Smoking cessation and health promotion around pregnancy

A smoking cessation program targeting pregnant women and their partners was monitored during 17 years and subjected to several substudies. All women in Blekinge, who gave birth in the months of September during the period 1984 to 2000, were asked to fill out a questionnaire, anonymously, about their smoking habits before and during pregnancy. During these years a long-term educational programme concerning health factors and pregnancy was in process. All personnel the woman met during pregnancy, labour and the infant period had continuously been offered specific education in smoking cessation. The proportion of women smoking that stopped smoking during pregnancy increased from 20% in 1984 to 74% in 2000. Of the women, 84% reported having been informed about smoking cessation and 93% of them felt the information to be of good quality. Twenty-four women were interviewed 2-3 years after delivery with regard to their smoking habits during and after pregnancy. Women who still smoked at their first visit to the antenatal clinic often had an established smoking pattern. They had vague knowledge about the risks of smoking during pregnancy. All women stated that the midwife played an important role in their motivation to stop smoking but many women, however, lacked the support from other staff. In Kronoberg, 403 women, smoking at the time of conception, were asked about their smoking habits during their pregnancies. At the time of registration at the antenatal clinic, the proportion of smoking women had fallen from 403 (100%) to 308 (76%), and at the postpartum check-up, the proportion had fallen further to 225 (56%). Heavy smokers and women with smoking partners continued smoking to a greater extent, as did multiparae and women in unqualified jobs. Serum samples from 496 pregnant women were tested for cotinine. In stated non-smokers, 13 had cotinine levels suggesting substantial exposure to environmental smoke and 25 women who reported to be non-smokers had cotinine levels consistent with active smoking. Another 19 women reported to be light smokers but had values above the median of those of heavy smokers. Thus, 439 of the women (89%) had cotinine levels corresponding with their histories. Members from five groups of health care professionals, altogether 14 persons, involved in a long-term anti-smoking program in maternal and child health care were interviewed about their experiences. The interaction between the professional and the smoker was regarded as the most powerful and important factor to support smoking cessation. Continuous staff training, collaboration between different personnel groups, and program monitoring were other important factors. Pregnancy offers multiple windows of opportunity for smoking cessation intervention. The course of pregnancy and the reality of the postpartum period generate the moving goal for cessation efforts. The target of creating smoke free pregnancies, however, cannot be attained with a single, simple intervention

When do adolescents become smokers?

Objective. To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys. Setting. Kronoberg County in southern Sweden. Subjects. All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18. Design. Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom. Main outcome measures. Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff. Results. From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls. Conclusion. Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced

Tobacco cesssation - as we want it! An interview study with young people

Background Smoking among teenagers and young people is still common and about every third young smoker states that they want to quit smoking. There are no obvious evidence-based methods for tobacco cessation for young people, and therefore, the same methods are used for young people as well as adults. The aim was to study young people's views about what support they would like for quit smoking, with the intention of developing a model for tobacco cessation for young people through interviews with the target groups. Methods A qualitative study using a descriptive and exploratory design was conducted. Young smokers 16 - 29 years old (n=25) were interviewed in five focus groups in southern Sweden. Data were analyzed by content analysis. Results The results illuminate young people's suggestions to develop a model for tobacco cessation. Four main categories emerged; Existing support rejected - existing apps, support- by SMS, and self-help brochures did not appeal to young people. Agreement between friends - To sign an agreement between two friends which included a fee on relapse. A dult support - To organize the model with duo groups and give adapted support. Celebrate and competition - Lift the positive with the freedom of smoke and create the opportunity to win simple prizes to celebrate the achieved interim goals. Conclusions The young people suggested that the model for tobacco cessation would contain adult support and involves an agreement between friends and has elements of celebration and competition. The challenge will be to implement this model into environments where young people live

Obstetric and perinatal outcomes in pregnancies complicated by diabetes, and control pregnancies, in Kronoberg, Sweden

