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..on women
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www.ProjectCork.org
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Fall 2003
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Interventions for promoting smoking cessation during pregnancy.
Cochrane Pregnancy and Childbirth Group; Lumley J; Oliver S;
Waters E. IN: Cochrane Library Volume 1. Software Update:
Oxford, 2003. (127 refs.)
Background: Smoking remains one of the few potentially preventable factors associated
with low birthweight, very preterm birth and perinatal death. Objectives: The
objective of this review was to assess the effects of smoking cessation programs
implemented during pregnancy on the health of the fetus and infant, on the mother
and on the family. Search strategy: We searched the Cochrane Pregnancy and Childbirth
Group trials register and the Cochrane Tobacco Addiction Group trials register.
Selection criteria: Randomised and quasi-randomised trials of smoking cessation
programs implemented during pregnancy. Data collection and analysis: Trial quality
was assessed and data were extracted independently by two reviewers. Main results:
Forty-four trials were identified: 37 trials including 16,916 women provided
data on smoking cessation and/or perinatal outcomes, as did one cluster-randomised
trial including 3000 women. Over 800 women were included in trials of smoking
relapse prevention. There was substantial variation in the intensity of the intervention
and the extent of reminders and reinforcement through pregnancy. Based on 34
trials there was a significant reduction in smoking in the intervention groups
(odds ratio 0.53, 95% confidence interval 0.47 to 0.60), an absolute difference
of 6.4% women continuing to smoke. The eight trials with validated smoking cessation,
a high intensity intervention and a high quality score had an odds ratio of 0.53,
95% confidence interval 0.44 to 0.63 and an absolute difference in continued
smoking of 8.1%. The subset of trials with information on fetal outcome revealed
a reduction in low birthweight (odds ratio 0.80, 95% confidence interval 0.67
to 0.95), a reduction in preterm birth (odds ratio 0.83, 95% confidence interval
0.69 to 0.99) and an increase in mean birthweight of 28g (95% confidence interval
9 to 49). There were no differences in very low birthweight or perinatal mortality.
Five trials of smoking relapse prevention showed no significant difference. The
single large cluster-randomised trial showed no evidence of a decrease in continued
smoking or adjusted mean birthweight. Conclusions: Smoking cessation programs
in pregnancy appear to reduce smoking, low birthweight and preterm birth, but
no effect was detected for very low birthweight or perinatal mortality.
Copyright 2003, British Medical Publishing.
Alcohol use as predictor for infertility in a representative population of
Danish women.
Tolstrup JS; Kjaer SK; Holst C; Sharif H; Munk C; Osler M et al. Acta Obstetricia
et Gynecologica Scandinavica 82(8): 744-749, 2003. (28 refs.)
Background. Our aim was to examine the association between use of alcohol and
subsequent incidence of primary infertility. Methods. The study subjects were
chosen from a population-based cohort of Danish women aged 20-29 years. Eligible
women were nulliparous and not pregnant (n = 7760). Information on alcohol intake
and potential confounders (age, education, marital status, diseases in the reproductive
organs, and cigarette smoking) was assessed at enrollment. The incidence of fertility
problems during follow-up was obtained by record linkage with the Danish Hospital
Discharge Register and the Danish Infertility Cohort Register. Main outcome measures
were hazard ratios of infertility according to alcohol intake at baseline estimated
in a multivariate Cox proportional hazards model. Results. During a mean follow-up
of 4.9 years, 368 women had experienced infertility. Alcohol intake at baseline
was unassociated with infertility among younger women, but was a significant
predictor for infertility among women above age 30. In this age group, the adjusted
hazard ratio for consuming seven or more drinks per week was 2.26 (95% confidence
interval: 1.19-4.32) compared with women consuming less than one drink per week.
Conclusions. These findings suggest that alcohol intake is a predictor for infertility
problems among women in the later reproductive age group.
Copyright 2003, Munksgaard Int. Publ, Ltd.
Alcohol, estrogen replacement therapy, and visuospatial processes in postmenopausal
women.
Tivis LJ; Green MD; Nixon SJ; Tivis RD. Alcoholism: Clinical and Experimental
Research 27(7): 1055-1063, 2003. (72 refs.)
Background: Studies suggest that moderate drinking may benefit cognition and
the effect may favor women. This study investigated effects of moderate drinking
on visuospatial functioning in postmenopausal women. Visuospatial processes are
sensitive to alcohol abuse and are thought to be sensitive to hormonal fluctuations.
