/or salivary cotinine or anabasine. Outcomes will be analysed by intention-to-treat and regression models used to compare the proportion of abstinent women between the two intervention groups and between each intervention group and the control group. An economic evaluation will assess the cost-effectiveness of offering incentives and a qualitative process evaluation will examine barriers and facilitators to trial retention, effectiveness and implementation. Discussion This pragmatic randomised controlled trial will test whether offering financial incentives is effective and cost-effective for helping women to avoid smoking relapse during the 12 months after the birth of their baby. Trial registration International Standard Randomised Controlled Trial Number 55218215. Registered retrospectively on 5th June 2019 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05480-6.
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Affiliation(s)
- M Ussher
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK. .,Population Health Research Institute, St George's, University of London, SW17 ORE, London, UK.
| | - C Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - S Lewis
- Division of Epidemiology and Public Health, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - J McKell
- Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, UK
| | - T Coleman
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Cooper
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - S Orton
- Division of Primary Care, Medical School, University of Nottingham, Nottingham, NG7 2UH, UK
| | - L Bauld
- Usher Institute, University of Edinburgh, Edinburgh, EH8 9AG, UK
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Bowker K, Lewis S, Phillips L, Orton S, Ussher M, Naughton F, Bauld L, Coleman T, Sinclair L, McRobbie H, Khan A, Cooper S. Pregnant women's use of e-cigarettes in the UK: a cross-sectional survey. BJOG 2021; 128:984-993. [PMID: 33012050 DOI: 10.1111/1471-0528.16553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 09/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate prevalence of vaping in pregnancy. Compare characteristics and attitudes between exclusive smokers and vapers, and between exclusive vapers and dual users (smoke and vape). DESIGN Cross-sectional survey. SETTING Hospitals across England and Scotland. POPULATION Pregnant women attending antenatal clinics in 2017. METHODS Women at 8-24 weeks' gestation completed screening questions about their smoking and vaping. Current or recent ex-smokers and/or vapers completed a full detailed survey about vaping and smoking. MAIN OUTCOME MEASURES The prevalence of vaping, characteristics and attitudes of women who vape and/or smoke. RESULTS Of 3360 pregnant women who completed screening questions, 515 (15.3%, 95% CI 14.1-16.6) were exclusive smokers, 44 (1.3%, 95% CI 1.0-1.8) exclusive vapers and 118 (3.5%, 95% CI 2.9-4.2) dual users. In total, 867 (25.8%) women completed the full survey; compared with smokers (n = 434), vapers (n = 140) were more likely to hold higher educational qualifications (odds ratio [OR) 1.51, 95% CI 1.01-2.25). Compared with exclusive vapers (n = 33), dual users (n = 107) were younger (OR 0.91 95% CI 0.85-0.98) and less likely to hold high qualifications (OR 0.43, 95% CI 0.20-0.96). Compared with smokers, dual users were more likely to be planning to quit smoking (OR 2.27, 95% CI 1.24-4.18). Compared with smokers, vapers were more likely to think vaping was safer than smoking (78.6% versus 36.4%). CONCLUSIONS One in 20 pregnant women report vaping, and most also smoke. Dual users are more motivated towards stopping smoking than smokers. Where women have tried but cannot stop smoking, clinicians could encourage them to consider vaping for smoking cessation. TWEETABLE EXTRACT One in 20 women report vaping during pregnancy but of those that do vape, most also smoke, despite having intentions to quit.
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Affiliation(s)
- K Bowker
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies, Nottingham City Hospital, University of Nottingham, Nottingham, UK
| | - L Phillips
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Orton
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - M Ussher
- Population Health Research Institute, St George's, University of London, London, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - F Naughton
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - L Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - T Coleman
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - L Sinclair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - H McRobbie
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia
| | - A Khan
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
| | - S Cooper
- Division of Primary Care Research and UK Centre for Tobacco and Alcohol Studies, School of Medicine, University of Nottingham, Nottingham, UK
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Naughton F, Vaz LR, Coleman T, Orton S, Bowker K, Leonardi-Bee J, Cooper S, Vanderbloemen L, Sutton S, Ussher M. Interest in and Use of Smoking Cessation Support Across Pregnancy and Postpartum. Nicotine Tob Res 2020; 22:1178-1186. [PMID: 31570944 PMCID: PMC7291796 DOI: 10.1093/ntr/ntz151] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/15/2019] [Indexed: 12/02/2022]
Abstract
Background Limited research exists on interest in and use of smoking cessation support in pregnancy and postpartum. Methods A longitudinal cohort of pregnant smokers and recent ex-smokers were recruited in Nottinghamshire, United Kingdom (N = 850). Data were collected at 8–26 weeks gestation, 34–36 weeks gestation, and 3 months postpartum and used as three cross-sectional surveys. Interest and use of cessation support and belief and behavior measures were collected at all waves. Key data were adjusted for nonresponse and analyzed descriptively, and multiple regression was used to identify associations. Results In early and late pregnancy, 44% (95% CI 40% to 48%) and 43% (95% CI 37% to 49%) of smokers, respectively, were interested in cessation support with 33% (95% CI 27% to 39%) interested postpartum. In early pregnancy, 43% of smokers reported discussing cessation with a midwife and, in late pregnancy, 27% did so. Over one-third (38%) did not report discussing quitting with a health professional during pregnancy. Twenty-seven percent of smokers reported using any National Health Service (NHS) cessation support and 12% accessed NHS Stop Smoking Services during pregnancy. Lower quitting confidence (self-efficacy), higher confidence in stopping with support, higher quitting motivation, and higher age were associated with higher interest in support (ps ≤ .001). A recent quit attempt and greater interest in support was associated with speaking to a health professional about quitting and use of NHS cessation support (ps ≤ .001). Conclusions When asked in early or late pregnancy, about half of pregnant smokers were interested in cessation support, though most did not engage. Cessation support should be offered throughout pregnancy and after delivery. Implications There is relatively high interest in cessation support in early and late pregnancy and postpartum among smokers; however, a much smaller proportion of pregnant or postpartum women access any cessation support, highlighting a gap between interest and engagement. Reflecting women’s interest, offers of cessation support should be provided throughout pregnancy and after delivery. Increasing motivation to quit and confidence in quitting with assistance may enhance interest in support, and promoting the discussion of stopping smoking between women and health practitioners may contribute to higher support engagement rates.
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Affiliation(s)
- Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Luis Reeves Vaz
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Katharine Bowker
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Division of Primary Care, UK Centre for Tobacco and Alcohol Studies and National Institute for Health Research School for Primary Care Research, University of Nottingham, Nottingham, UK
| | - Laura Vanderbloemen
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Stephen Sutton
- Behavioural Science Group, Institute of Public Health, University of Cambridge, CB2 0SR, UK
| | - Michael Ussher
- Population Health Research Institute, St Georges, University of London, London, UK.,Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Brown TJ, Gentry S, Bauld L, Boyle EM, Clarke P, Hardeman W, Holland R, Naughton F, Orton S, Ussher M, Notley C. Systematic Review of Behaviour Change Techniques within Interventions to Reduce Environmental Tobacco Smoke Exposure for Children. Int J Environ Res Public Health 2020; 17:E7731. [PMID: 33105823 PMCID: PMC7660048 DOI: 10.3390/ijerph17217731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
Children are particularly vulnerable to environmental tobacco smoke (ETS). There is no routine support to reduce ETS in the home. We systematically reviewed trials to reduce ETS in children in order to identify intervention characteristics and behaviour change techniques (BCTs) to inform future interventions. We searched Medline, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, and Cochrane Tobacco Addiction Group Specialised Register from January 2017 to June 2020 to update an existing systematic review. We included controlled trials to reduce parent/caregiver smoking or ETS in children <12 years that demonstrated a statistically significant benefit, in comparison to less intensive interventions or usual care. We extracted trial characteristics; and BCTs using Behaviour Change Technique Taxonomy v1. We defined "promising" BCTs as those present in at least 25% of effective interventions. Data synthesis was narrative. We included 16 trials, of which eight were at low risk of bias. All trials used counselling in combination with self-help or other supporting materials. We identified 13 "promising" BCTs centred on education, setting goals and planning, or support to reach goals. Interventions to reduce ETS in children should incorporate effective BCTs and consider counselling and self-help as mechanisms of delivery.
