Investigating the effects of comprehensive smoke-free legislation on neonatal and infant mortality in Thailand using the synthetic control method

Background: Almost all of the evidence on the benefits of smoke-free legislation on child health comes from evaluations in high-income countries. We investigated the effects of Thailand’s 2010 comprehensive smokefree legi

Socioeconomic inequalities in smoking and drinking in adolescence:social network dynamics

BackgroundNetwork-based interventions have the potential to prevent socioeconomic inequalities in health behaviors but require a good understanding of the underlying social network mechanisms. We investigated whether (1) adolescents selected friends with a similar socioeconomic status (SES), (2) smoking and alcohol consumption spread in networks, and (3) the exclusion of non-smokers or non-drinkers differed between SES groups.MethodsWe applied Stochastic Actor Oriented Models to the complete social network data (“Wired into Each Other” data) of 253 adolescents in eight Hungarian secondary school classes over three waves between 2010 and 2013. SES was measured based on entitlement to an income-tested regular child protection benefit.ResultsHigh SES adolescents were most likely to form friendships with peers from their own SES group (odds ratio [OR] = 1.1, 95% Confidence Interval [CI] = 1.0-1.1). Adolescents adjusted their smoking behavior (OR = 24.0, 95% CI 1.3-454.9) but not their alcohol consumption (OR = 1.6, 95% CI 0.6-4.4) to emulate the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 1.0, 95% CI 0.9-1.1), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.2, 95% CI 1.0-1.3), but this association was not significantly different according to SES.ConclusionsSocioeconomic inequalities in health behaviors were driven by preferences to form friendships within their own SES group and the spread of smoking and alcohol consumption in the network. These inequalities were not amplified by SES differences in encouraging smoking or drinking.Main messages: In three waves of observations in a Hungarian adolescent cohort, the study found social network effects for inequalities in smoking and alcohol consumption

Socio-economic inequalities in smoking and drinking in adolescence:Assessment of social network dynamics

AIMS: We investigated whether (1) adolescents selected friends with a similar socio-economic status (SES), (2) smoking and alcohol consumption spread in networks and (3) the exclusion of non-smokers or non-drinkers differed between SES groups.DESIGN: This was a longitudinal study using stochastic actor-oriented models to analyze complete social network data over three waves.SETTING: Eight Hungarian secondary schools with socio-economically diverse classes took part.PARTICIPANTS: This study comprised 232 adolescents aged between 14 and 15 years in the first wave.MEASUREMENTS: Self-reported smoking behavior, alcohol consumption behavior and friendship ties were measured. SES was measured based upon entitlement to an income-tested regular child protection benefit.FINDINGS: Non-low-SES adolescents were most likely to form friendships with peers from their own SES group [odds ratio (OR) = 1.07, 95% confidence interval (CI) = 1.02-1.11]. Adolescents adjusted their smoking behavior (OR = 24.05, 95% CI = 1.27-454.86) but not their alcohol consumption (OR = 1.65, 95% CI = 0.62-4.39) to follow the behavior of their friends. Smokers did not differ from non-smokers in the likelihood of receiving a friendship nomination (OR = 0.98, 95% CI = 0.87-1.10), regardless of their SES. Alcohol consumers received significantly more friendship nominations than non-consumers (OR = 1.16, 95% CI = 1.01-1.33), but this association was not significantly different according to SES.CONCLUSIONS: Hungarian adolescents appear to prefer friendships within their own socio-economic status group, and smoking and alcohol consumption spread within those friendship networks. Socio-economic groups do not differ in the extent to which they encourage smoking or alcohol consumption.</p

Impact of an Inner-City Smoke-Free Zone on Outdoor Smoking Patterns:A Before-After Study

