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1.
MMWR Morb Mortal Wkly Rep ; 69(31): 1009-1014, 2020 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-32759915

RESUMEN

Drinking alcohol during pregnancy can cause fetal alcohol spectrum disorders, including birth defects, behavioral disorders, and impaired cognitive development (1). Little is known about the co-use of other substances by females who drink during pregnancy. CDC used 2015-2018 data from the National Survey on Drug Use and Health (NSDUH) to estimate the overall and trimester-specific prevalence of self-reported drinking in the past 12 months, current drinking, and binge drinking, overall and by trimester, and the co-use of other substances among pregnant females aged 12-44 years. Past drinking (12 months) was reported by 64.7% of pregnant respondents. Current drinking (at least one drink in the past 30 days) was reported by 19.6% of respondents who were in their first trimester of pregnancy and 4.7% of respondents who were in their second or third trimester. Binge drinking (consuming four or more drinks on at least one occasion in the past 30 days) was reported by 10.5% of first trimester respondents and 1.4% of second or third trimester respondents. Overall, 38.2% of pregnant respondents who reported current drinking also reported current use of one or more other substances. The substances used most with alcohol were tobacco and marijuana. Self-reported drinking prevalence was substantially lower among second or third trimester respondents than among first trimester respondents. The American College of Obstetricians and Gynecologists (ACOG) recommends alcohol use and substance use disorders screening for all females seeking obstetric-gynecologic care and counseling patients that there is no known safe level of alcohol use during pregnancy (2).


Asunto(s)
Alcoholismo/epidemiología , Mujeres Embarazadas/psicología , Trastornos Relacionados con Sustancias/epidemiología , Adolescente , Adulto , Niño , Femenino , Humanos , Embarazo , Estados Unidos/epidemiología , Adulto Joven
2.
MMWR Morb Mortal Wkly Rep ; 69(25): 790-794, 2020 Jun 26.
Artículo en Inglés | MEDLINE | ID: mdl-32584797

RESUMEN

The first reported U.S. case of coronavirus disease 2019 (COVID-19) was detected in January 2020 (1). As of June 15, 2020, approximately 2 million cases and 115,000 COVID-19-associated deaths have been reported in the United States.* Reports of U.S. patients hospitalized with SARS-CoV-2 infection (the virus that causes COVID-19) describe high proportions of older, male, and black persons (2-4). Similarly, when comparing hospitalized patients with catchment area populations or nonhospitalized COVID-19 patients, high proportions have underlying conditions, including diabetes mellitus, hypertension, obesity, cardiovascular disease, chronic kidney disease, or chronic respiratory disease (3,4). For this report, data were abstracted from the medical records of 220 hospitalized and 311 nonhospitalized patients aged ≥18 years with laboratory-confirmed COVID-19 from six acute care hospitals and associated outpatient clinics in metropolitan Atlanta, Georgia. Multivariable analyses were performed to identify patient characteristics associated with hospitalization. The following characteristics were independently associated with hospitalization: age ≥65 years (adjusted odds ratio [aOR] = 3.4), black race (aOR = 3.2), having diabetes mellitus (aOR = 3.1), lack of insurance (aOR = 2.8), male sex (aOR = 2.4), smoking (aOR = 2.3), and obesity (aOR = 1.9). Infection with SARS-CoV-2 can lead to severe outcomes, including death, and measures to protect persons from infection, such as staying at home, social distancing (5), and awareness and management of underlying conditions should be emphasized for those at highest risk for hospitalization with COVID-19. Measures that prevent the spread of infection to others, such as wearing cloth face coverings (6), should be used whenever possible to protect groups at high risk. Potential barriers to the ability to adhere to these measures need to be addressed.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitalización/estadística & datos numéricos , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Ciudades/epidemiología , Infecciones por Coronavirus/epidemiología , Femenino , Georgia/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Factores de Riesgo , Adulto Joven
3.
J Womens Health (Larchmt) ; 29(6): 780-788, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32109175