Background: Diabetes during pregnancy is an increasingly common metabolic disorder, associated with significantly increased risks for both mother and child. Aim of this study was to compare maternal and perinatal outcomes in women with pregestational (PDM) type 1 (T1DM), type 2 diabetes (T2DM), gestational diabetes mellitus (GDM) and compare these to pregnancies not complicated with diabetes. This study also evaluated a specifically organized care-model mostly involving specialist diabetes nurses. Methods: Retrospective population-based records review 2009-2012. Rates of maternal (preeclampsia, pre-term delivery, cesarean section (CS)) and fetal outcomes (large for gestational age (LGA), macrosomia, congenital malformations/intrauterine death) were assessed and potential predisposing or contributing factors as maternal age, ethnicity, obesity, weight gain, parity, HbA1c levels, insulin types and doses. Results: Among 280 pregnancies 48 were PDM, 97 GDM and 135 without diabetes. Within the group with diabetes, early-pregnancy BMI was higher (p = 0.0001), pregnancy weight gain lower (11.1 ± 6.7 kg vs 13.1 ± 7.1 kg, p = 0.005), more delivered preterm (p = 0.0001), by CS (p = 0.05), and had more LGA neonates (p = 0.06) than the group without diabetes. Among pregnancies with diabetes, GDM mothers gained less weight (9.9 kg vs 13.5 kg) (p = 0.006), and rates of CS (p = 0.03), preterm deliveries (p = 0.001) and LGA (p = 0.0001) were not increased compared to PDM; More T1DM infants were LGA, 60% vs. 27% in T2DM. In pregnancies with diabetes obesity, excessive weight gain and multiparity were associated with increased risk of LGA neonates, and mother's type of diabetes and gestational week were associated with higher rates of CS. Conclusion: Weight gain during pregnancy was lower in pregnancies with diabetes and prevalence of LGA, CS and preterm deliveries in GDM was not elevated, also for T2DM, except increased prevalence of LGA in T1DM that warrants increased clinical attention, indicating that this model of antenatal diabetes care may have contributed to improved maternal and fetal outcomes

The social environment is most important for not using snus or smoking among adolescents

Aims: To identify factors, which were related to being smoke-free and snus-free, respectively, among adolescents in relation to adolescents who were smoking and/or using snus, and de-termine if there were any sex differences. Me- thods: A questionnaire study was performed among students in year two in upper secondary schools (17-years-old) in southern Sweden in 2009. More than 2200 students completed the questionnaire regarding health and living habits anonymously. The variables were tested by χ²-test, before selection into the logistic model. Because of the salutogenic approach in the study, the results of the logistic regression analyses were expressed as Positive Odds Ratio (POR). Results: The prevalence of being smoke- free was 75.6 percent for girls and 70.2 percent for boys, whilst the prevalence of being snus- free was 95.1 percent for girls and 70.2 percent for boys. Having a tobacco-free best friend was the most important factor that correlated with being smoke- and snus-free as an adolescent, for both boys and girls. Good living habits, such as drinking less alcohol, were also central to being smoke-free and snus-free. Conclusions: The results show that a tobacco-free environ-ment has a great influence on whether or not adolescents stay tobacco-free. As the environ-ment has a big impact, the school has a big challenge to work with the school environment and policies but also with family responsibility, norms and attitudes to tobacco

Patients’ experiences of physical activity on prescription with access to counsellors in routine care: a qualitative study in Sweden

