[Ten Years of Smoking Ban - Effects of the Federal Nonsmoker Protection Act Exemplified by the Traditional Pub District of Cologne's Südstadt]. / Zehn Jahre Rauchverbot − Auswirkungen des Nichtraucherschutzgesetzes am Beispiel des traditionellen Kneipenviertels der Kölner Südstadt.

BACKGROUND: Since September 2007, the Federal Nonsmoker Protection Act regulates a general legal ban on smoking in federal facilities, public transport vehicles and passenger stations. Other smoking bans are not uniformly regulated and vary from state to state. In addition to places of public interest, sports venues and the workplace, particular attention in political debates has always been paid to bars and restaurants, where smoking has always been part of the picture. The situation of the Südstadt pubs in Cologne considered in this paper is governed by the expanded law for the protection of non-smokers in North Rhine Westphalia (NRW) of December 20, 2007. METHODS: A survey using a specifically created questionnaire comprising 24 items was carried out. Persons over 26 years of age visiting selected bars were interviewed in order to ensure that at the time the Nonsmoker Protection Act was introduced, participants had reached the legal age for smoking. Data acquisition was carried out both by direct surveys of participants in selected pubs in Cologne's Südstadt and by means of online surveys, attention to which had been drawn in the press, television and through social media. RESULTS: A total of 1318 completed questionnaires were evaluated. Participants were on average 49 years old (±â€Š12.1). Of the 1318 respondents, 726 were active smokers in 2007 (55.1 %). In 2018, 518 (39.3 %) (p: < 0.001) respondents stated that they were still active smokers. Of the 726 active smokers, 289 (39.8 %) had been consuming more than 20 cigarettes a day in 2007. In 2018, 179 of 518 (34.6 %) (p: < 0.001) were heavy smokers. In 2007, 303 persons (41.7 % of smokers) fell into the group of medium smokers with 10 - 19 cigarettes per day, in 2018 there were 227 (43.8 %) (p: < 0.001). The group of people who smoked less and consumed 1 - 9 cigarettes per day included a total of 134 persons (18.5 %) in 2007 and 112 (21.6 %) in 2018 (p: < 0.001). Among active smokers, the smoking ban was the most relevant cause for a change in smoking behaviour in this survey. Among non-smokers or former smokers, health aspects as well as family and friends were the decisive factors in rejecting tobacco products. SUMMARY: Based on a sample of 1318 participants among pub visitors, the study showed that the number of active smokers had significantly and distinctly decreased since the introduction of the Nonsmoker Protection Act in 2007. Furthermore, the number of people with rather low cigarette consumption showed a significant increase.

Black Raspberry Inhibits Oral Tumors in Mice Treated with the Tobacco Smoke Constituent Dibenzo(def,p)chrysene Via Genetic and Epigenetic Alterations.

We previously reported that the environmental pollutant and tobacco smoke constituent dibenzo[def,p]chrysene (DBP) induced DNA damage, altered DNA methylation and induced oral squamous cell carcinoma (OSCC) in mice. In the present study, we showed that 5% dietary black raspberry (BRB) significantly reduced (P < 0.05) the levels of DBP-DNA adducts in the mouse oral cavity with comparable effect to those of its constitutes. Thus, only BRB was selected to examine if aberrant DNA methylation induced by DBP can be altered by BRB. Using comparative genome-wide DNA methylation analysis, we identified 479 hypermethylated and 481 hypomethylated sites (q < 0.01, methylation difference >25%) between the oral tissues of mice treated with DBP and fed control diet or diet containing BRB. Among the 30 differential methylated sites (DMS) induced by DBP, we found DMS mapped to Fgf3, Qrich2, Rmdn2, and Cbarp were hypermethylated by BRB whereas hypomethylated by DBP at either the exact position or proximal sites; DMS mapped to Vamp3, Ppp1rB1, Pkm, and Zfp316 were hypomethylated by BRB but hypermethylated by DBP at proximal sites. In addition to Fgf3, 2 DMS mapped to Fgf4 and Fgf13 were hypermethylated by BRB; these fibroblast growth factors are involved in regulation of the epithelial-mesenchymal transition (EMT) pathway as identified by IPA. Moreover, BRB significantly reduced (P < 0.05) the tumor incidence from 70% to 46.7%. Taken together, the inhibitory effects of BRB on DNA damage combined with its effects on epigenetic alterations may account for BRB inhibition of oral tumorigenesis induced by DBP. SIGNIFICANCE: We provided mechanistic insights that can account for the inhibition of oral tumors by BRB, which could serve as the framework for future chemopreventive trials for addicted smokers as well as non- or former smokers who are exposed to environmental carcinogens.

