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1.
Nicotine Tob Res ; 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31570944

RESUMO

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.

2.
Artigo em Inglês | MEDLINE | ID: mdl-31395818

RESUMO

Negative life events (NLEs) increase the risk of suicidal ideation (SI) in adolescents. However, it is not known whether the association between NLEs and SI can be moderated by self-esteem and varies with gender. The aim of the current paper was to examine gender differences in the association of SI with NLEs in adolescents, and assess the effects of self-esteem on the association and their gender variations. We conducted a school-based health survey in 15 schools in China between November 2013 and January 2014. A total of 9704 participants aged 11-19 years had sociodemographic data reported and self-esteem (Rosenberg self-esteem scale), NLEs, and SI measured. Multivariate-adjusted logistic regression was used to calculate the odds ratio (OR) of having SI in relation to NLEs. Increased risk of SI was significantly associated with NLEs (adjusted OR 2.19, 95%CI 1.94-2.47), showing no gender differences (in females 2.38, 2.02-2.80, in males 1.96, 1.64-2.36, respectively). The association was stronger in adolescents with high esteem (2.93, 2.34-3.68) than those with low esteem (2.00, 1.65-2.42) (ORs ratio 1.47, p = 0.012). The matched figures in females were 3.66 (2.69-4.99) and 2.08 (1.61-2.70) (1.76, p = 0.006), while in males these figures were 2.27(1.62-3.19) and 1.89 (1.41-2.53) (1.20, p = 0.422), respectively. Self-esteem had moderate effects on the association between NLEs and SI in adolescents, mainly in females. NLEs, self-esteem, and gender need to be incorporated into future intervention programs to prevent SI in adolescents.

3.
J Med Internet Res ; 21(8): e11506, 2019 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-31407672

RESUMO

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.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31466394

RESUMO

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.

5.
Artigo em Inglês | MEDLINE | ID: mdl-31163663

RESUMO

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).

6.
Artigo em Inglês | MEDLINE | ID: mdl-31014015

RESUMO

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.


Assuntos
Cuidado Pré-Natal/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Prevenção do Hábito de Fumar/estatística & dados numéricos , Inglaterra , Estudos de Viabilidade , Feminino , Humanos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos
7.
Addict Behav ; 92: 236-243, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30731328

RESUMO

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.

8.
Artigo em Inglês | MEDLINE | ID: mdl-30609823

RESUMO

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.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Gestantes/psicologia , Abandono do Hábito de Fumar/métodos , Vaping , Atitude Frente a Saúde , Inglaterra , Feminino , Humanos , Gravidez , Abandono do Hábito de Fumar/psicologia , Inquéritos e Questionários
9.
Health Technol Assess ; 22(41): 1-84, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30079863

RESUMO

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.

10.
BMC Pregnancy Childbirth ; 18(1): 233, 2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-29902987

RESUMO

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.

11.
Nicotine Tob Res ; 20(6): 665-673, 2018 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-29065203

RESUMO

Background: Finding effective ways to help pregnant women quit smoking and remain abstinent is a major public health issue. Approximately half of UK women who smoke attempt cessation after conception; unfortunately, up to 75% return to smoking within 12 months postpartum. Interventions for preventing postpartum return to smoking (PPRS) have not been found to be effective. It is important to identify factors associated with PPRS, to inform development of alternative interventions. Aim: Identify by systematic review factors associated with PPRS. Methods: Systematic searches of electronic databases (MEDLINE, EMBASE, PsychINFO, CINAHL), trials registers, and conference proceedings were conducted to November 2016. Studies statistically examining factors associated with PPRS were included. Modified versions of the Newcastle Ottawa Quality Assessment Scale were used to assess studies' quality and a narrative synthesis focused on those judged of high quality. Results: Thirty-nine studies (12 trials, 27 observational studies) were included. Thirty-one (79.5%) studies were high-quality. Among these, the most common significant predictors of PPRS were being less well educated, younger, multiparous, living with a partner or household member who smoked, experiencing higher stress, depression or anxiety, not breastfeeding, intending to quit only for pregnancy and low confidence to remain abstinent postpartum. Conclusions: Of the factors found to be associated with PPRS, intending to quit smoking only for the duration of pregnancy, partner/household member smoking and confidence to remain abstinent are those most likely to have a direct, causal impact on smoking behavior after childbirth, and need to be considered when designing interventions to prevent PPRS. Implications: This is the first systematic review of factors that may facilitate or inhibit PPRS. Considering how having a partner or household member who smokes, intending to quit smoking only for pregnancy, having self-efficacy to quit long term, breastfeeding and depression exert direct or indirect impacts on women's relapse to smoking and how such impacts could successfully be manipulated will inform development of new interventions to prevent PPRS.

