Kontie Moussa

Trends in smoking behaviour between 1985 and 2000 in nine European countries by education

Objective: To examine whether trends in smoking behaviour in Western Europe between 1985 and 2000 differed by education group. Design: Data of smoking behaviour and education level were obtained from national cross sectional surveys conducted between 1985 and 2000 (a period characterised by intense tobacco control policies) and analysed for countries combined and each country separately. Annual trends in smoking prevalence and the quantity of cigarettes consumed by smokers were summarised for each education level. Education inequalities in smoking were examined at four time points. Setting: Data were obtained from nine European countries: Norway, Sweden, Denmark, Finland, the United Kingdom, the Netherlands, Germany, Italy, and Spain. Participants: 451 386 non-institutionalised men and women 25–79 years old. Main outcome measures: Smoking status, daily quantity of cigarettes consumed by smokers. Results: Combined country analyses showed greater declines in smoking and tobacco consumption among tertiary educated men and women compared with their less educated counterparts. In country specific analyses, elementary educated British men and women, and elementary educated Italian men showed greater declines in smoking than their more educated counterparts. Among Swedish, Finnish, Danish, German, Italian, and Spanish women, greater declines were seen among more educated groups. Conclusions: Widening education inequalities in smoking related diseases may be seen in several European countries in the future. More insight into effective strategies specifically targeting the smoking behaviour of low educated groups may be gained from examining the tobacco control policies of the UK and Italy over this period.

Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study

BackgroundGhanas maternal mortality ratio remains high despite efforts made to meet Millennium Development Goal 5. A number of studies have been conducted on maternal mortality in Ghana; however, little is known about how the causes of maternal mortality are distributed in different socio-demographic subgroups. Therefore the aim of this study was to assess and analyse the causes of maternal mortality according to socio-demographic factors in Ghana.MethodsThe causes of maternal deaths were assessed with respect to age, educational level, rural/urban residence status and marital status. Data from a five year retrospective survey was used. The data was obtained from Ghana Maternal Health Survey 2007 acquired from the database of Ghana Statistical Service. A total of 605 maternal deaths within the age group 12-49 years were analysed using frequency tables, cross-tabulations and logistic regression.ResultsHaemorrhage was the highest cause of maternal mortality (22.8%). Married women had a significantly higher risk of dying from haemorrhage, compared with single women (adjusted OR = 2.7, 95%CI = 1.2-5.7). On the contrary, married women showed a significantly reduced risk of dying from abortion compared to single women (adjusted OR = 0.2, 95%CI = 0.1-0.4). Women aged 35-39years had a significantly higher risk of dying from haemorrhage (aOR 2.6, 95%CI = 1.4-4.9), whereas they were at a lower risk of dying from abortion (aOR 0.3, 95% CI = 0.1-0.7) compared to their younger counterparts. The risk of maternal death from infectious diseases decreased with increasing maternal age, whereas the risk of dying from miscellaneous causes increased with increasing age.ConclusionsThe study shows evidence of variations in the causes of maternal mortality among different socio-demographic subgroups in Ghana that should not be overlooked. It is therefore recommended that interventions aimed at combating the high maternal mortality in Ghana should be both cause-specific as well as target-specific.

“Never My Daughters”: A Qualitative Study Regarding Attitude Change Toward Female Genital Cutting Among Ethiopian and Eritrean Families in Sweden

To explore attitudes toward female genital cutting (FGC) in a migration perspective, qualitative interviews were conducted with men and women from Ethiopia and Eritrea in Sweden. We found firm rejection of all forms of FGC and absence of a guiding motive. Informants failed to see any meaning in upholding the custom. We conclude that children of Ethiopian or Eritrean parents resident in Sweden run little risk of being subjected to FGC. A societal structure prepared to deal with suspected cases of FGC with a high level of alertness should be combined with a healthy sceptical attitude toward exaggerations of risk estimates.

Assessing knowledge, attitude, and practice of emergency contraception: a cross- sectional study among Ethiopian undergraduate female students

BackgroundEmergency contraception (EC) is a type of modern contraception which is indicated after unprotected sexual intercourse when regular contraception is not in use. The importance of EC is evident in preventing unintended pregnancies and its ill consequences like unintended child delivery or unsafe abortion, which are the most common causes of maternal mortality. Therefore, EC need to be available and used appropriately as a backup in case regular contraception is not used, misused or failed. Knowing that Ethiopia is one of the countries with highest maternal mortality rate, this study aimed to assess the knowledge, attitude and practice of EC, and to further elucidate the relationship between these factors and some socioeconomic and demographic characteristics among female undergraduate students of Addis Ababa University (AAU). This information will contribute substantially to interventions intended to combat maternal mortality.MethodsA Cross-sectional quantitative study among 368 AAU undergraduate students was conducted using self-administered questionnaire. Study participants were selected by stratified random sampling. Data was entered and analyzed using SPSS Version 17. Results were presented using descriptive statistics, cross-tabulation and logistic regression.ResultsAmong the total participants (n = 368), only 23.4% were sexually active. Majority (84.2%) had heard of EC; 32.3% had a positive attitude towards it. The main source of information reported by the respondents was Media (69.3%). Among those who were sexually active, about 42% had unprotected sexual intercourse. Among those who had unprotected sexual intercourse, 75% had ever used EC. Sexually active participants had significantly better attitude towards EC than sexually inactive participants (crude OR 0.33(0.15-0.71)); even after adjusting for possible confounders such as age, region, religion, ethnicity, marital status, department and family education and income (adj. OR 0.36(0.15-0.86)).ConclusionsThe study showed high EC awareness and usage in contrast to other studies in the city, which could be due to the fact that university students are relatively in a better educational level. Therefore, it is highly recommended that interventions intended to combat maternal mortality through contraceptive usage need to be aware of such information specific to the target groups.