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Affiliation(s)
- Tracey J. Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Elaine M. Boyle
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Paul Clarke
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester LE1 7HA, UK;
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London SW17 0RE, UK;
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
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Bowker K, Ussher M, Cooper S, Orton S, Coleman T, Campbell KA. Addressing and Overcoming Barriers to E-Cigarette Use for Smoking Cessation in Pregnancy: A Qualitative Study. Int J Environ Res Public Health 2020; 17:ijerph17134823. [PMID: 32635510 PMCID: PMC7369696 DOI: 10.3390/ijerph17134823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
Abstract
E-cigarettes may have a role in supporting pregnant women who would otherwise smoke to stop smoking. The study aimed to understand pregnant women’s vaping experiences, in particular how vaping to stop smoking is facilitated and how barriers to this are overcome. We conducted semi structured telephone interviews (n = 15) with pregnant or postpartum women who vaped during pregnancy, either exclusively (n = 10) or dual-used (n = 5) (smoked and vaped). Thematic analysis was used to analyse the interviews. Two themes emerged. First, ‘facilitating beliefs’: inherent beliefs that helped women overcome barriers to vaping. These included understanding the relative safety of vaping and economic gains compared with smoking and pregnancy being a motivator to stop smoking. Second, ‘becoming a confident vaper’: accumulating sufficient skill and confidence to comfortably vape. This included experimentation with e-cigarettes to ensure nicotine dependence and sensory needs were met. Seeking social support and employing strategies to address social stigma were also important. Positive beliefs about vaping and becoming proficient at vaping were viewed as ways to overcome barriers to vaping. The theoretical domain framework informed intervention recommendations to assist pregnant smokers who have tried but cannot stop smoking to switch to vaping.
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Affiliation(s)
- Katharine Bowker
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (S.O.); (T.C.); (K.A.C.)
- Correspondence: ; Tel.: +44-0115-748-4040
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London SW17 0RE, UK;
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (S.O.); (T.C.); (K.A.C.)
| | - Sophie Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (S.O.); (T.C.); (K.A.C.)
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (S.O.); (T.C.); (K.A.C.)
| | - Katarzyna Anna Campbell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (S.O.); (T.C.); (K.A.C.)
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Wan Y, Chen R, Wang S, Clifford A, Zhang S, Orton S. Associations of coping styles with nonsuicidal self-injury in adolescents: Do they vary with gender and adverse childhood experiences? Child Abuse Negl 2020; 104:104470. [PMID: 32234639 DOI: 10.1016/j.chiabu.2020.104470] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The impact of positive coping style on non-suicidal self-injury in adolescents remains unclear, while negative coping style increases the risk of non-suicidal self-injury (NSSI). There is less investigation on gender differences in the impacts of positive coping style and negative coping style on NSSI. It is unknown whether the impacts vary with different levels of adverse childhood experiences (ACEs). AIMS To identify gender differences in the impacts of positive coping style and negative coping style on NSSI, and investigate the impacts at different levels of ACEs. METHOD An adolescent health survey was conducted in 15 schools in China between November 2013 and January 2014. 9704 students aged 11-19 years completed standard questionnaires to record the details of coping style, NSSI and ACEs. RESULTS 38.5 % of adolescents had ≥1 NSSI over the past 12 months. NSSI was significantly increased with the low positive coping style in girls with ≥3 ACEs, but not with 0 and 1-2 ACEs, and not in boys with any levels of ACEs. NSSI was increased with high negative coping style in both girls and boys across all ACEs. The negative coping style impact was stronger in girls than in boys (odds ratio 1.66, p < 0.05), especially in those with 1-2 ACEs. CONCLUSIONS Adolescents at high risk of NSSI in relation to coping styles should be targeted accordingly. Reducing negative coping style in girls and boys and improving positive coping style in girls who have high ACEs could help prevent NSSI in adolescents.
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Affiliation(s)
- Yuhui Wan
- Department of Maternal, Child& Adolescent Health, School of Public Health, Anhui Medical University, China; Anhui Provincial Key Laboratory of Population Health &Aristogenics, 81 Meishan Road, Hefei, 230032, Anhui, China; Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK.
| | - Shanshan Wang
- Department of Maternal, Child& Adolescent Health, School of Public Health, Anhui Medical University, China; Anhui Provincial Key Laboratory of Population Health &Aristogenics, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Angela Clifford
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
| | - Shichen Zhang
- Department of Maternal, Child& Adolescent Health, School of Public Health, Anhui Medical University, China; Anhui Provincial Key Laboratory of Population Health &Aristogenics, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Sophie Orton
- Division of Primary Care, School of Medicine, University of Nottingham, UK
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Petersen L, Mcneil R, Dean M, Chan A, Orton S, Kovalchuk O, Bebb G. P2.04-30 Seq-ing a Better Way to Detect PD-L1 in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1535] [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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Brown TJ, Bauld L, Hardeman W, Holland R, Naughton F, Orton S, Ussher M, Notley C. Re-Configuring Identity Postpartum and Sustained Abstinence or Relapse to Tobacco Smoking. Int J Environ Res Public Health 2019; 16:ijerph16173139. [PMID: 31466394 PMCID: PMC6747523 DOI: 10.3390/ijerph16173139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/16/2022]
Abstract
Relapse to smoking postpartum is a common and important public health problem. Difficulty in adjusting to a non-smoking identity is a key factor prompting relapse. However, postpartum relapse prevention interventions rarely focus upon offering support for identity change. We conducted an exploratory inductive analysis of a dataset from the Prevention of Return to Smoking Postpartum (PReS) study to understand identity constructs and experiences of pre- and postpartum women (smokers and ex-smokers), partners and health professionals. Data were obtained from 77 unique participants via focus groups, interviews, email or online questionnaires, and were analyzed by two researchers independently, using NVivo 12. Four main themes emerged reflecting identity transition from the pre- to the postpartum period: (i) Pregnancy and the categorization of smoking status; (ii) the disruption of motherhood and loss of self; (iii) adapting to a maternal non-smoking identity; and (iv) factors influencing sustained abstinence versus relapse to smoking. Postpartum relapse prevention interventions need to consider support for women, and the whole family unit, in adjusting to a new identity as a non-smoking mother. Smoking status should be revisited throughout pregnancy and into the postpartum period to aid the long-term integration of smoke-free behavior.