Implementing Parental Tobacco Dependence Treatment Within Bronchiolitis QI Collaboratives.

BACKGROUND AND OBJECTIVES: We sought to implement systematic tobacco dependence interventions for parents and/or caregivers as secondary aims within 2 multisite quality improvement (QI) collaboratives for bronchiolitis. We hypothesized that iterative improvements in tobacco dependence intervention strategies would result in improvement in outcomes between collaboratives. METHODS: This study involved 2 separate yearlong, multisite QI collaboratives that were focused on care provided to inpatients with a primary diagnosis of bronchiolitis. In each collaborative, we provided tools and training in tobacco dependence treatment and expert coaching on interventions for parents as a secondary aim. Data were collected by chart review and results analyzed by using analysis of means and statistical process control analysis. Outcomes between collaboratives were compared by using relative risks. RESULTS: Between both collaboratives, 56 hospitals participated and 6258 inpatient charts were reviewed. In the first collaborative, 22% of identified parents who smoke received tobacco dependence interventions at baseline. This rate increased to 51% during the postintervention period, with special cause revealed by analysis of means. In the second collaborative, 31% of parents who smoke received baseline interventions. This rate increased to 53% by the conclusion of the collaborative, with special cause revealed by statistical process control analysis. The relative risk for providing any cessation intervention in 1 collaborative versus the other was 0.9 (confidence interval 0.8-1.1). CONCLUSIONS: Tobacco dependence treatment of parents and/or caregivers can be integrated into bronchiolitis QI by using relatively low-resource strategies. Using a more intensive QI intervention did not alter the rates of screening or intervention for caregivers who smoke.

Parental Depression is Prospectively Associated With Lower Smoking Cessation Rates and Poor Child Asthma Outcomes.

Background: Depressive symptoms are elevated in parents of asthmatic children compared with parents of healthy children. The role of depression in smoking cessation and pediatric asthma outcomes in this population is unclear. Purpose: To prospectively examine the effect of parent depression on smoking cessation and child asthma outcomes. Methods: Secondary analysis from a cessation induction trial involving Motivational Interviewing (MI) and biomarker feedback on secondhand smoke exposure (SHSe). Parents (n=341) had an asthmatic child (mean age=5.2 years) and did not have to want to quit smoking to enroll. Intervention included asthma education, MI, and SHSe feedback plus randomization to six counseling (MI; repeated feedback) or control calls (brief check on asthma) for 4 months. Depressive symptoms were defined as scoring ≥22 on the Center for Epidemiologic Study-Depression scale. Smoking outcomes were bioverified 7- and 30-day point-prevalence abstinence (ppa). Child asthma outcomes were past month functional limitation, health care utilization, and number of days with asthma symptoms. Data were obtained at baseline, 2, 4, and 6 months. Results: Parental depression was associated with lower odds of abstinence (7-day ppa odds ratio [OR]=0.38, 95% confidence interval [CI]=0.23, 0.64; 30-day ppa OR=0.27, 95% CI=0.15, 0.47), greater odds of child health care utilization for asthma (OR=1.71, 95% CI=1.01, 2.92), and greater child asthma functional limitation (B=0.16, SE=0.06, p=.03) even after controlling for smoking status. Depression predicted a greater number of child asthma symptom days (B=1.08, SE=0.44, p=.01), but this became nonsignificant after controlling for smoking status. Conclusions: Among parents who smoke, both depressive symptoms and smoking should be targeted for treatment aimed at improving pediatric asthma.

[THE DIFFERENTIATED APPROACH TO PREVENTION OF NEURAL TUBE DEFECTS IN CHILDREN].

