Michele Bloch

Tobacco use and secondhand smoke exposure during pregnancy: An investigative survey of women in 9 developing nations:

OBJECTIVES We examined pregnant womens use of cigarettes and other tobacco products and the exposure of pregnant women and their young children to secondhand smoke (SHS) in 9 nations in Latin America, Asia, and Africa. METHODS Face-to-face surveys were administered to 7961 pregnant women (more than 700 per site) between October 2004 and September 2005. RESULTS At all Latin American sites, pregnant women commonly reported that they had ever tried cigarette smoking (range: 78.3% [Uruguay] to 35.0% [Guatemala]). The highest levels of current smoking were found in Uruguay (18.3%), Argentina (10.3%), and Brazil (6.1%). Experimentation with smokeless tobacco occurred in the Democratic Republic of the Congo and India; one third of all respondents in Orissa, India, were current smokeless tobacco users. SHS exposure was common: between 91.6% (Pakistan) and 17.1% (Democratic Republic of the Congo) of pregnant women reported that smoking was permitted in their home. CONCLUSIONS Pregnant womens tobacco use and SHS exposure are current or emerging problems in several low- and middle-income nations, jeopardizing ongoing efforts to improve maternal and child health.

Tobacco use and secondhand smoke exposure during pregnancy in low- and middle-income countries: the need for social and cultural research

Tobacco use is a leading cause of death and of poor pregnancy outcome in many countries. While tobacco use is decreasing in many high‐income countries, it is increasing in many low‐ and middle‐income countries (LMICs), where by the year 2030, 80% of deaths caused by tobacco use are expected to occur. In many LMICs, few women smoke tobacco, but strong evidence indicates this is changing; increased tobacco smoking by pregnant women will worsen pregnancy outcomes, especially in resource‐poor settings, and threatens to undermine or reverse hard‐won gains in maternal and child health. To date, little research has focused on preventing pregnant womens tobacco use and secondhand smoke (SHS) exposure in LMICs. Research on social and cultural influences on pregnant womens tobacco use will greatly facilitate the design and implementation of effective prevention programs and policies, including the adaptation of successful strategies used in high‐income countries. This paper describes pregnant womens tobacco use and SHS exposure and the social and cultural influences on pregnant womens tobacco exposure; it also presents a research agenda put forward by an international workgroup convened to make recommendations in this area.

Prenatal tobacco prevention and cessation interventions for women in low- and middle-income countries.

Although the prevalence of tobacco use is decreasing in many high‐income countries, it is increasing in many low‐ and middle‐income countries. The health and economic burden of increasing tobacco use and dependence is predictable and will have devastating effects in countries with limited resources, particularly for vulnerable populations such as pregnant women. We sought to review effective tobacco prevention and intervention strategies for decreasing tobacco use and secondhand smoke exposure before and during pregnancy in high‐, middle‐, and low‐income countries. We reviewed several types of interventions, including population‐level efforts (increasing tobacco prices, implementing tobacco control policies), community interventions, clinical interventions, and pharmacological treatments.

Developmental toxicity of nicotine: A transdisciplinary synthesis and implications for emerging tobacco products

HIGHLIGHTSElectronic cigarettes are often promoted as a safer alternative to combusted cigarettes.Human and animal research supports that nicotine contributes to the adverse effects of gestational tobacco exposure on fetal development.Nicotine exposure during adolescence is associated with cognitive deficits.Measures to protect pregnant women and adolescents from nicotine exposure are warranted. ABSTRACT While the health risks associated with adult cigarette smoking have been well described, effects of nicotine exposure during periods of developmental vulnerability are often overlooked. Using MEDLINE and PubMed literature searches, books, reports and expert opinion, a transdisciplinary group of scientists reviewed human and animal research on the health effects of exposure to nicotine during pregnancy and adolescence. A synthesis of this research supports that nicotine contributes critically to adverse effects of gestational tobacco exposure, including reduced pulmonary function, auditory processing defects, impaired infant cardiorespiratory function, and may contribute to cognitive and behavioral deficits in later life. Nicotine exposure during adolescence is associated with deficits in working memory, attention, and auditory processing, as well as increased impulsivity and anxiety. Finally, recent animal studies suggest that nicotine has a priming effect that increases addiction liability for other drugs. The evidence that nicotine adversely affects fetal and adolescent development is sufficient to warrant public health measures to protect pregnant women, children, and adolescents from nicotine exposure.

