Visualizing Europe's demographic scars with coplots and contour plots

We present two enhancements to existing methods for visualizing vital statistics data. Data from the Human Mortality Database were used and vital statistics from England and Wales are used for illustration. The simpler of these methods involves coplotting mean age of death with its variance, and the more complex of these methods is to present data as a contour plot. The coplot method shows the effect of the 20th century’s epidemiological transitions. The contour plot method allows more complex and subtle age, period and cohort effects to be seen.<p></p> The contour plot shows the effects of broad improvements in public health over the 20th century, including vast reductions in rates of childhood mortality, reduced baseline mortality risks during adulthood and the postponement of higher mortality risks to older ages. They also show the effects of the two world wars and the 1918 influenza pandemic on men of fighting age, women and children. The contour plots also show a cohort effect for people born around 1918, suggesting a possible epigenetic effect of parental exposure to the pandemic which shortened the cohort’s lifespan and which has so far received little attention.<p></p> Although this article focuses on data from England and Wales, the associated online appendices contain equivalent visualizations for almost 50 series of data available on the Human Mortality Database. We expect that further analyses of these visualizations will reveal further insights into global public health.<p></p&gt

Visualizing fertility trends for 45 countries using composite lattice plots

Background: The Human Fertility Database (HFD) and Human Fertility Collection (HFC) provide disaggregated data on age-specific fertility rates for 45 countries. These sources offer the opportunity to learn about the development of different pathways of transition to low fertility both within and between countries. Objective: The aim of this paper is to use composite fertility lattice plots, which combine information from different visualization techniques of the Lexis surface, namely level plots and contour plots, to explore changes in age-specific fertility rates (ASFRs) and the implied (period-based) cumulative cohort fertility rates (cumulative pseudo cohort fertility rates, CPCFRs) across countries and geographic regions. Methods: Through key examples we introduce a new refinement of the Lexis surface, combining level plots, which use colour/shade to indicate ASFRs, and contour lines to indicate fertility milestones for given cohorts (CPCFRs). We have also developed a web-based app to allow researchers to produce their own fertility Lexis surfaces. Results: Results show that once countries have fallen below a replacement fertility level, they tend to not return to it. Exceptions are Norway and the United States, which saw rising fertility rates for cohorts born after the 1950s and late 1960s respectively. The age-specific fertility trends, as well as broader political and socioeconomic conditions, are very different in these countries, suggesting different paths by which replacement fertility rates might be achieved. Contribution: Complex data visualizations show, in an intuitive way, how ASFRs are related to successive cohorts’ fertility milestones (CPCFRs). Combining this information enables us to explore differences between countries and can make an important contribution to comparative fertility research

Interest in and Use of Smoking Cessation Support Across Pregnancy and Postpartum.

BACKGROUND: Limited research exists on interest in and use of smoking cessation support in pregnancy and postpartum. METHODS: A longitudinal cohort of pregnant smokers and recent ex-smokers were recruited in Nottinghamshire, United Kingdom (N = 850). Data were collected at 8-26 weeks gestation, 34-36 weeks gestation, and 3 months postpartum and used as three cross-sectional surveys. Interest and use of cessation support and belief and behavior measures were collected at all waves. Key data were adjusted for nonresponse and analyzed descriptively, and multiple regression was used to identify associations. RESULTS: In early and late pregnancy, 44% (95% CI 40% to 48%) and 43% (95% CI 37% to 49%) of smokers, respectively, were interested in cessation support with 33% (95% CI 27% to 39%) interested postpartum. In early pregnancy, 43% of smokers reported discussing cessation with a midwife and, in late pregnancy, 27% did so. Over one-third (38%) did not report discussing quitting with a health professional during pregnancy. Twenty-seven percent of smokers reported using any National Health Service (NHS) cessation support and 12% accessed NHS Stop Smoking Services during pregnancy. Lower quitting confidence (self-efficacy), higher confidence in stopping with support, higher quitting motivation, and higher age were associated with higher interest in support (ps ≤ .001). A recent quit attempt and greater interest in support was associated with speaking to a health professional about quitting and use of NHS cessation support (ps ≤ .001). CONCLUSIONS: When asked in early or late pregnancy, about half of pregnant smokers were interested in cessation support, though most did not engage. Cessation support should be offered throughout pregnancy and after delivery. IMPLICATIONS: There is relatively high interest in cessation support in early and late pregnancy and postpartum among smokers; however, a much smaller proportion of pregnant or postpartum women access any cessation support, highlighting a gap between interest and engagement. Reflecting women's interest, offers of cessation support should be provided throughout pregnancy and after delivery. Increasing motivation to quit and confidence in quitting with assistance may enhance interest in support, and promoting the discussion of stopping smoking between women and health practitioners may contribute to higher support engagement rates

Smoking and quit attempts during pregnancy and postpartum: a longitudinal UK cohort.

