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Tobacco Induced Diseases, Volume 19, pp 1-11; https://doi.org/10.18332/tid/138227

Abstract:
This study aimed to elucidate the biological implication of miR-937 in cigarette smoke extract (CSE)-induced human bronchial epithelial (HBE) cells and to further investigate its possible regulatory mechanism. Public datasets were downloaded to identify differentially expressed genes and subjected to Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis in chronic obstructive pulmonary disease (COPD). Online prediction site and luciferase reporter assay were applied to determine the target correlation between miR-937 and IL1B. RT-qPCR, Western blot and Enzyme-Linked Immunosorbent Assays (ELISA) analyses were used to evaluate the expressions of indicated molecules. HBE cells were exposed with CSE (20 μg/mL) to construct the in vitro COPD model. Cell proliferation and apoptosis were measured through cell counting kit 8 and Annexin-V/propidium iodide (PI) staining assays. IL1B was found to be up-regulated in COPD samples compared with healthy controls and had a high correlation with the TNF and IL-17 pathways according to the data from GSE57148. Moreover, IL1B was predicted to be a target of miR-937, and it was negatively regulated by miR-937. CSE treatment reduced the miR-937 expression, meanwhile decreased the HBE cells proliferation, enhanced cells apoptosis, and elevated the expression of IL-6, IL-17, and TNF-α. Moreover, in the CSE model, upregulation of miR-937 promoted cells viability, restrained cells apoptosis, and decreased levels of IL-6, IL-17, and TNF-α were noted, which could be abolished by overexpression IL1B. In contrast, inhibiting miR-937 impeded cells proliferation, promoted cells apoptosis and elevated levels of IL-6, IL-17 and TNF-α, which could be rescued by IL1B-knockdown in CSE-induced HBEs. These findings suggest that miR-937 plays a protective role on the HBEs after CSE damage, which may be achieved via targeting IL1B and inhibiting the TNF-α/IL-17 signaling pathway.
, Juhee Cho, Kevin Welding, Kate Smith, Joanna E. Cohen
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/136421

Abstract:
South Koreans continue to smoke at high rates. Tobacco manufacturers have a history of branding cigarettes with misleading descriptors including the introduction of low or ultra-low tar brand variants. The government bans traditional misleading descriptors (low, mild) but requires the presence of machine-assessed tar yields on cigarette packages. Literature suggests the presence of quantitative constituents can be misleading for smokers. We analyzed the machine-assessed tar value branding and the presence of additional branding that highlight tar levels on South Korean cigarette packs. In August 2018, we analyzed 178 unique cigarette packs purchased in Seoul and Busan, South Korea using a systematic protocol. Cigarette packs were coded for tar levels and classified as ultra-low, low, mid, and high tar. The presence of misleading descriptors and any additional branding relating to tar or potentially indicating strength were also coded. Machine-assessed tar yields ranged from 0.1 to 8 mg. Cigarettes with a 1 mg machine-assessed tar yield accounted for 38% of all packs purchased. A majority (80%) of packs with tar values <3 mg had additional marketing present on the pack that highlighted tar yields, compared to 45% for packs with tar values 3 mg or greater. Many (85%) of the 1 mg packs and all of the 0.1 and 0.5 mg packs had additional marketing present that referenced tar levels. These findings suggest that tobacco manufacturers are highlighting and reinforcing the tar yields of lower tar cigarettes by the deliberate use of tar level branding. These actions have the potential to mislead South Korean consumers that some cigarettes are less harmful than others. Strengthening of tobacco packaging regulations to prohibit references to tar yields on packs are needed to further protect consumers.
Isabell K. Tøkje, Solfrid L. Kirkeli, Lena Løbø,
European Journal of Midwifery, Volume 5, pp 1-7; https://doi.org/10.18332/ejm/137356

Abstract:
Mastitis (inflammation of the breast) occurs in 10–20% of breastfeeding women. Different levels of the health service meet the needs of women in different ways, and treatment procedures vary at a local level. As maternity care evolves, with a greater need for efficiency, and the treatment for women is also changing. The purpose of the study is to investigate women’s experiences of treatment for mastitis in the interface with the health service. The study has a qualitative design. It was conducted in 2018 and included semi-structured interviews with 11 women living throughout Norway who received treatment for mastitis. The data material was analyzed using systematic text condensation. The analysis resulted in three themes. The first theme was the interaction with healthcare personnel and related to being treated in a caring manner. The second concerned the women’s experience of feeling overwhelmed by pain and having to depend on help. The third theme related to the hospital stay and the women’s experiences of how random factors govern the treatment of the disease. The study shows that women who were treated for mastitis were at risk of being admitted to hospital wards characterized by a lack of knowledge about mastitis, insufficient or flawed treatment competence, and an absence of necessary equipment. Treatment should be organized in a way that enables women to be placed in wards where staff have knowledge and experience, such as maternity and gynaecological wards, as well as associated outpatient clinics.
, José F. Pascual-Lledó, Santos Asensio-Sánchez, Segismundo Solano-Reina, Marcos García-Rueda, Manuel Á. Martínez-Muñiz, Lourdes Lázaro-Asegurado, Daniel Bujulbasich, Susana Luhning, Rogelio Pendino, et al.
Tobacco Prevention & Cessation, Volume 7, pp 1-13; https://doi.org/10.18332/tpc/136506

Abstract:
The aim of this study was to explore the utility of measuring motivation to quit smoking as a predictor of abstinence maintenance among smokers who wanted to quit and who were included in a multicenter study conducted in daily clinical practice. This observational, longitudinal (prospective cohort), multicenter study was conducted in smoking clinics in Spain and the Argentine Republic in daily clinical practice. Motivation was assessed using three quantitative motivation tests and a Visual Analogue Scale. Statistical analysis included descriptive, association measures and logistic regression models. Of a total of 404 subjects, 273 were ultimately included for analysis (147 women; 53.8%), mean age 51±11 years). In one year, 53.5% (36.13% by intention to treat) of subjects (146) were successful in quitting smoking [men: 45.2% (66) and women: 54.8% (80)], with no differences between sexes. None of the scales utilized was associated, in an unquestionable or direct way, with long-term abstinence, although three of them, in a very complex model, with additional variables and added interactions, were associated with the ‘result’ variable, when other variables intervened in certain circumstances. None of the analyzed motivational scales alone demonstrated an association with success or failure in quitting smoking; thus, their use in isolation is of no value. Some of the scales analyzed might be related to the maintenance of abstinence but in complex models where other variables intervene, which makes interpretation considerably difficult. Therefore, the predictive capacity of the tests analyzed, based on the models, was low.
Bakhtawar M. H. Khowaja, Quratulain Shalwani
European Journal of Midwifery, Volume 5, pp 1-2; https://doi.org/10.18332/ejm/137484

Tobacco Prevention & Cessation, Volume 7, pp 1-13; https://doi.org/10.18332/tpc/137085

Abstract:
Globally, there has been a rapid rise in non-communicable diseases driven by changing lifestyle choices and health behaviors. Different lifestyle choices threaten to exacerbate existing health inequalities, yet evidence monitoring the extent of this impact in emerging economies is lacking. The article sets out to measure the level of wealth-related inequality and its drivers in one of these lifestyle choices, tobacco consumption, among populations aged ≥50 years in six Low- and Middle-Income Countries. The study provides empirical evidence of the inequality in tobacco consumption across wealth groups in China, Ghana, India, Mexico, the Russian Federation and South Africa using the Erreygers’ corrected concentration indices. These inequalities are then decomposed to gain a deeper understanding of the factors and broader social forces driving inequality. The WHO SAGE data set, collected between 2008 and 2010, is used for the analysis. Current tobacco consumption is concentrated among the poor in China, Ghana, India, and South Africa, and among the wealthy in the Russian Federation and Mexico. The inequalities widen when we focus solely on the male population. Although the results differ by country, the major drivers of inequality include wealth, locality, and gender. The focus on tobacco consumption in this age group is key to curbing rising healthcare costs and ensuring longevity. Policies aimed at reducing wealth-related inequalities should especially target high tobacco consumption rates among males, while simultaneously pre-empting and curbing rising rates among women.
Ingrid Ström, Amanda Söderman,
European Journal of Midwifery, Volume 5, pp 1-5; https://doi.org/10.18332/ejm/137365

Abstract:
Cultural doulas have a unique role in providing support to foreign-born women and improving their reproductive health. The aim was to explore cultural doulas’ experiences of giving support to foreign-born women during pregnancy and after childbirth. A qualitative descriptive study with an inductive approach included six cultural doulas in Sweden. Individual semi-structured interviews were conducted, and the data were analyzed with qualitative content analysis. The theme ‘To lead the way with pride’ was explored and described by the categories: A rewarding mission, A personal guide, and Makes the new society understandable. The cultural doulas gave support in the women’s mother tongue, something they experienced had contributed to reducing the risk of misunderstanding between women and healthcare professionals. The cultural doulas found their work important because the support they provided to women made healthcare more available to them. The cultural doulas felt proud when they experienced their work as meaningful and important. It was clear to them that their support and guidance had a positive impact on the women’s reproductive health as well as their integration into Swedish society. Cultural doulas could play an important role in building equal maternal healthcare in Sweden.
Mehrnush Mostafayi, , Shirdel Zandi, Faeze Jongi
European Journal of Midwifery, Volume 5, pp 1-7; https://doi.org/10.18332/ejm/137366

