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      Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals

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          Abstract

          Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.

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          In Related News, That Was Wrong: The Correction of Misinformation Through Related Stories Functionality in Social Media

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            Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy.

            We conducted a systematic review and meta-analysis to characterize the relationship between smoking and miscarriage. We searched the PubMed database (1956-August 31, 2011) using keywords and conducted manual reference searches of included articles and reports of the US Surgeon General. The full text of 1,706 articles was reviewed, and 98 articles that examined the association between active or passive smoking and miscarriage were included in the meta-analysis. Data were abstracted by 2 reviewers. Any active smoking was associated with increased risk of miscarriage (summary relative risk ratio = 1.23, 95% confidence interval (CI): 1.16, 1.30; n = 50 studies), and this risk was greater when the smoking exposure was specifically defined as during the pregnancy in which miscarriage risk was measured (summary relative risk ratio = 1.32, 95% CI: 1.21, 1.44; n = 25 studies). The risk of miscarriage increased with the amount smoked (1% increase in relative risk per cigarette smoked per day). Secondhand smoke exposure during pregnancy increased the risk of miscarriage by 11% (95% CI: 0.95, 1.31; n = 17 studies). Biases in study publication, design, and analysis did not significantly affect the results. This finding strengthens the evidence that women should not smoke while pregnant, and all women of reproductive age should be warned that smoking increases the risk of miscarriage.
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              The Impact of the Internet on Cancer Outcomes

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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                22 May 2019
                May 2019
                : 16
                : 10
                : 1814
                Affiliations
                [1 ]Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; sue.cooper@ 123456nottingham.ac.uk (S.C.); manerba.it@ 123456hotmail.co.uk (J.D.); tim.coleman@ 123456nottingham.ac.uk (T.C.)
                [2 ]School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; L.Mcdaid@ 123456uea.ac.uk (L.M.); Joanne.Emery@ 123456uea.ac.uk (J.E.); f.naughton@ 123456uea.ac.uk (F.N.)
                Author notes
                [* ]Correspondence: ross.thomson1@ 123456nottingham.ac.uk ; Tel.: +44-11-5748-6677
                Author information
                https://orcid.org/0000-0003-4078-0657
                https://orcid.org/0000-0002-1994-6395
                https://orcid.org/0000-0002-7303-4805
                Article
                ijerph-16-01814
                10.3390/ijerph16101814
                6571581
                31121850
                d71da959-6221-49c2-b534-f6360f2a95f6
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 18 April 2019
                : 20 May 2019
                Categories
                Article

                Public health
                smoking cessation,pregnancy,nicotine replacement therapy,nrt,stop smoking services
                Public health
                smoking cessation, pregnancy, nicotine replacement therapy, nrt, stop smoking services

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