Neural tube defects occupy second place in frequency after the defects of the cardiovascular system. The folate metabolism violation and hyperhomocysteinemia in women are proved to be the leading risk factors for the NTD of the fetus. Polymorphism of the 5,10-methylenetetrahydrofolate reductase gene (MTHFR) is a genetic determinant of folate metabolism violation. Admission of folic acid in a standard dose of 0.4 mg and / or the use of fortified foods does not allow reaching the protective level of folic acid if there is a mutation of the MTHFR gene or when several risk factors combine, which requires a higher dose of folic acid. The aim of the study is to develop an algorithm for the identification of women of reproductive age with the risk of having a child with NTD and to apply differentiated approach to the choice of a preventive dose of folic acid. A retrospective analysis of NTD cases in the Odessa region (Ukraine) for 2000-2013 was carried out. The frequency of the birth of children with CNS defects and NTD, risk factors of NTD in children were studied. Mothers and their children with NTD were evaluated for the level of folic acid, homocysteine and the presence of C677T and A1298C MTHFR polymorphisms. The incidence of spina bifida aperta is 4.9 per 10,000 newborns. Two groups of significant risk factors for the NTD in children were identified: 1) risk factors that can be eliminated - the absence of preconceptional prevention of NTD with folic acid (AR 0.4), second-hand tobacсo smoking (AR 0.33), fever/hot baths in the first trimester of pregnancy (AR 0.64), use of well water for cooking (AP 0.44); 2) risk factors that can not be eliminated, and which indicate a genetic risk of NTD - a family history of a stroke, heart attack, thrombosis, congenital malformations, malignant tumors (AR 0.54-0.7), an obstetrical history of miscarriage (AR 0.56 ), mother's diseases (varicose disease, obesity), NTD in other children in this family (AR 0.74). The mothers of children with NTD showed a decreased level of folic acid and an increased level of homocysteine in addition to the correlation of hyperhomocysteinemia with the mutations of the MTHFR gene. The algorithm for assessing the individual risk of having a child with NTD includes the evaluation of risk factors. If a genetic factor of folate metabolism violation or environmental risk factors that can not be eliminated are found, we recommend an additional examination. It includes determining the level of homocysteine and the MTHFR polymorphisms (in the case of hyperhomocysteinemia), which will identify the required dose of folic acid.

¿Pueden el coaching, la inteligencia emocional y la programación neurolingüística (PNL) aportar herramientas útiles para potenciar la autoeficacia en la deshabituación del tabaquismo? La visión de los profesionales / ¿Can coaching, emotional intelligence and neurolingustic programming (NLP) provide useful tools to strengthen self-efficacy in smoking cessation? The view of the professionals

Se trata de un estudio que describe la utilidad que da un grupo de profesionales de medicina y enfermería a la formación en coaching, inteligencia emocional y PNL (programación neurolingüística) como herramientas para potenciar la autoeficacia de los pacientes sometidos a tratamiento para su tabaquismo. Objetivos. El objetivo principal de este trabajo es conocer el perfil y opinión de los profesionales que muestran interés hacia ese tipo de formación. Material y métodos. Se ha diseñado un curso de formación acreditado con 10 horas ofertado en dos ediciones. Se ha recogido una muestra de 55 alumnos que han completado de manera anónima un cuestionario específicamente diseñado a este efecto. Resultados. El 71% de los alumnos pertenecen al grupo profesional de enfermería, en el 80% son mujeres y el rango de edad más numeroso está entre 41-50 años. Los conocimientos adquiridos sobre el concepto de autoeficacia han sido muy altos ya que 34 de los 55 participantes respondió correctamente el 100% del cuestionario y ninguno falló más de 3 preguntas sobre 10. El 100% señaló su acuerdo con puntuación ≥ 8 puntos sobre 10 que 'En la deshabituación del tabaquismo es importante entrenar al paciente para que mejoren sus recursos relacionados con la autoeficacia' y el 94% señaló su acuerdo con ≥ 8 puntos sobre 10 que 'El coaching puede ser una buena herramienta para el incremento de la autoeficacia en nuestros pacientes'. Conclusiones. La formación en torno al concepto de autoeficacia resulta bien valorada por los profesionales y es rentable en términos de aprovechamiento. El coaching, la inteligencia emocional y la PNL (programación neurolingüística) pueden resultar buenas herramientas para ello (AU)

