A randomized trial to promote health belief and to reduce environmental tobacco smoke exposure in pregnant women

Exposure to environmental tobacco smoke (ETS) is widespread among women in Iran. This study aimed to explore the impact of education on health belief and environmental tobacco smoke exposure in pregnant women. This randomized trial was administrated to 130 pregnant women exposed to ETS. The face-to-face education was provided for the intervention group after completing the questionnaire compiled on the constructs of the health belief model and self-reports of weekly ETS exposure. The theoretical constructs and weekly ETS exposure were compared in the study groups at the intake, third, fourth and fifth sections. In the intervention group, perceived susceptibility/severity and perceived benefits increased and the weekly ETS exposure decreased on the third as opposed to the first section (P < 0.05). Perceived susceptibility/severity and benefits significantly correlated with weekly ETS exposure in the intervention group (P < 0.05). The findings of this study point to the fact that education about the impacts of ETS exposure of pregnant women is an effective way to increase the theoretical constructs according to the health belief model and is associated with a reduction of ETS exposure. But this is not sufficient for making smoke-free homes.     

Exposure to environmental tobacco smoke in pregnant women: the association between self-report and serum cotinine

The risk of delivering a low-birth-weight infant as the result of exposing a nonsmoking pregnant woman to environmental tobacco smoke (ETS) is not well defined. The method of ascertaining ETS exposure during pregnancy may explain the lack of consistent study findings. In a large sample of pregnant women, we compared distributions between two methods of ETS exposure: self-report and cotinine, a nicotine metabolite, from serum. At livery, subjects were asked about duration and location of exposure to ETS during their second trimester. A single cotinine measurement was assayed from serum collected at 15-19 weeks gestation (limit of detection=0.05 ng/mL). Self-reported (hours per day) ETS exposure was correlated (r=0.38) with cotinine concentration. Regression analysis revealed that while self-reported ETS was significantly associated with (log) cotinine, it did not explain a large amount of total variation. While 72% of subjects reported no exposure to ETS, almost all had measurable levels of cotinine. Studies of pregnant women based upon an hours per day ETS question have likely misclassified a sizable portion of ETS-exposed women as "unexposed." Since there is recent evidence that low levels of ETS exposure result in unfavorable pregnancy outcomes, these studies have underestimated the effect of ETS.     

Nutrition and oral health guidelines for pregnant women,infants, and children

Good oral health care and nutrition during pregnancy, infancy, and childhood are essential but often overlooked factors in the growth and development of the teeth and oral cavity. Pregnant women and parents and caregivers of infants and children often receive little guidance about proper preventive dental and oral health care, including fluoride and dietary measures. Pregnant women can maintain their health through proper diet, good oral hygiene, and appropriate use of fluoride. An adequate diet during gestation is important for optimal oral development of the fetus. To promote good oral health in infancy, caregivers need to provide the infant with appropriate amounts of fluoride in addition to a healthful diet. As the teeth erupt into the mouth, the caregiver needs to clean the teeth thoroughly on a daily basis. When solid foods are introduced in later infancy, it is also important to limit the frequency of caries-promoting fermentable carbohydrates between meals. Good oral hygiene habits and dietary practices that emphasize minimum exposure to retentive, fermentable carbohydrates; use of fluoridated water; and a varied, balanced diet should continue throughout childhood to set the stage for optimal oral health for a lifetime.     

A community health center smoking-cessation intervention for pregnant and postpartum women

OBJECTIVES: To evaluate the effect of a provider counseling and office systems intervention in obstetric, pediatric, and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics on smoking and relapse rates in pregnant and postpartum women. METHODS: Five community health centers were randomized to special intervention (SI) or usual care (UC). Subjects (n =601) were current smokers or had quit with pregnancy. Prenatal and postpartum interviews assessed smoking status and related factors. Data were collected between May 1997 and November 2000. RESULTS: There was a statistically significant difference in 30-day abstinence rates between SI (26%) and UC (12%) conditions at the end of pregnancy among women who had not quit spontaneously with pregnancy (odds ratio [OR]=2.57, p =0.05). This effect remained at 1 month postpartum but was lost at 3- and 6-month postpartum follow-ups. CONCLUSIONS: Brief interventions delivered by healthcare providers during routine prenatal care increased smoking abstinence during pregnancy among women who did not quit spontaneously. Interventions extended into postpartum care did not affect relapse and smoking rates postdelivery.     