Three questions were posed in order to: explore visuospatial processes in moderate-drinking
and abstaining postmenopausal women, assess visuospatial differences in women
using no estrogen replacement therapy (No-ERT), ERT alone (ERT-only), and ERT
with progestin (ERT+Pro), and identify alcohol/ERT interactions associated with,
visuospatial performance. Methods: Two hundred fourteen postmenopausal women
participated (75 No-ERT; 63 ERT-only; 76 ERT+Pro. All were moderate drinkers
or teetotalers and all received the Block Design test from the Wechsler Adult
Intelligence Scale-Revised. A raw score was calculated and progress at 30-sec
intervals was assessed. Results: ANOVA revealed an alcohol main effect [F(3,202)
= 4.74;p < 0.004] on 60- to 120-sec change scores. Teetotalers had significantly
smaller change scores (less improvement) compared with all levels of drinkers.
ANOVA on design 9 (the most difficult trial) revealed an ERT main effect [F(3,202)
= 4.37; p < 0.02]. ERT nonusers scored significantly lower than ERT-only and
ERT+Pro groups. A design 9 trend toward an alcohol X ERT interaction was noted
[F(6,202) = 1.93; p < 0.08], and a design 9 time X alcohol interaction was revealed
[F(6,404) = 2.65; p < 0.02]. Conclusions: These data suggest that moderate drinking
may be positively associated with, visuospatial processes in postmenopausal women.
They also suggest that ERT, alone and with progestin, is positively associated
with visuospatial processes, but only when the task is difficult. These findings
support Kaplan's assertion that subtle performance deficits may not be detectible
with traditional endpoint measures. A provocative alcohol X ERT trend suggests
that alcohol consumption should be considered in studies of ERT effects on cognitive
ability.
Copyright 2003, Research Society on Alcoholism. Used with permission.
Alcohol drinking patterns and risk of type 2 diabetes mellitus among younger
women.
Wannamethee SG; Camargo CA; Manson JAE; Willett WC; Rimm EB. Archives of Internal
Medicine 163(11): 1329-1336, 2003. (33 refs.)
Objective: To examine the relationship between alcohol consumption and the incidence
of type 2 diabetes mellitus among relatively young and middle-aged women. Methods:
In a prospective study, 109 690 women, aged 25 to 42 years, without a history
of coronary heart disease, stroke, cancer, or diabetes mellitus completed a detailed
lifestyle and medical history questionnaire in 1989. During 10 years of follow-up,
we documented 935 incident cases of type 2 diabetes mellitus. Results: We found
a nonlinear relationship between alcohol consumption and risk of type 2 diabetes
mellitus after adjustment for multiple confounders, including body mass index,
smoking, physical activity, and family history of diabetes mellitus (quadratic
trend P=.003). Compared with lifelong abstainers, the adjusted relative risks
(95% confidence intervals) were 0.80 (0.66-0.96) for those consuming 0.1 to 4.9
g/d, 0.67 (0.50-0.89) for those consuming 5.0 to 14.9 g/d, 0.42 (0.20-0.90) for
those consuming 15.0 to 29.9 g/d, and 0.78 (0.34-1.78) for those consuming 30.0
g/d or more. Further adjustment for dietary factors, including glycemic load,
trams-fatty acid, polyunsaturated fat, and total fiber intake, did not appreciably
alter these findings. The inverse association with light to moderate drinking
was most apparent in women who reported wine or beer drinking. Women who reported
30.0 g/d or more of liquor intake showed a significantly increased risk of diabetes
mellitus compared with those who did not report liquor intake (adjusted relative
risk, 2.50; 95% confidence interval, 1:00-6.23). Conclusion: Light to moderate
alcoholic beverage consumption may be associated with a lower risk of type 2
diabetes mellitus among women aged 25 to 42 years, although this benefit.may
not- persist at higher levels.
Copyright 2003, American Medical Association.
Gender differences in drug use behavior in people with serious mental illnesses.
Gearon JS; Nidecker M; Bellack A; Bennett M. American Journal on Addictions: 12(3):
229-241, 2003. (67 refs.)
The gender-specific aspects of drug use in women with serious mental illness
(SMI) remains under-investigated. To improve our understanding of substance use
in this population, gender differences in how drugs are initially accessed, how
habits are financed and maintained, and reasons for drug use were examined in
28 women and 24 men with SMI. Women were found more likely than men to report
being victimized, having drugs given to them by significant others, using money
given to them by family members to support their habits, and using drugs to test
their ability to control their use.
