The effect of Transtheoretical Model based interventions on smoking cessation.

The Transtheoretical Model (TTM) proposes that stage matching improves the effectiveness of behaviour change interventions, such as for smoking cessation. It also proposes that standard smoking cessation interventions are matched to the relatively few smokers in the preparation stage and will not assist the majority of smokers, who are in the precontemplation or contemplation stages. This study tested the hypothesis that stage-matched interventions increase movement through the stages relative to interventions not stage-matched. It also tested the hypothesis that the relative effectiveness of stage-matched interventions is greater for people in precontemplation or contemplation (stage-matched for TTM but not for control) than for people in preparation (where both intervention and control were stage-matched). A total of 2471 UK adult smokers were randomised to either control or TTM-based self-help intervention and followed up 12 months after beginning the programme. Content analysis of the intervention and control self-help interventions examined whether control interventions were action-oriented, meaning they emphasised the processes of change relevant for preparation and action. Participants in the TTM arm were slightly more likely to make a positive move in stage, but this was not significant. There was no evidence that the TTM-based intervention was more effective for participants in precontemplation or contemplation than for participants in preparation. There was no evidence that TTM-based interventions were effective in this trial. The control intervention advocated process use appropriate for all stages and was not action-orientated. Stage matching does not explain the modest effects of TTM-based interventions over control interventions observed in some trials. These effects may instead have occurred because TTM-based interventions were more intensive than control interventions.

Perceptions of the health effects of stoves in Mongolia.

PURPOSE: The purpose of this paper is to evaluate the views of stove users in Ulaanbaatar, Mongolia on how stoves affect their health. DESIGN/METHODOLOGY/APPROACH: In this paper focus groups were conducted with improved stove users; traditional stove users; and a mix of traditional and improved stove users. Individual interviews were also held with various types of stove users. A translator moderated all discussions with a questioning route. All discussions were fully transcribed and translated. The transcripts were analysed by identifying common themes in responses to form an emerging theory. FINDINGS: The findings in the paper are that all stove users recognised respiratory symptoms caused by stove smoke and other health effects such as warmth, dirt and workload, which they perceived to be important. Stove users had a lack of knowledge about the diseases caused by the smoke. Public health was a key driver for the improved stove project, yet has been neglected in improved stove marketing. RESEARCH LIMITATIONS/IMPLICATIONS: The study used in this paper was limited by the language barrier. Some of the meanings of participants' responses may have been lost in translation. PRACTICAL IMPLICATIONS: This paper has highlighted the importance of the health effects of stove smoke to stove users. Uptake of the improved stoves has been low. Public health should be included in marketing strategies for improved stoves to increase their uptake. ORIGINALITY/VALUE: The paper shows that acute respiratory infections are a major cause of mortality world-wide. Indoor air pollution from burning biomass fuels in household stoves causes a significant proportion of respiratory infections. No qualitative research has been published exploring stove users' views on the health effects of stoves. This paper provides an insight into stove users' perceptions for those interested in people-centred approaches to tackling international health issues.

The risk of preterm delivery in women from different ethnic groups.

OBJECTIVE: To examine whether routinely measured variables explained the increased risk of preterm delivery in some UK ethnic groups. DESIGN: Cross sectional study of deliveries recorded in the Child Health Record System. SETTING: North Birmingham, UK. POPULATION: All North Birmingham women delivering singletons, 1994-1997 inclusive. METHOD: Logistic regression. MAIN OUTCOME MEASURES: Odds ratio (OR) and 95% confidence interval (CI) for preterm delivery, defined as less than 37 weeks, less than 34 weeks and less than 28 weeks, unadjusted and adjusted for maternal age, an area-based socio-economic status measure, and marital status, year of birth, fetal sex and past obstetric history. RESULTS: For Afro-Caribbean women, the ORs (95% CIs) were: for delivery less than 37 weeks, 1.44 (1.26-1.64) unadjusted and 1.22 (1.07-1.41) adjusted; for delivery less than 34 weeks, 1.55 (1.25-1.92) unadjusted and 1.29 (1.02-1.61) adjusted; for delivery less than 28 weeks, 1.66 (1.08-2.55) unadjusted and 1.32 (0.84-2.06) adjusted. For African women, the risk of delivery less than 37 weeks was not significantly raised; for delivery less than 34 weeks, the OR (95% CI) was 1.88 (0.99-3.58) unadjusted and 1.78 (0.93-3.40) adjusted; for delivery less than 28 weeks, the OR (95% CI) was 4.02 (1.60-10.12) unadjusted and 4.10 (1.66-10.16) adjusted. In Afro-Caribbeans, deprivation and marital status explained the differences between the unadjusted and adjusted ORs. There was a linear relation between deprivation and preterm delivery for all ethnic groups, except for Asians. CONCLUSIONS: Factors associated with deprivation and marital status explain about half of the excess of preterm births in Afro-Caribbeans, but not Africans. The risk of preterm delivery might not be related to deprivation in Asians.