Abstract:
Cesarean section (C-section) is one of the most prevalent surgeries among women. The preoperative stages in the surgery day and lack of control over being in an unfamiliar situation and feeling danger cause anxiety, and consequently, instability in patients. This study aimed to determine the effect of familiarization with preoperative nursing care on anxiety and vital signs of patients in cesarean section. This randomized controlled trial study was performed on 80 pregnant candidates for C-section in Hamadan Fatemieh Hospital, Iran, in 2020. Patients were randomly divided into control (n=40) and intervention (n=40) groups. The control group just received the routine intervention of the hospital, but the intervention group, in addition, received the two familiarizing sessions with preoperative nursing care. Data were collected via vital signs sheet and Spielberger situational anxiety questionnaire and were analyzed using SPSS16 software at a significance level of p=0.05. Before the intervention, there was no significant difference between the mean anxiety scores of the control and intervention groups, and the two groups were homogeneous (p=0.396). However, after the intervention, the mean anxiety of the intervention group decreased significantly (p=0.001) and increased in the control group (p=0.600); and the mean post-test of the two groups showed a significant difference (p=0.001). After the intervention, the mean heart rate, respiration rate, systolic and diastolic blood pressure in the intervention group decreased significantly (p0.05). Based on the results of this study we conclude that familiarity with preoperative care reduces the level of anxiety and stabilized the level of vital signs parameters.
, Reeta Lamminpää, Kimmo Räsänen, Katri Vehviläinen-Julkunen, Tuomas Selander, Mika Gissler
European Journal of Midwifery, Volume 5, pp 1-6; https://doi.org/10.18332/ejm/137355

Abstract:
Work as a practical nurse (nurse assistant) may have an effect on pregnancy outcomes. Exposure to chemical, physical and biological hazards are common among hospital personnel. Stressful work conditions such as shift work, prolonged standing and long working hours have been reported among practical nurses. The aim of this study was to examine whether working as a practical nurse is associated with adverse perinatal outcomes. Data were obtained from the Finnish Medical Birth Register of 1997–2014. We included 58512 singleton newborns of practical nurses as cases, and 8765 and 39485 newborns of secretaries and housewives, respectively, as controls. Outcomes included preterm birth (<37 weeks), low birthweight (<2500 g), perinatal death (stillbirth or neonatal death within the first seven days), SGA (<2.5th percentile), and breech presentation, among others. Logistic regression analysis was performed and adjusted for confounders such as maternal age, parity, smoking, and diabetes. Being a practical nurse had lower likelihood of low birthweight (OR=0.88; 95% CI: 0.81–0.96), perinatal death (OR=0.77; 95% CI: 0.62–0.96), SGA (OR=0.79; 95% CI: 0.72–0.86) and episiotomy (OR=0.90; 95% CI: 0.86–0.94). Practical nursing was significantly related to higher odds of instrumental delivery (OR=1.08; 95% CI: 1.00–1.17), but not with preterm birth, breech presentation, shoulder presentation, or caesarean section. After adjusting for confounding variables, working as a practical nurse was associated with higher likelihood of instrumental delivery, particularly vacuum delivery. The risk for shoulder presentation was nearly two-fold compared to controls. Further studies to determine when mothers started their maternity leave and the consequent effect on pregnancy outcome is highly recommended.
Dimitra P. Mpousiou, Nikolaos Sakkas, Elpidoforos S. Soteriades, Michalis Toumbis, Stavros Patrinos, Anna Karakatsani, Areti Karathanassi, Vasilios Raftopoulos, Christina G. Gratziou,
Published: 23 June 2021
Tobacco Induced Diseases, Volume 19, pp 1-10; https://doi.org/10.18332/tid/134605

Abstract:
School-based tobacco control programs exhibit great variety. Our study aimed to evaluate the effectiveness of an experiential learning smoking prevention program in facilitating knowledge acquisition, forging healthy attitudes, and decreasing intention to smoke. A school-based intervention-control study was implemented during the 2016–2017 academic year among middle-school students in Athens, Greece. The experiential learning intervention was delivered using an interdisciplinary approach, bridging excerpts from ancient classical Greek myths, Aesop fables and ancient classical literature (Aristotle, Herodotus, Plutarch, Xenophon, Homer’s Epics), with their decoded archetypal symbols applied in a smoking and tobacco control paradigm. An anonymous self-administered questionnaire was used at baseline and at follow-up at 3 months to evaluate program effectiveness. A total of 351 students participated in our study; 181 (51.6%) in the intervention group and 170 (48.4%) in the control group. The mean age of student participants was 13 years (SD=0.96). Students in the intervention group were more likely to improve their knowledge of the adverse effects of smoking, develop attitudes against smoking and report a negative intention to smoke in the first year following the intervention, compared to the control group. This study provides evidence that school-based experiential learning smoking prevention programs improve smoking-related knowledge, enhance anti-smoking attitudes and reinforce negative intentions toward tobacco products.
, Gaby Schmidt, Kathrin Stoll, Mechthild M. Gross
European Journal of Midwifery, Volume 5, pp 1-6; https://doi.org/10.18332/ejm/136453

Abstract:
This study aimed to review and pilot-test feedback from childbearing women who completed the German short version of the Childbirth Self-Efficacy Inventory (CBSEI-C32), which is widely used and validated in different languages. Ten pregnant nulliparas, who planned a natural childbirth, completed the German CBSEI-C32 and provided comments about the comprehensibility of the tool. When applying the standardized translated German CBSEI-C32, we discovered that women generally gave positive feedback, and reported that the items made them think about coping strategies for labor and birth. Some pregnant woman had problems in understanding two items: ‘Mich beherrschen’ (original English item: ‘Keep myself in control’), and ‘Mich ruhig halten’ (original English item: ‘Keep myself calm’). Some of the items were not comprehensible for pregnant women and might not represent contemporary concepts of childbirth self-efficacy. Two items of the German CBSEI-C32 were interpreted ambiguously by the pilot testers. The CBSEI should be checked to identify which items could serve as the basis for a new questionnaire because there are clear and appropriate coping strategies when dealing with labour pain such as item 3 on breathing. These could be complemented with other coping behaviours that are positively worded and serve to empower rather than restrain women. For measuring self-efficacy beliefs in childbirth nowadays, it appears that health-oriented aspects, such as concentrating on the pauses between contractions or mentally staying in the present moment, are more important for women than focusing on control during childbirth.
European Journal of Midwifery, Volume 5, pp 1-7; https://doi.org/10.18332/ejm/136424

Abstract:
Continuity models of midwifery care are significant factors in facilitating a positive childbirth experience for birthing women. A knowledge gap exists regarding partners’ experiences of continuity of midwifery care during pregnancy, birth, and after birth, although it is essential to understand the experiences of both parents in relation to continuity of care. Thus, the aim of this study was to highlight partners’ expectations and experiences of having participated in a continuity of midwifery care project. A qualitative interview study using thematic analysis was carried out. Thirty-six partners in a rural area in northern Sweden were recruited after the closure of the local labor ward. Interviews were conducted in October 2019 and in May 2020. An overarching theme: ‘A partner-midwife relationship facilitated a sense of security’; and two themes ‘The concept of availability’ and ‘The midwife’s competence and professionalism’ reflect partners’ expectations and experiences after participating in a continuity of midwifery care project. Professionalism was most highly valued, but establishing a relationship with a known midwife facilitated a sense of security. When birthing women feel safe with the known midwife, the partners also feel safe. Having to travel a long-distance to a labor ward caused concern for the partners. This highlights the importance of an organization that supports families to gain access to continuity models of midwifery care and to have a possibility to give birth closer to their residence. The results of this qualitative study further strengthen the growing evidence of the positive effects of continuity models of midwifery care.
Chung-Yuan Yang, Jerry Cheng-Yen Lai, Wei-Lun Huang, Chiao-Lin Hsu,
Published: 17 June 2021
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/136419

Abstract:
Osteoporosis is major public health concern, but the long-term impacts of tobacco and alcohol consumption on its development are unclear. This study analyzed the relationship between tobacco and alcohol use and osteoporosis by using data from the Taiwan Biobank (TWB), established in 2012. Participants in TWB were included in our study, with a total of 18394 respondents included for analysis. To investigate the relationship between tobacco and alcohol use and osteoporosis, we surveyed their bone mineral density (BMD), consumption of tobacco and alcohol and other covariate data. We found that participants in the tobacco smoking only group (OR=1.24; 95% CI: 1.08–1.42, p=0.003) and the group that both smoked and consumed alcohol (OR=1.39; 95% CI: 1.09–1.77, p=0.008) were more likely to develop osteoporosis than were participants who neither drank alcohol nor smoked. Menopause is strongly associated with osteoporosis in women, and we found that women who used alcohol or tobacco were not at a significantly higher risk than those in the reference group (tobacco only, OR=1.15; 95% CI: 0.86–1.53, p=0.345; both tobacco and alcohol, OR=0.61; 95% CI: 0.14–2.60, p=0.5040). However, men in these groups were at a significantly higher risk than the reference group (tobacco only, OR=1.26; 95% CI: 1.07–1.48, p=0.006; both tobacco and alcohol, OR=1.32; 95% CI: 1.03–1.70, p=0.030). Menopause was a significant risk factor for osteoporosis (OR=2.46; 95% CI: 1.77–3.41, p<0.001). The influence of tobacco use on osteoporosis was significant, particularly in men, but the effects of alcohol consumption were equivocal in our study. The interactions between tobacco use, alcohol use, and menopausal status on osteoporosis should be considered in future studies.
, Seyma Baslilar,
Published: 16 June 2021
Tobacco Induced Diseases, Volume 19, pp 1-9; https://doi.org/10.18332/tid/136422