Socioeconomic and demographic differences in exposure to environmental tobacco smoke at work: the Scania Public Health Survey 2000

Background: A study was undertaken to investigate the sociodemographic distribution of workplace exposure to environmental tobacco smoke (ETS) in a Swedish working population sample. Methods: 8,270 individuals were assessed by questionnaire in the Scania Public Health Survey. The influence of sociodemographic factors on ETS exposure at work was investigated by multivariable regression analysis. Results: Individuals under 25 years old were at highest risk of ETS exposure. Male skilled manual workers and female unskilled manual workers had higher adjusted odds ratios (OR 4.0, 95% CI: 3.1 - 5.3 and OR 3.2, 95% CI: 2.2 - 4.7, respectively) of ETS exposure than non-manual high-level employees. Conclusions: ETS should be recognized as a factor contributing to health inequalities. Women of childbearing age need protective strategies.

Socioeconomic differences in smoking trends among pregnant women at first antenatal visit in Sweden 1982-2001: increasing importance of educational level for the total burden of smoking.

Background: There was a decrease in smoking during early pregnancy in Swedish women between 1982 and 2001. We sought to determine whether there was a parallel decrease in socioeconomic inequality in smoking. Methods: Registry data indicating educational level and smoking status at first antenatal visit in all 2 022 469 pregnancies in Sweden 1982–2001 were analysed. Prevalence differences, odds ratios based on prevalences and total attributable fractions were compared for five-year intervals. Results: The prevalence differences of smoking showed a greater decrease at the lowest and middle educational level compared with the highest educational level (14.5%, 15.7% and 10.2%, respectively) indicating reduced inequality in absolute terms. However, odds ratios regarding low educational attainment versus high, increased from 5.6 to 14.2, signifying increased inequality in relative terms. Moreover, the total attributable fraction of low and intermediate educational level regarding smoking at first antenatal visit increased from 61% to 76% during the period studied. Conclusions: Smoking at first antenatal visit in Sweden between 1982 to 2001 decreased in a way that conclusions regarding trends in inequalities in smoking at first antenatal visit depend on the type of measure applied. However, using the measure of total attributable fraction, which takes into consideration the impact of the exposure on the individual as well as the effect of the varying size of the group of exposed, the growing importance of educational level for the behaviour in the population was demonstrated.

Differences in socioeconomic and gender inequalities in tobacco smoking in Denmark and Sweden; a cross sectional comparison of the equity effect of different public health policies

BackgroundDenmark and Sweden are considered to be countries of rather similar socio-political type, but public health policies and smoking habits differ considerably between the two neighbours. A study comparing mechanisms behind socioeconomic inequalities in tobacco smoking, could yield information regarding the impact of health policy and -promotion in the two countries.MethodsCross-sectional comparisons of socioeconomic and gender differences in smoking behaviour among 6 995 Danish and 13 604 Swedish persons aged 18-80 years.ResultsThe prevalence of smoking was higher in Denmark compared to Sweden. The total attributable fraction (TAF) of low education regarding daily smoking was 36% for Danish men and 35% for Danish women, and 32% and 46%, respectively, for Swedish men and women. TAF of low education regarding continued smoking were 16.2% and 15.8% for Danish men and women, and 11.0% and 18.8% for Swedish men and women, respectivelyThe main finding of the study was that the socioeconomic patterning of smoking, based on level of education and expressed as the relative contribution to the total burden of smoking exposure, was rather different in Sweden and Denmark. Moreover, these differences were modified by gender and age. As a general pattern, socioeconomic differences in Sweden tended to contribute more to the total burden of this habit among women, especially in the younger age groups. In men, the patterns were much more similar between the two countries. Regarding continued smoking/unsuccessful quitting, the patterns were similar for women, but somewhat different for men. Here we found that socioeconomic differences contributed more to overall continued smoking in Danish men, especially in the middle-age and older age strata.ConclusionThe results imply that Swedish anti-smoking policy and/or implemented measures have been less effective in a health equity perspective among the younger generation of women, but more effective among men, compared to Danish policy implementation. The results also raises the more general issue regarding the possible need for a trade-off principle between overall population efficacy versus equity efficacy of anti-tobacco, as well as general public health policies and intervention strategies.