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Affiliation(s)
- Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester LE1 7RH, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London SW17 0RE, UK
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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Johnston EJ, Campbell K, Coleman T, Lewis S, Orton S, Cooper S. Safety of Electronic Cigarette Use During Breastfeeding: Qualitative Study Using Online Forum Discussions. J Med Internet Res 2019; 21:e11506. [PMID: 31407672 PMCID: PMC6709563 DOI: 10.2196/11506] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 01/15/2019] [Accepted: 03/05/2019] [Indexed: 01/19/2023] Open
Abstract
Background Electronic cigarettes (e-cigs) are an increasingly popular alternative to smoking, helping to prevent relapse in those trying to quit and with the potential to reduce harm as they are likely to be safer than standard cigarettes. Many women return to smoking in the postpartum period having stopped during pregnancy, and while this can affect their decisions about breastfeeding, little is known about women’s opinions on using e-cigs during this period. Objective The aim of this study is to explore online forum users’ current attitudes, motivations, and barriers to postpartum e-cig use, particularly as a breastfeeding mother. Methods Data were collected via publicly accessible (identified by Google search) online forum discussions, and a priori codes identified. All transcripts were entered into NVivo for analysis, with a template approach to thematic analysis being used to code all transcripts from which themes were derived. Results Four themes were identified: use, perceived risk, social support and evidence, with a number of subthemes identified within these. Women were using e-cigs to prevent postpartum return to smoking, but opinions on their safety were conflicting. They were concerned about possible transfer of harmful products from e-cigs via breastmilk and secondhand exposure, so they were actively seeking and sharing information on e-cigs from a variety of sources. Although some women were supportive of e-cig use, others provided harsh judgement for mothers who used them. Conclusions E-cigs have the potential to reduce the number of women who return to smoking in the postpartum period and potentially improve breastfeeding rates, if breastfeeding mothers have access to relevant and reliable information. Health care providers should consider discussing e-cigs with mothers at risk of returning to smoking in the postpartum period.
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Affiliation(s)
- Emily Jade Johnston
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Katarzyna Campbell
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Tim Coleman
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sarah Lewis
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sophie Orton
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Sue Cooper
- Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Notley C, Brown TJ, Bauld L, Hardeman W, Holland R, Naughton F, Orton S, Ussher M. Development of a Complex Intervention for the Maintenance of Postpartum Smoking Abstinence: Process for Defining Evidence-Based Intervention. Int J Environ Res Public Health 2019; 16:E1968. [PMID: 31163663 PMCID: PMC6603989 DOI: 10.3390/ijerph16111968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 11/17/2022]
Abstract
Relapse to tobacco smoking for pregnant women who quit is a major public health problem. Evidence-based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory-driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women (ex-smokers who had remained quit and those who had relapsed), their partners and healthcare professionals (N = 74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack, but need for, relapse prevention support. This should be initiated by a trusted 'credible source'. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face-to-face support reiterated throughout the postpartum period, tailored digital and self-help support and novel elements such as gifts and nicotine replacement therapy (NRT).
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Affiliation(s)
- Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Tracey J Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9YL, UK.
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester LE1 7RH, UK.
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK.
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK.
| | - Michael Ussher
- Population Health Research Institute, St George's, University of London, London WC1E 7HU, UK.
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK.
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Brown TJ, Hardeman W, Bauld L, Holland R, Maskrey V, Naughton F, Orton S, Ussher M, Notley C. A systematic review of behaviour change techniques within interventions to prevent return to smoking postpartum. Addict Behav 2019; 92:236-243. [PMID: 30731328 PMCID: PMC6518963 DOI: 10.1016/j.addbeh.2018.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 12/13/2018] [Accepted: 12/22/2018] [Indexed: 11/04/2022]
Abstract
Introduction There is no routine support to prevent postpartum smoking relapse, due to lack of effective interventions. Previous reviews have identified behaviour change techniques (BCTs) within pregnancy cessation trials to specify which components might be incorporated into more effective interventions, but no reviews have identified BCTs for prevention of smoking relapse postpartum. We reviewed BCTs and potential delivery modes, to inform future interventions. Methods We searched Medline and EMBASE from January 2015–May 2017; and identified trials published before 2015 by handsearching systematic reviews. We included RCTs where: i) ≥1 intervention component aimed to maintain smoking abstinence versus a less intensive intervention; ii) participants included pregnant or postpartum smoking quitters; iii) smoking status was reported in the postpartum period. We extracted trial characteristics and used the Behaviour Change Technique Taxonomy v1 to extract BCTs. We aimed to identify ‘promising’ BCTs i.e. those frequently occurring and present in ≥2 trials that demonstrated long-term effectiveness (≥6 months postpartum). Data synthesis was narrative. Results We included 32 trials, six of which demonstrated long-term effectiveness. These six trials used self-help, mainly in conjunction with counselling, and were largely delivered remotely. We identified six BCTs as promising: ‘problem solving’, ‘information about health consequences’, ‘information about social and environmental consequences’, ‘social support’, ‘reduce negative emotions’ and ‘instruction on how to perform a behaviour’. Conclusions Future interventions to prevent postpartum smoking relapse might include these six BCTs to maximise effectiveness. Tailored self-help approaches, with/without counselling, may be favourable modes of delivery of BCTs. Registration: PROSPERO CRD42018075677. First review of behaviour change techniques to prevent postpartum smoking relapse. Six promising behaviour change techniques (BCTs) were frequently coded. BCTs were problem solving, social support, information about consequences. How to perform a behaviour and reduce negative emotions were also promising BCTs.
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23
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Campbell KA, Orton S, Bowker K, Cooper S, Coleman T. Feasibility and Acceptability of 'Opt-In' Referrals for Stop Smoking Support in Pregnancy. Int J Environ Res Public Health 2019; 16:ijerph16081358. [PMID: 31014015 PMCID: PMC6518207 DOI: 10.3390/ijerph16081358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 03/28/2019] [Accepted: 04/11/2019] [Indexed: 01/17/2023]
Abstract
Background: International guidelines recommend that following an early-pregnancy ‘opt-out’ referral for smoking cessation support, pregnant women who smoke should also be offered referrals at subsequent antenatal appointments (‘opt-in’ referrals). We assessed feasibility and acceptability of introducing ‘opt-in’ self-referral forms to stop smoking services (SSS) in antenatal clinics. Method: A ‘before–after’ service evaluation and qualitative interviews. ‘Opt-in’ self-referral forms were distributed by reception staff to women attending antenatal ultrasound appointments. We collected hospital/SSS data for the study period and a comparison period 12 months prior. Reception staff were interviewed and data analyzed thematically. Results: Over 6500 women entered antenatal care in each period; ~15% smoked and ~50% of those who smoked were referred to SSS at their first appointment. In the study period, 17.4% of women completed ‘opt-in’ forms. Of these 17.3% smoked, and 23.1% of those who smoked requested a referral. The staff thought new procedures had minimal impact on workload, but were easy to forget. They believed the pathway would be better delivered by midwifery staff, with additional information/advice to improve engagement. Conclusions: ‘Opt-in’ referrals in later pregnancy result in significant numbers of women who smoke indicating interest in smoking cessation support. Additional training and support is necessary to motivate reception staff to oversee self-referral pen-and-paper procedures effectively.
