Smoking among pregnant women

SMOKING AND SECONDHAND SMOKING EXPOSURE AMONG PREGNANT WOMEN & CHILDREN

 

Leader:

Monica Tarcea, MD, PhD

Associate professor at University of Medicine and Pharmacy Tirgu-Mures / Romania

 

Team Members:

Ovidiu Grama, Septimiu Voidazan, Claudiu Marginean, Geanina Moldovan, Florina Ruta, Daniela Ceana, Remus Sipos, Calin Avram , Mihai Georgescu, Szasz Simona, Farcas Dan, Cornelia Rada, Ioana Bathori

(4 Gynecologist, 1 Epidemiologist, 3 Public Health specialists, 1 General Practitioner, 1 Psychologist, 1 Cardiologist, 1 Dietitian, 1 Nurse and 1 IT specialists)

Team Members 2014-2015:

Monica Tarcea, Ovidiu Grama, Florina Ruta, Septimiu Voidazan, Claudiu Marginean, Daniela Ceana, Geanina Moldovan, Remus Sipos, Calin Avram, Mihai Georgescu, Simona Szasz, Dan Farcas, Felicia Toma, Ioana Bathori.

Team members 2016-2017:

Monica Tarcea, Florina Ruta si Victoria Rus

 

Mentors:

Prof. Kristie Foley, Prof. Balazs Peter, Dr. Fogarasi-Grenczer Andreea, Dr. Penzes Melinda

 

Goals and Objectives:

Relevance: In our county we have a high frequency of smokers and especially pregnant women who smokes, we have three main ethnic population with different culture and lifestyle, and also a high number of healthcare givers that can be involved in efficient programs for quitting smoking...all we need is to evaluate the best ways of interventions for them and than start to work !

Goals:

  • To increase cessation among pregnant women
  • Decrease SHS exposure in households and workplaces for pregnant women
  • To involve GP’s to Minimal Intervention for smoking cessation of pregnant women
  • First Target group: GP’s and Gynecologists from Mures district
  • Second Target group: Pregnant women

 

Objectives:

  • To decrease the number of cigarettes by 25% smoked by pregnant women in a 6 month period
  • To reduce the SHS exposure among family members (indoors) by 15% in a 6 months period
  • To increase the knowledge, attitudes and skills of health care professionals for using Minimal Intervention strategy for smoking cessation
  • To set up the quitting date for pregnant women in 3 months

Background: 

  • Despite existing interventions, pregnant women remain difficult to motivate and support in the quitting process, with research illustrating that only 30% are quitting vs the same frequency of 30% that continues to smoke during pregnancy
  • We made already a pilot study on 800 newborn mums in Tg. Mures and evaluate their profile of smoking behavior and SHS, so we can complete our findings with new data, in order to find the best ways for efficient interventions…
  • Because there are a lot of qualitative studies made directly on pregnant women we thought that it’s a good idea to study the physicians’s point of view (from their experience with pregnant women)

Research question:

What are the best ways of intervention for quitting smoking during pregnancy, from the physicians point of view, in Tirgu-Mures city?

  • Purpose: To evaluate the most efficient methods to promote smoking cessation and prevent smoking relapse among pregnant women
  • Program Focus: Awareness building and Behavior modification from the health caregivers to pregnant women
  • Population Focus: Pregnant women to be trained by the health caregivers
  • Topic: Tobacco smoking and health risks
  • Settings: Clinical and Cabinets from Urban location.

Logic Model for the intervention:

INPUTS

ACTIVITIES

OUTCOMES

SHORT TERMS OUTCOMES

LONG TERM OUTCOMES

  • Human resources

  • Trainers for our team (by experts)

  • National and international Guidelines for Best Practice in smoking cessation

  • Result from our former research and from literature

  • Time: 18 months

  • Dissemination of our research data to professional healthcare organizations, mass-media, to general population and through specific designed websites

  • Training about MI for healthcare providers (GPs and Gynec)

  • Technical assistance for trainers

  • Practicum facilitation: who, where, when (1 day training), how many times (3-4 times with 25 persons/meeting)

  • Feedback = after training meeting at 1-3-6 months, based on short questionnaires for GPs