RESUMEN

Background: Electronic cigarettes (e-cigarettes) are increasing in popularity in the United States. Prior prevalence estimates of e-cigarette use in pregnancy range from 1% to 15%. Materials and Methods: We assessed prevalence of e-cigarette and conventional cigarette use during preconception or pregnancy in a large sample of racially/ethnically diverse, low-income pregnant women via telephone survey (2015-2018) and compared sociodemographic characteristics and mental health conditions. Results: Of 1365 pregnant women surveyed, 54 (4.0%) reported e-cigarette use (regardless of other tobacco use), 372 (27.3%) reported conventional cigarette use without e-cigarette use (conventional cigarette use), and 939 (68.8%) reported no tobacco or nicotine replacement therapy (NRT) product use during the preconception period and/or pregnancy. Seventy-four percent of women using e-cigarettes reported also using conventional cigarettes. Women who used e-cigarettes were more likely to report high school education or greater, income <$30,000, White race, and non-Hispanic ethnicity than women who used conventional cigarettes. Women who used e-cigarettes were more likely than women who used conventional cigarettes or no tobacco/NRT to report symptoms of depression. Women who used e-cigarettes and women who used conventional cigarettes were more likely than women who used no tobacco/NRT to report a history of severe mental health conditions, alcohol use during pregnancy, and marijuana or other drug use during preconception. Conclusions: In this sample, 4% of women used e-cigarettes during preconception and/or pregnancy and most also used conventional cigarettes. Increased efforts by providers to screen for tobacco (including use of e-cigarette) and polysubstance use and to provide cessation services could improve outcomes of mothers and children.

4.
MMWR Morb Mortal Wkly Rep ; 68(36): 787-790, 2019 Sep 13.
Artículo en Inglés | MEDLINE | ID: mdl-31513561

RESUMEN

On September 6, 2019, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). As of August 27, 2019, 215 possible cases of severe pulmonary disease associated with the use of electronic cigarette (e-cigarette) products (e.g., devices, liquids, refill pods, and cartridges) had been reported to CDC by 25 state health departments. E-cigarettes are devices that produce an aerosol by heating a liquid containing various chemicals, including nicotine, flavorings, and other additives (e.g., propellants, solvents, and oils). Users inhale the aerosol, including any additives, into their lungs. Aerosols produced by e-cigarettes can contain harmful or potentially harmful substances, including heavy metals such as lead, volatile organic compounds, ultrafine particles, cancer-causing chemicals, or other agents such as chemicals used for cleaning the device (1). E-cigarettes also can be used to deliver tetrahydrocannabinol (THC), the principal psychoactive component of cannabis, or other drugs; for example, "dabbing" involves superheating substances that contain high concentrations of THC and other plant compounds (e.g., cannabidiol) with the intent of inhaling the aerosol. E-cigarette users could potentially add other substances to the devices. This report summarizes available information and provides interim case definitions and guidance for reporting possible cases of severe pulmonary disease. The guidance in this report reflects data available as of September 6, 2019; guidance will be updated as additional information becomes available.


Asunto(s)
Enfermedades Pulmonares/epidemiología , Guías de Práctica Clínica como Asunto , Índice de Severidad de la Enfermedad , Vapeo/efectos adversos , Centers for Disease Control and Prevention, U.S. , Humanos , Estados Unidos/epidemiología
5.
Diabetes Res Clin Pract ; 152: 146-155, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31063853

RESUMEN

AIMS: To determine whether women with abnormal gestational diabetes (GDM) screening test results short of frank GDM have increased health-services utilization compared to women with normal results. METHODS: We conducted a retrospective-cohort study among 29,999 women enrolled in Kaiser Permanente Northwest who completed GDM screening (two-step method: 1-h, 50-g glucose-challenge test (GCT); 3-h, 100-g oral-glucose-tolerance test (OGTT)). Test results were categorized as normal GCT (referent, n = 25,535), normal OGTT (n = 2246), abnormal OGTT but not GDM (n = 1477), and GDM (n = 741). Rate ratios (RRs) were calculated for utilization measures and analyses were age- and BMI-adjusted. RESULTS: Compared to women with normal GCT, rates for obstetrical ultrasound, noninvasive and invasive antenatal testing, and ambulatory visits to the obstetrics department were significantly greater among women with abnormal OGTT (RRs 1.2 [95%CI 1.1, 1.4], 1.3 [1.1, 1.4], 1.7 [1.3, 2.3], and 1.1 [1.1, 1.1], respectively) and GDM (RRs 1.8, 1.8, 2.0, and 1.3, respectively). Women with abnormal OGTT results were more likely to visit a dietician than women with normal GCT; RRs ranged from 4.0 [3.3, 4.9] for women with abnormal GCT but normal OGTT to 72.1 [64, 81] for women with GDM. CONCLUSIONS: Health-services utilization increased with severity of glucose result, even among women without GDM.