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Affiliation(s)
- Katarzyna Anna Campbell
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
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24
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Aveyard P, Lindson N, Tearne S, Adams R, Ahmed K, Alekna R, Banting M, Healy M, Khan S, Rai G, Wood C, Anderson EC, Ataya-Williams A, Attwood A, Easey K, Fluharty M, Freuler T, Hurse M, Khouja J, Lacey L, Munafò M, Lycett D, McEwen A, Coleman T, Dickinson A, Lewis S, Orton S, Perdue J, Randall C, Anderson R, Bisal N, Hajek P, Homsey C, McRobbie HJ, Myers-Smith K, Phillips A, Przulj D, Li J, Coyle D, Coyle K, Pokhrel S. Nicotine preloading for smoking cessation: the Preloading RCT. Health Technol Assess 2019; 22:1-84. [PMID: 30079863 DOI: 10.3310/hta22410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Nicotine preloading means using nicotine replacement therapy prior to a quit date while smoking normally. The aim is to reduce the drive to smoke, thereby reducing cravings for smoking after quit day, which are the main cause of early relapse. A prior systematic review showed inconclusive and heterogeneous evidence that preloading was effective and little evidence of the mechanism of action, with no cost-effectiveness data. OBJECTIVES To assess (1) the effectiveness, safety and tolerability of nicotine preloading in a routine NHS setting relative to usual care, (2) the mechanisms of the action of preloading and (3) the cost-effectiveness of preloading. DESIGN Open-label randomised controlled trial with examination of mediation and a cost-effectiveness analysis. SETTING NHS smoking cessation clinics. PARTICIPANTS People seeking help to stop smoking. INTERVENTIONS Nicotine preloading comprised wearing a 21 mg/24 hour nicotine patch for 4 weeks prior to quit date. In addition, minimal behavioural support was provided to explain the intervention rationale and to support adherence. In the comparator group, participants received equivalent behavioural support. Randomisation was stratified by centre and concealed from investigators. MAIN OUTCOME MEASURES The primary outcome was 6-month prolonged abstinence assessed using the Russell Standard. The secondary outcomes were 4-week and 12-month abstinence. Adverse events (AEs) were assessed from baseline to 1 week after quit day. In a planned analysis, we adjusted for the use of varenicline (Champix®; Pfizer Inc., New York, NY, USA) as post-cessation medication. Cost-effectiveness analysis took a health-service perspective. The within-trial analysis assessed health-service costs during the 13 months of trial enrolment relative to the previous 6 months comparing trial arms. The base case was based on multiple imputation for missing cost data. We modelled long-term health outcomes of smoking-related diseases using the European-study on Quantifying Utility of Investment in Protection from Tobacco (EQUIPT) model. RESULTS In total, 1792 people were eligible and were enrolled in the study, with 893 randomised to the control group and 899 randomised to the intervention group. In the intervention group, 49 (5.5%) people discontinued preloading prematurely and most others used it daily. The primary outcome, biochemically validated 6-month abstinence, was achieved by 157 (17.5%) people in the intervention group and 129 (14.4%) people in the control group, a difference of 3.02 percentage points [95% confidence interval (CI) -0.37 to 6.41 percentage points; odds ratio (OR) 1.25, 95% CI 0.97 to 1.62; p = 0.081]. Adjusted for use of post-quit day varenicline, the OR was 1.34 (95% CI 1.03 to 1.73; p = 0.028). Secondary abstinence outcomes were similar. The OR for the occurrence of serious AEs was 1.12 (95% CI 0.42 to 3.03). Moderate-severity nausea occurred in an additional 4% of the preloading group compared with the control group. There was evidence that reduced urges to smoke and reduced smoke inhalation mediated the effect of preloading on abstinence. The incremental cost-effectiveness ratio at the 6-month follow-up for preloading relative to control was £710 (95% CI -£13,674 to £23,205), but preloading was dominant at 12 months and in the long term, with an 80% probability that it is cost saving. LIMITATIONS The open-label design could partially account for the mediation results. Outcome assessment could not be blinded but was biochemically verified. CONCLUSIONS Use of nicotine-patch preloading for 4 weeks prior to attempting to stop smoking can increase the proportion of people who stop successfully, but its benefit is undermined because it reduces the use of varenicline after preloading. If this latter effect could be overcome, then nicotine preloading appears to improve health and reduce health-service costs in the long term. Future work should determine how to ensure that people using nicotine preloading opt to use varenicline as cessation medication. TRIAL REGISTRATION Current Controlled Trials ISRCTN33031001. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 41. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Nicola Lindson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tearne
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rachel Adams
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Khaled Ahmed
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Rhona Alekna
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Miriam Banting
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Mike Healy
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Shahnaz Khan
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Gurmail Rai
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Carmen Wood
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Emma C Anderson
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | | | - Angela Attwood
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Kayleigh Easey
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Fluharty
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Therese Freuler
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Megan Hurse
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Jasmine Khouja
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Lindsey Lacey
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Marcus Munafò
- School of Experimental Psychology, University of Bristol, Bristol, UK
| | - Deborah Lycett
- Faculty of Health and Life Sciences, Coventry University, Coventry, UK
| | - Andy McEwen
- National Centre for Smoking Cessation and Training (NCSCT), Dorchester, UK
| | - Tim Coleman
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Anne Dickinson
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Sophie Orton
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Johanna Perdue
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Clare Randall
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Rebecca Anderson
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Natalie Bisal
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Peter Hajek
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Celine Homsey
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Hayden J McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Katherine Myers-Smith
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Anna Phillips
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Dunja Przulj
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jinshuo Li
- Health Sciences, University of York, York, UK
| | - Doug Coyle
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| | - Katherine Coyle
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
| | - Subhash Pokhrel
- Institute of Environment, Health and Societies, Brunel University, Uxbridge, UK
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Cooper S, Orton S, Campbell KA, Ussher M, Coleman-Haynes N, Whitemore R, Dickinson A, McEwen A, Lewis S, Naughton F, Bowker K, Sinclair L, Bauld L, Coleman T. Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study. Int J Environ Res Public Health 2019; 16:E110. [PMID: 30609823 PMCID: PMC6338976 DOI: 10.3390/ijerph16010110] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/13/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
Abstract
Smoking in pregnancy remains a public health problem. In the UK e-cigarettes are the most popular aid to quitting smoking outside of pregnancy, but we don't know the extent of e-cigarette use in pregnancy or how English Stop Smoking Services (SSS) respond to pregnant women who vape. In 2015 we surveyed SSS managers about cessation support for pregnant women and responses to clients who vaped. Subsequently we interviewed a sub-sample of managers to seek explanations for the SSS' position on e-cigarettes; interviews were thematically analysed. Survey response rate was 67.8% (72/106); overall managers reported 2.2% (range 1.4⁻4.3%) of pregnant clients were using e-cigarettes. Most SSS reported supporting pregnant women who already vaped, but would not recommend e-cigarette use; for women that were still smoking and not using e-cigarettes, 8.3% of SSS were likely/very likely to advise using e-cigarettes, with 56.9% of SSS unlikely/very unlikely to advise using them. Fifteen respondents were interviewed; interviewees were generally positive about the potential of e-cigarettes for cessation in pregnancy although concerns about perceived lack of evidence for safety were expressed and most wanted research on this. Clear guidance on e-cigarette use informed by pregnancy specific research will assist SSS to provide consistent evidence-based support.
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Affiliation(s)
- Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Katarzyna A Campbell
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK.
| | - Naomi Coleman-Haynes
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Rachel Whitemore
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Anne Dickinson
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Andy McEwen
- National Centre of Smoking Cessation and Training, Dorchester DT1 2DY, UK.
| | - Sarah Lewis
- Division of Epidemiology and Public health, University of Nottingham, Nottingham City Hospital, Nottingham NG5 1PB, UK.
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK.
| | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
| | - Lesley Sinclair
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK.