Abstract:
Long-term outcomes of smoking cessation treatments are crucial to optimize standards of cessation services, which are known to prevent excess morbidity and mortality. This study aimed to evaluate long-term outcomes of a smoking cessation program, to compare the success rates of interventions, to assess relapse rates after quitting, and to determine the duration until relapse. Patients admitted for smoking cessation between 2010–2018 were contacted to evaluate short- and long-term treatment outcomes. The patients were asked whether they were currently smoking, and whether they quit after smoking cessation treatment and the duration of abstinence. The study included 579 patients (341 males) with a mean age of 50±12 years. The median time from the date of visit to the smoking cessation clinic to analysis was 5 years (range: 2–10). Of the patient, 436 used medications, including varenicline, bupropion, and nicotine replacement therapy (NRT). The overall quit rate was 31.8% by the primary intervention (varenicline: 45.5%, bupropion: 38.2%, NRT: 33%, psychosocial support: 4.2%), and quit rate was similar in the intervention groups (p=0.073). In the long-term, the quit rates were 19.6, 22.5, 25.9, and 21.7%, respectively (p=0.405). About 9% of the patients failed to quit smoking initially but succeeded for a while after the first intervention at the cessation clinic. The relapse rate after initial cessation was 19%. The longest period of abstinence was in patients using NRT (14±17 months), followed by the patients using varenicline (9.5±12.7 months) and bupropion (8.2±14.8 months). Both short- and long-term quit rates with varenicline, bupropion, and NRT, were similar. The long-term quit rates among patients who did not use medication and received psychosocial support initially were comparable to those who used a smoking cessation drug.
Kuang Hock Lim, Sumarni Mohd Ghazali, Hui Li Lim, Yoon Ling Cheong, Chee Cheong Kee, Pei Pei Heng, Tsye Yih Tiunh, Mohd Hazilas Mat Hashim, Jia Hui Lim
Published: 16 June 2021
Tobacco Induced Diseases, Volume 19, pp 1-9; https://doi.org/10.18332/tid/136029

Abstract:
Secondhand (SHS) smoke exposure has caused various health problems. Therefore, continuous monitoring of SHS exposure is important to determine the efficacy of various anti-tobacco measure implemented. The study aims to compare the prevalence and factor(s) associated with SHS exposure among secondary school-going adolescents in Malaysia during 2012 and 2017. We derived data from the Global School Health Survey (GSHS) 2012 and GSHS 2017, which was carried out in Malaysia using multistage sampling to select representative samples of secondary school-going adolescents. Both surveys used similar questionnaires to measure SHS exposure. Descriptive and multivariate logistic regression was used to determine the prevalence and factors associated with SHS exposure. Approximately four in ten respondents were exposed to SHS in the past week in both surveys (41.5% in GSHS 2012 and 42.0% in GSHS 2017, respectively). Both surveys revealed a significantly higher SHS exposure among respondents who smoked than among non-smokers and higher among males compared to females. The likelihood of SHS exposure in both surveys was also similar, with a higher likelihood of SHS exposure among smoking adolescents and non-smoking adolescents who had at least one smoking parent/guardian, regardless of their own smoking status. Male adolescents had a higher risk of SHS exposure compared to their female counterparts. Meanwhile, SHS risk also increased with age, regardless of smoking status. Our findings suggested that there were no changes in the prevalence of SHS exposure and recorded only a slight change in the factors associated with exposure to SHS among school-going adolescents in Malaysia between the years 2012 and 2017. A more pro-active, extensive and comprehensive programme should be implemented to address the problem of SHS exposure. Parents should be advised to stop smoking or abstain from smoking in the presence of their children, and smoking cessation interventions are necessary for smoking adolescents and their parents.
Tobacco Prevention & Cessation, Volume 7, pp 1-6; https://doi.org/10.18332/tpc/136028

Abstract:
Since 2016, multi-family housing developments in South Korea can designate public areas such as staircases, elevator, corridors, and underground parking lots as non-smoking areas if at least half of the households residing in the development agree. This study investigated whether there were changes in the use of heat-not-burn tobacco products (HnB) based on whether non-smoking areas were introduced in multi-family housing developments. An online survey of 1200 apartment residents (599 men and 601 women) in seven metropolitan cities in South Korea was conducted from 10 to 18 October 2018. Among the 1200 people who completed the survey, 493 were smokers (351 men and 142 women), of whom 287 (195 men and 92 women) were currently using HnB. In total, 51.5% (n=148) of the HnB users reported that their smoking frequency inside (n=75) or outside (n=73) the apartment building increased after using HnB, whereas the smoking frequency of 27.5% (n=79) decreased and that of 20.9% (n=6) remained unchanged. Of the HnB users, 25.4% (n=73) were currently living in non-smoking apartments, of whom 39.7% reported that the smoking frequency outside the apartment building increased. On the other hand, of 214 people who did not currently reside in non-smoking apartments, 30.4% reported that the smoking frequency in the apartment increased. For smokers to quit smoking, the expansion of non-smoking areas should be accompanied by the facilitation of a smoke-free atmosphere and a smoking-cessation service for smokers.
, Burak G. Yildirim, Mehmet Mimaroglu, Muhammet B. Yavuz
Published: 11 June 2021
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/136418

Abstract:
Dentists are in a critical position to help patients quit smoking. This study analyses the effectiveness of Turkish dentists in smoking cessation as part of routine patient care. An in-person cross-sectional survey on previous dental visit experiences was completed by 226 patients recruited from the Department of Periodontology, Eskisehir Osmangazi University, Turkey, from March 2019 to September 2019. The questionnaire included topics on patient’s smoking/quit characteristics, experiences on smoking cessation from their dentists, and willingness for the implementation of smoking cessation advice by dentists. In all, 38% of the patients were current smokers, 8% were former smokers, and 68% tried to quit previously. Smokers demonstrated consistently higher scores for plaque index, gingival index, and probing depth, than former/non-smokers (p<0.05). Patients’ knowledge of adverse effects was high, and the patients presented a positive attitude toward receiving cessation activities from dentists (86.7%). A total of 89% responded positively to be asked about their smoking behavior. However, the dentists’ approach for cessation discussions did not go any further than listing the harmful effects. Only 32% of the patients were informed about side effects of smoking and one-third were encouraged to quit. In general, offering smoking cessation advice was relatively infrequent, and the majority of patients tried to quit smoking by themselves (76%) without using any nicotine replacement product (84%). Smoking leads to oral health problems. Dentists in Turkey may ask their patients’ about their smoking habits but less frequently offer practical help to quit.
, Eric N. Lindblom, Ramzi G. Salloum, Kenneth D. Ward
Published: 11 June 2021
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/136040

Abstract:
The perceived health risks of tobacco products may change during the ongoing COVID-19 pandemic. This study aimed to examine the perceived risks of tobacco use on COVID-19 infection and severity, and possible COVID-related changes in perceptions of tobacco use and overall health. We conducted an online survey of adults in the United States in June 2020 (n=2097). The survey covered cigarettes, cigars, e-cigarettes, and hookah. We also assessed changes in the use of any of the four tobacco products. Multivariate logistic regression models were used to estimate the odds of agreeing with the perceived risks for each risk and each product, with the adjustment of demographic and COVID-19 related variables. For all four tobacco products, the perceived risks to general health were slightly higher during the pandemic than before the pandemic (77% vs 79.5% for cigarettes) and the perceived risk of COVID-19 severity was larger than the perceived risk of COVID-19 infection (73.3% vs 56.2% for cigarettes). All risk measures varied with tobacco products consistently, with the risks highest for cigarettes, then cigars, followed by e-cigarettes and hookah. Females and people with higher income or education were more likely to endorse the risks of tobacco use than their counterparts. People who perceived higher risks of using cigarettes (OR=1.65; 95% CI: 1.20–2.27) and cigars (OR=1.63; 95% CI: 1.17–2.27) to COVID-19 severity were more likely to have decreased or quit their use. Tobacco/nicotine use was perceived to increase the risk of COVID-19 severity and the perceived risk of tobacco/nicotine use to general health was high during the pandemic, particularly for cigarettes. The change of perceived risks appeared to be prompting harm-reducing changes in tobacco product use.
Case H. Keltner, Tzu-Cheg Kao, Anwar Ahmed,
Tobacco Prevention & Cessation, Volume 7, pp 1-12; https://doi.org/10.18332/tpc/135516

Abstract:
Cigarette and e-cigarette use are threats to the health and readiness of the US military. The study objective was to determine the prevalence and factors associated with e-cigarette, cigarette, and dual use among active duty service members (SMs). We used data from the 2015 Health Related Behaviors Survey—a crosssectional survey weighted to represent the US military (n=16699). Weighted prevalence and odds ratios assessed associations between risk factors and e-cigarette/cigarette use via weighted multinomial logistic models. The prevalence of cigarette use in the US military declined from 24% in 2011 to 13.8% in 2015. However, e-cigarette use (12.4%) and dual product use (4.7%) increased during this period. Additionally, prevalence of e-cigarette use was higher in the military compared to the general population (12.4% vs 3.5%), particularly among those aged 17–24 years (22.8% vs 5.2%); cigarette use was also higher in the military in this age group (19.3% vs 13.0%). After adjustment, SMs who were enlisted, lacked a Bachelor’s degree, and/or had probable alcohol use disorder had significantly greater odds of cigarette, e-cigarette, and dual use. While SMs aged 17–24 years had the highest prevalence of all types of product use, only being aged ≥45 years was significantly associated with decreased odds of product use in adjusted models. Military efforts to control cigarette use among SMs seem to have been successful, as demonstrated by the dramatic declines in its use and the lower prevalence seen in the military compared to the general population. However, the concurrent increases in e-cigarette use are concerning, particularly among the youngest members of the military. The US military must continue to monitor emerging trends in e-cigarette, cigarette, and dual use and rapidly take steps to address them as threats to health and readiness.
Bekir Kaplan, Arik V. Marcell, Tugba Kaplan, Joanna E. Cohen
Tobacco Induced Diseases, Volume 19, pp 1-7; https://doi.org/10.18332/tid/136031