Abstract Background Physical activity on prescription (PAP) has been implemented in several countries, including Sweden, to support patients who might benefit from increased physical activity. This study explores the experiences of recipients of PAP in routine health care in Sweden that offers the recipients support from physical activity counsellors. The aim was to explore influences on engagement in physical activity by PAP recipients’ from a long-term perspective. Methods We conducted individual semi-structured interviews using a topic guide with a purposively selected sample of 13 adult PAP recipients 1.5 to 2.5 years after PAP. Interviews were recorded, transcribed verbatim and analysed through inductive and deductive content analysis. The questions were informed by Capability-Opportunity-Motivation-Behaviour (COM-B), which was also used as a framework to analyse the data by means of categorizing the factors (influences on the behaviour). Results Ten factors (i.e. sub-categories) that influenced the participants’ engagement in physical activity were identified. PAP recipients’ capability to engage in physical activity was associated with adapting the PAP to the individual’s physical capacity and taking into account the individual’s previous experiences of physical activity. PAP recipients’ opportunity to engage in physical activity was related to receiving a prescription, receiving professional counselling and follow-up from a physical activity counsellor, collaboration between prescriber and counsellor, having access to appropriate activities, having a balanced life situation and having support from someone who encouraged continued physical activity. PAP recipients’ motivation to engage in physical activity was associated with the desire to improve his or her health condition and finding activities that encouraged continuation. Conclusions PAP recipients’ engagement in physical activity was influenced by their capability, opportunity and motivation to undertake this behaviour. Numerous extraneous factors influence capability and motivation. Physical activity counsellors were found to be important for sustained activity because they use an individual approach to counselling and flexible follow-up adapted to each individual’s need of support

Fimpar du, fimpar jag. Tobaksavvänjning för unga av unga: Tobacco cessation for young people of young people

During 2016–2020, a tobacco cessation program for young people in Region Kronoberg was designed and tested. It was called “Quit smoking together” and targeted 16–29-year-olds. The model was designed together with the young smokers, and the program was led by an MI-trained coach. The participants joined the program with a friend, mostly also a smoker, with meetings 7–8 times. The participants were satisfied with the tobacco cessation program. By the end, three participants were completely smoke-free, five participants smoked less. Six months after quitting, two participants were still non-smokers. The model with influencing and involved participants, who also receive support, encouragement and feedback from a coach, meets the National Board of Health and Welfare requirements for qualified counseling. However, its effect on tobacco cessation needs further study.Under 2016 till 2020 pågick ett projekt med att ta fram och pröva en tobaksavvänjning för unga i Region Kronoberg. Den kallades ”Fimpar du, fimpar jag” och vände sig till 16–29-åringar. Modellen utformades tillsammans med unga som var tobaksbrukare. Tobaksavvänjningen leddes av en MI-utbildad coach (MI står för Motiverande samtal). De unga deltog tillsammans med en kompis som oftast också var tobaksbrukare. De träffades 7–8 gånger. Deltagarna var nöjda med tobaksavvänjningen. Vid avslutningen var tre deltagare tobaksfria och fem deltagare använde mindre tobak än innan. Sex månader senare var två deltagare fortfarande tobaksfria. Modellen där deltagarna har inflytande och är delaktiga samtidigt som de får stöd, uppmuntran och feedback av en coach uppfyller Socialstyrelsens krav för kvalificerad rådgivning. Modellen behöver fortsätta att användas och studeras för att kunna fastställa dess effekt på tobaksanvändning

Smoking during pregnancy: comparison of self-reports and cotinine levels in 496 women

Objective. To validate self-reported smoking habits in smoking pregnant women and estimate the prevalence of substantial exposure to passive smoking in non-smoking pregnant women. Design. Retrospective, quantitative study, consecutively collected samples. Setting. One antenatal clinic in Blekinge County, Sweden. Subjects. 509 pregnant women. Method. Information about smoking habits were taken from the antenatal records of 496 women (97%). Serum samples from these women were tested for cotinine, a nicotine metabolite. Main outcome measures. Self-reported smoking habits and cotinine levels in ng/mL. Results. Of 407 women, reporting to be non-smokers, 6% were most likely smokers, and 3% had cotinine levels suggesting exposure to substantial passive smoking. Of 60 women, reporting smoking 1-10 cigarettes per day, 32% were likely to smoke more. Conclusion. If the true facts about exposure to tobacco smoke are not revealed, a number of women who might benefit from information and support at the antenatal clinic will miss the opportunity of such assistance, resulting in increased risks for both the woman and her fetus