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
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26
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Bowker K, Orton S, Cooper S, Naughton F, Whitemore R, Lewis S, Bauld L, Sinclair L, Coleman T, Dickinson A, Ussher M. Views on and experiences of electronic cigarettes: a qualitative study of women who are pregnant or have recently given birth. BMC Pregnancy Childbirth 2018; 18:233. [PMID: 29902987 PMCID: PMC6003107 DOI: 10.1186/s12884-018-1856-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 05/25/2018] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Electronic cigarettes (ECs) are increasingly used for reducing or stopping smoking, with some studies showing positive outcomes. However, little is known about views on ECs during pregnancy or postpartum and previous studies have nearly all been conducted in the US and have methodological limitations, such as not distinguishing between smokers and ex/non-smokers. A greater understanding of this topic will help to inform both clinicians and EC interventions. We elicited views and experiences of ECs among UK pregnant or recently pregnant women. METHODS We conducted semi-structured telephone interviews, using topic guides, with pregnant or recently pregnant women, who were current or recent ex-smokers. To ensure broad views of ECs were obtained, recruitment was from several geographical locations and via various avenues of recruitment. This included stop smoking services, antenatal and health visitor clinics, a pregnancy website and an informal network. Participants were 15 pregnant and 15 postpartum women, including nine current EC users, 11 ex-users, and 10 never-users. Five women who were interviewed in pregnancy were later interviewed in postpartum to explore if their views had changed. Audio data was transcribed verbatim and framework analysis was applied. RESULTS Five main themes emerged: motivations for use (e.g., for stopping or reducing smoking), social stigma (e.g., avoiding use in public, preferring 'discrete' NRT), using the EC (e.g., mostly used at home); consumer aspects (e.g., limited advice available), and harm perceptions (e.g., viewed as less harmful than smoking; concerns about safety and addiction). CONCLUSIONS ECs were viewed positively by some pregnant and postpartum women and seen as less harmful than smoking and useful as aids for reducing and stopping smoking. However, due to perceived social stigma, some women feel uncomfortable using ECs in public, especially during pregnancy, and had concerns about safety and nicotine dependence. Health professionals and designers of EC interventions need to provide women with up-to-date and consistent information and advice about safety and dependence, as well as considering the influence of social stigma.
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Affiliation(s)
- Katharine Bowker
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Sophie Orton
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Sue Cooper
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Edith Cavell Building, Norwich, NR4 7TJ UK
| | - Rachel Whitemore
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health and UK Centre for Tobacco and Alcohol Studies and, University of Nottingham, Clinical Sciences Building 2, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB UK
| | - Linda Bauld
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| | - Lesley Sinclair
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
| | - Tim Coleman
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Anne Dickinson
- NIHR School for Primary Care Research and UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD UK
| | - Michael Ussher
- Institute for Social Marketing and UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA UK
- Population Health Research Institute, St George’s, University of London, London, SW17 0RE UK
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Cooper S, Orton S, Leonardi-Bee J, Brotherton E, Vanderbloemen L, Bowker K, Naughton F, Ussher M, Pickett KE, Sutton S, Coleman T. Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort. BMJ Open 2017; 7:e018746. [PMID: 29146659 PMCID: PMC5695489 DOI: 10.1136/bmjopen-2017-018746] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women's smoking and quitting behaviour throughout pregnancy and after delivery. DESIGN Longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING Two maternity hospitals in one National Health Service hospital trust, Nottingham, England. PARTICIPANTS 850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012. OUTCOME MEASURES Self-reported smoking behaviour, quit attempts and quitting intentions. RESULTS Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3). CONCLUSIONS Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation.
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Affiliation(s)
- Sue Cooper
- Division of Primary Care, University of Nottingham, University Park, Nottingham, UK
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, University Park, Nottingham, UK
| | - Jo Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Emma Brotherton
- Division of Primary Care, University of Nottingham, University Park, Nottingham, UK
| | - Laura Vanderbloemen
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Katharine Bowker
- Division of Primary Care, University of Nottingham, University Park, Nottingham, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich, Norfolk, UK
| | - Michael Ussher
- Population Health Research Institute, St George’s University of London, London, UK
| | - Kate E Pickett
- Department of Health Sciences, University of York, York, UK
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, University Park, Nottingham, UK
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Orton S, Coleman T, Coleman-Haynes T, Ussher M. Predictors of Postpartum Return to Smoking: A Systematic Review. Nicotine Tob Res 2017; 20:665-673. [DOI: 10.1093/ntr/ntx163] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 07/19/2017] [Indexed: 11/13/2022]
Affiliation(s)
- Sophie Orton
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Tom Coleman-Haynes
- Division of Primary Care, University Park, University of Nottingham, Nottingham, UK
| | - Michael Ussher
- Population Health Research Institute, St. Georges, University of London, London, UK
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Foster K, Bowker K, Orton S, Naughton F, Cooper S, Coleman T. Using qualitative interviews with nihr crn research midwives to refine trial recruitment methods. Trials 2015. [PMCID: PMC4660221 DOI: 10.1186/1745-6215-16-s2-p74] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
OBJECTIVES Children's exposure to secondhand smoke (SHS) is causally linked to childhood morbidity and mortality. Over 38% of English children (aged 4-15) whose parents are smokers are exposed to SHS in the home. Little is known about the prevalence of SHS exposure in the homes of young infants (≤3 months). This study aimed to estimate maternal self-reported prevalence of SHS exposure among infants of women who smoked just before or during pregnancy, and identify factors associated with exposure. SETTING Primary Care, Nottingham, England. PARTICIPANTS Current and recent ex-smoking pregnant women (n=850) were recruited in Nottingham, England. Women completed questionnaires at 8-26 weeks gestation and 3 months after childbirth. Data on smoking in the home 3 months after childbirth was available for 471 households. PRIMARY AND SECONDARY OUTCOME MEASURES Maternal-reported smoking in the home 3 months after childbirth. RESULTS The prevalence of smoking in the home 3 months after childbirth was 16.3% (95% CI 13.2% to 19.8%) and after multiple imputation controlling for non-response 18.2% (95% CI 14.0% to 22.5%). 59% of mothers were current smokers; of these, 24% reported that smoking occurred in their home compared to 4.7% of non-smokers. In multivariable logistic regression, mothers smoking ≥11 cigarettes per day were 8.2 times (95% CI 3.4 to 19.6) more likely to report smoking in the home. Younger age, being of non-white ethnicity, increased deprivation and less negative attitudes towards SHS were also associated with smoking in the home. CONCLUSIONS This survey of smoking in the home 3 months after childbirth found a lower prevalence than has been reported in older children. Interventions to support smoking mothers to quit, or to help them restrict smoking in the home, should target attitudinal change and address inequality relating to social disadvantage, younger age and non-white ethnic groups.
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Affiliation(s)
- Sophie Orton
- UK Centre for Tobacco & Alcohol Studies & Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- UK Centre for Tobacco & Alcohol Studies & Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Laura L Jones
- UK Centre for Tobacco & Alcohol Studies & Unit of Public Health, Epidemiology & Biostatistics, School of Health & Population Sciences, University of Birmingham, Birmingham, UK
| | - Sue Cooper
- UK Centre for Tobacco & Alcohol Studies & Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- UK Centre for Tobacco & Alcohol Studies & Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
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Orton S, Bowker K, Cooper S, Naughton F, Ussher M, Pickett KE, Leonardi-Bee J, Sutton S, Dhalwani NN, Coleman T. Longitudinal cohort survey of women's smoking behaviour and attitudes in pregnancy: study methods and baseline data. BMJ Open 2014; 4:e004915. [PMID: 24833689 PMCID: PMC4025445 DOI: 10.1136/bmjopen-2014-004915] [Citation(s) in RCA: 22] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES To report the methods used to assemble a contemporary pregnancy cohort for investigating influences on smoking behaviour before, during and after pregnancy and to report characteristics of women recruited. DESIGN Longitudinal cohort survey. SETTING Two maternity hospitals, Nottingham, England. PARTICIPANTS 3265 women who attended antenatal ultrasound scan clinics were offered cohort enrolment; those who were 8-26 weeks pregnant and were currently smoking or had recently stopped smoking were eligible. Cohort enrollment took place between August 2011 and August 2012. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of smoking at cohort entry and at two follow-up time points (34-36 weeks gestation and 3 months postnatally); response rate, participants' sociodemographic characteristics. RESULTS 1101 (33.7%, 95% CI 32.1% to 35.4%) women were eligible for inclusion in the cohort, and of these 850 (77.2%, 95% CI 74.6% to 79.6%) were recruited. Within the cohort, 57.4% (N=488, 95% CI 54.1% to 60.7%) reported to be current smokers. Current smokers were significantly younger than ex-smokers (p<0.05), more likely to have no formal qualifications and to not be in current paid employment compared to recent ex-smokers (p<0.001). CONCLUSIONS This contemporary cohort, which seeks very detailed information on smoking in pregnancy and its determinants, includes women with comparable sociodemographic characteristics to those in other UK cross-sectional studies and cohorts. This suggests that future analyses using this cohort and aimed at understanding smoking behaviour in pregnancy may produce findings that are broadly generalisable.