Abstract:
There is paucity of literature that evaluates e-cigarette use rates among the youth with attention deficit hyperactivity disorder (ADHD). The aim of this study is to compare the rates of cigarette only, e-cigarette only, dual use, and initiation age of regular use and trying to quit cigarettes or e-cigarettes among the youth with and without ADHD. We used Population Assessment of Tobacco and Health (PATH) study Wave 3 (2015–2016) youth data, a nationally representative cross-sectional study in the US. The main outcome was tobacco use status of youth and ADHD diagnosis was based on parent report. The survey included 11801 youth (50%, 12–14 years; 49% female). Compared to youth without ADHD, the relative risk ratio (RRR) was 1.79 (95% CI: 1.02–3.21) for cigarette only use, 1.41 (95% CI: 1.01–2.21) for e-cigarette only use, 3.40 (95% CI: 1.69–6.84) for dual use, 1.75 (95% CI: 0.92–3.35) for cigarette and other product(s) use, 1.48 (95% CI: 0.58–3.77) for e-cigarette and other product(s) use, and 3.37 (95% CI: 1.88–6.17) for poly use among youth with ADHD, after adjusting for age group, sex, and race/ethnicity. Cigarette only use, e-cigarette only use, dual use of cigarettes and e-cigarettes, and poly use of cigarettes, e-cigarettes, and other product(s) were significantly associated with parent report of an ADHD diagnosis. It is critical for healthcare providers to be screening youth for e-cigarette use, especially youth who are diagnosed with ADHD.
Dina Farran, Grace Khawam, Rima Nakkash, Juhan Lee, Nivine Abu-Rmeileh, Muhammad W. Darawad, Aya Mostafa, Khalid A. Kheirallah, Mohamed Salama, Randah R. Hamadeh, et al.
Tobacco Prevention & Cessation, Volume 7, pp 1-10; https://doi.org/10.18332/tpc/134561

Abstract:
This study aimed to determine associations between health warning label content and motivation to quit waterpipe smoking by gender and smoking location. Convenience samples of university students in three Eastern Mediterranean countries – Egypt (n=442), Jordan (n=535) and Palestine (n=487) – completed an online survey assessing health warning labels. Multinomial logit regression models were conducted to determine the association between different variables, particularly gender and smoking location, with motivation to quit. In Palestine, female smokers were more motivated to quit waterpipe smoking when seeing textual warning labels related to children (T2) and pregnancy (T6) [T2: 1.8 (95% CI: 1.1–2.8), T6: 2.7 (95% CI: 1.6–4.3)] compared to males. Similar results were found in Jordan [T2: 1.6 (95% CI: 1.0–2.6), T6: 1.8 (95% CI: 1.1–3.0)]. As for the smoking location, home-only smokers in Palestine were more likely to quit in response to the following warnings: waterpipe smoking is addictive T1: 2.3 (95% CI: 1.4–3.7), harmful for children T2: 2.3 (95% CI: 1.4–4.1), harmful for the baby during pregnancy T6: 2.4 (95% CI: 1.3–4.3), and to believe that quitting reduces the health risks T9: 1.8 (95% CI: 1.0–3.1). These results were not found in Jordan nor Egypt. Smokers reported that the most noticeable location of a HWL on a waterpipe device is the mouthpiece. A better understanding of motivation to quit and its association with various warnings and smoking location could guide countries on which warnings to require in legislation and where best to require them particularly in relation to location.
, Bharathi Upadhya, Elsayed Z. Soliman
Tobacco Induced Diseases, Volume 19, pp 1-7; https://doi.org/10.18332/tid/136415

Abstract:
Chronic hypertension is associated with left ventricular hypertrophy. Recent evidence suggests that secondhand smoke (SHS) exposure is associated with chronic hypertension, so we sought to examine the relationship between secondhand smoke exposure and electrocardiographic left ventricular (LV) mass among non-smokers. This analysis included 4982 non-smoker participants from the Third National Health and Nutrition Examination (NHANES-III). Non-smoking was defined by self-report and serum cotinine ≤10 ng/mL, a biomarker for tobacco exposure. SHS exposure was defined as serum cotinine level ≥1 ng/mL. LV mass was estimated using an electrocardiographic model developed and applied in NHANES-III then validated in the Cardiovascular Health Study. Multivariable linear regression was used to examine the cross-sectional association between SHS exposure (vs no exposure) with estimated LV mass index. In similar models, we also examined the associations of LV mass index across quartiles of serum cotinine (reference group, 1st quartile) and in subgroups stratified by age, race, sex, hypertension, and obesity. About 9.8% (n=489) of the participants were exposed to SHS. Exposure to SHS was associated with an estimated 2.9 g/m2 increase in LV mass index, with a dose-response relationship between higher serum cotinine and LV mass index. These results were consistent in men and women, Whites and non-Whites, elderly and non-elderly, and those with and without hypertension. Significant effect modification was present among obese individuals with an estimated 4.8 g/m2 increase in LV mass index (interaction p=0.01). In a racially diverse sample of non-smokers, SHS is associated with increased LV mass with a dose-response relationship between level of exposure and LV mass. Effect modification was present among obese individuals. These findings underscore the harmful effect of passive smoking on the cardiovascular system and highlight the need for more restrictions on smoking in public areas, especially in countries or regions with less-stringent public health policies.
, Indah Nur Chomsy, Wiwit Nurwidyaningtyas, Fibe Yulinda Cesa, Cholid Tri Tjahjono, Titin Andri Wihastuti
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/135320

Abstract:
Endothelial Progenitor Cells (EPCs) are part of hematopoietic stem cells that differentiate into endothelial cells during their blood vessels’ maturation process. The role of EPCs is widely known to contribute to repair of the vascular wall when endothelial dysfunction occurs. However, various risk factors for cardiovascular disease (CVD) influence EPC performance, leading to endothelial dysfunction. One EPC dysfunction is decreased amount of EPC mobilization to the injured tissue. EPC dysfunction reduces the angiogenetic function of EPCs. The vital maturation process that the EPCs must pass is the late phase. The dysfunction of late EPCs is known as senescence. This study aimed to identify and compare senescence of late EPCs, through CD62E and CD41 markers, in non-smokers and smokers as a risk factor for CVD. EPC collection was from peripheral mononuclear cells (PBMCs) in non-smokers (n=30) and smokers (n=31). The EPCs were then marked by CD62E/CD41 and senescence β-galactosidase assay using FACS. Identification of senescence cells was based on fluorescence with DAPI. Positive percentage of late EPCs in non-smokers was not significantly different from that in smokers (p=0.014). The number of senescent late EPCs in smokers was higher than in non-smokers (p<0.0001). Endothelial progenitor cells that experienced senescence in the smokers showed EPC dysfunction, which resulted in decreased cell angiogenic function. Further research is needed to explain the mechanism of re-endothelialization failure in EPC dysfunction due to smoking.
Gitte S. Jakobsen, Dina Danielsen, Marie P. Jensen, , , , , Susan Andersen
Tobacco Prevention & Cessation, Volume 7, pp 1-12; https://doi.org/10.18332/tpc/133934

Abstract:
Youth smoking remains a major challenge for public health. Socioeconomic position influences the initiation and maintenance of smoking, and alternative high school students are at particularly high risk. The school environment is an important setting to promote health, however there is a lack of evidence-based school intervention programs. This article presents the Focus study, which aims to test the implementation and effectiveness of a school-based intervention integrating1 a comprehensive school smoking policy [i.e. smoke-free school hours (SFSH)]2, a course for school staff in short motivational conversations3, school class-based teaching material4, an edutainment session5, a class-based competition, and6 access to smoking cessation support. Together these intervention components address students’ acceptability of smoking, social influences, attitudes, motivation, and opportunities for smoking. The setting is alternative high schools across Denmark, and the evaluation design is based on a stratified cluster randomized controlled trial comparing the intervention group to a control group. Outcome data is collected at baseline, midway, and at the end of the intervention period. Moreover, a detailed process evaluation, using qualitative and quantitative methods, is conducted among students, teachers, and school principals. The results from this trial will provide important knowledge on the effectiveness of a smoke-free school environment. The findings will lead to a better understanding of which policies, environments, and cognitions, contribute to preventing and reducing cigarette use among young people in a diverse and high-risk school setting, and illuminate which complementary factors are significant to achieve success when implementing SFSH.
, Xian Yi Ng, Jeong Kyu Lee
Tobacco Induced Diseases, Volume 19, pp 1-11; https://doi.org/10.18332/tid/135321