Asunto(s)
Glucemia/análisis , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo/sangre , Atención Prenatal/estadística & datos numéricos , Adulto , Glucemia/metabolismo , Estudios de Cohortes , Diabetes Gestacional/sangre , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/epidemiología , Femenino , Intolerancia a la Glucosa/sangre , Intolerancia a la Glucosa/diagnóstico , Intolerancia a la Glucosa/epidemiología , Prueba de Tolerancia a la Glucosa , Servicios de Salud/estadística & datos numéricos , Humanos , Tamizaje Masivo/métodos , Diagnóstico Prenatal/métodos , Diagnóstico Prenatal/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Adulto Joven
6.
MMWR Morb Mortal Wkly Rep ; 68(8): 189-194, 2019 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-30817748

RESUMEN

Electronic vapor products (EVPs) comprise a diverse group of devices, including electronic cigarettes (e-cigarettes). EVP users inhale an aerosol that typically contains nicotine, flavorings, and other additives (1). Nicotine is a developmental toxicant that adversely affects pregnancy and infant outcomes (2). Data from the 2015 Pregnancy Risk Assessment Monitoring System (PRAMS) for Oklahoma and Texas were analyzed to estimate population-based EVP use among women with a recent live birth. EVP use before pregnancy (defined as >3 months before pregnancy) and around the time of pregnancy (defined as any time during the 3 months before pregnancy, the last 3 months of pregnancy, or 2-6 months after delivery), reasons for EVP use, and dual use of EVPs and cigarettes were assessed. Prevalence of EVP use was 10.4% before pregnancy and 7.0% around the time of pregnancy, including 1.4% during the last 3 months of pregnancy. Among women using EVPs during the last 3 months of pregnancy, 38.4% reported use of EVPs containing nicotine, and 26.4% were unsure of nicotine content. Among women who had used EVPs and cigarettes, dual use prevalence was 38.0% in the 3 months before pregnancy, 7.7% during the last 3 months of pregnancy, and 11.8% in the 2-6 months after delivery. The most frequently reported reasons for EVP use around the time of pregnancy were curiosity (54.0%), the perception that EVPs might help with quitting or reducing cigarette smoking (45.2%), and the perception of reduced harm to the mother, when compared with cigarette smoking (45.2%). Clear messages that EVP use is not safe during pregnancy are needed, and broad, barrier-free access to evidence-based tobacco cessation strategies need to be made available.


Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Mujeres Embarazadas/psicología , Fumar/epidemiología , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Nacimiento Vivo , Oklahoma/epidemiología , Embarazo , Efectos Tardíos de la Exposición Prenatal , Medición de Riesgo , Fumar/efectos adversos , Texas/epidemiología , Factores de Tiempo
7.
Birth ; 46(2): 326-334, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30633363

RESUMEN

BACKGROUND: Prenatal smoking cessation has substantial health benefits for mothers and offspring, but concerns about weight gain may be a barrier to quitting. We quantified gestational weight gain associated with biochemically confirmed smoking cessation. METHODS: Data originated from a randomized controlled cessation trial: Smoking Cessation in Pregnancy project (1987-1991). We calculated gestational weight gain using self-reported prepregnancy weight and measured weight at 30-34 weeks of gestation. We used linear regression to estimate adjusted mean differences in gain for quitters versus continuing smokers by the last trimester. The effects of quitting earlier (by 2nd trimester) versus later (by 3rd trimester) were calculated. We assessed the percentages who gained weight according to Institute of Medicine (IOM) recommendations within 2 weeks of a full-term delivery. RESULTS: At 30-34 weeks, nulliparous and multiparous quitters gained an average of 3.0 pounds (95% CI 0.9-5.1 pounds) (1.4 kg [0.4-2.3 kg]) and 6.6 pounds (95% CI 4.3-8.9 pounds) (3.0 kg [1.9-4.0 kg]) more, respectively, than continuing smokers. Weight gain in early quitters did not differ significantly from that in late quitters. Quitters were more likely than continuing smokers to gain above current guidelines (60.3% vs 46.3%) and were less likely to gain below guidelines (11.5% vs 21.6%) (P = 0.002). CONCLUSIONS: Although quitters had modest additional weight gain by 30-34 weeks compared to continuing smokers, a high proportion in both groups gained in excess of IOM recommendations. Both quitters and continuing smokers may need support to achieve optimal gestational weight gain.