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Affiliation(s)
- Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham, UK
- UK Centre for Tobacco and Alcohol Studies, UK
- National Institute for Health Research, School for Primary Care Research, UK
| | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Nottingham, UK
- UK Centre for Tobacco and Alcohol Studies, UK
- National Institute for Health Research, School for Primary Care Research, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham, UK
- UK Centre for Tobacco and Alcohol Studies, UK
- National Institute for Health Research, School for Primary Care Research, UK
| | - Felix Naughton
- UK Centre for Tobacco and Alcohol Studies, UK
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Michael Ussher
- UK Centre for Tobacco and Alcohol Studies, UK
- Division of Population Health Sciences and Education, St. Georges, University of London, London, UK
| | - Kate E Pickett
- UK Centre for Tobacco and Alcohol Studies, UK
- Department of Health Sciences, University of York, York, UK
| | - Jo Leonardi-Bee
- UK Centre for Tobacco and Alcohol Studies, UK
- National Institute for Health Research, School for Primary Care Research, UK
- Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Stephen Sutton
- UK Centre for Tobacco and Alcohol Studies, UK
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - Nafeesa N Dhalwani
- Division of Primary Care, University of Nottingham, Nottingham, UK
- UK Centre for Tobacco and Alcohol Studies, UK
- National Institute for Health Research, School for Primary Care Research, UK
- Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
- UK Centre for Tobacco and Alcohol Studies, UK
- National Institute for Health Research, School for Primary Care Research, UK
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Chen R, Hu Z, Orton S, Chen RL, Wei L. Association of passive smoking with cognitive impairment in nonsmoking older adults: a systematic literature review and a new study of Chinese cohort. J Geriatr Psychiatry Neurol 2013; 26:199-208. [PMID: 23877565 DOI: 10.1177/0891988713496165] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Association of passive smoking with cognitive impairment in older adults is unclear. We carried out a systematic literature review and a new study to determine the association. There were 3 cross-sectional studies published, showing a significant association of passive smoking with cognitive impairment (a relative risk (RR) of about 1.30-1.90). In the new cohort study, we interviewed 1081 never-smoking participants aged ≥ 65 years in China using a standard method of the Geriatric Mental State-Automated Geriatric Examination for Computer Assisted Taxonomy and found a significant association with dose response; multivariate adjusted RR was 1.02 (95% confidence interval 0.67-1.55) in > 0 to 49 exposure level years of passive smoking, 1.57 (1.00-2.47) in 50 to 99, and 2.12 (1.24-3.63) in ≥ 100, trend P = .008. The relationship seems not to be a reverse causality of the effect. Passive smoking could be considered an important risk factor for cognitive impairment in older adults. Avoiding exposure to passive smoking would help to preserve cognitive decline in later life.
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Affiliation(s)
- Ruoling Chen
- Division of Health and Social Care Research, King's College London, London, UK
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Zhang DM, Hu Z, Orton S, Wang JJ, Zheng JZ, Qin X, Chen RL. Socio-economic and psychosocial determinants of smoking and passive smoking in older adults. Biomed Environ Sci 2013; 26:453-467. [PMID: 23816579 DOI: 10.3967/0895-3988.2013.06.006] [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] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 02/12/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To determine the associations of socio-economic and psychosocial factors with active and passive smoking in older adults. METHODS Using a standard interview method, we examined random samples of 6071 people aged⋝60 years in 5 provinces of China during 2007-2009. RESULTS World age-standardised prevalence for current and former smoking in men was 45.6% and 20.5%, and in women 11.1% and 4.5%. Current smoking reduced with older age but increased with men, low socioeconomic status (SES), alcohol drinking, being never-married, pessimistic and depressive syndromes. Former smoking was associated with men, secondary school education, a middle-high income, being a businessman, being widowed, less frequencies of visiting children/relatives and friends, and worrying about children. Among 3774 never-smokers, the prevalence of passive smoking was 31.5%, and the risk increased with women, low SES, alcohol drinking, being married, having a religious believe, and daily visiting children/relatives. There were sex differences in the associations, and an interaction effect of education and income on smoking and passive smoking. CONCLUSION Older Chinese had a higher level of smoking and passive smoking than those in high income countries, reflecting China's failures in controlling smoking. The associations with low SES and different psychosocial aspects and sex differences suggest preventative strategies for active and passive smoking.
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Affiliation(s)
- Dong Mei Zhang
- School of Health Administration, Anhui Medical University, Hefei 230032, Anhui, China
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Chen R, Orton S. No smoke without fire: should we be more concerned about the association between smoking and dementia? Neurodegener Dis Manag 2012. [DOI: 10.2217/nmt.12.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Ruoling Chen
- Division of Health & Social Care Research, King’s College London, 7th Floor, Capital House, 42 Weston Street, London, SE1 3QD, UK
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham, NG7 2RD, UK
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Lang L, Orton S, Sallah D, Hewitt-Moran T, Zhang D, Cullen S, Dixon S, Bell B, Bell D, Meeson L, Chen R. A survey of engagement and competence levels in interventions and activities in a community mental health workforce in England. BMC Health Serv Res 2011; 11:352. [PMID: 22206471 PMCID: PMC3315436 DOI: 10.1186/1472-6963-11-352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 12/29/2011] [Indexed: 11/10/2022] Open
Abstract
Background National Health Service (NHS) mental health workforce configuration is at the heart of successful delivery, and providers are advised to produce professional development strategies. Recent policy changes in England have sharpened the focus on competency based role development. We determined levels of intervention activities, engagement and competence and their influencing factors in a community-setting mental health workforce. Methods Using a modified questionnaire based on the Yorkshire Care Pathways Model we investigated 153 mental health staff working in Coventry and Warwickshire NHS Trust. A median score of competence was computed across 10 cluster activities. Low engagement and competence levels were examined in a logistic regression model. Results In 220 activities, Monitoring risk was the highest rate of engagement (97.6%) and Group psychological therapy/Art/Drama therapy was the lowest engagement (3.6%). The median competence level based on all activities was 3.95 (proficient). There were significant differences in the competence level among professional groups; non-qualified support group (3.00 for competent), Counsellor/Psychologist/Therapist (3.38), Occupational therapists (3.76), Nurses (4.01), Medical staff (4.05), Social workers (4.25) and Psychologists (4.62 for proficient/expert). These levels varied with activity clusters; the lowest level was for Counsellor/Psychologist/Therapist in the accommodation activity (1.44 novice/advance beginner) and the highest for Occupational therapists in personal activity (4.94 expert). In a multivariate analysis, low competence was significantly related to non-qualified community support professions, late time of obtaining first qualification, more frequencies of clinical training, and training of cognitive behavioural therapy. The associations were similar in the analysis for 10 activity clusters respectively. Conclusions There was a reasonable competence level in the community-setting mental health workforce, but competence varied with professional groups and cluster activities. New staff and other non-qualified support professions need to receive efficient training, and the training content is more important than frequency to increase level of competence.