  • Low cost or free dissemination of documents, resources and facilities for training activities

  • Enforcing the existing rules for decreasing SHS in Obstetrical wards

  • Improving the knowledge, attitudes and skills regarding MI of GPs and Gynec

  • Increasing resolution capacities for quitting among pregnant women

  • Increasing accessibility to cessation programs for pregnant women (meetings, websites, brochures, leaflets, media)

  • Increase definitive/final cessation for pregnant women (with no attempts to start again smoking)

  • Decrease SHS indoor exposure

  • Decrease the morbidity and mortality of infants

  • Provide on national level an efficient Guideline for smoking cessation Minimal Intervention for pregnant women and lobby to the Ministry of Health

  • Behavioral changes for GPs and Gynecologists regarding their attitudes towards smoking (even smoking cessation)

 

Limitations = very low motivation of GPs and Gynecologist for MI

 

KEY OUTCOME

 

INDIVIDUAL

Increasing cessation rate among pregnant women

Decrease the no of cigarettes smoked per day

Decrease the SHS exposure at home

ORGANIZATIONAL

Training GP’s and Gynecologists for Minimal Intervention for smoking cessation and Practice implementation

Decrease the rate of smoking among GPs and Gynecologists

COMMUNITY

(effect of family members smoking)

Decrease indoor smoking exposure

POLICY

Enforce existing indoor smoking ban

 

Measurements

Training for GP’s and Obstetricians-Gynecologists and implement the MI plan for pregnant women during pregnancy (1 visit for basic information and questionnaire about smoking and 1-2 follow-up)

 

Evaluation Plan

  • Dissemination of our research data to professional healthcare organizations, mass-media, to general population and through specific designed websites

  • Training of Minimal Intervention for healthcare providers (GPs and Gynecologists) during their monthly meetings

  • Technical assistance for trainers

  • Practicum facilitation: who = our team members (number increased since last year), where = in our university classrooms or the gathering rooms of GP and OG associations, when = 1 day training starting September 2014, how many times = 3-4 times with 25 persons/meeting

  • Monitoring the implementation of the intervention sessions: assessing the number of participating physycians in each session during the intervention period, checking if they effectively follow the schedule of the sessions and implement the MI in their offices, developing a free Guide for pregnant women disseminated by leaflets

  • After the intervention = feed-back on meetings at 1-3-6 months after, based on short questionnaires for GPs and OG, in order to evaluate the efficiency of MI plan and to assess the changes of the indicators corresponding to the short-term outcomes

 

Key findings

  • Cotinine test not easy to be used + high rate of refusal
  • First impact on GP’s of cessation methods =positive, but the following intervention on pregnant women not so good
  • Not easy to develop a good relationship with GP’s in our area before training

Conclusions

  • Some behavioral risk factors in pregnancy (including smoking) have to be followed closely by the General Practitioners, Gynecologist and Midwifes in order to avoid complications and to maintain the health of the mother and fetus
  • Its a real challenge for the individual, the family and the society also to find the best ways of community intervention in order to reduce active or second-hand smoking
  • Moreover, attention should be given to the impact of social networks in smoking cessation interventions given, that pregnant women with parents, friends, and partners who smoke are at an increased risk of smoking during pregnancy.

 

Publications:

  1. Ruta F, Rus V, Tarcea M, Voidazan S, Penzes M, Fogarasi-Grenczer AQ, Foley K.: “Romanian GP’s attitudes towards smoking cessation training”, 2017, under preparation
  2. Georgescu M, Ruta F, Rus V, Voidazan S, Tarcea M, Foley K, Abram Z.: “The predictibility of pregnant women answers regarding their smoking practices – cotinine validation and self-reported smoking exposure”, 2017, under preparation
  3. Tarcea M, Voidazan S, Marginean C, Ruta F, Moldovan G, Grama O, Sipos R, Georgescu M, Rus V, Abram Z, Fogarasi-Grenczer A, Penzes M, Balazs P, Foley K.: “Evaluation of Romanian General Practitioner’s practices towards secondhand smoking among Pregnancy”, SRNT- Annual Meeting, Florence/Italy, March 2017, POS467, abstracts vol. page 318.
  4. Georgescu M, Tarcea M, Mărginean C, Ruța F, Rus V, Șipoș R, Abram Z.: „Relationship between high levels of Salivary Cotinine test and demographic characteristics of pregnant smokers from Mures county”, Acta Medica Marisiensis, 2017, 63(1):31-35.
  5. Ruta F, Avram C, Voidazan S, Marginean C, Bacarea V, Abram Z, Foley K, Fogarasi-Grenczer A, Penzes M, Tarcea M.: “Active smoking and associated behavioral risk factors before and during pregnancy – prevalence and attitudes among newborn’s mothers in Mures county, Romania “, Cent Eur J Public Health 2016; 24(4): 276-280, ISSN 1210-7778, ISI journal with IF of 0.77.
  6. Tarcea M, Voidazan S, Ruta F, Georgescu IM, Marginean C, Sipos R, Abram Z, Foley K.: Knowledge, Attitudes and Practices related to Smoking Cessation support among Romanian General Practitioner's, European Public Health Conference, Vienna, 10-12 November 2016, European Journal of Public Health, 2016, 26(suppl. 2):E-Poster E6, ISSN 1101-1262, IF: 2.516.
  7. Georgescu M, Tarcea M., Marginean C, Voidazan S, Ruta F, Foley K, Abram Z: Association between smoking during pregnancy and low birth weight in Mures county, Romania, SRNT-Annual Meeting, Chicago, febr 2016, POS2 103, abstracts vol. page 181.
  8. Tarcea M.: „Community intervention for smoking cessation among pregnant women”, Symposion ”Impact of legislation towards smoking cessation”, 31st of May 2016, Tirgu Mures, Romania.
  9. Tarcea M., Ruta F., Voidăzan S., Mărginean C., Georgescu M. : “The role of pregnant women in smoking cessation – causes and effects”, VIth Tobacco National Conference,Tirgu-Mures, 28-30 of May 2015.
  10. Tarcea M., Ruța F., Moldovan G, Mărginean C, Voidăzan S, Avram C, Georgescu M.: „Quality of smoking cessation interventions among pregnant women from Mures general practitioners’s cabinets”, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2015, Acta Medica Marisiensis, 2015, 61(suppl 8): 19, ISSN: 2068-3324.
  11. Moldovan G, Tarcea M., Ruta F, Ceana D, Voidazan S, Abram Z, Szasz S.: „Smoking and other risk behaviours during pregnancy”, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2015, Acta Medica Marisiensis, 2015, 61(suppl 8): pag 19, ISSN 2068-3324.
  12. Voidăzan S, Ruța F, Marginean C, Moldovan G, Grama O, Tarcea M.: „Determinants of smoking and cessation during pregnancy: a qualitative study”, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2015, Acta Medica Marisiensis, 2015, 61 (suppl 8):12.
  13. Avram C, Tarcea M., Rus V, Mărginean C, Georgescu M, Ruță F.: „Strains on the family budget as a consequence of risky behavior during pregnancy, on a lot of women in the district of Mures”, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2015, Acta Medica Marisiensis, 2015, 61(suppl 8): pag 57, ISSN 2068-3324.
  14. Georgescu M, Tarcea M., Mărginean C, Ruța F, Rus V, Voidăzan S, Abram Z.: „Smoking behavior related with cotinine levels in a group of pregnant women from Mures county”, PhD National Conference, 9-10th Dec 2015, Tirgu-Mures, Acta Medica Marisiensis, 2015, 61(suppl 7):43.