This is a study that describes the utility provided by training in coaching, emotional intelligence and NLP (neurolinguistic programming) to medical and nursing professionals as tools to strengthen self-efficacy of the patients subjected to smoking cessation treatment. Objectives. The primary objective of this work is to know the profile and opinion of the professionals who demonstrate interest in this type of training. Material and methods. A training course accredited with 10 hours offered in two editions has been designed. A sample of 55 students who have completed anonymously a questionnaire specifically designed to this effect was collected. Results. A total of 71% of the students belong to the professional group of nursing, 80% being women whose most numerous age range goes from 41-50 years. The knowledge acquired on the concept of self-efficacy was very high since 34 of the 55 participants correctly responded to 100% of the questionnaire and none incorrectly answered more than 3 questions out of 10. One hundred percent indicated their agreement with the score ≥ 8 points out of 10 that 'In smoking cessation, it is important to train the patient to improve their resources related with self-efficacy' and 94% indicted their agreement with ≥ 8 points out of 10 that 'Coaching can be a good tool to increase the self-efficacy in our patients.' Conclusions. Training regarding the concept of self-efficacy is well-evaluated by the professionals and is profitable in terms of utilization. Coaching, emotional intelligence and NLP (neurolinguistic programming) may be good tools for it (AU)

[Protection against tobacco smoke--compounds and substances of natural orgin]. / Ochrona przed dymem tytoniowym--zwiazki i substancje pochodzenia naturalnego.

Tobacco smoke contains thousands of ingredients, including those causing serious respiratory and cardiovascular diseases, and which are carcinogens or cancer promoters. Plants and plant products have antioxidant properties and have a protective role against cancer defined as chemoprevention. This paper presents an overview of published experiments on the protective effect against tobacco smoke or its by compounds and raw materials of natural origin, from plants mainly. These were: N-acetyl-L-cysteine, vitamin C, A and E, beta-carotene, lycopene, andrographolide, farnesol, resveratrol, marigold and tea. These studies were carried out on experimental animals or animal or human cells, which were exposed to cigarette smoke or its extract, or components of tobacco smoke. The studies have shown that the mentioned compounds and raw materials have a protective effect against the harmful effects of tobacco smoke. Mechanisms of action were different--the increase of the level of glutathione and antioxidant enzymes, prevention DNA strand breakage and lipid peroxidation, increased accumulation of the transcription factor Nrf2 that controls the expression of antioxidant genes. Authors frequently suggested that the investigated compounds and the materials may have similar protective effects against tobacco smoke in humans.

Impact of a long-term tobacco-free policy at a comprehensive cancer center: a series of cross-sectional surveys.

BACKGROUND: Spain has passed two smoke-free laws in the last years. In 2005, the law banned smoking in indoor places, and in 2010 the ban was extended to outdoor areas of certain premises such as hospitals. This study assesses the impact of smoking consumption among hospital workers at a comprehensive cancer center after the passage of two national smoke-free laws. METHODS: Six cross-sectional surveys were conducted among a representative sample of hospital workers at a comprehensive cancer center in Barcelona (2001-2012) using a standardized questionnaire. Logistic regression was used to compare differences in the odds of smoking after the laws took effect (baseline vs. 1st law; 2nd law vs. 1st law). RESULTS: Baseline smoking prevalence was 33.1%. After passage of the 1st and 2nd laws, prevalence decreased, respectively, to 30.5% and 22.2% (p for trend =0.005). Prevalence ratios (PR) indicated a significant decrease in overall smoking after the 2nd law (PR = 0.65, 95% CI = 0.47-0-89). Smoking dropped in all professional groups, more prominently among those ≥35 years old, doctors, and women. Observed trends over the time included an increase in occasional smokers, a rise in abstinence during working hours but an increase in smoking dependence, and an increase in the employees' overall support for the smoke-free hospital project. CONCLUSIONS: A long-term tobacco control project combined with two smoke-free national laws reduced smoking rates among health workers and increased their support for tobacco control policies. The decrease was more significant after the passage of the outdoor smoke-free ban.

