Tuovi Hakulinen-Viitanen

Smoking cessation in the first trimester reduces most obstetric risks, but not the risks of major congenital anomalies and admission to neonatal care: a population-based cohort study of 1 164 953 singleton pregnancies in Finland

Background In industrialised countries, approximately 5–20% of women smoke during pregnancy. We aim to study the association between smoking during pregnancy and adverse perinatal outcomes. Methods A retrospective population–based cohort study using data on all singleton births between 1991 and 2010 (n=1 164 953) derived from the Finnish Medical Birth Register. Results Of all the mothers included, 82.3% were non-smokers, 2.6% quit smoking during the first trimester of pregnancy, 12.5% smoked throughout pregnancy and 2.7% had no information on smoking. Continuing smoking after the first trimester of the pregnancy was associated with an increased prevalence of admission to a neonatal intensive care unit, stillbirth, preterm birth (<37 gestational weeks), low birth weight (LBW, <2500 g), small for gestational age (SGA, <−2 SDs) and major congenital anomaly compared with non-smokers. Smoking cessation reduced the risk of prematurity, stillbirth, LBW and SGA close to or at similar levels as those of non-smokers. Tobacco exposure in early pregnancy resulted in a 19% increased prevalence of admission to neonatal intensive care unit and a 22% increased prevalence of major congenital anomaly compared with non-smokers. Conclusions Smoking cessation appeared to reduce pregnancy risks close to those of non-smoking peers. Exposure to early pregnancy smoking was, however, associated with an increased admission to neonatal intensive care and an increased prevalence of major congenital anomalies.

Smoking during pregnancy was up to 70% more common in the most deprived municipalities - a multilevel analysis of all singleton births during 2005-2010 in Finland.

OBJECTIVE We investigated whether there was an association between maternal smoking habits during pregnancy and municipality level deprivation defined based on education, income and unemployment after adjustment for individual level covariates, including socioeconomic status (SES), in Finland, a Nordic welfare state. METHODS Data were gathered from the Medical Birth Register and comprised all singleton births (n=337,876) during 2005-2010. To account for any correlation of women clustered within a municipality, we fitted generalized estimating equation (GEE) models. RESULTS In total, 15.3% of the women with singleton pregnancies smoked during pregnancy. After adjustment for individual level confounders, smoking during pregnancy was 5.4-fold higher among women with the lowest as compared with highest individual SES. Controlling for individual SES, age and year of birth, women living in municipalities defined as intermediately and highly deprived based on education were 53.7% (adjusted odds ratio [aOR] 1.537, 95% confidence interval [CI] 1.493-1.583) and 71.5% (aOR 1.715, 95% CI 1.647-1.785), respectively, more likely to smoke during pregnancy than women in the least deprived municipalities. CONCLUSIONS Individual SES is the strongest correlate of smoking during pregnancy but conditional on individual variables; lower municipality aggregate education is associated with up to 70% higher smoking prevalence.

School nurses' descriptions of concerns arising during pupils' health check-ups: A qualitative study

Objective: To describe the concerns and modes of action of Finnish school nurses during pupils’ health check-ups. Methods: Focus group interviews with 17 school nurses were performed in 2011 and again in 2013. Data were analysed using inductive content analysis. Results: School nurses’ concerns were mostly associated with the psychosocial development of pupils and with problems in the family, for example, the loss of a parental role. With regard to physical health, school nurses were particularly concerned with obesity among pupils. The new phenomenon of cyberbullying also caused concern. School nurses were able to identify the causes for their concern at school health check-ups, but they were uncertain regarding how they should act and finding the right mode of action and sufficient multidisciplinary support when pupils had problems. Conclusion: The concern of school nurses at health check-ups was mainly associated with pupils’ health habits, their psychosocial development and family characteristics, and with addressing the need to taking the health behaviours and well-being of the entire family into consideration during health check-ups. Linked-up processes in school health care and multidisciplinary collaboration within schools are of primary importance in supporting the work of nurses and in promoting pupils’ well-being and health.

A New Participative, Family-Oriented Health Counseling Approach for Children and Their Families: A Comparative Qualitative Analysis

Health counseling is an essential part of health promotion and there is a need for new, family-oriented health counseling methods. The objective of this study was to describe the differences in physical activity conversations from the perspective of family-oriented care between child health visits using the Weighty Matter Toolkit and those using normal protocol. In total, 35 health visits were analyzed. The results indicate that the Weighty Matter Toolkit offers the child, and other family members, a better opportunity to participate to conversations, and the focus of the conversation is more diverse and based on the family’s perception regarding physical activity compared to the normal protocol. Thus, the Weighty Matter Toolkit is a promising method for family-oriented health counseling.