Socioeconomic Determinants of Exposure to Secondhand Smoke

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Mar 10, 2016 - In Saudi Arabia, the prevalence of active smoking among ... Keywords: Passive smoking, Pregnant women, Saudi Arabia, Secondhand smoke, ...

doi 10.15296/ijwhr.2016.14 doi 10.15296/ijwhr.2015.27

Open Access Open Access

Original ReviewArticle International Journal of Women’s and Reproduction Sciences International Journal of Women’s HealthHealth and Reproduction Sciences Vol.Vol. 3, No. 3, July 2015,2016, 126–131 4, No. 2, April 59–63 ISSN 2330-  4456 ISSN 2330-  4456

Women on the Other Side of Warofand Poverty: to Its Secondhand Effect Socioeconomic Determinants Exposure on the Health ofPregnant Reproduction Smoke Among Women Ayse Cevirme1, Yasemin Hamlaci2*, Kevser Ozdemir2

Ahmad Saeed Alghamdi1, Hazem Faisal Jokhadar1, Ibraheem Mohammed Alghamdi1*, Saleh Abdullah Alsohibani1, Odai Jamaan Alqahtani1, Hayfaa Abdelmageed Wahabi2 Abstract

War and poverty are ‘extraordinary conditions created by human intervention’ and ‘preventable public health problems.’ War and

poverty have many negative effects on human health, especially women’s health. Health problems arising due to war and poverty are Abstract

being observed as sexualtoabuse and rape, smoke all kinds(SHS) of violence and subsequent gynecologic andthat obstetrics problems with physiological Objectives: Exposure secondhand constitutes major health problems threaten human health around the world; andadverse psychological pregnancies as the forcedand or obliged marriages and even rapes. of Certainly, its effects courses, can leadand to serious illnesses inresult both of theundesired pregnantbut women the growing fetus. The purpose this study was to unjust treatment such as being unable to gain footing on thewomen land it in is lived seeker, refugee, etc.) and being and deprived of determine the prevalence of SHS among Saudi pregnant King (asylum Khalid University Hospital (KKUH) to determine the social security, citizenship rights and human rights bringsof about the deprivation of and access to healthtoservices association between the socioeconomic characteristics the pregnant women exposure SHS. and of provision of service intended for gynecology The purpose of this article is to effects ofclinic, war and povertyData on the health of Materials and Methods: Thisand wasobstetrics. a cross-sectional study conducted inaddress the antenatal KKUH. were collected from reproductionwomen of women and to offer scientificquestionnaire contribution and solutions. the participants’ demographics and exposure to SHS status. consecutive using a predesigned addressing Keywords: Poverty, Reproductive Waramong pregnant women was 24%. Low maternal education level and being unemployed Results: The prevalence of SHShealth, exposure were associated with more exposure to SHS (P = 0.039) and (P = 0.02), respectively. There was no association between maternal age, parity and monthly income and exposure to SHS (P = 0.697), (P = 0.420) and (P = 0.543), respectively. Conclusion: Maternal educational levels and unemployment arethought associated factors for SHSconflicts exposureinduring thatrisk severe military Africapregnancy. shorten Introduction Keywords: Passive smoking, Pregnant women, Saudi Arabia, Secondhand smoke, Socioeconomic factors the expected lifetime for more than 2 years. In general, Throughout the history of the world, the ones who had WHO had calculated that 269 thousand people had died confronted the bitterest face of poverty and war had alin 1999 due to the effect of wars and that loss of 8.44 milways been the women. As known poverty and war affects Introduction the socio-demographic determinants lion healthy years of life had occurred (2,3). of exposure to SHS human health either directly or indirectly, the effects of Exposure to secondhand smoke constitutes major Warsamong Saudi pregnant women the antenatal negatively affect the provision of attending health services. this condition on health and status(SHS) of women in the sohealth problems thatignored. threaten human care clinic in King University Hospitaland (KKUH). institutions suchKhalid as hospitals, laboratories ciety should not be This study health intendsaround to cast the Health world (1). is a preventable cause of and mor- health centers are direct targets of war. Moreover, the wars light on theIteffects of war and poverty onmorbidity the reproductive the migration of qualified health employees, and health(1). of women. For this purpose, the face war affecttality Its adverse effects can lead to of serious illnesses causeMaterials and Methods the health hitches. Assessments made ingboth the women, the problem of immigration, inequalities in the pregnant women and the growing fetus (1). thus This was services prospective cross-sectional studyindidesigned to cate that the effect of destruction in the infrastructure in distribution of income based on gender and the effects During pregnancy SHS exposure can lead to long lasting investigate the socioeconomic determinants ofof SHS expohealth continues 5-10 yearsand even the finalization of all these on the reproductive health of women will central be effects on the infant’s respiratory, cardiovascular, sure duringfor pregnancy to after evaluate the pregnant womof conflicts (3). Due to resource requirements in the readdressed. nervous system and other systemic abnormalities (1). en’s knowledge about the harmful effects of SHS. structuring investments after war, the share allocated to More than 600 000 premature deaths every year are caused The study was done in an antenatal outpatient clinic at health has decreased (1). War and Women’s Health by exposure to SHS (1). About 40% of all children, 33% KKUH, Riyadh, Saudi Arabia. KKUH is a tertiary referral Famine, synonymous with war and poverty, is clearer for of male non-smokers and 35% female non-smokers are centerand andMorbidities includes a neonatal intensive care unit (NICU) women; war means deep disadvantages such as full deMortalities exposed SHS indoors 31% of the and who an in Thewomen obstetrics struction,toloss of future and(1). uncertainty for deaths women.caused Wars by The ones arevitro most fertilization affected fromunit. wars are and departSHS occur inthat children (1). mentWhile provides services for 3500 to 4000 deliveries are conflicts destroy families, societies and cultures children. deaths depending on direct violence af- per year. In Saudi Arabia, the the prevalence active smoking among fect the Formale thispopulation, study, we the invited pregnant from KKUH indirect deaths women kill children, that negatively affect health ofof community and cause and elders Iraq October between 1990-1994, in- 2014 to violation of human According to the World males and femalesrights. ranges according todata the ofage groups women antenatal caremore. clinicInfrom 2013 to March fant deaths had shown this reality its more bare form of parity Health Organization (WHO) andrespectively World Bank, 2002 with median of 26.5% and 9%, (2).inAlthough participate. The women wereininvited irrespective an gestational increase of age. 600% (4). The war taking five years wars had been among the firstactive ten reasons which killed according to previous study, smoking among preg- with or increases the child deaths age ofexposure 5 by 13%. during Also 47% the most and caused disabilities. Civil losses are at the rate nant women was low 0.08%, exposure to SHS is reported The prevalence rateunder for SHS pregnancy of all the refugees in the world and 50% of asylum seekers of 90% within all losses (1). to be as high as 31% (3). was estimated to be 31% from a recently published study and displaced people are women and girls and 44% refWar has many negative effects on human health. One of The demographic profile of pregnant women exposed to (3). Based on that prevalence the sample size was calculatugees and asylum seekers are children under the age of these is its effect of shortening the average human life. SHS showed thatdata theofexposed participants werelifeyounged with 95% CI and 5% precision. The minimum sample 18 (5). According to the WHO, the average human is er in age, of low parity and lower level of education than sizeresult needed was 328 As the of wars and participants. armed conflicts, women are 68.1 years for males and 72.7 years for females. It is being

