Nancy Moss

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.

Domestic violence prior to and during pregnancy among Pakistani women

Objective. Abuse of women has been associated with adverse pregnancy outcomes. Data about abuse from developing countries are scarce, especially from Muslim societies. Our objective was to investigate domestic violence before and during pregnancy among women in an urban area of Pakistan. Design. Population‐based cohort study. Setting. An urban community in Hyderabad, Pakistan. Population. Thousand three hundred and twenty‐four pregnant women at 20–26 weeks gestation. Methods. Socio‐demographic and reproductive history data were obtained through structured interviews. We used a modified World Health Organization screening instrument to assess womens experience of domestic violence. Measures. Physical, sexual, and verbal abuse and demographic characteristics. Results. The majority of women had received some schooling and in most households the husbands were employed; by Pakistani standards, they were middle class. Young maternal age, having an unemployed husband and one with other wives/partners, and having had a prior pregnancy were significant predictors of abuse. In the six months prior to and/or during pregnancy, 51% reported experiencing verbal, physical or sexual abuse. Twenty percent reported physical or sexual abuse alone. Sixteen percent of women considered suicide as a response to the abuse. Conclusions. Domestic violence is common among urban Pakistani women of reproductive age, suggesting a need for universal screening during antenatal care, and for support and referral. Further research is needed to determine factors that place women at greatest risk, and to assess the impact of domestic violence on pregnancy outcomes.

Socioeconomic disparities in health in the US: an agenda for action

Inequality of income and wealth in the US has been growing rapidly since 1972. Evidence of socioeconomic effects on health is documented for many endpoints, and there is evidence that socioeconomic disparities in health are increasing. In Europe, equity in health and health care is a target of the World Health Organization, and has led to a variety of activities to reduce socioeconomic disparities in morbidity and mortality. In the US, activities in the public and private sectors have increased in recent years but attention, especially among the public-at-large in addition to elites, needs to be shifted to socioeconomic disparities. The paper suggests action strategies drawn from the European experience and other US efforts to place public health priorities on the policy agenda. A first step is to create a climate of unacceptability for socioeconomic disparities in health. Recommended activities include improvement and utilization of existing data; dissemination to broad audiences; building on existing initiatives; creating multi-sectoral alliances; formation of state and community task forces; attention to human capital as well as social justice issues; creative use of media; attraction of new funders; and implementation of quantitative targets.

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.

Measuring Antenatal Depression and Anxiety: Findings from a Community-Based Study of Women in Hyderabad, Pakistan

ABSTRACT This study evaluated the psychometric properties of two possible measures of depression and anxiety among pregnant women in Pakistan for use in the Global Network for Womens and Childrens Health Research project, a collaborative, international multi-site research network investigating methods for improving pregnancy and birth outcomes in developing countries. The first measure, the Aga Khan University Anxiety and Depression Scale (AKUADS), is an Urdu language scale originally developed for the general Pakistani population, whereas the second measure, the How I Feel scale, was designed for pregnant women in the United States. In an earlier pilot study, we found that the two scales demonstrated similar levels of diagnostic validity. Because neither scale was designed for the specific population of interest, item response theory analyses were conducted to evaluate the psychometric properties of the scales at three levels of measurement: scale, item, and response option. The study results provide insights that may be useful to researchers or clinicians developing or using scales in this population. In particular, our findings suggest that scales designed for populations with lower literacy, such as our target population, may improve data quality by including no more than three response options (e.g., almost always, sometimes, and never) and keeping the direction of item wording consistent throughout the scale. Based on the results from the current study, we recommend a short form of the AKUADS which removes poorly functioning items and reduces respondent burden while retaining the reliability and validity of the longer form.

43 – Socioeconomic Inequalities in Women's Health

The relationship between socioeconomic position or social class and health is one of the most robust and well documented in epidemiology and public health and has been noted by observers since the time of the Romans. Poverty and affluence are intrinsically entwined with gender and ethnicity and race as well as with marital status and household configuration. On a social structural level, women face many socioeconomic obstacles. Men outpace women in earnings and in workplace authority, even though women have higher educational levels than men in similar occupations. Despite progress made in the equitable allocation of household responsibilities between men and women, women continue to carry the lions share of domestic work. In developing countries, women often take full responsibility for domestic work, even when they also have substantial responsibility for economic maintenance of the household. The distribution of resources and power within the household is intimately tied to womens health and survival. Irrespective of race, women who are poor or near poor are far more likely to describe themselves as being in fair or poor health than are women with middle or higher incomes.

Child health outcomes among central American refugees and immigrants in Belize

The purpose of this study was to investigate the effect of international migration, including refugee status, upon child health outcomes. Data were drawn from a survey conducted in 1989 in three settlements in Belize, Central America, that have a high proportion of refugees and economic immigrants living side-by-side with the local population. In two of the settlements, the entire population of mothers with children under 6 was interviewed; in the third settlement a two-thirds random sample was interviewed. Health history data were obtained for 255 children of 134 mothers, from whom sociodemographic data were also collected. The majority of children were born to Salvadoran or Guatemalan mothers, but native and naturalized Belizeans in the survey communities were included for comparison purposes. Migration, the exposure variable, was characterized by mothers residency/refugee legal status, nationality, and duration of time in country. Socioeconomic and proximate control variables were included as suggested by the Mosley-Chen framework. Despite normal birthweight averaging 3374 g, a large proportion of children are at the lowest percentiles of the weight-for-age curves (44% below the tenth percentile for the international reference population). A high incidence of diarrheal and respiratory illnesses (30% and 47% of children, respectively, having frequent episodes), and 50% of children with measles vaccination appropriate for age, indicate a population with high potential morbidity. Logistic regression was used to model the effects of migration on weight-for-age and frequency of diarrheal and respiratory tract episodes independent of socioeconomic and proximate factors, as suggested by the Mosley-Chen framework.(ABSTRACT TRUNCATED AT 250 WORDS)