Findings are presented from matched case-control studies of risk factors for diabetes, cryptorchidism and inguinal hernia in children using routine data collected by the Oxford Record Linkage Study since 1965. There were 315 cases born 1965-85 in the diabetes study, 947 and 1449 cases in studies of cryptorchidism diagnosed at birth and at orchidopexy respectively, and 1701 male and 347 female cases in the study of inguinal hernia. Each case was individually matched with up to eight controls on sex, year, and hospital or place of birth. A potential bias caused by differential migration of cases and controls was identified. A sample of 753 controls born in Oxfordshire was checked against the Oxfordshire Family Health Services Authority register to determine migration out of the study area in relation to perinatal risk factors. A general procedure was developed to estimate the strength of the migration bias. Pre-eclampsia was identified as a significant pre-natal risk factor for diabetes. The studies of cryptorchidism identified significantly raised risks with low birth weight, low social class and breech presentation. The results suggested that asymmetric growth retardation in the third trimester may be involved in the aetiology of undescended testes that do not spontaneously descend in later life. Analysis of risk factors among siblings of cases and controls suggested that permanent changes to the mother may occur around the time of the pregnancy involving the affected child. Low birth weight, short gestation and smoking during pregnancy were associated with significantly raised risks of inguinal hernia among boys. Among girls the results were similar, suggesting that mechanisms independent of the sex of the child may be important in the aetiology of this condition. Estimates of disease risk in siblings showed a strong familial aggregation, especially among girls.

This study revisits the effect of duration by residence in relation to smoking during pregnancy. It contributes to the literature by incorporating a health inequity perspective, and discusses whether immigrants tend to converge with Swedish women’s smoking. The study is based on Swedish Medical Birth Register and includes 1 1864 52 pregnancies between 1991 and 2012. Logistic regression was performed to attain crude and adjusted Odds Ratios and 95 % confidence intervals. Immigrants’ are divided by categorizing countries of origin depending on levels of Human Development (IHDI). Overall immigrant women show low levels of smoking during pregnancy when they arrive to Sweden, by duration of residence levels of smoking increase and converge with smoking patterns of Swedish women. I found that there are differences in smoking patterns depending on IHDI of the country. Immigrant women of higher categories of IHDI show higher levels of smoking although the increase of smoking is higher among immigrant women from categories of lower IHDI. However, immigrant women’s smoking during pregnancy is affected by duration of residence, and the increased smoking is associated with health inequalities related to their country of origins IHDI, and by socioeconomic inequalities in Sweden.

AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses Objective: To implement and evaluate training session related to smoking during pregnancy for baccalaureate nursing students in rural Southern Appalachia. Design: Nursing students attended training on dangers and intervention techniques related to smoking during pregnancy. Sample: Third year students beginning clinical rotations in obstetrics. Methods: One and one half hour training including pre‐ and post tests. Implementation Strategies: Four months later, a follow‐up survey assessed gains in knowledge, skill, comfort, and willingness to address smoking during pregnancy. Results: During seven semesters, 659 nursing students were trained. Substantial gains in knowledge of issues related to smoking during pregnancy were seen from pre‐ to post testing, and knowledge was retained at 4‐month follow‐up. The percentage of students who felt they lacked skills to intervene with pregnant smokers dropped from 39% at pretest to 6% at same day post test. In addition, the percentage who reported they would be uncomfortable talking with pregnant women about smoking dropped from 10% to 1%; the percentage who indicated they would always make time to address smoking with pregnant women increased from 54% to 87%. While most students did address smoking with multiple pregnant patients during clinicals, and more than half felt the patients benefited from their actions, only 58% were confident in their intervention skills at 4‐month follow‐up. Finally, 83% felt the training had been beneficial, and more than 90% committed to addressing smoking with pregnant patients once they graduated. Conclusion/Implications for Nursing Practice: Rates of smoking during pregnancy in the rural South are twice as great as national averages and contribute to poor birth and long‐term outcomes for affected women and children. Efforts to intervene during prenatal care with pregnant women have been hampered by lack of knowledge, skill, comfort, and commitment from prenatal providers and their nursing staff. Regional community providers and staff have been reluctant to participate in available trainings, and even those who do seldom exhibit attitude and practice change long term. Therefore, efforts to educate healthcare professionals on the dangers of smoking during pregnancy and to provide necessary skills for intervention efforts may need to occur before students enter practice, and ongoing education may be needed to promote skills and confidence long term. In the rural South, where smoking rates are high and provider efforts to address pregnancy smoking are inconsistent, educating future nurses could have substantial impact on rates of smoking during pregnancy and birth outcomes into the future.

AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses Objective: To implement and evaluate training session related to smoking during pregnancy for baccalaureate nursing students in rural Southern Appalachia. Design: Nursing students attended training on dangers and intervention techniques related to smoking during pregnancy. Sample: Third year students beginning clinical rotations in obstetrics. Methods: One and one half hour training including pre‐ and post tests. Implementation Strategies: Four months later, a follow‐up survey assessed gains in knowledge, skill, comfort, and willingness to address smoking during pregnancy. Results: During seven semesters, 659 nursing students were trained. Substantial gains in knowledge of issues related to smoking during pregnancy were seen from pre‐ to post testing, and knowledge was retained at 4‐month follow‐up. The percentage of students who felt they lacked skills to intervene with pregnant smokers dropped from 39% at pretest to 6% at same day post test. In addition, the percentage who reported they would be uncomfortable talking with pregnant women about smoking dropped from 10% to 1%; the percentage who indicated they would always make time to address smoking with pregnant women increased from 54% to 87%. While most students did address smoking with multiple pregnant patients during clinicals, and more than half felt the patients benefited from their actions, only 58% were confident in their intervention skills at 4‐month follow‐up. Finally, 83% felt the training had been beneficial, and more than 90% committed to addressing smoking with pregnant patients once they graduated. Conclusion/Implications for Nursing Practice: Rates of smoking during pregnancy in the rural South are twice as great as national averages and contribute to poor birth and long‐term outcomes for affected women and children. Efforts to intervene during prenatal care with pregnant women have been hampered by lack of knowledge, skill, comfort, and commitment from prenatal providers and their nursing staff. Regional community providers and staff have been reluctant to participate in available trainings, and even those who do seldom exhibit attitude and practice change long term. Therefore, efforts to educate healthcare professionals on the dangers of smoking during pregnancy and to provide necessary skills for intervention efforts may need to occur before students enter practice, and ongoing education may be needed to promote skills and confidence long term. In the rural South, where smoking rates are high and provider efforts to address pregnancy smoking are inconsistent, educating future nurses could have substantial impact on rates of smoking during pregnancy and birth outcomes into the future.

OF THE THESIS Name: Mgr. Markéta Šídová Specialization: Adiktologie Head of the thesis: Mgr. Lenka Šťastná, Ph.D. Pages: 145 The name of thesis: Tobacco smoking and motivation to change in relation to pregnancy Abstract: Background: The pregnancy gives the smoking women the opportunity to change their attitude to smoking tobacco. In the Czech Republic is still missing a study describing the motivation to change smoking specifically in connection with pregnancy. Goals: Describe the basic motivation to stop smoking by pregnant women. Methods: Quantitative survey. The questionnaire consists of four sections (anamnesis, gathering information about smoking during pregnancy, motivation to change smoking behaviour, Fagerström Test of Nicotine Dependence). Motivation section is inspired by Reasons for Quiting Scale (RFQ). Evaluation using the descriptive statistics and non-parametric statistical tests. File: The study analyses two sets of pregnant women - electronic (collection via web form, N = 96) and clinical (collection from the Department of Gynaecology and Obstetrics, 1st Faculty of Medicine and VFN, N = 40). The files are divided into 4 subgroups according to the current smoking behaviour. Results: Most women in both groups do not smoke and have never smoked or stopped in connection with pregnancy....