The experiences of women who quit smoking during pregnancy and how they dealt with their spouses' continued smoking.

OBJECTIVE: to explore how pregnant women in Taiwan dealt with their spouses who continued to smoke and with passive smoking during their own process of quitting and abstaining. DESIGN: a qualitative study using an oral history approach. Data were collected via tape-recorded open-ended interviews. All interviews were transcribed verbatim. Data were analysed using narrative analysis. SETTING: the homes of the participant women living in the district of a regional hospital of eastern Taiwan. PARTICIPANTS: a purposive sample of 10 Taiwanese women who had quit smoking while pregnant was recruited at 1-3 months following the birth of their infants. FINDINGS: five major themes emerged: (1) the women coping with tobacco addiction on their own, (2) creating a non-smoking section or environment at home, (3) dealing with passive smoking, (4) conflict over the wife's sensitivity to her spouse's residual tobacco smell, and (5) allowing the husband to continue smoking to avoid conflicts. KEY CONCLUSIONS: the pregnant women were expected by their spouses to quit smoking, yet the husbands continued to smoke. Women had to struggle to quit smoking on their own. The findings from this study support the need to listen to pregnant women's stories, as this is paramount to understanding their experiences of tobacco-use reduction and cessation, and for developing gender appropriate interventions to support their efforts. IMPLICATIONS FOR PRACTICE: health care providers should encourage and help pregnant women who are willing to quit smoking. This help could be more family-centred instead of focusing on the pregnant women alone, and therefore involve educating the spouse to support his wife.

Development of policy performance indicators to assess the implementation of protection from exposure to secondhand smoke in China.

OBJECTIVE: To develop an approach for rapid assessment of tobacco control interventions in China. We examined the correlation between components of the Strength of Tobacco Control (SOTC) index and a proposed rapid evaluation indicator, the Policy Performance Indicator (PPI), which is based on protection of non-smokers from secondhand smoke (SHS). The PPI was used to assess the implementation of policies related to SHS at the provincial/municipal level in China. METHODS: Stratified random sampling was used to select five types of organisational and household respondents in two municipalities and five provinces in China (Shanghai and Tianjin, Heilongjiang, Henan, Guangdong, Zhejiang and Jiangxi, respectively). Data collection methods included key informant interviews, observation and intercept surveys (organisations), and a modified Global Adult Tobacco Survey (GATS) questionnaire (households). SOTC scores (SHS policy, capacity and efforts), PPI (no smoking in designated smoke-free places) and mid-term to long-term impact (knowledge, attitude and reduced exposure to SHS) were measured, and correlations among them were calculated. RESULTS: The PPI varied across the seven locations. Shanghai led in the component indicators (at 56.5% for indoor workplaces and 49.1% for indoor public places, respectively), followed by Guangdong, Tianjin and Zhejiang (at 30-35% for these two indicators), and finally, Henan and Jiangxi (at 20-25%). Smoke-free policies were more effectively implemented at indoor workplaces than indoor public places. The PPI correlated well with certain components of the SOTC but not with the long-term indicators. CONCLUSIONS: The PPI is useful for evaluating implementation of smoke-free policies. As tobacco control programmes are implemented, the PPI offers an indicator to track success and change strategies, without collecting data for a full SOTC index.

Global alliance against chronic respiratory diseases in Italy (GARD-Italy): strategy and activities.

The steady increase in incidence of chronic respiratory disease (CRD) now constitutes a serious public health problem. CRDs are often underdiagnosed and many patients are not diagnosed until the CRD is too severe to prevent normal daily activities. The prevention of CRDs and reducing their social and individual impacts means modifying environmental and social factors and improving diagnosis and treatment. Prevention of risk factors (tobacco smoke, allergens, occupational agents, indoor/outdoor air pollution) will significantly impact on morbidity and mortality. The Italian Ministry of Health (MoH) has made respiratory disease prevention a top priority and is implementing a comprehensive strategy with policies against tobacco smoking, indoor/outdoor pollution, obesity, and communicable diseases. Presently these actions are not well coordinated. The Global Alliance against Chronic Respiratory Diseases (GARD), set up by the World Health Organization, envisages national bodies; the GARD initiative in Italy, launched 11/6/2009, represents a great opportunity for the MoH. Its main objective is to promote the development of a coordinated CRD program in Italy. Effective prevention implies setting up a health policy with the support of healthcare professionals and citizen associations at national, regional, and district levels. What is required is a true inter-institutional synergy: respiratory diseases prevention cannot and should not be the responsibility of doctors alone, but must involve politicians/policymakers, as well as the media, local institutions, and schools, etc. GARD could be a significant experience and a great opportunity for Italy to share the GARD vision of a world where all people can breathe freely.