non-exposed (3). However, the study did not show the soA consecutive sampling technique was used. The inclucioeconomic determinants of SHS exposure among Saudi sion criteria were: pregnant women aged 18 years and Received 12 December 2014, Accepted 25 April 2015, Available online 1 July 2015 pregnant women (3). older who consented to participate in the study. Exclusion 1 2 Department Sakarya were University, Turkey.the Department of Midwifery, Sakarya University, Turkey. The aims ofofNursing, this study to Sakarya, determine prevalence criteria were Sakarya, women who actively smoked and those who *Corresponding author: Yasemin Hamlaci, Department of Midwifery, Sakarya University, Sakarya, Turkey. Tel: +905556080628, of SHS exposure among pregnant women and to explore declined to participate in the study. Email: [email protected] Received 20 December 2015, Accepted 23 February 2016, Available online 10 March 2016 College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. 2Department of Family and Community Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. *Corresponding author: Ibraheem Mohammed Alghamdi, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. Tel: +966560460516, Email: [email protected] 1

Alghamdi et al

A questionnaire was used for data collection. The questionnaire was designed to assess the demographic characteristics and SHS exposure of the participants (Appendix 1). The first section of the questionnaire concerned the demographic characteristics of the participants. In this section, closed-ended questions were used in addition to open-ended ones. For instance, open-ended questions were used when asking about age and nationality, while closed-ended questions were used for educational level, marital status, parity, income, and employment. The next section was designed to determine the prevalence of SHS. We calculated the number of women who were exposed to SHS as a percentage from the total study population. We then determined, as a secondary outcome, the prevalence of active smoking among pregnant women in addition to quantifying the amount of SHS according to the hours of exposure and the number of smokers in the house. Statistical Analysis The statistical analysis for this study was performed using SPSS, version 21.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were computed to assess the exposure to SHS during pregnancy. Univariate analysis was applied to assess the association between exposure to SHS and the socio-demographic characteristics by comparing these characteristics on exposed and non-exposed participants in the following; age, parity, educational level, employment, and monthly income. Chi-squared test used to compare dichotomous outcomes (unemployment, monthly income, educational level and parity), while independent t test used to compare continuous variables (age). Statistical significance was determined with a P value of

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