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      Preventing smoking during pregnancy: the importance of maternal knowledge of the health hazards and of the treatment options available*

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          Abstract

          OBJECTIVE:

          To examine the pattern of tobacco use and knowledge about tobacco-related diseases, as well as to identify popular types of electronic media, in pregnant women, in order to improve strategies for the prevention or cessation of smoking among such women.

          METHODS:

          A cross-sectional study involving 61 pregnant women, seen at primary care clinics and at a university hospital, in the city of Botucatu, Brazil. For all subjects, we applied the Hospital Anxiety and Depression Scale. For subjects with a history of smoking, we also applied the Fagerström Test for Nicotine Dependence, and we evaluated the level of motivation to quit smoking among the current smokers.

          RESULTS:

          Of the 61 pregnant women evaluated, 25 (40.9%) were smokers (mean age, 26.4 ± 7.4 years), 24 (39.3%) were former smokers (26.4 ± 8.3 years), and 12 (19.8%) were never-smokers (25.1 ± 7.2 years). Thirty-nine women (63.9%) reported exposure to passive smoking. Of the 49 smokers/former smokers, 13 (26.5%) were aware of the pulmonary consequences of smoking; only 2 (4.1%) were aware of the cardiovascular risks; 23 (46.9%) believed that smoking does not harm the fetus or newborn infant; 21 (42.9%) drank alcohol during pregnancy; 18 (36.7%) reported increased cigarette consumption when drinking; 25 (51.0%) had smoked flavored cigarettes; and 12 (24.5%) had smoked a narghile. Among the 61 pregnant women evaluated, television was the most widely available and favorite form of electronic media (in 85.2%), as well as being the form most preferred (by 49.2%).

          CONCLUSIONS:

          Among pregnant women, active smoking, passive smoking, and alternative forms of tobacco consumption appear to be highly prevalent, and such women seem to possess little knowledge about the consequences of tobacco use. Educational programs that include information about the consequences of all forms of tobacco use, employing new and effective formats tailored to this particular population, should be developed, in order to promote smoking prevention and cessation among pregnant women. Further samples to explore regional and cultural adaptations should be evaluated.

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          Most cited references71

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          Smoking cessation guidelines--2008.

          These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, recommending measures and strategies for managing each case based on clinical evidence. Written in a simplified and objective manner, the text is divided into two principal sections: Evaluation and Treatment. The sections both present comments on and levels of evidence represented by the references cited, as well as some proposals for the reduction of damage and for intervening in specific and still poorly explored situations, such as relapse, passive smoking, physician smoking, and tobacco use in specific environments.
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            Self-change and therapy change of smoking behavior: a comparison of processes of change in cessation and maintenance.

            Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: Aversion Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.
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              The association of depressive, anxiety, and stress symptoms and postpartum relapse to smoking: a longitudinal study.

              The aim of this prospective repeated measures, mixed-methods observational study was to assess whether depressive, anxiety, and stress symptoms are associated with postpartum relapse to smoking. A total of 65 women who smoked prior to pregnancy and had not smoked during the last month of pregnancy were recruited at delivery and followed for 24 weeks. Surveys administered at baseline and at 2, 6, 12, and 24 weeks postpartum assessed smoking status and symptoms of depression (Beck Depression Inventory [BDI]), anxiety (Beck Anxiety Inventory [BAI]), and stress (Perceived Stress Scale [PSS]). In-depth interviews were conducted with women who reported smoking. Although 92% of the participants reported a strong desire to stay quit, 47% resumed smoking by 24 weeks postpartum. Baseline factors associated with smoking at 24 weeks were having had a prior delivery, not being happy about the pregnancy, undergoing counseling for depression or anxiety during pregnancy, and ever having struggled with depression (p < .05). In a repeated measures regression model, the slope of BDI scores from baseline to the 12-week follow-up differed between nonsmokers and smokers (-0.12 vs. +0.11 units/week, p = .03). The slope of PSS scores also differed between nonsmokers and smokers (-0.05 vs. +0.08 units/week, p = .04). In qualitative interviews, most women who relapsed attributed their relapse and continued smoking to negative emotions. Among women who quit smoking during pregnancy, a worsening of depressive and stress symptoms over 12 weeks postpartum was associated with an increased risk of smoking by 24 weeks.
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                Author and article information

                Contributors
                Role: Doctoral Student
                Role: Physiotherapist
                Role: Professor
                Role: Full Professor
                Journal
                J Bras Pneumol
                J Bras Pneumol
                Jornal Brasileiro de Pneumologia
                Sociedade Brasileira de Pneumologia e Tisiologia
                1806-3713
                1806-3756
                Mar-Apr 2015
                Mar-Apr 2015
                : 41
                : 2
                : 175-181
                Affiliations
                São Paulo State University, Botucatu School of Medicine, Department of Clinical Medicine, Botucatu, Brazil. Pulmonology Division, Department of Clinical Medicine, Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil
                São Paulo State University, Botucatu School of Medicine, Botucatu Hospital das Clínicas, Botucatu, Brazil. Botucatu Hospital das Clínicas, Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil
                São Paulo State University, Botucatu School of Medicine, Department of Internal Medicine, Botucatu, Brazil. Pulmonology Division, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil
                São Paulo State University, Botucatu School of Medicine, Department of Internal Medicine, Botucatu, Brazil. Pulmonology Division, Department of Internal Medicine, Botucatu School of Medicine, São Paulo State University, Botucatu, Brazil
                Author notes
                Correspondence to: André Luís Bertani. Faculdade de Medicina de Botucatu, Unesp, Distrito de Rubião Junior, s/n, CEP: 18618-970, Botucatu, SP, Brasil. Tel/Fax: 55 14 3880-1171. E-mail: andrelubert@ 123456gmail.com
                Article
                10.1590/S1806-37132015000004482
                4428855
                25972970
                ccecdf97-3855-4516-a691-37d0f1797b05

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 04 November 2014
                : 27 January 2015
                Page count
                Figures: 2, Tables: 8, Equations: 0, References: 25, Pages: 7
                Categories
                Original Article

                pregnancy,health knowledge, attitudes, practice,smoking,mass media,smoking cessation,primary prevention

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