In vitro assessment of tobacco smoke toxicity at the BBB: do antioxidant supplements have a protective role?

BACKGROUND: Tobacco smoke (TS) contains highly reactive oxygen species (such as hydrogen peroxide, peroxynitrite, etc), which cause oxidative damage in vascular tissue and may exacerbate inflammatory events leading to the blood-brain barrier damage (BBBD) which accompanies the development of a variety of neurological disorders. Smokers often have elevated leukocyte counts (primarily neutrophils and monocytes), and significant decreases in plasma alpha-tocopherol (vitamin E) and ascorbic acid (vitamin C) levels due to increased anti-oxidative mobilization in response to oxidative stress evoked by TS. For this purpose, using static culture systems and a well-established dynamic in vitro BBB model (DIV-BBB) we tested the hypothesis that antioxidant vitamin supplementation (E and/or C) can protect the BBB during exposure to whole soluble TS. RESULTS: TS exacerbates inflammatory events and leads to endothelial overexpression of vascular adhesion molecules (VCAM-1, P-selectin and E-selectin), release of pro-inflammatory cytokines (TNF-α and IL-6) and nitric oxide (NO), release and activation of matrix metalloproteinases (MMP-2 and MMP-9), monocytic maturation into macrophages, and adhesion to the vascular endothelium. Furthermore, TS altered the normal glucose metabolic behaviour of in vitro BBB capillaries and caused a period of transient anaerobic respiration to meet the cellular bioenergetic demand. Pre-treatment with antioxidant vitamins (C and/or E) effectively reduced the pro-inflammatory activity associated with TS, protecting the viability and functions of the BBB. CONCLUSION: Our results have shown that loss of endothelial viability as well as BBB function and integrity caused by TS exposure can be prevented or at least reduced by normal physiologic concentrations of antioxidant vitamins in vitro.

The clinical implications of a smoking ban on submarines in the U.S. Navy.

By the end of calendar year 2010, a total smoking ban on submarines is expected to be implemented throughout the submarine force because of the negative health effects of environmental tobacco smoke and the recently demonstrated exposure of nonsmoking submariners to measurable levels of nicotine during submarine deployments. Historically, smoking has been highly prevalent in the military, but new data on the negative health effects of tobacco have led the military to change its policies, restricting its use in certain environments. A number of research studies have examined the effect of smoking on the military, cessation and prevention interventions, effect of environmental tobacco smoke onboard the submarine, and treatment modalities aimed at smokers attempting to quit. With the potential for considerable physical and psychological effects, a mass tobacco cessation program is being implemented to support the prohibition onboard the submarine. Recommendations for a successful implementation program are included.

[Systematic literature review on interventions in rehabilitation for children and adolescents with asthma bronchiale]. / Systematische Literaturanalyse zur rehabilitativen Behandlung von Kindern und Jugendlichen mit Asthma bronchiale.

Relevant data bases were used to collect and evaluate guidelines, meta-analyses, and reviews as well as primary studies dealing with asthma therapy for children and adolescents. Treatment approaches whose effectiveness with regard to bronchial asthma was empirically verified (i. e., evidence-based) were identified (medical and diagnostic procedures as well as drug trials were excluded from the analysis). 152 methodically sound studies referring to asthma treatment of children and adolescents were selected. Strong evidence was found for patient education, parent education, exercise therapy, inhalation, and tobacco withdrawal. Nutritional counseling and avoidance of allergens showed limited evidence. Psychotherapy, relaxation techniques, breathing exercises, climate therapy, clinical social work (social and legal counseling services, vocational reintegration counseling, aftercare) and integration counseling showed inconsistent evidence. No evidence was found for alternative medicine. Challenges regarding the development of treatment standards for children and adolescent rehabilitation are highlighted; these refer to limitations in report quality in some of the studies, the validity of treatments for comorbid conditions, a lack of differentiation for different age groups, and transferability of outpatient or international study results to inpatient rehabilitation.