Asunto(s)
Ganancia de Peso Gestacional , Madres/estadística & datos numéricos , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/efectos adversos , Adolescente , Adulto , Femenino , Humanos , Modelos Lineales , Embarazo , Autoinforme , Fumar/epidemiología , Estados Unidos/epidemiología , Adulto Joven
8.
BMJ Open ; 7(12): e016826, 2017 Dec 19.
Artículo en Inglés | MEDLINE | ID: mdl-29259054

RESUMEN

OBJECTIVES: In 2012, theCenters for Disease Control and Prevention initiated a national anti-smoking campaign, Tips from Former Smokers (Tips). As a result of the campaign, quit attempts among smokers increased in the general population by 3.7 percentage points. In the current study, we assessed the effects of Tips on smoking cessation in pregnant women. METHODS: We used 2009-2013 certificates of live births in three US states: Indiana, Kentucky and Ohio. Smoking cessation by the third trimester of pregnancy was examined among women who smoked in the 3 months prepregnancy. Campaign exposure was defined as overlap between the airing of Tips 2012 (March 19-June 10) and the prepregnancy and pregnancy periods. Women who delivered before Tips 2012 were not exposed. Adjusted logistic regression was used to determine whether exposure to Tips was independently associated with smoking cessation. RESULTS: Cessation rates were stable during 2009-2011 but increased at the time Tips 2012 aired and remained elevated. Overall, 32.9% of unexposed and 34.7% of exposed smokers quit by the third trimester (p<0.001). Exposure to Tips 2012 was associated with increased cessation (adjusted OR: 1.07, 95% CI 1.05 to 1.10). CONCLUSIONS: Exposure to a national anti-smoking campaign for a general audience was associated with smoking cessation in pregnant women.


Asunto(s)
Programas de Gobierno , Promoción de la Salud/métodos , Medios de Comunicación de Masas , Mujeres Embarazadas , Cese del Hábito de Fumar/métodos , Fumar/epidemiología , Adolescente , Adulto , Femenino , Humanos , Indiana/epidemiología , Kentucky/epidemiología , Modelos Logísticos , Análisis Multivariante , Ohio/epidemiología , Embarazo , Fumar/tendencias , Adulto Joven
9.
PLoS One ; 12(2): e0170381, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28207744

RESUMEN

OBJECTIVE: To assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes. METHODS: We used the linked National Health Interview Survey (survey years 1995, 1997-2005) and the Medicaid Analytic eXtract files (1999-2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18-64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding. RESULTS: In 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization. CONCLUSIONS: Utilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999-2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.


Asunto(s)
Planes de Aranceles por Servicios/economía , Cobertura del Seguro/estadística & datos numéricos , Medicaid/estadística & datos numéricos , Cese del Hábito de Fumar/economía , Cese del Uso de Tabaco/métodos , Tabaquismo/tratamiento farmacológico , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Patient Protection and Affordable Care Act , Estados Unidos , Adulto Joven
10.
Paediatr Perinat Epidemiol ; 31(2): 144-148, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-28181676

RESUMEN

BACKGROUND: Few studies have examined the effects of nondaily smoking or low-intensity daily smoking and infant outcomes. We examined the associations between preterm delivery and small for gestational age (SGA) infants in relation to both nondaily and daily smoking. METHODS: We used population-based data on women who delivered live singleton infants using the 2009-11 Pregnancy Risk Assessment Monitoring System. Women's smoking status in the last 3 months of pregnancy was categorised as nonsmokers, quitters, nondaily smokers (<1 cigarette/day), and daily smokers. Controlling for maternal age, maternal race/ethnicity, education, marital status, prepregnancy body mass index (BMI), trimester of prenatal care entry, parity, and alcohol use, we estimated adjusted prevalence ratios (PR) for the outcomes of preterm delivery (<37 weeks' gestation) and SGA. RESULTS: Of the 88 933 women, 13.1%, 1.7%, and 9.6% of the sample were quitters, nondaily smokers, and daily smokers, respectively, in the last 3 months of pregnancy. While nondaily smoking was not associated with preterm delivery, daily smoking was. However, we found no dose-response relationship with the number of cigarettes smoked per day. Risk of delivering a SGA infant was increased for both nondaily and daily smokers (PR 1.4, 95% CI 1.1, 1.8 and PR 2.0, 95% CI 1.9, 2.2 respectively). CONCLUSIONS: Nondaily smoking in the last 3 months of pregnancy was associated with an increased risk of delivering a SGA infant. Pregnant women should be counselled that smoking, including nondaily and daily smoking, can adversely affect birth outcomes.