Copyright 2003, American Academy of Psychiatrists in Alcoholism
and Addictions.
Stopping smoking during pregnancy: Are we on the right track?
Paterson JM; Neimanis IM; Bain E. Canadian Journal of Public Health: 94(4):
297-299, 2003. (17 refs.)
Background: Recent data suggest that although smoking during pregnancy has declined
in North America, this has more to do with falling rates of smoking initiation
among women of childbearing age than with increased rates of pregnancy-related
smoking cessation. One possible explanation is poor exposure to effective stop-smoking
strategies. Better information about women who smoke during pregnancy may help
target these interventions more effectively. Methods: The study was a cross-sectional,
self-administered survey of a consecutive sample of 916 (40.4% of eligible) women
who delivered healthy babies in 1997-98 at a tertiary teaching hospital in Hamilton,
Ontario. Our main focus was on health behaviours (smoking, drinking, eating,
and exercise habits) before and during pregnancy; but we also included questions
about the presence of (other) children and (other) smokers in the household,
perceived health status, the subject's age and level of education, and whether
or not the present pregnancy was planned. Factors associated with pregnancy-related
smoking cessation were identified using multiple logistic regression. Results:
Respondents were better educated and healthier, but smoked at rates similar to
women of childbearing age in Hamilton at the time of the survey. Two thirds of
prior smokers or 20% of respondents overall continued to smoke during pregnancy.
After adjustment for other factors, three factors were associated with ongoing
smoking during pregnancy: having other smokers in the household; having other
children in the household; and not having post-secondary education. Conclusions:
Many pregnant smokers are not being reached by current stop-smoking strategies.
New ways to help these women and their partners are needed.
Copyright 2003, Canadian Public Health Association.
Co-existing problems of mental health and substance misuse (dual diagnosis):
A literature review. (review).
Crawford V; Crome IB; Clancy C. Drugs: Education, Prevention & Policy 10(Supplement):
S1-S74, 2003. (138 refs.)
This review looks at ten years of literature relating to substance use and psychiatric
disorders. The aim is to introduce the reader to the themes within the literature.
These range from assessment and screening, substance-specific research, specific
common psychiatric conditions, childhood, women, violence and suicide through
to treatment.
Copyright 2003, Carfax Publishing Co.
Extrinsic barriers to substance abuse treatment among pregnant drug dependent
women.
Jessup MA; Humphreys JC; Brindis CD; Lee KA. Journal of Drug Issues 33(2):
285-304, 2003. (56 refs.)
The objective of this qualitative study was to examine extrinsic barriers to
substance abuse treatment among pregnant and parenting women enrolled in residential
perinatal substance abuse treatment programs in Northern California. Life history
interviews were conducted with 36 women to examine help-seeking behaviors before
treatment enrollment. Data analysis used the analytic framework of Mandelbaum
(1973) to describe dimensions, turnings, and adaptations of participants. Results
indicated that the majority (n = 34) of participants sought prenatal care but
identified fear of punitive actions from helping institutions and individuals
as a major barrier. Other extrinsic barriers included substance abuse treatment
program barriers, partners, the status of opiate dependency, and the status of
pregnancy. Biological, socio-cultural, and psychosocial dimensions of participants'
care-seeking experiences were identified. The turning was pregnancy and adaptations
included preserving the family, managing fear and manifesting faith. Findings
describe the transformation of the therapeutic alliance and the gendered impact
of two decades of the War on Drugs in the United States. Participants' coping
strategies suggest that the desire for child custody and concern for fetal and
child well-being was a priority and motivated care seeking despite extrinsic
barriers perceived to be threatening to the woman's safety and autonomy.
Copyright 2003, Journal of Drug Issues, Inc. Used with permission.
Where are the children? An examination of children's living arrangements
when mothers enter residential drug treatment.
Knight DK; Wallace G. Journal of Drug Issues 33(2): 305-324, 2003. (18
refs.)
Although providing child care and family residency options has become central
to substance abuse treatment for women with dependent children, research documenting
status of child coresidence prior to, during, and following treatment is currently
unavailable. The purpose of this study is to examine the degree to which mothers
are successful in maintaining or reestablishing their role as parents during
the course of treatment. The sample included 152 female clients admitted to a
residential drug treatment program for women with dependent children. Findings
document an increase in child coresidency from admission to follow-up. Women
who entered treatment with all children or who were reunited with children previously
in others' care at admission were over five times more likely to coreside with
all children at follow-up. At follow-up, mothers who reported complete coresidence
were more likely to be 30 years old or younger, live independently, and have
fewer than two parenting challenges.