Abstract:
Singapore, a city-state with a multi-ethnic Asian population, has one of the world’s largest market shares for cigarettes with added flavors, such as menthol and fruit, which increase the appeal of smoking. Little is known on the sociodemographic or smoking-related traits associated with flavored cigarette use in the Asian context. A cross-sectional survey was conducted in January–March 2020 of 1123 Singaporean adult (aged 21–69 years) current smokers using a self-completed online or postal questionnaire. We used descriptive statistics and bivariate analyses to compare the answers of flavored and non-flavored cigarette users and fitted a multivariate logistic regression model to identify correlates of flavored cigarette use. Of the respondents, 85.2% reported ever use and 52.7% of respondents with a regular brand reported current use of flavored cigarettes. Older age 40–49 years (AOR= 0.63) age ≥50 years (AOR=0.60), Indian ethnicity (AOR=0.39), and a moderate (AOR=0.57) or high (AOR=0.34) dependence level were correlated with non-flavored cigarette use, while female gender (AOR=2.53) and a later initiation age (16–20 years: AOR=1.72; age ≥21 years: AOR=2.19) were correlated with flavored cigarette use. Consistent with findings from other countries, flavored cigarette use in Singapore is associated with being younger in age, female, of a certain ethnicity (Malay or Chinese), and having a lower nicotine dependence level.
, Pirjo Kaakinen, Maria Kääriäinen, Risto Bloigu, Leena Hannula, Satu Elo
European Journal of Midwifery, Volume 5, pp 1-11; https://doi.org/10.18332/ejm/134846

Abstract:
This study aimed to describe exclusive breastfeeding (EBF, Step 6 of the Baby-Friendly Hospital Initiative) in Finnish maternity hospitals and identify factors that promote or limit EBF. A cross-sectional study design was used, and data were collected from eight maternity hospitals in Finland during a 10-day period in May 2014. The staff completed questionnaires (n=1554) from separate work shifts. The data were analyzed using descriptive statistics, and chi-squared and Fisher’s tests. Responses to open-ended questions were analyzed using content analysis. Maternity ward staff reported that 72% (n=1105) of the infants were exclusively breastfed during their work shift. The strongest promoting factors of exclusive breastfeeding were: maternity ward staffs’ profession and education in breastfeeding counselling; multiparity; vaginal delivery; early skin-to-skin contact between mother and infant; initial breastfeeding after birth; rooming-in; and initial success of breastfeeding. The use of a nipple shield, the need for additional breastfeeding counselling, and infants’ blood tests were limiting factors to exclusive breastfeeding. Open-ended answers revealed that exclusive breastfeeding was mainly delayed because of medical issues for the mother or infant. Finnish maternity hospitals could improve exclusive breastfeeding rates by focusing attention and resources on breastfeeding counselling and evidence-based maternity care practices related to immediate care after birth, promoting vaginal delivery, rooming-in and availability of skilled counselling.
, Rein R. Distelvelt, Ingri G. Olsen, Ien A. M. van de Goor, Anton E. Kunst, Andrea D. Rozema
Tobacco Prevention & Cessation, Volume 7, pp 1-7; https://doi.org/10.18332/tpc/134612

Abstract:
Outdoor smoke-free policies (SFPs) at sports clubs may contribute to the prevention of smoking among adolescents. Adolescents’ support for such policy is important to its success. The aim of this study is to explore adolescents’ perceptions with regard to an outdoor SFP at sports clubs in the Netherlands. Focus group discussions (n=27) were held with 180 participants (aged 13–18 years) at 16 sports clubs. Thematic analysis was used to analyze the data. Participants generally supported an outdoor SFP at sports clubs. Five reasons for this support were reported: 1) children should not be exposed to smoking, 2) smoking and sports (clubs) do not fit together, 3) secondhand smoke is undesirable, 4) an outdoor SFP may enhance a sports club’s image, and 5) an outdoor SFP contributes to the prevention of smoking. Some participants voiced considerations against an outdoor SFP, arguing amongst others, that smokers need to be taken into account, and that problems may occur with compliance and enforcement. Support for an outdoor SFP was stronger among participants at clubs with an outdoor SFP than among those without such policy. This study shows that adolescents generally support an outdoor smoke-free policy at sports clubs. After implementation, the outdoor SFP was generally experienced as a normal practice. These results could encourage sports clubs without an outdoor SFP to become smoke-free as well.
, Yajun Zhu, Chenhui Li, Yi Wang, Shichang Wang, Shuang Wu, Shiyan Zhang,
Tobacco Induced Diseases, Volume 19, pp 1-10; https://doi.org/10.18332/tid/135440

Abstract:
Hearing loss and cigarette smoking are major challenges that affect public health in China. Revealing the effect of smoking on hearing loss in the Chinese general population is critical for hearing health protection. We investigated the relationship between smoking status and hearing loss in China, especially in stratified sex and age groups. A cross-sectional study was conducted on 4685 individuals aged 20– 80 years in Zhejiang province from 2016 to 2018, with audiometric testing for hearing loss and a structured questionnaire for collecting smoking status and covariates. Logistic regression was used to estimate the association between smoking and hearing loss. Cigarette smoking was not significantly associated with hearing loss in females and young males. In middle-aged males, after adjusting for covariates, current smokers and past smokers had a significantly higher prevalence of speech-frequency loss (OR=1.65; 95% CI: 1.17–2.33 and OR=1.88; 95% CI: 1.11–3.17; respectively) and high-frequency hearing loss (OR=2.01; 95% CI: 1.43–2.84 and OR=2.64; 95% CI: 1.50–4.66; respectively). In older males, only past smokers had a significantly higher prevalence of speech-frequency hearing loss than never smokers (OR=2.58; 95% CI: 1.38–4.85). Regarding middle-aged and older current smokers, a dose-dependent relationship between smoking intensity and hearing loss was found. Passive smoking was not significantly associated with an increased hearing loss risk in all the three male groups. The relationship between cigarette smoking and hearing loss varied according to gender and age. Therefore, the interventions for smoking need to be tailored according to age in males.
Lærke P. Lidegaard, , Charlotta Pisinger
Tobacco Prevention & Cessation, Volume 7, pp 1-9; https://doi.org/10.18332/tpc/134800

Abstract:
Workplaces are important settings for implementation of smoke-free environments. In this study, we follow a medical production company with 677 employees that implemented one of the most stringent tobacco policies legally possible in Denmark – smoke-free work hours – which means that employees are not allowed to smoke during work time. This study explores tobacco use restrictions during work hours regarding readiness of implementation, focusing specifically on middle managers’ perceptions and considerations, as well as their perceived responsibility in enforcing these. A case study is presented. Two focus groups of 10 middle managers were conducted, seven months before smoke-free work hours were implemented. The facilitators used open-ended questions, which consisted of a structured section with specific themes related to the implementation of smoke-free work hours. Focus groups were recorded, transcribed, and analyzed thematically. We identified five main themes: 1) Benefits of the new policy due to better health, lower sickness-related absences, increased productivity, and improved branding value; 2) Social interactions across smoking status; 3) Smoking is a private matter with ethical dimensions; 4) The role of middle managers and concerns about enforcement; and 5) Limited experience with resistance from the smoking employees. The findings suggest that workplaces in the preparation phase should ensure that: 1) The middle managers gain training on how to talk with employees about smoking cessation; 2) The middle managers are equipped to handle the new policy and have a joint vision and understanding of why and how they should enforce it; and 3) Room is made for discussions on resistance and enforcement-related challenges as well as ethical issues.
, Judith S. Gordon, Michael S. Lyons, Roman A. Jandarov,
Tobacco Prevention & Cessation, Volume 7, pp 1-13; https://doi.org/10.18332/tpc/134751

Abstract:
The study objective was to assess tobacco screening and cessation counseling practices of pediatric emergency department (PED) and urgent care (UC) nurses and physicians, and factors associated with these practices. Secondarily, we assessed factors associated with performing tobacco smoke exposure reduction and tobacco cessation counseling. We conducted a cross-sectional survey of 30 PED/UC nurses and physicians working at one large, urban, Midwestern children’s hospital. Measures included current practices of performing the 5 As of tobacco counseling (Ask, Advise, Assess, Assist, Arrange), and attitude and practice factors that may influence practices. Overall, 90.0% of participants had not received recent tobacco counseling training, 73.3% were unaware of the 5 As, and 63.3% did not have a standardized, routine screening system to identify patients exposed to secondhand smoke. The majority of participants reported that they: asked about patients’ secondhand smoke exposure status (70.0%) and parents’ tobacco use status (53.3%), and advised parental smokers to not smoke around their child (70.0%) and to quit smoking (50%). One in five participants reported they assessed smokers’ interest in quitting smoking, and 16.7% talked with smokers about cessation techniques and tactics; of these, 10% referred/enrolled smokers to the Tobacco Quitline or cessation program, and 6.7% made a quit plan or recommended nicotine replacement therapy medication. Key findings identified are the need for professional tobacco counseling training, standardizing efforts during visits, and emphasizing pediatric patients’ potential health benefits. This information will be used for developing a PED/ UC-based parental tobacco cessation and child tobacco smoke exposure reduction intervention.
, Jordan Van Godwin, Nick Page, Linda Bauld, Jennifer McKell, Britt Hallingberg, Olivia Maynard, Anna Blackwell,
Tobacco Prevention & Cessation, Volume 7, pp 1-10; https://doi.org/10.18332/tpc/134370