Prevalence of smoking during pregnancy and associated risk factors among Canadian women: a national survey.

BACKGROUND: Cigarette smoking carries a threat both to the expecting mother and her newborn. Data on the prevalence and predictors of smoking during pregnancy is limited in Canada. Canadian studies are mainly representative of specific cities and/or provinces. Therefore, the study aims to assess the prevalence of smoking during pregnancy and its associated risk factors throughout the Canadian provinces and territories. METHODS: The analysis was based on the Maternity Experience Survey targeting women aged > or =15 years who had singleton live births during 2005/06 in the Canadian provinces and territories. The outcome was ever smoking during the thirst trimester of pregnancy. Socio-economic factors, demographic factors, maternal characteristics, and pregnancy related factors that proved to be significant at the bivariate level were considered for a logistic regression analysis. Bootstrapping was performed to account for the complex sampling design. RESULTS: The sample size was 6,421 weighted to represent 76,508 Canadian women. The prevalence of smoking during pregnancy was 10.5%, whereby smoking mothers consumed on average 7 cigarettes a day (95% Confidence interval - CI: 6.5-7.4; SD = 5.7). Regression analysis revealed that mothers who smoked during pregnancy were more likely to be of low socio-economic status, non-immigrant, single and passive smokers during pregnancy. Not attending prenatal classes and experiencing stressful events before/during pregnancy also increased the mothers' odds of smoking during pregnancy. While the age of the mother's first pregnancy was negatively associated with smoking during pregnancy, the mother's current age was positively associated with it. CONCLUSION: Smoking during pregnancy is still prevalent among Canadian women. The findings may be useful to enhance smoking prevention programs and integrated health promotion strategies to promote positive health behaviors among disadvantaged pregnancies.

The design, implementation and acceptability of an integrated intervention to address multiple behavioral and psychosocial risk factors among pregnant African American women.

BACKGROUND: African American women are at increased risk for poor pregnancy outcomes compared to other racial-ethnic groups. Single or multiple psychosocial and behavioral factors may contribute to this risk. Most interventions focus on singular risks. This paper describes the design, implementation, challenges faced, and acceptability of a behavioral counseling intervention for low income, pregnant African American women which integrated multiple targeted risks into a multi-component format. METHODS: Six academic institutions in Washington, DC collaborated in the development of a community-wide, primary care research study, DC-HOPE, to improve pregnancy outcomes. Cigarette smoking, environmental tobacco smoke exposure, depression and intimate partner violence were the four risks targeted because of their adverse impact on pregnancy. Evidence-based models for addressing each risk were adapted and integrated into a multiple risk behavior intervention format. Pregnant women attending six urban prenatal clinics were screened for eligibility and risks and randomized to intervention or usual care. The 10-session intervention was delivered in conjunction with prenatal and postpartum care visits. Descriptive statistics on risk factor distributions, intervention attendance and length (i.e., with < 4 sessions considered minimal adherence) for all enrolled women (n = 1,044), and perceptions of study participation from a sub-sample of those enrolled (n = 152) are reported. RESULTS: Forty-eight percent of women screened were eligible based on presence of targeted risks, 76% of those eligible were enrolled, and 79% of those enrolled were retained postpartum. Most women reported a single risk factor (61%); 39% had multiple risks. Eighty-four percent of intervention women attended at least one session (60% attended > or = 4 sessions) without disruption of clinic scheduling. Specific risk factor content was delivered as prescribed in 80% or more of the sessions; 78% of sessions were fully completed (where all required risk content was covered). Ninety-three percent of the subsample of intervention women had a positive view of their relationship with their counselor. Most intervention women found the session content helpful. Implementation challenges of addressing multiple risk behaviors are discussed. CONCLUSION: While implementation adjustments and flexibility are necessary, multiple risk behavioral interventions can be implemented in a prenatal care setting without significant disruption of services, and with a majority of referred African American women participating in and expressing satisfaction with treatment sessions.