Exposure to environmental tobacco smoke and children health

This paper reviews the investigations of the effects of pre- and/or postnatal exposure to environmental tobacco smoke (ETS) on children health reported in the literature. The evidence from epidemiological studies demonstrate that children's exposure to ETS is a risk factor for a variety of diseases, including respiratory disorders and middle ear disease. However, the current research base on the ETS-associated risks is still inadequate to fully support strategies, programs and policy development in this area. For example, it is not definitively determined what methods should be used for assessing ETS exposure and predicting potential health risks of exposed children. Based on the available data, we tried to find out which methods seem to be most desirable for quantifying ETS exposure in children. It is our opinion that among all biomarkers, the measurements of blood, saliva or urinary cotinine and hair nicotine are, as for today, the most specific and sensitive methods for an objective assessment of ETS exposure in children. A combination of the measurement of body fluids cotinine and hair nicotine with the questionnaire and interview-derived information seems to be the optimal method for assessing ETS exposure in children.     

Perspectives of pregnant and postpartum latino women on diabetes, physical activity, and health.

Impaired glucose tolerance and diabetes are prevalent among Latino women of childbearing age. Physical activity during and after pregnancy may contribute to weight control and improved metabolic status, but recommended activities may not be perceived as appropriate or feasible. To plan realistic and acceptable interventions, pregnant and postpartum Latino women in Detroit met in a focus group series to discuss their beliefs about diabetes and factors influencing their participation in regular physical activity during pregnancy and postpartum. Women believed that diabetes was primarily related to heredity and diet but not to physical activity. Exercise was believed to reduce stress and improve general health. Women suggested an organized group intervention, in a respected location, that offered safe physical activities within the context of a variety of activities for women and children. This strategy reduced concerns about safety and social acceptability while addressing their primary interest in social support.     

The smoking habits of pregnant women and their husbands, and the effect on their infants

A survey of the smoking habits of 3,025 couples, whose infants were receiving medical examinations, was conducted before and after pregnancy to determine the effect of smoking patterns of the parents on the newborn infant. Of the husbands 55.2% were smoking before pregnancy; 53.4% during pregnancy; and 51.8% after delivery. During pregnancy proportion of smokers decreased by only 1.8%. The percentages for wives, on the other hand, were 13.9%, 4.4%, and 5.3% respectively showing a reduction of 9.5% during pregnancy. Young couples, under 24 years of age, those with low educational backgrounds, and self-employed husbands showed the highest proportion of smokers. Examination of the relation between parents' smoking habits and their effect on the newborn infants, showed no difference in weeks of gestation nor in height. However, the infants of smoking parents were on the average 99.6 grams lighter at birth (p less than 0.02) and the rate of SFD was higher (p less than 0.05). The relative risk for SFD appearance was 1.21 with a smoking father, and 1.39 with both parents smoking. Husbands who decreased or stopped smoking during the pregnancy were largely in the 30 to 34 year old category, university graduates, and those whose wife was having their first baby. A remarkable decrease was observed in the average weight at birth of infants with a mother smoking 6 cigarettes a day or with father smoking 20 cigarettes a day compared to non-smoking parents, especially in the case of female infants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Association between secondhand smoke exposure and quality of life in pregnant women and postpartum women and the consequences on the newborns

Purpose

Secondhand smoke (SHS) exposure is prevalent and could damage the health of non-smokers, especially that of pregnant women (PW) and postpartum women (PPW). Nevertheless, there is no study on the impact of SHS during pregnancy on the quality of life (QOL) of PW and PPW. The study’s purpose is to study the effects of exposure to SHS on the QOL of pregnant and postpartum women and health of the newborns.

Methods

Self-reports and urine tests for cotinine were used to obtain data on SSH exposure in 296 women in the second trimester of pregnancy and 106 women in the postpartum period at the Obstetrics & Gynecology Clinic located in a university hospital. The WHOQOL-BREF-THAI and the Edinburgh Postnatal Depression Scale were used to assess QOL and postpartum depression, respectively.