Abstract:
From May 2016, the European Union introduced the Tobacco Products Directive (TPD) regulations, which included restrictions to advertising and new safety and labeling standards for e-cigarette products. This represented the first supranational policy regulating e-cigarette sales and marketing. This study explores perceptions of TPD and its implementation in Wales, Scotland and England, from perspectives of stakeholders involved in tobacco and e-cigarette policy and implementation in each nation. Semi-structured qualitative interviews were completed with 12 stakeholders from government and third sector organizations in the UK involved in tobacco control policy-making processes, and Trading Standards Officers from 13 UK local authorities. Data were analyzed thematically and a sub-sample double-coded. Stakeholders held varying views of e-cigarettes, recognizing potential benefits and harms of both the products and the new policy actions. Nevertheless, most perceived TPD to be a positive step in introducing regulation for e-cigarettes. Compliance was perceived as high across nations, although stakeholders highlighted product adaptations to circumvent restrictions, and absence of controls on non-nicotine products. Budgetary and staffing limitations also meant that capacity to communicate new measures, and enforce change, was limited. This led to a gap occupied by industry representatives, who played a substantial role in preparing retailers for adoption of new measures. TPD policy roll-out was largely perceived positively and as having been effectively implemented. However, contribution of industry to communication of new measures and absence of resourcing for effective communication perhaps introduced widespread innovations within regulations. While largely viewed positively, some refinements to device regulations were proposed.
Bara S. Bataineh, Anna V. Wilkinson, Kathleen R. Case, , Aslesha Sumbe, Baojiang Chen, Melissa B. Harrell
Tobacco Prevention & Cessation, Volume 7, pp 1-10; https://doi.org/10.18332/tpc/133571

Abstract:
Although emotional symptoms and sensation seeking are recognized as important risk factors for tobacco use among youth and young adults, to date, their joint influence on tobacco use has not been examined. Data used in this study are from the Texas Adolescent Tobacco and Marketing Surveillance study, a population-based cohort. At baseline, in 2014, participants were in the 10th grade. Mixed-effects logistic regression models examined associations between emotional symptoms and sensation seeking in 2014 and odds of past 30-day cigarette and e-cigarette use in 2018. Interactions between emotional symptoms and sensation seeking were examined to assess whether one modifies the effect of the other on cigarette and e-cigarette use. After adjusting for age, sex, race/ethnicity, school type, and ever use of cigarettes or e-cigarettes at baseline, adolescents with high emotional symptoms (AORcig=1.97; 95% CI:1.07–3.60, and AORe-cig=1.68; 95% CI: 1.06–2.66) and with high sensation seeking tendencies (AORcig=2.05; 95% CI: 1.03–4.10, and AORe-cig=1.68; 95% CI: 1.02–2.76) had significantly higher odds of past 30-day cigarette and e-cigarette use four years later compared to adolescents with low emotional symptoms and low sensation seeking tendencies. The interaction was significant (p=0.01) for e-cigarette use only; among low sensation seekers, adolescents who reported high levels of emotional symptoms were at increased risk for past 30-day use (AORe-cig=3.43; 95% CI: 1.38–8.51), and among adolescents with low emotional symptoms, high sensation seekers were at increased for risk for past 30-day use (AORe-cig=3.50; 95% CI: 1.54–7.91). It is important for tobacco use prevention programs to consider both behavioral risk factors – sensation seeking and emotional symptoms – in an integrative way, to target high risk subgroups and thereby increase the efficacy of existing effective intervention strategies in order to curb tobacco use among youth and young adults.
, Viviana Lira
European Journal of Midwifery, Volume 5, pp 1-9; https://doi.org/10.18332/ejm/136423

Abstract:
Maternal positions and mobility during childbirth can have different and specific effects on labor and affect some birth outcomes. The aim of the survey is to investigate the knowledge and skills regarding maternal positions in labor among midwives and to consider the need of training. A semi-structured questionnaire was distributed in August and September 2020 among midwives working in eight hospitals of Brescia, Northern Italy. The sample consisted of 115 midwives and data were analyzed using a quantitative, descriptive approach. The majority of the sample identified the general and specific benefits of maternal positions. Factors limiting the proposal of maternal positions were the context, the relationships with healthcare providers, the woman features, the fetal heart rate registration, continuous cardiotocography, amniotomy, episiotomy, operative vaginal birth, and epidural analgesia. Vaginal examination, the detection of uterine contractions, intrapartum ultrasounds, and ‘hands-on’ perineum technique were considered irrelevant by the participating midwives. The promoting factors were the presence of the partner, the telemetry, and the partogram with a section dedicated to positions. Nearly the totality of the sample considered appropriate to deepen the topic with training. Post-graduate courses are desirable to improve midwives’ skills. An educational toolkit is proposed to make the promotion of maternal positions more effective and appropriate. In order to improve midwifery intrapartum care, further research addressed to midwives of other settings appears essential to compare different training contexts, to expand the proposed toolkit, and to invest on midwifery practice and education.
, Thomas G. Kuijpers, Anton E. Kunst
Tobacco Prevention & Cessation, Volume 7, pp 1-11; https://doi.org/10.18332/tpc/134220

Abstract:
In most countries, public health partnerships exist to advance national tobacco control. We assessed characteristics related to tobacco control partnership capacity across Europe. We developed a tool to assess partnership characteristics related to their theoretical capacity to influence policy. The tool was based on an existing framework in the literature, which we adapted for the tobacco control field, through an expert panel, insights from the literature and pilot tests. The tool consists of three dimensions: resources (8 items), member characteristics (2 items), and organizational characteristics (8 items) and was administered to 18 European partnerships across 17 European countries in 2019. Whereas several characteristics likely related to tobacco control partnership capacity were highly prevalent across European partnerships, some were not. Of all 18 partnerships, 5 did not include professional lobbyists, 7 did not have access to national information on tobacco industry presence and lobbying, 9 had no influence on national research agendas, and 7 did not maintain working relationships with the relevant Minister or Secretary of State. Furthermore, 5 of 18 partnerships had no agreement on roles and responsibilities of member organizations, and 6 had no agreement on how credits are divided across member organizations. A leadership figure was absent in 6 of 18 partnerships. This study confirms that tobacco control partnerships vary greatly in the extent to which they possess characteristics associated with their ability to advance tobacco control. There is much room for improvement of European tobacco control partnerships.
Monica P. Diaz, Naomi Simpson, Angela Brown, Faith C. Diorgu, Mary Steen
European Journal of Midwifery, Volume 5, pp 1-12; https://doi.org/10.18332/ejm/134511

Abstract:
Perineal trauma is a commonly observed complication of childbirth, affecting more than 75% of women who have a vaginal birth. Perineal trauma is associated with significant short- and long-term comorbidities that negatively impact women’s quality of life. Severe perineal trauma (SPT) rates in Australia have almost doubled in the last decade. Reasons for increased rates are not completely understood; some researchers suggest improvements in diagnosis and reporting, while others have a view that it may be due to a lack of structured and standardized education in perineal wound assessment and repair for clinicians. The Joanna Briggs Institute (JBI) scoping review methodology was adopted as a systemic process to identify studies that have investigated the effectiveness of perineal wound assessment and repair education and training for midwives and midwifery students. Five studies met the inclusion criteria for this review, to have evaluated a type of education or training, on childbirth-related perineal wound assessment and repair that included midwives and midwifery students. A total of 1279 midwives and midwifery students volunteered to participate in all five studies. The length of the education or training implemented varied between each study from a 1-day workshop to 100 hours of education. All five studies measured the effectiveness of each program through changes in participants’ confidence, knowledge and skills in perineal assessment and repair before and after an intervention using various self-assessment questionnaires. The implementation of a structured educational workshop on perineal wound assessment and repair improves the confidence, skills and knowledge of midwives and students.
, Tremayne Koochin, Ryan Ottwell, Wade Arthur, Taylor C. Rogers, Micah Hartwell, Elizabeth Chen, Alicia Ford, Drew N. Wright, Meghan Sealey, et al.
Tobacco Prevention & Cessation, Volume 7, pp 1-11; https://doi.org/10.18332/tpc/134238

Abstract:
Smoking cessation treatments and available evidence continue to evolve. To stay current with the latest research, physicians often refer to abstracts of systematic reviews. Because abstracts of systematic reviews may have direct effects on patient care, the information within them should be free of ‘spin’. Spin is a specific way of reporting, intentional or not, to highlight that the beneficial effect of the experimental treatment in terms of efficacy or safety is greater than that shown by the results (i.e. overstate efficacy and/or understate harm). We searched systematic reviews and meta-analyses focused on interventions and treatments for smoking cessation. Full-text screening, data extraction, evaluation of spin, and quality assessment were conducted in masked, duplicate fashion. Study and journal characteristics were also recorded to determine whether they were associated with the presence of spin. A total of 200 systematic reviews that met inclusion criteria were included in the final analyses. Spin occurred in 3.5% (7/200) of the systematic review abstracts included in our sample. No study characteristics were significantly associated with spin. Of the reviewed abstracts in systematic reviews and meta-analyses, 96.5% of those that focused on smoking cessation were free of spin. However, the existence of spin warrants further steps to improve the scientific accuracy of abstracts on smoking cessation treatments. By identifying and acknowledging the presence of spin in systematic reviews, we hope to increase awareness about reporting practices in an ultimate effort to improve the integrity of scientific research as a whole.
, Tania O. Abe, Patricia V. Gaya, Bianca Bellini, Iana R. A. de Moraes, Juliana R. Santos, Paulo R. X. Tomaz, Paulo C. Jr. de Lima Santos, Serena Tonstad
Tobacco Prevention & Cessation, Volume 7, pp 1-10; https://doi.org/10.18332/tpc/133570