Asunto(s)
Recién Nacido Pequeño para la Edad Gestacional , Nacimiento Prematuro/etiología , Fumar/efectos adversos , Adolescente , Adulto , Femenino , Humanos , Embarazo , Nacimiento Prematuro/epidemiología , Factores de Riesgo , Fumar/epidemiología , Estados Unidos/epidemiología , Adulto Joven
11.
Neurosci Biobehav Rev ; 72: 176-189, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27890689

RESUMEN

While the health risks associated with adult cigarette smoking have been well described, effects of nicotine exposure during periods of developmental vulnerability are often overlooked. Using MEDLINE and PubMed literature searches, books, reports and expert opinion, a transdisciplinary group of scientists reviewed human and animal research on the health effects of exposure to nicotine during pregnancy and adolescence. A synthesis of this research supports that nicotine contributes critically to adverse effects of gestational tobacco exposure, including reduced pulmonary function, auditory processing defects, impaired infant cardiorespiratory function, and may contribute to cognitive and behavioral deficits in later life. Nicotine exposure during adolescence is associated with deficits in working memory, attention, and auditory processing, as well as increased impulsivity and anxiety. Finally, recent animal studies suggest that nicotine has a priming effect that increases addiction liability for other drugs. The evidence that nicotine adversely affects fetal and adolescent development is sufficient to warrant public health measures to protect pregnant women, children, and adolescents from nicotine exposure.


Asunto(s)
Nicotina/toxicidad , Animales , Femenino , Feto , Humanos , Embarazo , Efectos Tardíos de la Exposición Prenatal , Fumar , Tabaco
12.
Nicotine Tob Res ; 19(7): 810-816, 2017 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-27986912

RESUMEN

Introduction: This study aimed to calculate the prevalence of pre-pregnancy nondaily smoking (<1 cigarette/day), risk factors, and report of prenatal provider smoking education; and assess the likelihood of prenatal cessation and postpartum relapse for nondaily smokers. Methods: We analyzed data from 2009 to 2011 among women with live-born infants participating in the Pregnancy Risk Assessment Monitoring System. We compared characteristics of pre-pregnancy daily smokers (≥1 cigarette/day), nondaily smokers, and nonsmokers (chi-square adjusted p < .025). Between nondaily and daily smokers, we compared proportions of prenatal cessation, postpartum relapse (average 4 months postpartum), and reported provider education. Multivariable logistic regression calculated adjusted prevalence ratios (APR) for prenatal cessation among pre-pregnancy smokers (n = 27 360) and postpartum relapse among quitters (n = 13 577). Results: Nondaily smokers (11% of smokers) were more similar to nonsmokers and differed from daily smokers on characteristics examined (p ≤ .001 for all). Fewer nondaily smokers reported provider education than daily smokers (71.1%, 86.3%; p < .001). A higher proportion of nondaily compared to daily smokers quit during pregnancy (89.7%, 49.0%; p < .001), and a lower proportion relapsed postpartum (22.2%, 48.6%; p < .001). After adjustment, nondaily compared to daily smokers were more likely to quit (APR: 1.65; 95% confidence interval [CI]: 1.58-1.71) and less likely to relapse postpartum (APR: 0.55; 95% CI: 0.48-0.62). Conclusions: Nondaily smokers were more likely to quit smoking during pregnancy, less likely to relapse postpartum, and less likely to report provider education than daily smokers. Providers should educate all women, regardless of frequency of use, about the harms of tobacco during pregnancy, provide effective cessation interventions, and encourage women to be tobacco free postpartum and beyond. Implication: Nondaily smoking (<1 cigarette/day) is increasing among US smokers and carries a significant risk of disease. However, smoking patterns surrounding pregnancy among nondaily smokers are unknown. Using 2009-2011 data from the Pregnancy Risk Assessment Monitoring System, we found pre-pregnancy nondaily smokers compared to daily smokers were 65% more likely to quit smoking during pregnancy and almost half as likely to relapse postpartum. Providers should educate all women, regardless of frequency of use, about the harms of tobacco during pregnancy, provide effective cessation interventions, and encourage women to be tobacco free postpartum and beyond.