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Affiliation(s)
- Linda Lang
- School of Health and Wellbeing, University of Wolverhampton, Wolverhampton, UK
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Abstract
OBJECTIVE Genetic and environmental factors have important roles in multiple sclerosis (MS) susceptibility. The precise nature of these factors and mode of inheritance remains unknown. A female predominance is universally found. Recently, offspring of affected fathers were reported to be more likely to have MS than those of affected mothers. This was attributed to the Carter effect, which is seen in polygenic disorders. The Carter effect predicts that affected parents of the sex lesser affected by a disease/trait are more genetically loaded for risk alleles and thus transmit these more often to their offspring. This hypothesis was tested in a population-based Canadian MS cohort. METHODS Using the longitudinal Canadian database, we identified 3,088 nuclear families with one affected parent and a total of 8,401 offspring, of which 798 had MS. Transmission to daughters and sons from affected mothers and fathers was compared. RESULTS There was equal transmission of MS from affected fathers vs affected mothers (9.41% vs 9.76%). Stratifying by gender of affected parent there were no differences in the female:male sex ratio of affected (2.46% vs 2.41%, p = 0.88) or unaffected offspring (0.91% vs 0.95%, p = 0.46). CONCLUSIONS We observed equal disease transmission to offspring from affected mothers and affected fathers, no difference in the female:male sex ratio of affected offspring, and previously no difference in sibling recurrence risk by gender of parent affected. These findings show no evidence for the Carter effect and do not support the hypothesis of polygenic inheritance of multiple sclerosis susceptibility by parent.
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Affiliation(s)
- B M Herrera
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
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DeLuca GC, Ramagopalan SV, Cader MZ, Dyment DA, Herrera BM, Orton S, Degenhardt A, Pugliatti M, Sadovnick AD, Sotgiu S, Ebers GC. The role of hereditary spastic paraplegia related genes in multiple sclerosis. A study of disease susceptibility and clinical outcome. J Neurol 2007; 254:1221-6. [PMID: 17420921 DOI: 10.1007/s00415-006-0505-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 10/26/2006] [Accepted: 11/05/2006] [Indexed: 11/28/2022]
Abstract
Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system unsurpassed for its variability in disease outcome. It has been observed that axonal loss in MS is significant and that irreversible clinical disability relates to such axonal loss. The clinical similarities between Hereditary Spastic Paraplegia (HSP) and progressive MS, along with their analogous profiles of axonal loss in the long tracts, make the genes known to cause HSP biologically relevant candidates for the study of clinical outcome in MS. A cohort of sporadic MS cases and a set of unaffected controls were used to determine the role of HSP genes on MS susceptibility and disease severity. The MS cases were taken from opposite extremes of the putative distribution of long-term outcome using the most stringent clinical criteria to date. Genotyping the two sets of MS patients and controls could not provide any evidence to suggest that genes involved in the pathogenesis of HSP (Paraplegin, NIPA1, KIF5A, HSPD1, Atlastin, Spartin, Spastin, PLP1, L1CAM, Maspardin and BSCL2) play a role in susceptibility to, or modifying the course of, MS, although small effects of these genes cannot be ruled out.
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Affiliation(s)
- G C DeLuca
- University Dept. of Clinical Neurology, University of Oxford, Radcliffe Infirmary, Woodstock Rd, Oxford, OX2 6LE, UK
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Ramagopalan SV, Deluca GC, Morrison KM, Herrera BM, Dyment DA, Orton S, Bihoreau MT, Degenhardt A, Pugliatti M, Sadovnick AD, Sotgiu S, Ebers GC. No effect of APOE and PVRL2 on the clinical outcome of multiple sclerosis. J Neuroimmunol 2007; 186:156-60. [PMID: 17376543 DOI: 10.1016/j.jneuroim.2007.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 02/13/2007] [Accepted: 02/16/2007] [Indexed: 11/23/2022]
Abstract
Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system unsurpassed for its variability in disease outcome. Apolipoprotein E (APOE) is involved in neuronal remodelling and several studies have attempted to examine the effect of APOE on MS disease severity, but its function in modifying the course of MS is controversial. It has been suggested recently that PVRL2, not APOE, is the locus on chromosome 19 which influences clinical outcome of MS. A cohort of sporadic MS cases, taken from opposite extremes of the putative distribution of long-term outcome using the most stringent clinical criteria to date, was used to determine the role of APOE and PVRL2 on MS disease severity. The MS cases selected represent the prognostic best 5% (benign MS) and worst 5% (malignant MS) of cases in terms of clinical outcome assessed by the EDSS. Genotyping the two sets of MS patients (112 benign and 51 malignant) and a replication cohort from Sardinia provided no evidence to suggest that APOE or PVRL2 have any outcome modifying activity. We conclude that APOE and PVRL2 have little or no effect on the clinical outcome of MS.
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Herrera BM, Cader MZ, Dyment DA, Bell JT, Ramagopalan SV, Lincoln MR, Orton S, Chao MJ, Sadovnick AD, Ebers GC. Follow-up investigation of 12 proposed linkage regions in multiple sclerosis. Genes Immun 2006; 7:366-71. [PMID: 16738670 DOI: 10.1038/sj.gene.6364308] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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] [Indexed: 11/09/2022]
Abstract
Multiple sclerosis (MS) is an autoimmune disease with overwhelming evidence for genetic determination, and for which a maternal parent-of-origin effect has been reported. As with many complex diseases, multiple suggestive linkage signals have been observed. However, the only unambiguous association and linkage identified to date is with alleles of the human lymphocyte antigen (HLA) class II region. We have now carried out high-density microsatellite genotyping for 12 of the most promising regions (1p, 1q, 2q, 4q, 5p, 9q, 10p, 11p, 12q, 17q, 18p, 19p) from a whole-genome scan in 552 affected sibling pairs. This has been carried out in 194 families containing avuncular pairs. These permit examination of parent-of-origin effects in non-colineal pairs when divided into likely maternal and paternal trait transmission. The results do not confirm any non-major histocompatibility complex linkage in the overall subset nor in the maternal, paternal or HLA-DRB1*1501 subsets. We were able to establish exclusion for a locus with lambda(AV) > or = 1.3 for all the previously suggested regions. These results again raise the possibility that the paradigm of multiple genes of small individual effect used to justify genome searches in MS is incorrect.
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Affiliation(s)
- B M Herrera
- The Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
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Abstract
The lack of transfusion-transmitted syphilis in the United States in the past 30 years has led us to question the rationale for continued syphilis testing of blood donors. In addition, the significance of a confirmed positive syphilis test result in a blood donor is not clear. The following 2 questions have been raised: (1) Are we detecting any truly infectious donors? and (2) If not, what is the significance of a confirmed positive test for syphilis in contemporary blood donors? This review will summarize what is and what is not known about syphilis testing in blood donors and will discuss the need for further research to answer these questions.