Abstract:
Varenicline effectively helps smokers quit by reducing withdrawal symptoms and blocking the reward of smoking. However, most quitters return to smoking within one year. ‘Cue Restricted Smoking’ is a behavioral technique designed to increase quit rates by asking smokers attempting to quit to restrict smoking to the standing position, while alone, in an isolated area facing a wall, with the cigarette as the only stimulus. Using retrospective clinic records we compared quit rates in 281 smokers (50% males) instructed in the cue restricted smoking cessation method during 2016–2018 to quit rates in 324 smokers (46% males) advised to completely stop smoking on the target quit date which we previously used during 2011–2014. All were prescribed varenicline for 12 weeks alone, with the addition of bupropion if needed after 4 weeks. Follow-up consisted of behavioral support at 4–6 visits during active drug treatment and telephone counselling at 24 and 52 weeks. The smoking cessation rate was confirmed with exhaled carbon monoxide at the clinic visit at 12 weeks and only by telephone at 52 weeks. The mean age of smokers was 49 years in both groups and the number of cigarettes smoked daily was similar (18/day in the cue restricted vs 19/day in the target quit day group). The smoking cessation rate at 12 weeks was 75% in the cue restricted versus 45% in the target quit day group (relative risk, RR=1.8; 95% CI: 1.4–2.2, p<0.001). At 52 weeks the quit rate was 65% vs 34%, respectively (RR=1.9; 95% CI: 1.5–2.4, p<0.001). Cue restricted smoking was associated with a substantially increased chance of quitting compared with standard advice during treatment with varenicline. These results should be further studied in a randomized controlled trial.
, Joshua S. Yang, Vidya L. Purushothaman, Matthew Nali, Jiawei Li, Tim K. Mackey
Tobacco Prevention & Cessation, Volume 7, pp 1-10; https://doi.org/10.18332/tpc/133933

Abstract:
Concomitant with the popularization of vaping, vape shops have dramatically proliferated over the past years. This study assesses whether vape storefronts in California are significantly associated with density of different age groups, and whether this differs between tobacco storefronts or non-specific tobacco retailers. Addresses for licensed tobacco retailers were obtained from the California Department of Tax and Fee Administration. Business names and addresses were used to obtain store categories cross-referenced from Yelp. Using a cross-sectional ecological design, stores categorized as ‘Vape Shop’ or ‘Tobacco Shop’ were geolocated and compared with age-related variables from the American Community Survey. Regression was conducted in R to determine relationships between age group concentration, in ventiles, and proportion of tracts with tobacco-specific or vape-specific stores. Geospatial visualization was conducted using ArcGIS. We found 848 vape shops, 820 tobacco shops, 419 categorized as both, and 20320 retailers with neither category. Overall, 1800 tobacco and/or vape shops were categorized in 1557 of California’s 23194 census tracts. A positive linear association was found between ventiles of two age categories, 20–24 and 25–34 years, and proportion of tracts with vape-specific or tobacco-specific shops separately. Positive associations were found for ages 20–34 years but not for other ages, suggesting vape shops are strategically located in areas populated by young adults. Location-based targeting increases access, thereby increasing proportion of tobacco users, and could be a critical factor in e-cigarette uptake and use. Further study to identify additional age-related demographic characteristics among clientele of tobacco storefronts is warranted.
Tobacco Induced Diseases, Volume 19, pp 1-12; https://doi.org/10.18332/tid/133932

Abstract:
Compared with the number of studies in adults, body weight in relation to tobacco use has been understudied in the adolescent population. This study aimed to examine the association between underweight, overweight and tobacco use in low- and middle-income countries. Data were derived from the Global School-Based Student Health Survey (GSHS). Data from 71176 adolescents aged 12–15 years residing in 23 countries were analyzed. The Centers for Disease Control and Prevention (CDC) 2000 growth charts were used to identify underweight, normal weight, and overweight/ obesity. Weighted age- and gender-adjusted prevalence of weight categories and tobacco use was calculated. Multivariate logistic regression analysis was performed to estimate the association between weight categories and tobacco use for each country, controlling for covariates. Pooled odds ratios and confidence intervals were computed using random- or fixed-effects meta-analyses. A significant association between weight categories and tobacco use was evident in only a few countries. Adolescents reporting tobacco use in French Polynesia, Suriname, and Indonesia, had 72% (95% CI: 0.15–0.56), 55% (95% CI: 0.24–0.84), and 24% (95% CI: 0.61–0.94) lower odds of being underweight, respectively. Adolescents reporting tobacco use in Uganda, Algeria, and Namibia, had 2.30 (95% CI: 1.04–5.09), 1.71 (95% CI: 1.25–2.34), and 1.45 (95% CI: 1.00–2.12) times greater odds of being overweight/obese, but those in Indonesia and Malaysia had 33% (95% CI: 0.50–0.91) and 16% (95% CI: 0.73–0.98) lower odds of being overweight/obese. The association between tobacco use and BMI categories is likely to be different among adolescents versus adults. Associating tobacco use with being thin may be more myth than fact and should be emphasized in tobacco prevention programs targeting adolescents.
Hong Chao+, Yu Cheng+, Jie Shan, Hai-Feng Xue, Wei-Lan Xu, Hong-Jie Li, Meng E
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/133704

Abstract:
Cigarette smoking has been hypothesized to be a risk factor for meningioma. However, the results of studies exploring the relationship between smoking exposure and the occurrence of meningioma are inconsistent. A search of PubMed, Medline, Embase, and Science Direct (up to June 2020) databases was performed. Two authors independently extracted the data. The Newcastle–Ottawa Scale was employed for judging the quality of articles. A random-effects model was utilized for meta-analysis. Association analysis between smoking and meningioma was based on the adjusted RR and the 95% CI, as reported by eligible studies. Subgroup and sensitivity analyses were performed and publication bias was assessed. Subgroup analysis was conducted by geographical region, study design, sex, study quality, and adjustments of RR score. Begg’s and Egger’s tests were employed for detecting publication bias. Twelve articles, including 2 cohort studies and 10 case–control studies, and a total of 1210167 participants were identified. The pooled relative risk (RR) with 95% confidence interval (95% CI) implied that smoking was not associated with increased risk of meningioma in men and women combined (RR=1.09; 95% CI: 0.90–1.33). From the sex-stratified subgroup analysis, the risk of meningioma was significant in men (RR=1.42; 95% CI: 1.16–1.74). Risk of meningioma in women did not remain significant (RR=0.92; 95% CI: 0.73–1.16). There was a high heterogeneity in the results (I2=58.4%, p=0.002). Sensitivity analyses showed stable results and there was no evidence of publication bias. Cigarette smoking is not associated with a significantly increased risk of meningioma in the whole population, but there is a positive association in men but not in women.
Dina Farran, Rima Nakkash, Mahmoud Al-Hindi, Maya Romani, Martin J. O. Asser, Mary Khairallah,
Tobacco Induced Diseases, Volume 19, pp 1-10; https://doi.org/10.18332/tid/133751

Abstract:
A growing body of research has evaluated the effect of university tobacco-free policies on faculty and staff, however, none of these studies has been carried out in the Eastern Mediterranean Region. This study evaluates changes in faculty and staff attitudes, perceptions and smoking behavior, at 1 year post adoption of a tobacco-free policy in a medium-sized university in Lebanon and the region. Two cross-sectional surveys were conducted in 2017 and 2018: baseline and at 1 year post policy implementation. A random sample of 625 and 624 participants took part in the 2017 and 2018 studies, respectively. Faculty and staff had a positive attitude towards the policy at the two time points. The belief that there should be exceptions to the policy significantly decreased from 79% to 59% (p=0.002) among all smokers, particularly those with lower educational attainment (81% to 57%, p=0.007). Perception of compliance among peer smokers increased from 73% to 87% (p=0.009). The proportion of smokers did not significantly change at 1 year post policy implementation, however, 44% of smokers with lower educational attainment, compared to only 7% of those with higher educational attainment (p<0.001), reported a decrease in their smoking behavior outside campus. The policy had a positive effect on the attitude, behavior and perception of policy benefits among smokers with lower educational attainment, who constitute the majority of smokers. Findings from this study inform and support future efforts to develop university and workplace tobacco-free policies.
Peeraya Suteerangkul, , Surintorn Kalampakorn, Naruemon Auemaneekul
Tobacco Induced Diseases, Volume 19, pp 1-8; https://doi.org/10.18332/tid/133876

Abstract:
Smoking inside the home affects the health of both the smoker and family members via secondhand exposure. This research examined the impact of a community participation program on creating smoke-free homes in a suburban community in Thanyaburi district, Pathumthani province in Thailand. The study involved families, with a smoker in the home, that were randomly assigned to intervention and control groups each containing 27 families. The intervention group was administered with the community participation program for smoke-free homes for 5 sessions during the 6-month period of study. The program included providing information on secondhand smoking and harms, knowledge about quitting smoking and healthcare support, practice skills, campaigns in the community, visiting and encouraging, and reflecting and evaluation. The control group was normally treated by the community committee and health volunteers. Data collection was undertaken at baseline and at 6 months after implementation by an interview with questionnaires. Our results show that after the implementation, the intervention group reported significantly higher mean score on skills in negotiating with smokers for a smoking-ban inside home and mean score on emotional support for non-smoking inside the home than those at baseline and those of the control group. The proportion having smoking ban home rules in the intervention group was significantly higher than at baseline and that of the control group (92.6% vs 18.5%). The proportion of smoke-free homes was higher in the intervention than in the control group (75% vs 0%). These findings suggest that community participation programs for smoke-free home may be effective in raising awareness on the impact of secondhand smoke among family members and in working together to manage smoke-free home environments. The program may be applicable for further development within communities to achieve smoke-free homes.
, Rajeev Cherukupalli, Kevin Welding, Ryan D. Kennedy, Joanna E. Cohen
Tobacco Induced Diseases, Volume 19, pp 1-5; https://doi.org/10.18332/tid/133874