Results

Of the participants, 88.2% of PW and 62.3% of PPW reported exposure to SHS during pregnancy. Of the PPW, 5.7% had postpartum depression. PW with good QOL were less likely to have family member who smoked (p?=?0.007) or to be exposed to SHS in public parks (p?=?0.037) or in the household or workplace (p?=?0.011). Likewise, PPW with good QOL in the psychological domain were less likely to be exposed to SHS during pregnancy, as shown in both verbal report (p?=?0.010) and objective measure of urine cotinine test (p?=?0.034). In addition, maternal exposure to SHS during pregnancy is associated with low birth weight and other health problems in the newborns (p?<?0.05).

Conclusions

Exposure to SHS during pregnancy is associated with a lower QOL and a poorer health condition in the newborns.

     

Anaemia in pregnant, postpartum and non pregnant women in Lak district, Daklak province of Vietnam

OBJECTIVES: To determine anaemia prevalence and related factors in pregnant women (PW), post partum women (PPW) and non pregnant women (NPW) in a remote mountainous district. METHODS: A cross-sectional survey was conducted in 2001. All PW, all PPW within 6 months of delivery and a random number of NPW equivalents to the number of PW in each commune were selected. Hemoglobin (Hb) was measured using Hemocue method. Mild anaemia was defined as Hb=7 g/dL-11 g/dL in PW, and 8 g/dL-12 g/dL in NPW and PPW. Severe anaemia was defined as Hb<7 g/dL in PW, and<8 g/dL in NPW and PPW. Pregnancy status was determined using urine pregnancy test and calculation of expected menstruum. RESULTS: There were 901 women surveyed: 281 PW, 348 PPW and 272 NPW. More than half (58%) were anaemic: 54% mild and 4% severe. Mean Hb was 11.1g/dL. More PPW had anaemia (62%; OR=1.4; 95%CI=1.1-2.1 compared to NPW) than NPW (54%) and PW (53%). Other related factors were being BoY, Ede and Koho ethnics (OR=2.7; 95%CI=1.4-5.0 compared to Kinh ethnic), having primary education or lower (OR=1.5; 95%CI=1.1-2.1 compared to secondary education or higher). Among PW, being pregnant during the third trimester increased anaemia (OR=2.2; 95%CI=1.3-3.8 compared to being pregnant during the second trimester). Among PPW, women aged 30 or older were more anaemic (OR=1.7, 95%CI=1.1-2.9 compared to women aged 20-29). CONCLUSION: Anaemia prevalence was very high. Interventions should be focused on PPW, PW during the last trimester, minority ethnic women, low-educated and older women.     

Occupational health risks due to shipboard cockroaches

Objectives In various investigated populations, sensitization to cockroaches was observed in 8% of screened subjects from temperate climatic zones and in 36% of those from tropical zones. Because of the numerous hiding places and food storages aboard a ship the crews can be highly exposed to cockroaches. The aim of this study is to assess the prevalence of sensitization to cockroaches and potentially associated health risks in seafarers. Methods In July 2005, a total of 145 seamen sailing under the German flag were recruited from a medical surveillance program for a cross-sectional study (response 95.4%). A standardized interview and a skin prick test (SPT) with nine common inhalant allergens and a cockroach extract (Blatella germanica) were performed. In cockroach-sensitized seafarers total and cockroach-specific IgE was measured and lung function tests conducted. Results In total, 39 seamen (26.9%) were cockroach-sensitized according to SPT results. Presence of cockroach sensitization in seamen from the tropical zone (37.3%) was significantly higher than in seamen from the temperate zone (21.3%) (odds ratio 2.20, 95% confidence interval 1.04–4.66). The prevalence of sensitization to any of the other nine common allergen mixtures tested was lower (between 2.1 and 12.4%). Neither current or past cockroach exposure on board nor cumulative cockroach exposure and time since last cockroach exposure were associated with cockroach sensitization. Among cockroach SPT-positive seamen, cockroach-specific IgE was detected in 52.8%. Five out of 37 (13.5%) SPT-positive seamen exhibited an obstructive ventilation pattern. The prevalence of work-related atopic symptoms was 9.0% (n = 13). These symptoms were not related to cockroach sensitization. Conclusion The high prevalence of sensitization to cockroaches among seamen in the presented study emphasizes the strong sensitization potency of these insects. Longitudinal studies and bronchial cockroach challenge tests are necessary to assess the clinical relevance of cockroach sensitization aboard a ship in more detail.     