Asunto(s)
Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Adulto , Femenino , Humanos , Modelos Logísticos , Periodo Posparto , Embarazo , Prevalencia , Recurrencia , Medición de Riesgo , Factores de Riesgo , Fumar/psicología , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
13.
Am J Public Health ; 106(12): e2-e3, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-27831785
14.
Prev Med Rep ; 4: 481-5, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27635381

RESUMEN

The increasing availability of emerging non-combusted tobacco products (snus, dissolvables, and electronic nicotine delivery systems or ENDS) may have implications for pregnant women and women of reproductive age. We conducted 15 focus groups to explore how women perceive emerging non-combusted tobacco products and nicotine replacement therapy (NRT) in general, and during pregnancy. Sessions were held in 2013 in four U.S. cities. Participants were 18-40 years old and were pregnant smokers, pregnant quitters, or smokers planning a pregnancy. Responses were coded and analyzed to identify key themes using NVivo 10.0 qualitative software (QSR). Several themes emerged from focus groups. Participants generally found snus unappealing, but viewed dissolvables as a discreet and stigma-free way to use tobacco during pregnancy. Participants perceived NRT as ineffective and having undesired side effects. ENDS were thought to offer advantages over cigarettes, including use in smoke-free areas, lower cost, appealing flavors, and fewer health effects, and were seen by some as a potential quit aid. Some participants, however, worried that the lack of natural stopping point could lead to excessive use. Many participants felt that the use of any tobacco or NRT product is harmful during pregnancy. Women seeking to reduce health risks or stigma related to smoking during pregnancy may perceive advantages of using some emerging products over cigarettes. These findings can inform future public health efforts to reduce risks associated with tobacco product use among women of reproductive age.

15.
Obstet Gynecol ; 128(3): 562-70, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27500342

RESUMEN

OBJECTIVE: To describe prepregnancy smoking, prenatal smoking, and prenatal cessation among women reporting and not reporting depression or anxiety. METHODS: We analyzed cross-sectional data from the 2009-2011 Pregnancy Risk Assessment Monitoring System, a population-based survey of women with live births (N=34,633). Smoking status was defined as self-reported prepregnancy smoking (during the 3 months before pregnancy), prenatal smoking (during the last 3 months of pregnancy), and prenatal cessation (no smoking by the last 3 months among prepregnancy smokers). Depression and anxiety status was self-reported of having either condition or both during the 3 months before pregnancy. We compared smoking prevalence by self-reported depression and anxiety status using χ tests and adjusted prevalence ratios. RESULTS: Overall, 16.9% of women in our sample reported depression, anxiety, or both during the 3 months before pregnancy. Compared with those who did not report, women who reported depression or anxiety had significantly higher prepregnancy (46.7% compared with 22.5%, P<.01) and prenatal smoking (27.5% compared with 10.5%, P<.01). A lower proportion of prepregnancy smokers who reported depression or anxiety quit smoking by the last 3 months of pregnancy than those who did not report (41.4% compared with 53.8%, P<.01). In adjusted analyses, women reporting depression or anxiety were 1.5 and 1.7 times more likely to smoke prepregnancy and prenatally, respectively, and less likely to quit smoking (adjusted prevalence ratio 0.86, 95% confidence interval 0.80-0.92). CONCLUSION: Women who reported depression, anxiety, or both were more likely to smoke before and during pregnancy and less likely to quit smoking during the prenatal period. Screening recommendations for perinatal depression and anxiety provide an opportunity to identify a subpopulation of women who may have a higher prevalence of smoking and to provide effective tobacco cessation interventions and mental health care.


Asunto(s)
Ansiedad/psicología , Depresión/psicología , Complicaciones del Embarazo/psicología , Fumar/epidemiología , Adulto , Estudios Transversales , Autoevaluación Diagnóstica , Femenino , Humanos , Embarazo , Prevalencia , Cese del Hábito de Fumar/estadística & datos numéricos
16.
J Womens Health (Larchmt) ; 25(10): 1066-1072, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27243366