Copyright 2003, Journal of Drug Issues, Inc.
Gender differences in outcomes from prison-based residential treatment.
Pelissier BMM; Camp SD; Gaes GG; Saylor WG; Rhodes W. Journal of Substance
Abuse Treatment 24(2): 149-160, 2003. (91 refs.)
This study examines gender similarities and differences in background characteristics,
the effectiveness of treatment, and the predictors of post-release outcomes among
incarcerated drug-using offenders. The sample of 1,842 male and 473 female treatment
and comparison subjects came from a multi-site evaluation of prison-based substance
abuse treatment programs. Three-year follow-up data for recidivism and post-release
drug use were analyzed using survival analysis methods. Despite the greater number
of life problems among women than men, women had lower three-year recidivism
rates and rates of post-release drug use than did men. For both men and women,
treated subjects had longer survival times than those who were not treated. There
were both similarities and differences with respect to gender and the other predictors
of the two post-release outcomes. Differences in background characteristics and
in factors related to post-release outcomes for men and women suggest the plausibility
of gender-specific paths in the recovery process.
Copyright 2003, Elsevier Inc.
Invited review series: Tobacco and lung health. Women and tobacco. (review).
Mackay J; Amos A. Respirology 8(2): 123-130, 2003. (37 refs.)
Smoking prevalence is lower among women than men in most countries, yet there
are about 200 million women in the world who smoke, and in addition, there are
millions more who chew tobacco. Approximately 22% of women in developed countries
and 9% of women in developing countries smoke, but because most women live in
developing countries, there are numerically more women smokers in developing
countries. Unless effective, comprehensive and sustained initiatives are implemented
to reduce smoking uptake among young women and increase cessation rates among
women, the prevalence of female smoking in developed and developing countries
is likely to rise to 20% by 2025. This would mean that by 2025 there could be
532 million women smokers. Even if prevalence levels do not rise, the number
of women who smoke will increase because the population of women in the world
is predicted to rise from the current 3.1 billion to 4.2 billion by 2025. Thus,
while the epidemic of tobacco use among men is in slow decline, the epidemic
among women will not reach its peak until well into the 21st century. This will
have enormous consequences not only for women's health and economic wellbeing
but also for that of their families. The health effects of smoking for women
are more serious than for men. In addition to the general health problems common
to both genders, women face additional hazards in pregnancy, female-specific
cancers such as cancer of the cervix, and exposure to passive smoking. In Asia,
although there are currently lower levels of tobacco use among women, smoking
among girls is already on the rise in some areas. The spending power of girls
and women is increasing so that cigarettes are becoming more affordable. The
social and cultural constraints that previously prevented many women from smoking
are weakening; and women-specific health education and quitting programmes are
rare. Furthermore, evidence suggests that women find it harder to quit smoking.
The tobacco companies are targeting women by marketing light, mild, and menthol
cigarettes, and introducing advertising directed at women. The greatest challenge
and opportunity in primary preventive health in Asia and in other developing
areas is to avert the predicted rise in smoking among women.
Copyright 2003, Blackwell Publishing Asia.
Teratology in the 20th century. Environmental causes of congenital malformations
in humans and how they were established.
Kalter H. Neurotoxicology and Teratology 25(2): 131-282, 2003. (1464 refs.)
This comprehensive review of teratology in the 20th century, begins with the
chance findings at the beginning of the 20th century, the "rediscovery of Mendel's
laws of inheritance" and Roentgen ray's ability to induce malformations. This
review covers early human studies, early experiments, and then in the wake of
abnormalities associated with thalidomide, the advent of drug testing for teratogenic
effects, surveillance efforts, and epidemiological studies. The focus of the
concluding chapters address congenital malformations associated with human disease,
environmental hazards, medications, and the concluding chapter deals with alcohol,
As part of this review, there is discussion of alcohol. This discussion covers
the early Seattle study, the description of fetal alcohol syndrome and the subsequent
expansion to include fetal alcohol effects. Attention then turns to diagnosis,
both epidemiological studies and retrospective and prospective studies. The major
and minor malformations are outlined, as well as the long term effects on growth,
orofacial defects, limb defects, neurodevelopmental studies. There is also discussion
of the role of drinking patterns, including moderate drinking, and the relationship
of alcohol use to spontaneous abortion.
Copyright 2003, Project Cork.
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