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Affiliation(s)
- S Orton
- Transmissible Diseases Department, Jerome Holland Laboratory, American Red Cross, Rockville, MD 20855, USA
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Orton-Gibbs S, Orton S, Orton H. Eruption of third permanent molars after the extraction of second permanent molars. Part 2: Functional occlusion and periodontal status. Am J Orthod Dentofacial Orthop 2001; 119:239-44. [PMID: 11244417 DOI: 10.1067/mod.2001.111555] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [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: 11/22/2022]
Abstract
Functional occlusion and periodontal health were investigated after orthodontic treatment that involved extraction of second molars and after eruption of the third molars in 37 patients (25 female, 12 male). The mean age was 21 years 9 months (range, 16 years 1 month-30 years 5 months). The third permanent molars invariably erupted into a position that maintained good functional occlusion. Sixty-three percent of patients had canine guidance in lateral excursion; the remainder of patients had satisfactory group function. There were only 2 non-working side interferences in the sample, 1 from a recently erupted mandibular third molar. The periodontal health of the sample was generally excellent. Plaque score and bleeding on probing was very low (1.7% of sites). Periodontal health around both maxillary and mandibular teeth was extremely good. When attachment loss was assessed, 2238 of 2240 sites were clinically healthy. One patient, who had generally poor oral hygiene, had a 4-mm probing depth interproximally on the maxillary first and third molar contact. There was no correlation between periodontal health and mandibular third molar position. Therefore, both functional occlusion and periodontal health in the sample were good after loss of second permanent molars and eruption of the third molars.
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Affiliation(s)
- S Orton-Gibbs
- St Helier Hospital, 12 Walpole Road, Surbiton, Surrey KT6 6BU, UK.
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Narayanan S, Orton S, Leparc GF, Garcia-Rubio LH, Potter RL. Ultraviolet and visible light spectrophotometric approach to blood typing: objective analysis by agglutination index. Transfusion 1999; 39:1051-9. [PMID: 10532597 DOI: 10.1046/j.1537-2995.1999.39101051.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [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: 11/20/2022]
Abstract
BACKGROUND A new blood typing technology based on ultraviolet (UV) and visible light spectroscopy (UV/visible spectroscopy) has been developed. Blood groups and types are determined by quantifying reproducible changes in the UV and visible light spectra of blood in the presence of agglutinating antibodies. STUDY DESIGN AND METHODS Samples of red cells in the presence and absence of agglutinating antibodies were examined by UV/visible spectroscopy. Blood groups and types were determined by comparing the optical density spectra obtained between 665 and 1000 nm. These comparisons generate numbers (agglutination index) ranging from 0 to 100, with smaller numbers corresponding to lack of agglutination and larger numbers corresponding to agglutination. RESULTS The optical density of agglutinated blood is dramatically different from that of unagglutinated blood. The agglutination index derived from the relative slopes of the spectra is an objective indicator of agglutination strength. An agglutination index greater than 17 consistently and accurately established blood group- and type-specific agglutination. CONCLUSION The method accurately predicted A, B, and O blood groups, and D type in over 275 samples. Scattering theory-based calculations of relative volumes of red cells before and after agglutination show a direct correlation with the agglutination index and provide the theoretical basis of the analysis. This quantitative technique is reproducible and has the potential for automation.
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Affiliation(s)
- S Narayanan
- Department of Chemistry, University of South Florida, and Florida Blood Services, Tampa 33620, USA
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Orton S, Weinstock D, Hammerberg B. Association of elevated lymph node cell release of histamine and tumor necrosis factor with genetic predisposition to limb edema formation in dogs infected with Brugia pahangi. Am J Trop Med Hyg 1998; 58:695-704. [PMID: 9660448 DOI: 10.4269/ajtmh.1998.58.695] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 11/07/2022] Open
Abstract
Brugia pahangi infection in the canine rear limb results in marked lymphatic duct and popliteal lymph node pathologic changes. Limb edema is variably associated with infection and does not correlate well with duct or node lesions. To understand the mechanisms of limb edema, lymph node cells were collected by sequential biopsy following infection and examined for production of inflammatory mediators. Lymph node cells from a litter of dogs selectively bred with a high incidence of edema formation (82%) demonstrated spontaneously released histamine and prostaglandin E2 levels higher than those of closely related nonedema-forming dogs (0-20%) and/or control dogs. These edema-forming dogs also showed elevated release of tumor necrosis factor-alpha when cells were cultured with Brugia antigen. Toluidine blue staining of infected lymph node sections revealed that the edema-forming dogs had higher numbers of mast cells than infected lymph nodes of nonedema-forming dogs.
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Affiliation(s)
- S Orton
- Department of Microbiology, Pathology and Parasitology, College of Veterinary Medicine, North Carolina State University, Raleigh, USA
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Gebhard D, Orton S, Edmiston D, Nakagaki K, DeBoer D, Hammerberg B. Canine IgE monoclonal antibody specific for a filarial antigen: production by a canine x murine heterohybridoma using B cells from a clinically affected lymph node. Immunol Suppl 1995; 85:429-34. [PMID: 7558131 PMCID: PMC1383916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Canine popliteal lymph node cells taken at the onset of clinical disease from a rear limb infected with the filarial nematode Brugia pahangi were fused with mouse myeloma cell line P3X63.Ag8.653 cells. Of the several canine immunoglobulin-producing clones from this fusion, one was found to produce canine IgE specific for a filarial nematode antigen. The cell line has undergone limiting dilution cloning six times over the past 3 years and continues to produce monoclonal antibody of the IgE subclass at a rate of greater than 3 mg/l. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE) of the cell culture supernatant protein that bound to protein A beads, showed bands at molecular weights (MW) of approximately 75,000 and 25,000 that were characteristic of epsilon and kappa or lambda chains, respectively. A mouse monoclonal antibody specific for canine IgE bound the 75,000 MW band, as demonstrated by Western blot. Western blots of aqueous extracts of adult filarial nematodes demonstrated binding of the canine IgE monoclonal antibody to a single 35,000 MW peptide from B. pahangi but not Dirofilaria immitis; immunochemistry using frozen sections of adult worms, microfilariae and fourth stage larvae revealed focal binding of the monoclonal IgE to worm tissue adjacent to dorsal and ventral cords of only Brugia adults.
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Affiliation(s)
- D Gebhard
- College of Veterinary Medicine, North Carolina State University, Raleigh, USA
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Abstract
This paper describes a modified Maxillary Intrusion Splint (M.I.S.) system which incorporates a near vertical pull headgear, and its use in the management of severe 'gummy' Class II division 1 malocclusion. The appliance was designed to reduce the visibility and vulnerability of the maxillary incisors in this difficult clinical situation by achieving the intrusion of maxillary teeth, restraining maxillary growth, and encouraging an element of subsequent forward mandibular rotation. The authors' initial experience using this system is presented in a retrospective cephalometric analysis of the lateral skull films of 26 treated patients contrasted with a similar number of comparable controls. The results showed that the principal effects of the M.I.S. were on the maxillary teeth giving decisive overjet control and incisor retraction with actual maxillary incisor intrusion. There was a similar effect on the maxillary molar and the M.I.S. provided effective en masse vertical control of the maxillary dentition. There was some degree of maxillary restraint in the M.I.S. group, but no noticeable difference in the change of mandibular position between the groups at the end of treatment. The possible reasons for this are discussed and suggestions made to improve this aspect of treatment in these patients.
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Affiliation(s)
- H S Orton
- Wrexham Park Hospital Slough Berkshire
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Orton HS, Sullivan PG, Battagel JM, Orton S. The management of class III and class III tendency occlusions using headgear to the mandibular dentition. Br J Orthod 1983; 10:2-12. [PMID: 6573194 DOI: 10.1179/bjo.10.1.2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The use of extra-oral traction to the lower arch in the treatment of Class III malocclusion is described. The results of the treatment of 43 consecutive cases employing both removable and fixed appliances are analysed and compared with an untreated control group of 15 further cases. It was found that the Class III malocclusion in the study fell into three groups, the characteristic of each group giving an indication of the recommended treatment approach.
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