Misclassified Maternal Deaths among East African Immigrants in Sweden

Western countries have reported an increased risk of maternal mortality among African immigrants. This study aimed to identify cases of maternal mortality among immigrants from the Horn of Africa living in Sweden using snowball sampling, and verify whether they had been classified as maternal deaths in the Cause of Death Registry. Three “locators” contacted immigrants from Somalia, Eritrea, and Ethiopia to identify possible cases of maternal mortality. Suspected deaths were scrutinised through verbal autopsy and medical records. Confirmed instances, linked by country of birth, were compared with Registry statistics. We identified seven possible maternal deaths of which four were confirmed in medical records, yet only one case had been classified as such in the Cause of Death Registry. At least two cases, a significant number, seemed to be misclassified. The challenges of both cultural and medical competence for European midwives and obstetricians caring for non-European immigrant mothers should be given more attention, and the chain of information regarding maternal deaths should be strengthened. We propose a practice similar to the British confidential enquiry into maternal deaths. In Sweden, snowball sampling was valuable for contacting immigrant communities for research on maternal mortality; by strengthening statistical validity, it can contribute to better maternal health policy in a multi-ethnic society. Résumé Les pays occidentaux ont déclaré une augmentation du risque de mortalité maternelle chez les immigrantes africaines. Cette étude souhaitait recenser les cas de mortalité maternelle chez les immigrantes de la Corne de l’Afrique vivant en Suède à partir d’un échantillon en « boule de neige », et vérifier s’ils avaient été classés comme tels dans le registre des causes de décès. Trois « enquêteurs » ont pris contact avec des immigrants éthiopiens, érythréens et somaliens pour identifier les cas possibles de mortalité maternelle. Les décès suspects ont été examinés par autopsie verbale et avec les dossiers médicaux. Les cas confirmés, ventilés par pays de naissance, ont été comparés avec les statistiques de l’état civil. Nous avons identifié sept décès maternels possibles dont quatre avaient été confirmés dans les dossiers médicaux. Pourtant, un seul figurait comme tel dans le registre des causes de décès. Au moins deux cas, soit un nombre non négligeable, semblaient avoir été mal classés. Il faut s’intéresser davantage aux compétences médicales et culturelles des sages-femmes et des obstétriciens européens qui soignent les mères immigrantes non européennes et renforcer la chaîne d’informations sur les décès maternels. Nous proposons une pratique similaire à l’enquête confidentielle britannique sur les décès maternels. En Suède, l’échantillonnage en boule de neige a permis de contacter des communautés immigrantes pour faire des recherches sur la mortalité maternelle ; en renforçant la qualité des statistiques, il peut améliorer la politique de santé maternelle dans une société pluriethnique. Resumen Los países occidentales han informado un mayor riesgo de mortalidad materna entre los inmigrantes africanas. El objetivo de este estudio fue identificar los casos de mortalidad materna entre inmigrantes del Cuerno de Ãfrica que vivían en Suecia, utilizando el muestreo de bola de nieve, y verificar si habían sido clasificadas como muertes maternas en el Registro de Causa de Defunción. Tres “localizadores” contactaron inmigrantes de Somalia, Eritrea y Etiopía para determinar los casos posibles de mortalidad materna. Las muertes sospechadas fueron examinadas mediante autopsia verbal e historiales médicos. Los casos confirmados, vinculados por país de nacimiento, fueron comparados con las estadísticas del Registro. Identificamos siete posibles muertes maternas, de las cuales cuatro fueron confirmadas en los historiales médicos, pero sólo un caso había sido clasificado como tal en el Registro de Causa de Defunción. Por lo menos dos casos, un número significante, parecieron ser mal clasificados. Se debe prestar más atención a los retos de competencia cultural y médica afrontados por parteras y obstetras europeos que atienden a madres inmigrantes no europeas, y se debe fortalecer la cadena de información sobre las muertes maternas. Proponemos una práctica similar a la investigación confidencial británica de muertes maternas. En Suecia, el muestreo de bola de nieve fue valioso para contactar comunidades inmigrantes para investigaciones sobre la mortalidad materna; el fortalecer la validez estadística puede contribuir a mejorar la política de salud materna en una sociedad multiétnica.

Smoking behavior and sociodemographic differences among young people: Further evidence from southern Sweden based on public health survey data

Aims: Tobacco-smoking behaviours of young people between the age of 18 and 25 years are less understood than those of middle-aged people. The aim of this study is to contribute to improved knowledge of some of the factors that are associated with smoking and cessation among young people. Methods: We use the most recently available public health survey data from the southern region of Skåne in Sweden to analyze these factors. The survey is a cross-sectional study with a total sample size of 28,198 individuals with 2801 in the age category of interest. We apply statistical measures of association between smoking and gender and also model the relationship between smoking and smoking cessation and the role of a set of sociodemographic determinants by means of logistic regression to estimate odds ratios. Results: The findings include significant differences between the younger age group and the older group with respect to the odds of smoking and method of cessation. We also find differences between young women and men with regard to smoking prevalence, intensity and cessation methods. In particular, young women attempt to quit smoking by means of unassisted methods to a significantly higher extent than do young men. Conclusions: There are significant differences between young people and older individuals with respect to a range of smoking behaviours. There are also strong gender effects within the group of young people. Policy development and anti-smoking interventions need to take such differences into consideration for improved effectiveness.