OBJECTIVES: Pregnancy motivates women to try stopping smoking, but little is known about timing of their quit attempts and how quitting intentions change during pregnancy and postpartum. Using longitudinal data, this study aimed to document women's smoking and quitting behaviour throughout pregnancy and after delivery. DESIGN: Longitudinal cohort survey with questionnaires at baseline (8-26 weeks' gestation), late pregnancy (34-36 weeks) and 3 months after delivery. SETTING: Two maternity hospitals in one National Health Service hospital trust, Nottingham, England. PARTICIPANTS: 850 pregnant women, aged 16 years or over, who were current smokers or had smoked in the 3 months before pregnancy, were recruited between August 2011 and August 2012. OUTCOME MEASURES: Self-reported smoking behaviour, quit attempts and quitting intentions. RESULTS: Smoking rates, adjusting for non-response at follow-up, were 57.4% (95% CI 54.1 to 60.7) at baseline, 59.1% (95% CI 54.9 to 63.4) in late pregnancy and 67.1% (95% CI 62.7 to 71.5) 3 months postpartum. At baseline, 272 of 488 current smokers had tried to quit since becoming pregnant (55.7%, 95% CI 51.3 to 60.1); 51.3% (95% CI 44.7 to 58.0) tried quitting between baseline and late pregnancy and 27.4% (95% CI 21.7 to 33.2) after childbirth. The percentage who intended to quit within the next month fell as pregnancy progressed, from 40.4% (95% CI 36.1 to 44.8) at baseline to 29.7% (95% CI 23.8 to 35.6) in late pregnancy and 14.2% (95% CI 10.0 to 18.3) postpartum. Postpartum relapse was lower among women who quit in the 3 months before pregnancy (17.8%, 95% CI 6.1 to 29.4) than those who stopped between baseline and late pregnancy (42.9%, 95% CI 24.6 to 61.3). CONCLUSIONS: Many pregnant smokers make quit attempts throughout pregnancy and postpartum, but intention to quit decreases over time; there is no evidence that smoking rates fall during gestation

Smoking during pregnancy and child mental health and wellbeing: evidence, policy and practice

Aim: The aim of this thesis was to further understand the link between maternal smoking during pregnancy and mental health outcomes among children. The thesis comprises (a) a longitudinal epidemiological analysis of smoking during pregnancy and child mental health outcomes using cohort data for UK children from before birth to 7 years of age (b) an exploration of what policy documents, official guidance and qualitative studies tell us about how the epidemiological risks of smoking in pregnancy are reflected in public policy and discourse. Methods: Existing epidemiological evidence was reviewed prior to the quantitative analyses. The data analysed are from the Millennium Cohort Study. Data for 13,161 mothers and children, analysed longitudinally, were used to link exposure to maternal smoking during pregnancy to child mental health outcomes (hyperactivity and aggressive behaviour) at 3, 5 and 7 years of age. Additionally a review of official and lay health guidance in two countries (United Kingdom and United States) was conducted to ascertain the extent to which the potential link between maternal smoking during pregnancy and increased risk of child mental health problems is reflected in ante-natal care policy and practice in these countries. Similarly, a review of qualitative studies was conducted to ascertain the extent to which the risk of child mental health problems is reflected in women's perceptions of the risks of smoking during pregnancy. Results: During the past 10 years high-quality studies (and studies of lower quality) have consistently observed an association between prenatal smoking exposure and child mental health problems, though a few well designed recent studies have provided conflicting findings, and further disentangling of exposure and potential confounding factors is needed. Prenatal smoking, socioeconomic position, genetics, family environment, parental mental health and other chemical and environmental exposures, including other endocrine disrupting chemicals, should be explored together, and in more depth, to understand the associations that have been observed between maternal smoking during pregnancy and child mental health during the past 20 years. The original and significant contribution of this thesis is a confirmation of the link between smoking in pregnancy and the development of disruptive behaviour problems in children in a large population-based sample from the United Kingdom. In terms of policy and discourse, ante-natal care packets could be modified to include information about these risks for pregnant women. Conclusions: Child mental health, prenatal smoking and the economic well- being of families are interlinked–so policies aimed at helping pregnant women to quit smoking, as well as those to help them out of disadvantage are likely to have positive effects on both the exposure (prenatal smoking) and the outcome (child mental health)