Barriers to prevent second-hand smoke (SHS) exposure among pregnant women and children in Egypt

Abstract Background The prevalence of daily second-hand smoke (SHS) exposure among pregnant non-smoking women and children in Egypt is estimated to be about 50% and 55%, respectively. This study aimed to explore barriers to preventing SHS exposure among pregnant women/children and smoking behavior at home in Egypt. Methods Focus group discussions (FGDs) with pregnant women/mothers of children residing in urban/rural areas (n = 61). Data were coded and analyzed thematically. Results 61 participants were recruited, aged 18-49. They reported being never smokers and SHS exposure for themselves and their children was mainly at home. Pregnant women/mothers had some general knowledge of the dangers of SHS, but their knowledge appeared incomplete. The most commonly reported barriers to preventing SHS exposure/adopting a smoke free home or workplace were having men who smoke in the household, doctors not being supportive regarding smoking cessation, SHS exposure is socially accepted and fear among women of damaging a relationship; being nervous about asking smokers to stop, and being worried about disputes and arguments with husband. The majority of interviewees’ families were reported to allow smoking anywhere in the home; others implemented some measures to prevent SHS, however, these tended to be inconsistently implemented and unlikely to be effective. Conclusions This study increases our knowledge of the barriers of non-smoking Egyptian pregnant women/mother of children in creating and maintaining smoke free environment for themselves and their children. There is a need to denormalise SHS exposure and better enforcement of smoke free policies. Key messages • Better enforcement of smoke free policies, and more support for smoking cession services are needed in Egypt. • SHS policy, practice, and research should focus on male family members to increase their effectiveness.


Background:
The prevalence of daily second-hand smoke (SHS) exposure among pregnant non-smoking women and children in Egypt is estimated to be about 50% and 55%, respectively. This study aimed to explore barriers to preventing SHS exposure among pregnant women/children and smoking behavior at home in Egypt.

Methods:
Focus group discussions (FGDs) with pregnant women/ mothers of children residing in urban/rural areas (n = 61). Data were coded and analyzed thematically. Results: 61 participants were recruited, aged 18-49. They reported being never smokers and SHS exposure for themselves and their children was mainly at home. Pregnant women/mothers had some general knowledge of the dangers of SHS, but their knowledge appeared incomplete. The most commonly reported barriers to preventing SHS exposure/adopting a smoke free home or workplace were having men who smoke in the household, doctors not being supportive regarding smoking cessation, SHS exposure is socially accepted and fear among women of damaging a relationship; being nervous about asking smokers to stop, and being worried about disputes and arguments with husband. The majority of interviewees' families were reported to allow smoking anywhere in the home; others implemented some measures to prevent SHS, however, these tended to be inconsistently implemented and unlikely to be effective.

Conclusions:
This study increases our knowledge of the barriers of nonsmoking Egyptian pregnant women/mother of children in creating and maintaining smoke free environment for themselves and their children. There is a need to denormalise SHS exposure and better enforcement of smoke free policies. Key messages: Better enforcement of smoke free policies, and more support for smoking cession services are needed in Egypt.
SHS policy, practice, and research should focus on male family members to increase their effectiveness.

Background:
Childhood obesity is a major public health challenge, and it is recommended to promote healthy weight development already during infancy. It is important to co-create interventions to maximize the feasibility and thus improve the chances of successful implementation. This paper describes the cocreation process of the Danish Bloom Trial -an early intervention to promote healthy weight development among children of first-time parents.

Methods:
Development of the trial is inspired by co-creation frameworks and the Intervention Mapping protocol. The co-creation process comprises three stages: 1) Evidence review, qualitative research with community health nurses (CHNs) and parents, and stakeholder consultations; 2) co-creation of the intervention content including workshops and group meetings with CHNs and other stakeholders and focus group discussions with parents; and 3) prototyping, feasibility-and pilot-testing. Currently, we are in stage 2 and have conducted four workshops with CHNs and one parent group discussion.

Results:
During stage 1, we identified the intervention setting; the unique system of CHNs in Danish municipalities. Furthermore, we identified the need for developing intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security to promote healthy child weight development. The main intervention components are a course for CHNs and guidelines on how to talk to parents about behavioral risk factors. The main components for parents are eight home visits and six telephone consultations from CHNs during pregnancy and until the child is 2½ years old and a video library.

Conclusions:
The description of the development of the Bloom Trial provides an example of how to co-create an intervention balancing evidence, the practical work of the implementers and the needs of the families. Co-creation with relevant stakeholders increases the chances of producing a relevant, successful, and sustainable intervention.

Key messages:
The co-creation process resulted in development of intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security from pregnancy to child age 2½ years. Involving parents and stakeholders in the development of an intervention increases the chances of producing a relevant, successful, and sustainable intervention.