Exposure to environmental tobacco smoke and absence from work in women in Nis, Serbia

Exposure to environmental tobacco smoke leads to very serious health effects, especially on the respiratory system. The objective of this paper was to estimate the influence of passive smoking on absence from work because of respiratory problems in women. The study sample consisted of 497 women aged 40-56 who live in an area with identical outdoor air pollution. Environmental tobacco smoke exposure was recorded in 346 women. Data about respiratory symptoms in women were entered into a structured questionnaire. Statistics tests showed no significant difference of living conditions, keeping pets, hereditary predisposition among women. The occurrence of congested nose (OR = 3.47; 95% Cl = 1.38-9.01), nasal secretion (OR = 3.48; 95% Cl = 1.38-9.02) and sinusitis (OR = 2.88; 95% Cl = 1.22-6.89) was significantly higher in women who were exposed to environmental tobacco smoke. Primary health care need for respiratory symptoms due to the effect of passive smoking is higher in the exposed women. Passive smoking can be a risk factor for the appearance of respiratory symptoms and illness in women that causes absence from work.     

Utilization of mental health services by low-income pregnant and postpartum women on medical assistance

This paper examines mental health service use among publicly insured white and African-American pregnant and postpartum women who live in a metropolitan area. The study examines the extent to which ethnicity, physical health problems, and behavioral health risk factors are associated with the probability of service use during the prenatal-postpartum period. It also analyzes the patterns of service utilization for those women who used mental health services. Medicaid claims and eligibility data, County Reporting System claims and admissions data, and Pennsylvania State Vital Birth Records were integrated using a unique algorithm. Logistic regression was employed to estimate the probability of mental health service use among 3,841 low-income women residing in Philadelphia who were continuously enrolled in Medicaid for 9 months preceding delivery and 6 months postpartum. Analyses were also conducted on the intensity and location of service use, as well as psychiatric diagnosis, during pregnancy and the postpartum period. About 10% of the women used mental health services during the study period. Women were more likely to use services if they were Caucasian, had a number of chronic diseases, had a number of pregnancy complications, and smoked. Among users, the same proportion (ca. 6%) used services during pregnancy and postpartum, with the average number of outpatient visits slightly higher during pregnancy than during the postpartum period. Most outpatient services (86%) were delivered in the specialty sector. Most women who used mental health services (84%) were diagnosed with minor psychiatric disorders including minor depression and anxiety disorders. Women who used services during the postpartum only were more likely to be diagnosed with major depression, whereas women who used services throughout the perinatal period were more likely to be diagnosed with severe mental disorders. Health providers can use information generated in this study to identify women who are likely to have a need for mental health services.     

Risk,morality and emotion: social media responses to pregnant women who smoke

In this article, we use qualitative data to examine the shape and nature of the online ‘moral outrage’ that was directed at a research trial that used financial incentives to encourage pregnant mothers to quit smoking. Mai Frandsen developed the research trial in Tasmania, a small island state in Australia characterised by high rates of smoking in pregnancy. In this article, we draw on data from 121 online text comments posted in relation to three Australia-wide media stories relating to the research trial in 2015. Two of the online stories came from popular Australian independent ‘mummy’ website ‘Mamamia’. We found that the intense negative moral judgement directed at the programme and the women it benefited was driven by an individualised risk discourse drawing on ideologies of the ‘good’ and ‘intensive’ mother. We argue in this article that the over-emphasis on risk in relation to pregnancy produces a conservative morality that demonise women, fails to account for the social determinants of health and diminishes care for the Other. We argue that the research programme with its incentive component was a useful alternative to more punitive risk approaches as it promoted reward rather than blame and shame and acknowledged the importance of including emotions and morality in analysing the relationship between risk, health and society.     