Behavioral Research in Cancer Prevention and Control A Look to the Future

Human behavior is central to the etiology and management of cancer outcomes and presents several avenues for targeted and sustained intervention. Psychosocial experiences such as stress and health behaviors including tobacco use, sun exposure, poor diet, and a sedentary lifestyle increase the risk of some cancers yet are often quite resistant to change. Cancer screening and other health services are misunderstood and over-utilized, and vaccination underutilized, in part because of the avalanche of information about cancer prevention. Coordination of cancer care is suboptimal, and only a small fraction of cancer patients enroll in clinical trials essential to the development of new cancer treatments. A growing population of cancer survivors has necessitated a fresh view of cancer as a chronic rather than acute disease. Fortunately, behavioral research can address a wide variety of key processes and outcomes across the cancer control continuum from prevention to end-of-life care. Here we consider effects at the biobehavioral and psychological, social and organizational, and environmental levels. We challenge the research community to address key behavioral targets across all levels of influence, while taking into account the many new methodological tools that can facilitate this important work.

The conception of the ABCD study: From substance use to a broad NIH collaboration

Adolescence is a time of dramatic changes in brain structure and function, and the adolescent brain is highly susceptible to being altered by experiences like substance use. However, there is much we have yet to learn about how these experiences influence brain development, how they promote or interfere with later health outcomes, or even what healthy brain development looks like. A large longitudinal study beginning in early adolescence could help us understand the normal variability in adolescent brain and cognitive development and tease apart the many factors that influence it. Recent advances in neuroimaging, informatics, and genetics technologies have made it feasible to conduct a study of sufficient size and scope to answer many outstanding questions. At the same time, several Institutes across the NIH recognized the value of collaborating in such a project because of its ability to address the role of biological, environmental, and behavioral factors like gender, pubertal hormones, sports participation, and social/economic disparities on brain development as well as their association with the emergence and progression of substance use and mental illness including suicide risk. Thus, the Adolescent Brain Cognitive Development study was created to answer the most pressing public health questions of our day.

Tobacco use and secondhand smoke exposure during pregnancy in two African countries: Zambia and the Democratic Republic of the Congo.

Objective. To study pregnant womens knowledge, attitudes and behaviors towards tobacco use and secondhand smoke (SHS) exposure, and exposure to advertising for and against tobacco products in Zambia and the Democratic Republic of the Congo (DRC). Design. Prospective cross‐sectional survey between November 2004 and September 2005. Setting. Antenatal care clinics in Lusaka, Zambia, and Kinshasa, DRC. Population. Pregnant women in Zambia (909) and the DRC (847). Methods. Research staff administered a structured questionnaire to pregnant women attending antenatal care clinics. Main outcome measures. Pregnant womens use of tobacco, exposure to SHS, knowledge of the harms of tobacco and exposure to advertising for and against tobacco products. Results. Only about 10% of pregnant women reported ever having tried cigarettes (6.6% Zambia; 14.1% DRC). However, in the DRC, 41.8% of pregnant women had tried other forms of tobacco, primarily snuff. About 10% of pregnant women and young children were frequently or always exposed to SHS. Pregnant womens knowledge of the hazards of smoking and SHS exposure was extremely limited. About 13% of pregnant women had seen or heard advertising for tobacco products in the last 30 days. Conclusions. Tobacco use and SHS exposure pose serious threats to the health of women, infants and children. In many African countries, maternal and infant health outcomes are often poor and will likely worsen if maternal tobacco use increases. Our findings suggest that a ‘window of opportunity’ exists to prevent increased tobacco use and SHS exposure of pregnant women in Zambia and the DRC.

Tobacco use and secondhand smoke exposure among pregnant women in low- and middle-income countries: a call to action

National Cancer Institute, Bethesda, MD, USA, Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA, San Diego State University, San Diego, California, USA, Institute for Global Health, University of Southern California, Los Angeles, CA, USA, Global Network for Perinatal and Reproductive Health, Portland, Oregon, USA, and Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon, USA