INTRODUCTION: On September 2, 2019, Rotterdam’s first inner-city outdoor smoke-free zone encompassing the Erasmus MC, a large university hospital in the Netherlands, the Erasmiaans high school, the Rotterdam University of Applied Sciences and the public road in between, was implemented. AIMS AND METHODS: We aimed to assess spatiotemporal patterning of smoking before and after implementation of this outdoor smoke-free zone. We performed a before–after observational field study. We systematically observed the number of smokers, and their locations and characteristics over 37 days before and after implementation of the smoke-free zone. RESULTS: Before implementation of the smoke-free zone, 4098 people smoked in the area every weekday during working hours. After implementation, the daily number of smokers was 2241, a 45% reduction (p = .007). There was an increase of 432 smokers per day near and just outside the borders of the zone. At baseline, 31% of the smokers were categorized as employee, 22% as student and 3% as patient. Following implementation of the smoke-free zone, the largest decreases in smokers were observed among employees (–67%, p value .004) and patients (–70%, p value .049). Before and after implementation, 21 and 20 smokers were visibly addressed and asked to smoke elsewhere. CONCLUSIONS: Implementation of an inner-city smoke-free zone was associated with a substantial decline in the number of smokers in the zone and an overall reduction of smoking in the larger area. Further research should focus on optimizing implementation of and compliance with outdoor smoke-free zones. IMPLICATIONS: A smoke-free outdoor policy has the potential to denormalize and discourage smoking, support smokers who want to quit, and to protect people from secondhand smoke exposure. Implementation of an inner-city smoke-free zone encompassing a large tertiary hospital and two educational institutions was associated with a substantial decline in the number of smokers in the zone, as well as in the larger area. Voluntary outdoor smoke-free zones can help reduce the number of smokers in the area and protect people from secondhand smoke. There is a need to explore effectiveness of additional measures to further improve compliance

Een rookvrije omgeving in het belang van het kind

Achtergrond: het percentage rokers onder medewerkers van de verslavingszorg is hoger dan onder de Nederlandse bevolking. Voor een succesvolle behandeling van een tabaksverslaving is het van groot belang dat de behandelaar niet rookt. Verslavingszorg Noord Nederland (VNN) streeft ernaar rookvrij te zijn, en daarom richt dit onderzoek zich op het in kaart brengen van barrières die rokende medewerkers ervaren bij het stoppen met roken.Methode: in totaal hebben 39 medewerkers van VNN een vragenlijst ingevuld. Antwoorden van rokende en niet-rokende respondenten zijn met elkaar vergeleken, en verschillen tussen de antwoorden zijn getoetst met een Fisher’s exact test.Resultaten: van de respondenten geeft 41 % aan te roken, van wie ruim 56 % dagelijks. Rokende respondenten lijken de barrières om te stoppen met roken voornamelijk bij zichzelf (dus in de interne context) te zoeken en minder in de omgeving (de externe context).Conclusie: de resultaten van dit onderzoek laten zien dat rokende respondenten door hun verslaving een beperktere blik hebben op de potentiële barrières om te stoppen met roken. Het is dus belangrijk om rokende medewerkers bewust te maken van het feit dat ze door het eigen rookgedrag bij anderen de behoefte aan roken versterken of anderen kunnen aanzetten om te gaan roken.<br/

Inequity in postpartum healthcare provision at home and its association with subsequent healthcare expenditure

BACKGROUND: Provision of postpartum care can support new families in adapting to a new situation. We aimed to determine whether various determinants of socioeconomic status (SES) were associated with utilization of postpartum care. In addition, to stress the relevance of increasing postpartum care uptake among low SES-groups, an assessment of the potential (cost-)effectiveness of postpartum care is required. METHODS: National retrospective cohort study using linked routinely collected healthcare data from all registered singleton deliveries (2010-13) in the Netherlands. Small-for-gestational age and preterm babies were excluded. The associations between SES and postpartum care uptake, and between uptake and health care expenditure were studied using multivariable regression analyses. RESULTS: Of all 569 921 deliveries included, 1.2% did not receive postpartum care. Among women who did receive care, care duration was below the recommended minimum of 24 h in 15.3%. All indicators of low SES were independently associated with a lack in care uptake. Extremes of maternal age, single parenthood and being of non-Dutch origin were associated with reduced uptake independent of SES determinants. No uptake of postpartum care was associated with maternal healthcare expenses in the highest quartile: aOR 1.34 (95% CI 1.10-1.67). Uptake below the recommended amount was associated with higher maternal and infant healthcare expenses: aOR 1.09 (95% CI 1.03-1.18) and aOR 1.20 (95% CI 1.13-1.27), respectively. CONCLUSION: Although uptake was generally high, low SES women less often received postpartum care, this being associated with higher subsequent healthcare expenses. Strategies to effectively reduce these substantial inequities in early life are urgently needed