12.
BMJ Open ; 7(11): e018746, 2017 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-29146659

RESUMO

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.


Assuntos
Período Pós-Parto , Gravidez , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Adulto , Inglaterra/epidemiologia , Feminino , Idade Gestacional , Humanos , Modelos Logísticos , Estudos Longitudinais , Motivação , Autorrelato , Adulto Jovem
13.
PLoS One ; 11(6): e0157525, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27308829

RESUMO

BACKGROUND: Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children's exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure. METHODS: Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum. FINDINGS: Central to mothers' accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a 'responsible mother'. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as 'social' or 'occasional' smokers rather than 'regular' smokers. CONCLUSIONS: Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as 'social' or 'occasional' smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.


Assuntos
Parto/psicologia , Abandono do Hábito de Fumar/psicologia , Fumar/psicologia , Poluição por Fumaça de Tabaco/estatística & dados numéricos , Tabagismo/psicologia , Adulto , Parto Obstétrico , Aconselhamento Diretivo/métodos , Características da Família , Feminino , Humanos , Lactente , Motivação , Período Pós-Parto , Gravidez , Pesquisa Qualitativa , Recidiva , Abandono do Hábito de Fumar/estatística & dados numéricos , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/prevenção & controle , Tabagismo/prevenção & controle
14.
BMJ Open ; 5(9): e008856, 2015 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-26351191

RESUMO

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.


Assuntos
Poluição do Ar em Ambientes Fechados , Exposição Ambiental , Comportamento Materno , Mães , Fumar/epidemiologia , Poluição por Fumaça de Tabaco , Adulto , Atitude , Inglaterra/epidemiologia , Feminino , Habitação , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Prevalência , Fatores Socioeconômicos , Inquéritos e Questionários , Produtos do Tabaco , Tabagismo/complicações , Adulto Jovem
15.
PLoS One ; 9(11): e112690, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25397875

RESUMO

BACKGROUND: Children's exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children's SHS exposure in the home. AIM: To identify by systematic review, the factors which are associated with children's SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter. METHODS: Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted. FINDINGS: Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children's SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS. CONCLUSION: Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial.


Assuntos
Poluição do Ar em Ambientes Fechados/análise , Exposição Ambiental/estatística & dados numéricos , Poluição por Fumaça de Tabaco/análise , Monóxido de Carbono/análise , Criança , Cotinina/análise , Escolaridade , Humanos , Material Particulado/análise , Fatores Socioeconômicos
16.
BMJ Open ; 4(5): e004915, 2014 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-24833689

RESUMO

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.


Assuntos
Atitude Frente a Saúde , Comportamento Materno , Projetos de Pesquisa , Fumar/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Gravidez , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
17.
Biomed Environ Sci ; 26(6): 453-67, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23816579

RESUMO

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.


Assuntos
Envelhecimento , Fumar/economia , Fumar/psicologia , Poluição por Fumaça de Tabaco/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
18.
J Geriatr Psychiatry Neurol ; 26(4): 199-208, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23877565

RESUMO

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.


Assuntos
Transtornos Cognitivos/epidemiologia , Exposição Ambiental/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Transtornos Cognitivos/complicações , Estudos Transversais , Relação Dose-Resposta a Droga , Feminino , Avaliação Geriátrica , Humanos , Masculino , Análise Multivariada , Fatores de Risco
19.
BMC Health Serv Res ; 11: 352, 2011 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-22206471

RESUMO

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.


Assuntos
Agentes Comunitários de Saúde , Procedimentos Clínicos , Serviços de Saúde Mental/organização & administração , Desenvolvimento de Programas , Comportamento Cooperativo , Inglaterra , Inquéritos Epidemiológicos , Humanos , Modelos Organizacionais , Programas Nacionais de Saúde , Inquéritos e Questionários
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