RESUMEN

OBJECTIVE: To estimate smoking prevalence during the year before pregnancy and during pregnancy and adverse outcomes among women who delivered infants with and without assisted reproductive technology (ART) using linked birth certificates (BC) and National ART Surveillance System (NASS) data. METHODS: Data were analyzed for 384,390 women and 392,248 infants born in Massachusetts and Michigan during 2008-2009. Maternal smoking prevalence was estimated using smoking indicated from BC by ART status. For ART users, to evaluate underreporting, prepregnancy smoking was estimated from BC, NASS, or both sources. Effect of prenatal smoking on preterm and mean birthweight (term only) for singleton infants were examined by ART status. RESULTS: Maternal smoking prevalence estimates were significantly lower for ART users than nonusers (prepregnancy = 3.2% vs. 16.7%; prenatal = 1.0% vs. 11.1%, p < 0.05). When combining smoking information from BC and NASS, prepregnancy smoking prevalence estimates for ART users could be as high as 4.4% to 6.1%. Adverse effects of smoking on infant outcomes in ART pregnancies were consistent with the effects seen in non-ART pregnancies, specifically decline in infant birthweight and increase in preterm delivery, although association between smoking and preterm was not significant. CONCLUSION: A low, but substantial proportion of ART users smoked before and during pregnancy. As ART users are highly motivated to get pregnant, it should be clearly communicated that smoking can decrease fertility and adversely affect pregnancy outcomes. Continued efforts are needed to encourage smoking cessation and maintain tobacco abstinence among all women of reproductive age.


Asunto(s)
Vigilancia de la Población , Resultado del Embarazo , Técnicas Reproductivas Asistidas/estadística & datos numéricos , Fumar/epidemiología , Adulto , Femenino , Fertilidad , Humanos , Recién Nacido , Recien Nacido Prematuro , Massachusetts , Edad Materna , Michigan , Embarazo , Nacimiento Prematuro/epidemiología , Prevalencia , Fumar/efectos adversos , Estados Unidos/epidemiología
17.
Am J Public Health ; 106(7): 1219-22, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-27077338

RESUMEN

Tobacco companies have begun to acquire pharmaceutical subsidiaries and recently started to market nicotine replacement therapies, such as Zonnic nicotine gum, in convenience stores. Conversely, tobacco companies are producing tobacco products such as tobacco chewing gum and lozenges that resemble pharmaceutical nicotine replacement products, including a nicotine pouch product that resembles snus pouches. This convergence of nicotine and tobacco product marketing has implications for regulation and tobacco cessation.


Asunto(s)
Mercadotecnía/organización & administración , Cese del Hábito de Fumar/métodos , Dispositivos para Dejar de Fumar Tabaco/economía , Tabaco sin Humo/economía , Publicidad/economía , Publicidad/legislación & jurisprudencia , Humanos , Mercadotecnía/economía , Mercadotecnía/legislación & jurisprudencia , Tabaco sin Humo/legislación & jurisprudencia
18.
Nicotine Tob Res ; 18(5): 894-9, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-26791371

RESUMEN

BACKGROUND: Employers play a vital role in promoting and supporting tobacco use cessation among tobacco-using workers. Cigarette smoking during pregnancy is a preventable cause of complications in pregnancy and adverse infant health outcomes. PURPOSE: To estimate cigarette smoking prevalence and attempts to quit among working women of reproductive age in different industries and occupations using a nationally representative survey. METHODS: The 2009-2013 National Health Interview Survey data for women of reproductive age (18-49 years) who were working in the week prior to the interview (n = 30855) were analyzed. Data were adjusted for nonresponse and weighted to produce nationally representative estimates. RESULTS: During 2009-2013, among working women of reproductive age, an estimated 17.3% (95% confidence interval [CI]: 16.7-17.8) and 12.9% (95% CI: 12.4-13.4) were current and former cigarette smokers, respectively. Of women who smoke daily, 44.5% (95% CI: 42.5-46.5) had made a quit attempt for more than 1 day in the year before the interview. Cigarette smoking prevalence was highest among women working in the construction industry (29.2%; 95% CI: 22.8-35.7) and in construction and extraction occupations (34.6%; 95% CI: 23.4-45.9). Among working women who were pregnant at the time of the interview, 6.8% (95% CI: 4.4-9.2) and 20.4% (95% CI: 16.9-24.0) were current and former cigarette smokers, respectively. CONCLUSIONS: Cigarette smoking prevalence varies by industry and occupation. Intensifying tobacco control efforts in high prevalence industries and occupations could result in higher cessation rates and improvements in health among women of reproductive age. IMPLICATIONS: This study identified discrepancies in cigarette smoking among women of reproductive age across industries and occupations. In the absence of smoke-free local and state laws, employer-established smoke-free policies and workplace cessation programs are important for achieving reduction of tobacco use among women and for protecting other workers' health. Results in this report may assist in developing educational campaigns targeting women in industries and occupations with high prevalence of cigarette smoking and low percentage of ever-smokers who had quit.