Low-income pregnant adolescents and their infants: dietary findings and health outcomes

Dietary and other health-related data were obtained for 99 low-income, pregnant adolescents aged 13 to 19 years and their infants who were enrolled in the Teen Pregnancy Service (TPS). The dietetic services provided through TPS are highlighted for this sample of teens, 97% of whom were eligible for the WIC program. Average gestational age at time of enrollment for prenatal care was 18 weeks; 59% of the sample was anemic (hemoglobin value less than 120 gm/L). The average number of servings teens consumed each day from the four food groups was as follows: bread/grain, 5.0; milk, 2.8; meat, 2.8; and fruit/vegetable, 2.3. Teens who were overweight before pregnancy had heavier infants (mean = 3,344 gm) than their underweight peers (mean = 2,770 gm). Teens who gained 24 lb or less during pregnancy and who gave birth to full-term infants had infants with significantly lower birth weights (mean = 3,094 gm, p less than .008) than those who gained at least 25 lb (mean = 3,356 gm). Teens who smoked also had infants with lower birth weights than teens who did not smoke. Most teens bottle-fed their infants (82%). On the basis of our data, we conclude that low-income pregnant teens are likely to be at dietary risk. Dietary work with low-income pregnant adolescents is challenging and requires a thorough knowledge base about adolescent pregnancy, coupled with the ability to adapt traditional dietary counseling practices to meet the unique needs of these clients.     

洛阳地区妊娠女性妊娠压力与心理健康及影响因素分析

目的调查并了解在妊娠期女性的心理健康与压力相关程度,分析和探讨其影响因素。方法选取河南科技大学第一附属医院孕期妇女到产科进行检查的符合排除和纳入标准的312名为研究对象,并采用妊娠压力量表以及症状自评量表进行问卷调查。结果孕妇的总体压力处于中等水平,得分为(1. 68±0. 43);其中"为确保母子健康和安全而引发的压力感"得分最高,为(2. 13±0. 70);不同文化程度在心理健康上差异有统计学意义(F=22. 105,P<0. 05),在压力上差异无统计学意义(F=1. 574,P>0. 05)、不同妊娠计划在压力和心理健康差异有统计学意义(t压力=3. 261,t心理健康=4. 065,P<0. 05),不同职业的孕妇在压力上差异无统计学意义(F=0. 769,P>0. 05),而在心理健康方面差异有统计学意义(F=2. 929,P<0. 05),是否接受试管婴儿对妊娠期女性妊娠压力和心理健康差异均无统计学意义(t压力=1. 364,t心理健康=0. 087,P>0. 05);孕妇的心理健康水平除了抑郁、偏执以及精神病这三项外(t=0. 567、0. 000、0. 295,P>0. 05),其余各项均值均显著高于中国常模(t=6. 160、2. 855、3. 683、3. 521、3. 122、4. 996,P<0. 05);压力的总均值以及各因子与心理健康的总均值以及各项目均值均呈现显著正相关(P<0. 05),即孕妇的压力越大,心理健康水平越低。结论洛阳地区妊娠压力水平处于中等水平,整体心理健康水平较差。多种因素都对妊娠压力水平对女性心理健康有显著影响,因此需要及时对孕妇进行压力评估和心理疏导,改善孕妇心理健康,使妊娠质量提高。     

Cultural influences on the management of environmental health risks among low-income pregnant women

Following environmental health disasters such as Hurricane Katrina and the Gulf Oil Spill, U.S. Gulf residents expressed concern regarding air quality. Women with children make many decisions that mitigate household air quality risks; however, research examining culture’s influence in their risk perception and the influence which this has on their behaviour is limited. In this article we examine the cultural connection between low-income women with children along the U.S. Gulf concerning the local threat of air quality. We used cultural consensus analysis to examine the perceptions of low-income, first-time pregnant women. We undertook an interview survey of 112 women living in Southeast Louisiana, USA between May 2014 and March 2015. In this article we examine if there was a shared (cultural) understanding among these women on how to manage air quality threats, evaluate what determined cultural sharing in the group, and explore what role cultural beliefs played in their intended household strategies. We found that although air quality was rarely discussed by the women in our study, we were able to identify two multi-centric cultural models of how these women sought to make sense of air quality issues. In one model they relied on their immediate social network of family and friends while in the other model they were willing to make use of official sources of information. These two models helped explain what measures these women planned to take to address air quality issues in and around their household. Our findings show that cultural norms permeate the assessment of risk in a community and that programmes designed to improve public health need to take into account the cultural context of the population.