  15. Ruța F., Avram C., Voidăzan S., Rus V., Georgescu M., Abram Z., Tarcea M.: “Associated behavioral risks in a group of women during pregnancy from Mures District”, Acta Medica Marisiensis, 2015, 61(3):236-240.
  16. Ruța F, Avram C, Rus V, Voidazan S, Moldovan G, Abram Z, Tarcea M.: „Smoking cessation failure duinrg the postpartum period – risk factors”, PhD National Conference, 9-10th Dec 2015, Tirgu-Mures, Acta Medica Marisiensis, 2015, 61(suppl 7):31.
  17. Mărginean C., Tarcea M., Ruta F., Voidazan S., Grama O., Moldovan G., Ceană D., Georgescu M., Mărginean O. : “Strategii de renunțare la fumat la gravidă”, The VIth Tobacco National Conference,Tirgu-Mures, 28-th May 2015.
  18. Ruta F., Tarcea M., Rus V., Abram Z., Avram C.: “Evaluarea consumului de tutun la femeile însărcinate din județul Mureș”, The VIth Tobacco National Conference,Tirgu-Mures, 28-th May 2015.
  19. Moldovan G, Tarcea M., Ruta F, Ceana D, Voidazan S, Abram Z, Marginean C.: „Aspects of pregnant women trying to quit smoking, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2014, Revista Acta Medica Marisiensis, 2014, 60(suppl 4):82, ISSN 2068-3324.
  20. Fogarasi-Grenczer A., Tarcea M., Pénzes M., Balázs P., K. L. Foley, Ábrám Z.: “Tobacco smoking research among expectant mothers in Hungary and Romania for Evidence Based Interventions”, 3rd IRI Health Conference, Sturovo, Slovakia, 7-8 December 2015.
  21. Ceana D, Abram Z, Tarcea M., Grama O, Ruta F, Voidazan S, Moldovan G.: „Aspects of active smoking in a group of pregnant women in Tirgu-Mures”, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2014, Revista Acta Medica Marisiensis, 2014, 60(suppl 4):125.
  22. Voidăzan S, Tarcea M., Ruța F, Moldovan G, Ceana D, Grama O, Marginean C.: „Smoking behavior, attitudes and smoking cessation counseling to pregnant smokers among family physicians”, University of Medicine and Pharmacy Teachers Scientific Session, Tirgu Mures, Dec 2014, Acta Medica Marisiensis, 2014, 60(suppl 4):73.
  23. Georgescu M, Ruța F, Voidăzan S, Tarcea M.: „Risk behavior related to secondhand smoking in a group of pregnant women from Mures district”, PhD National Conference, Dec 2014, Tirgu-Mures, Revista Acta Medica Marisiensis, 2014, 60(suppl 4):39.
  24. Ruța F, Tarcea M., Avram C., Voidazan S., Stere V., Georgescu M., Abram Z.: „Associated behavioral risks in a group of pregnant women from Mures district”, PhD National Conference, Dec 20154, Tirgu-Mures, Acta Medica Marisiensis, 2014, 60(suppl 4):40.
  25. Tarcea M., Abram Z . , Grenczer A., Penzes M . , Balazs P., Foley K.: “Active Smoking - a risk behavior for pregnant women from Mures county, Romania”. SRNT-Europe Annual Meeting, Santiago de Compostela/Spain, 18-20 Sept 2014.
  26. Georgescu IM, Tarcea M, Voidazan S, Marginean C, Grama O, Ceana D, Ruţa F, Moldovan G, Abram Z.: Smoking – A risky behavior for pregnant women from Mures county, Romania. Buletinul Academiei de ştiinţe a Moldovei - Ştiinţe Medicale, abstract volume of Sanitary and Practical National Public and Epidemiologic Conference, Preventive Medicine and Scientific National Center of Republic of Moldova / Chisinau, Sept 2014.
  27. Georgescu M., Ruta F., Voidazan S., Grama O., Ceana D., Tarcea M.: „Lifestyle risk factors during pregnancy in a group of newborn moms from Mures area”, 16th DKMT Conference on Environmental and Health, 25-26 aprilie 2014, Arad, Romania, Book of abstracts ISBN 978-973-664-707- 9, page 50.
  28. Tarcea M, Grama O, Marginean C, Georgescu IM, Ceana D, Ruta F, Moldovan G, Abram Z, Voidazan S.: “Tobacco attitudes, practices and behaviors among pregnant women in Mures county, Romania: qualitative assessment of contributing factors”. European Public Health Conference, Glasgow, 20 th November 2014, European Journal of Public Health, 2014,23(suppl.1):172, ISI journal, IF: 2.516.

 

Coordinator: Monica Tarcea, MD, PhD

Last update: 16.06.2017