Asunto(s)
Fumar/epidemiología , Mujeres Trabajadoras/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Humanos , Persona de Mediana Edad , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
19.
Contraception ; 93(3): 190-208, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26546021

RESUMEN

BACKGROUND: Women who use combined hormonal contraceptives and cigarettes have an increased risk for cardiovascular (CV) events. We reviewed the literature to determine whether women who use hormonal contraceptives (HC) and electronic cigarettes (e-cigarettes) also have an increased risk. STUDY DESIGN: Systematic review. METHODS: We searched for articles reporting myocardial infarction (MI), stroke, venous thromboembolism, peripheral arterial disease or changes to CV markers in women using e-cigarettes and HC. We also searched for indirect evidence, such as CV outcomes among e-cigarette users in the general population and among HC users exposed to nicotine, propylene glycol or glycerol. RESULTS: No articles reported on outcomes among e-cigarette users using HC. Among the general population, 13 articles reported on heart rate or blood pressure after e-cigarette use. These markers generally remained normal, even when significant changes were observed. In three studies, changes were less pronounced after e-cigarette use than cigarette use. One MI was reported among 1012 people exposed to e-cigarettes in these studies. One article on nicotine and HC exposure found both exposures to be significantly associated with acute changes to heart rate, though mean heart rate remained normal. No articles on propylene glycol or glycerol and HC exposure were identified. CONCLUSION: We identified no evidence on CV outcomes among e-cigarette users using HC. Limited data reporting mostly acute outcomes suggested that CV events are rare among e-cigarette users in the general population and that e-cigarettes may affect heart rate and blood pressure less than conventional cigarettes. There is a need for research assessing joint HC and e-cigarette exposure on clinical CV outcomes.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Anticonceptivos Femeninos/efectos adversos , Sistemas Electrónicos de Liberación de Nicotina/efectos adversos , Adolescente , Adulto , Presión Sanguínea , Femenino , Frecuencia Cardíaca , Hormonas/efectos adversos , Humanos
20.
J Womens Health (Larchmt) ; 25(5): 480-8, 2016 05.
Artículo en Inglés | MEDLINE | ID: mdl-26717489

RESUMEN

BACKGROUND: Relapsing to smoking postpartum jeopardizes a woman's health and her infant's health. Our study estimated the proportion and identified characteristics associated with postpartum relapse using a large population-based sample. MATERIALS AND METHODS: We analyzed Pregnancy Risk Assessment Monitoring System data among women with live births. Relapse was defined as smoking at survey completion among those who quit by the last 3 months of pregnancy. We assessed linear trends for relapse during 2000-2011 in 40 sites overall and individually using logistic regression. Adjusted prevalence ratios (aPRs) were calculated to assess characteristics associated with relapse during 2009-2011 (n = 13,076). RESULTS: During 2000-2011, the proportion of women who relapsed postpartum remained unchanged overall (p = 0.84) and by site (p ≥ 0.05 for each), ranging in 2011 from 30.8% to 52.2% (Wyoming-Arkansas). Characteristics associated with relapse compared with reference groups were prepregnancy daily smoking (aPR = 1.80; 95% confidence interval (CI): 1.59-2.04); age <20 years (aPR = 1.51; 1.24-1.84), 20-24 years (aPR = 1.39; 1.17-1.65), or 25-34 years (aPR = 1.26; 1.07-1.48); not initiating breastfeeding (aPR = 1.34; 1.24-1.44); not having a complete home smoking ban (aPR = 1.27; 1.14-1.42); being black non-Hispanic (aPR = 1.25; 1.14-1.38); being multiparous (aPR = 1.20; 1.11-1.28); experiencing 3-5 stressors during pregnancy (aPR = 1.12; 1.01-1.24); having an unintended pregnancy (aPR = 1.11; 1.03-1.19); and having 12 years of education (aPR = 1.09; 1.01-1.17). CONCLUSIONS: There was no change in the proportion of women relapsing postpartum during 2000-2011. In 2011, nearly half (42%) of women relapsed after quitting smoking during pregnancy. Disparities exist by site and by maternal characteristics. A comprehensive approach maximizing tobacco control efforts and developing effective clinical interventions delivered across sectors is necessary for long-term tobacco abstinence among women.


Asunto(s)
Vigilancia de la Población/métodos , Periodo Posparto , Cese del Hábito de Fumar/estadística & datos numéricos , Fumar/epidemiología , Adulto , Grupos Étnicos , Femenino , Encuestas Epidemiológicas , Humanos , Modelos Logísticos , Embarazo , Prevalencia , Recurrencia , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo
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