Abstract:
Past 30-day e-cigarette use increased by 78% among high school students from 2017 to 2018, an increase attributable to pod-style devices. JUUL Labs (JUUL) insists they do not market their product to teenagers. We created several scenarios to estimate the percentages of JUUL’s net revenue from adults and youth in the US in 2018. We used the number of youth (aged 12–17 years) and adults (aged ≥18 years) who reported using JUUL in the nationally representative Population Assessment of Tobacco and Health (PATH) Study wave 4 (Dec 2016–Jan 2018) to estimate the youth proportion of JUUL users. As a sensitivity analysis, we also used data from the nationally representative Truth Longitudinal Cohort (TLC) study to estimate the youth proportion of JUUL users. Based on this percentage, we then applied several scenarios to estimate JUUL’s net revenue from youth in the US in 2018. From the PATH Study, 31% of JUUL users were youth (aged 12–17 years). In the TLC study, 30% of current JUUL users were aged 15–17 years. Given that JUUL’s net revenue was $1.3 billion in 2018, we calculated that JUUL made between $130 million and $650 million of its net revenue from youth, depending on consumption scenarios. A substantial proportion of JUUL’s profits in 2018 were a result of use by youth. It could be required that all e-cigarette companies actively ensure that use by youth is below a pre-determined small fraction of their sales, requiring that a high penalty be paid by those that fail to do so.
Dipal Mehta+, Rory Dennis+, Susanna Nallamilli, , Jose María Martínez Sánchez
Tobacco Prevention & Cessation, Volume 7, pp 1-6; https://doi.org/10.18332/tpc/133008

Abstract:
To determine the correlation between tobacco control policies and mortality of haematological malignancies: leukemia, lymphoma and multiple myeloma (MM). Ecological study with the countries as the unit of analysis. Tobacco Control Scale (TCS) scores from 2010, 2013 and 2016 were used as measures for the level of tobacco control policy implementation in 27 European countries. Mortality rates for leukemia, lymphoma, and MM, were obtained from the WHO Mortality Database and the European Cancer Information System for each country for 2010, 2013, 2015 and 2018. Correlation between yearly TCS scores and mortality rates from the same and prospective years were calculated using Spearman’s rank correlation coefficients (rsp) and 95% confidence intervals (95% CI) (2010 TCS scores vs 2010, 2013, 2015, 2018 mortality rates; 2013 TCS scores vs 2013, 2015, 2018 mortality rates; and 2016 TCS scores vs 2018 mortality rates). The 2010 TCS scores were significantly negatively associated with leukemia mortality rates in 2013 (rsp=-0.58; 95% CI: -0.79, -0.24; p=0.002), 2015 (rsp=-0.65; 95% CI: -0.85, -0.30; p=0.001) and 2018 (rsp=-0.44; 95% CI: -0.71, -0.06; p=0.021). TCS scores from 2013 and 2016 had significant negative associations with leukemia mortality in all prospective years. TCS scores did not demonstrate consistent correlations with lymphoma and MM mortality. The level of tobacco control policies in European countries correlates negatively with leukemia mortality at ecological level, with no correlation seen for lymphoma and MM. This study advocates that increased tobacco control implementation may improve leukemia mortality.
Published: 28 April 2021
Tobacco Induced Diseases, Volume 19, pp 1-13; https://doi.org/10.18332/tid/133373

Abstract:
Mobile instant messaging could deliver real-time, personalized, interactive smoking cessation support. Nicotine replacement therapy (NRT) is effective in increasing quit attempts and abstinence but is underused. We assessed the feasibility of mobile chat-based intervention combined NRT sampling (NRT-S) on abstinence. In this two-arm, single-blinded, randomized controlled trial, adult (≥18 years) daily cigarette smokers were proactively recruited from Hong Kong community settings using ‘foot-in-the-door’ approach during December 2017 to March 2018. All participants received brief advice on quitting, 1-week of NRT-S, active referral to smoking cessation services, and were individually randomized (1:1) at baseline. The intervention group received two months of chat-based support via instant messaging. The control group received general smoking cessation text messages. The primary outcome was smoking abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 3 and 6 months using intention-to-treat analysis. A total of 119 participants (80.7% male, 60.5% aged 30–40 years) were randomized and analyzed. Among the 14 and 13 self-reported quitters at 3 and 6 months respectively, only 3 and 1 had biochemical validation. The 3 months validated abstinence rate was 2/62 (intervention) vs 1/57 (control) (AOR=1.07; 95% CI: 0.08–13.65). At 6 months follow-up (68.9% of participants retained), more participants in the intervention group reported quitting (10/62 vs 3/57; AOR=2.83; 95% CI: 0.70–11.30), smoking reduction (20/62 vs 11/57; AOR=1.74; 95% CI: 0.71–4.26), and quit attempts (56/62 vs 44/57; AOR=2.61; 95% CI: 0.88–7.82). Significantly more NRT-S use (39/62 vs 22/57; AOR=2.27; 95% CI: 1.04–4.96) was observed in the intervention group. Participants engaged in mobile chat support (21/62) reported more NRT-S use (76.2% vs 56.1%), although not statistically significant. Mobile chat-based support plus NRT-S was feasible and showed preliminary evidence of increased quitting, smoking reduction, quit attempts, and NRT-S use in proactively recruited community smokers. ClinicalTrials.gov: NCT03574077.
, David W. Wetter, Roy Otten, Rutger C. M. E. Engels, Marloes Kleinjan
Tobacco Prevention & Cessation, Volume 7, pp 1-11; https://doi.org/10.18332/tpc/133019

Abstract:
Recently, a Dutch proactive parent-tailored telephone smoking cessation counselling program, Smoke-free Parents (SFP), was demonstrated to be effective in helping parents to quit smoking. This study aimed to examine the program’s uptake and the costs of two recruitment approaches (i.e. healthcare vs mass media) for SFP. In addition, parent’s barriers to participating in SFP and the characteristics of participating parents were assessed. As part of an effectiveness-implementation hybrid trial, 402 smoking parents were recruited via healthcare settings and mass media for an informal, proactive, and free phone call with a smoking cessation counsellor about SFP (the Netherlands, September 2016 – September 2018). Parents were asked whether they wanted to participate in SFP. If parents refused, reasons for decline and additional information (e.g. educational level) were collected. Results revealed that 26.4% of the recruited parents participated in SFP. Although the program uptake of parents recruited via mass media was slightly, but not significantly, higher than via healthcare (27.3% vs 26.8%, p=0.92), the healthcare approach resulted in lower costs per participant (€99.62 vs €205.72). Smoking cessation counsellors were unable to reach almost one-third (32.7%) of the parents after they had agreed to be called about SFP. The present study showed that more than a quarter of all recruited parents participated in SFP and that the mass media approach and healthcare approach can be used to recruit parents for SFP. To increase the number of parents participating in SFP, it is important to overcome the identified barriers that prevent parents from participating.
, Renata L. Guerra, Rita de Cássia R. de Albuquerque, Aline Nascimento, Raphael D. Chança, Mirian C. de Souza, Liz M. de Almeida
Tobacco Prevention & Cessation, Volume 7, pp 1-10; https://doi.org/10.18332/tpc/132964

Abstract:
The use of e-cigarettes has been the subject of a public health debate on their possibility of undermining efforts for tobacco control. The aim of this study was to synthesize the risk of smoking relapse with the use of e-cigarettes by former smokers. MEDLINE, EMBASE, PsycInfo and LILACS were searched without restriction to language or date of publication. Longitudinal observational studies evaluating the association between e-cigarette use and smoking relapse were selected by two independent reviewers, and disagreements solved by discussion with a third researcher. Data extraction and risk of bias assessment were also carried out by two independent reviewers. The meta-analysis was performed using the random effect Mantel-Haenszel model. From 632 retrieved records, six studies were eligible and described, while three were included in the quantitative synthesis. The studies were conducted in the USA, UK and France, with final sample size varying from 374 to 4094 former smokers. Risk of relapse was 2.03 (95% CI: 1.39–2.96) among former smoker users than non-users of e-cigarettes, and 1.38 (95% CI: 1.11–1.65) when pooling the adjusted association measures. Long-term former smokers were the main contributors for the higher relapse risk, while the impact of frequency of exposure to e-cigarettes (past, non-daily, daily) was uncertain. Considering the growing popularity of e-cigarettes among former smokers, our results point to the great potential for an increase in the frequency of relapse to conventional smoking and vaping for those who move to regular use of e-cigarettes.
, Annika Karlström, Christine Rubertsson, Birgitta Larsson
European Journal of Midwifery, Volume 5, pp 1-10; https://doi.org/10.18332/ejm/134502

Abstract:
Continuity models are rare in Sweden. The aim was to compare the intrapartum care experiences between women who had or not a known midwife attending their birth. A cohort study was conducted in a rural area with long distance to a labor ward in Sweden. From August 2017 to June 2019, a continuity model with a known midwife was offered between 7 a.m. and 11 p.m. daily. Questions about intrapartum care were assessed in two aspects; the perceived reality and the subjective importance. A total of 226 women recruited in early pregnancy were followed up two months after giving birth. Women who had a known midwife providing labor care reported higher overall satisfaction and were more likely to value the subjective importance and the perceived reality significantly higher than women who received intrapartum care without a known midwife assisting. When analyzing the medical aspects of intrapartum care, the most important factors for not being satisfied were deficiencies in the partner’s involvement and insufficient pain relief. For the emotional aspects, deficiencies in participation in decision making was the most important aspect. Having a known midwife assisting at birth reduced discrepancies between women’s subjective importance and perceived reality of intrapartum care, especially regarding support and the involvement of the partner. A known midwife generated higher overall satisfaction with the medical and emotional aspects of intrapartum care. To improve satisfaction and the quality of intrapartum care, continuity midwifery models of care should be implemented.
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