Initiating Smokeless Tobacco Use across Reproductive Stages.
Initiating Smokeless Tobacco Use across Reproductive Stages.
复制标题
DOI：
10.7314/apjcp.2015.16.17.7547
复制
发表时间：
2015
期刊：
影响因子：
--
通讯作者：
S. Begum;J. Schensul;S. Nair;B. Donta
中科院分区：
文献类型：
--
作者：
S. Begum;J. Schensul;S. Nair;B. Donta
背景：印度妇女使用无烟烟草（SLT）的人数正在增加，尤其是那些受教育程度和资源有限的妇女。预防妇女开始性传播是至关重要的，因为它已知会对口腔和生殖健康产生负面影响。在印度，大多数关于吸烟的研究都集中在青少年身上。本文解决了育龄妇女婚后开始吸烟的未被认识的问题，强调了生育阶段在妇女烟草开始吸烟中的重要性。目的是检查孟买低收入妇女从婚前到早婚、第一次怀孕及以后开始进行特殊生活方式的相关关系，并使用案例说明在每个阶段的开始情况。材料与方法2011-2012年，从孟买低收入社区的409名18-40岁已婚妇女中收集代表性样本的横断面社区调查数据。通过一项研究人员管理的调查，收集了有关社会人口统计学、按生育阶段开始吸烟、烟草使用类型、儿童接触烟草、学习吸烟以及开始吸烟的影响和原因的信息。单因素和双因素分析评估了影响生殖阶段开始使用SLT的因素。此外，从有目的的怀孕和非怀孕已婚妇女样本中收集了42份关于烟草使用的叙述，详细解决了同样的问题。对包括开始使用烟草在内的关键概念进行转录、翻译和编码。结果32%的女性在婚前开始使用SLT， 44%的女性在婚后但怀孕前开始使用SLT， 18.1%的女性在第一次怀孕时开始使用SLT，其余的女性在第一次怀孕后开始使用SLT。研究中女性的平均结婚年龄为16岁。较年轻的女性（即访谈时年龄小于30岁）结婚后开始性行为的可能性比30岁以上的女性低0.47 [95% CI(0.32, 0.87)]个百分点。18岁前结婚的女性婚后发起性行为的可能性是同龄女性的2.34倍[95% CI(1.40, 3.93)]。童年接触是婚前而非婚后开始使用SLT的预测因子。报告牙齿和牙龈疼痛的女性婚后开始口交的可能性是同龄女性的1.85倍。丈夫和邻居对婚后启蒙的影响最大。叙述强调了婚前、婚后和怀孕期间的启蒙过程的差异。结论：大多数烟草预防干预措施针对在校青少年。这项研究表明，特别是对低识字率或不识字的妇女，以学校为基础的干预是无效的。要想有效地预防SLT的开始，就必须使城市地区的妇女在结婚或结婚后立即以及第一次怀孕期间接触到SLT。信息必须否定关于SLT对健康有益的文化根深蒂固的信念，以防止开始和开始日常使用。
BACKGROUND The use of smokeless tobacco (SLT) among women is increasing in India, especially among those with limited education and resources. Preventing the initiation of SLT among women is critical since it has known negative consequences for oral and reproductive health. Most research on tobacco initiation in India focuses on adolescents. This paper addresses the unrecognized issues of post marital initiation among women of reproductive age, highlighting the importance of reproductive stages in women's tobacco initiation. The objective is to examine the correlates of SLT initiation among low income women in Mumbai from pre-marriage through early marriage, first pregnancy and beyond, using case examples to illustrate initiation during each of these stages. MATERIALS AND METHODS In 2011-2012, cross-sectional community level survey data were collected from a representative sample of 409 daily SLT-using married women aged 18-40 years in a low income community in Mumbai. Information on socio-demographics, initiation by reproductive stage, types of tobacco use, childhood exposure to tobacco, learning to use, and initiation influences and reasons were collected through a researcher-administered survey. Univariate and bivariate analysis assessed factors influencing initiation of SLT use by reproductive stage. In addition 42 narratives of tobacco use were collected from a purposive sample of pregnant and non-pregnant married women addressing the same questions in detail. Narratives were transcribed, translated, and coded for key concepts including initiation of tobacco use. RESULTS Thirty-two percent of women initiated SLT use before marriage, 44% initiated after marriage but before pregnancy, 18.1% initiated during their first pregnancy and the remainder started after their first pregnancy. Mean age of marriage among women in this study was 16 years. Younger women (i.e. age at time of the interview of less than 30 years) were 0.47 [95% CI (0.32, 0.87)] percent less likely to initiate after marriage than women aged more than 30 years. Women who got married before 18 years of age were 2.34 [95% CI (1.40, 3.93)] times more likely to initiate after marriage than their counterparts. Childhood exposure was a predictor for initiating SLT use prior to marriage but not after. Women reporting tooth and gum pain were 1.85 times more likely to initiate after marriage than their counterparts. Husband and neighbours were the most significant influences on post-marital initiation. Narratives highlighted differences in processes of initiation pre and post marriage and during pregnancy. CONCLUSIONS Most tobacco prevention interventions are directed to adolescents in school. This study suggests that especially for low literate or illiterate women, school based interventions are ineffective. To be effective strategies to prevent SLT initiation must reach women in urban areas at or immediately after marriage and during their first pregnancy. Messages must negate culturally rooted beliefs about the health benefits of SLT in order to prevent initiation and onset of daily use.