Introdução: A exposição do feto a grandes quantidades de componentes tóxicos decorrente do consumo de tabaco e álcool durante a gestação pode acarretar problemas tais como prematuridade, baixo peso ao nascer, aborto e distúrbios no desenvolvimento infantil. Essa associação tem sido recentemente objeto de diversos estudos, porém os resultados são contraditórios devido aos métodos e amostras distintos. Objetivo: Estudar a associação entre o consumo de tabaco e/ou álcool pela gestante e o desenvolvimento infantil entre 13 e 30 meses de idade. Método: Estudo descritivo e analítico, prospectivo, de uma coorte de conveniência iniciada no pré-natal (2010), avaliada no nascimento e a partir do início do segundo ano de vida (2011/2013) no município de Ribeirão Preto, SP. A variável dependente foi o escore médio do desempenho dos filhos nas cinco subescalas da Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). A variável exploratória foi o consumo de tabaco e/ou álcool na gestação, classificado como nenhum consumo, consumo isolado de tabaco ou álcool e consumo concomitante das substâncias. As diferenças entre as médias nos escores das cinco subescalas foram comparadas por meio de regressão linear, em quatro modelos: ajustado pelas faixas etárias de aplicação do teste, propostas no manual técnico da escala (modelo 1); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e características da mãe, da gestação e do parto (modelo 2); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e variáveis do seguimento das crianças (modelo 3); ajustado por todas as variáveis dos modelos anteriores (modelo 4). Resultados: Foram estudadas 998 mulheres, das quais 121 (12,1%) fumaram e 246 (24,6%) referiram ter consumido bebida alcoólica na gravidez. O consumo isolado de álcool foi três vezes maior (18,6%) do que o consumo apenas de tabaco (6,1%). O consumo combinado de tabaco e álcool durante a gestação foi de 6,0%, sem diferença segundo a faixa etária das crianças avaliadas (p>0.05). Não houve diferença nas médias do escore cognitivo segundo o consumo das substâncias em nenhum modelo. Consumo concomitante foi associado a menor média dos escores em ambas as subescalas de comunicação (diferença de 1,12 pontos para comunicação receptiva, IC95% 0,45 a 1,79; 1,19 pontos para comunicação expressiva, IC95% 0,31 a 2,07) e motoras (diferença de 1,20 pontos na subescala motora fina, IC95% 0,55 a 1,85; 0,70 pontos para subescala motora grossa, IC95% 0,13 a 1,28), em torno de um ponto em média, comparado com nenhum consumo de tabaco e álcool. Conclusão: Consumo concomitante de tabaco e álcool teve efeito significativo, porém pequeno, na média dos escores de comunicação e motores, mas não na subescala cognitiva. / Introduction: Fetal exposure to large amounts of toxic compounds resulting from the consumption of tobacco and alcohol during pregnancy can lead to problems such as preterm birth, low birth weight, miscarriage and disorders in child development. This association has recently been the subject of several studies, but the results are contradictory due to differences in methods and samples. Objective: To study the association between the consumption of tobacco and/or alcohol by pregnant women and child development between 13 and 30 months of age. Methods: This is a descriptive and analytical, prospective study of a cohort of convenience initiated prenatally (2010), assessed at birth and from the beginning of the second year of life (2011-2013) in the city of Ribeirão Preto, Brazil. The dependent variable was the mean score of the performance of children in the five subscales of the Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). The explanatory variable was the use of tobacco and/or alcohol during pregnancy rated as no consumption, isolated consumption of tobacco and alcohol and concomitant consumption of the substances. The differences between the mean scores in the five subscales were compared using linear regression in four models: adjusted for age of test application proposed in the technical manual of the scale (model 1); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and maternal characteristics of pregnancy and childbirth (model 2); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and variables related to children in the follow-up (model 3); adjusted for all the variables of the previous models (model 4). Results: 998 women were studied, 121 of them (12.1%) smoked and 246 (24.6%) reported having consumed alcohol in pregnancy. The isolated alcohol consumption was three times higher (18.6%) than the consumption of tobacco only (6.1%). The combined use of tobacco and alcohol during pregnancy was 6.0%, with no difference according to the child\'s age group (p> 0.05). There was no difference in mean cognitive score based on consumption of substances in any model. Concomitant intake was associated with lower mean scores in both communication subscales (1.12 points difference for receptive communication, 95% CI 0.45 to 1.79; 1.19 points for expressive communication, 95% CI 0.31 to 2.07) and motor subscale (1.20 points difference in the fine motor subscale, 95% CI 0.55 to 1.85; 0.70 points for gross motor subscale, 95% CI 0.13 to 1.28), around a point on average compared with no consumption of tobacco and alcohol. Conclusion: concomitant consumption of tobacco and alcohol had a significant effect, however small, in the mean score of the communication and motor subscales, but not in the cognitive subscale.

Introdução: A exposição do feto a grandes quantidades de componentes tóxicos decorrente do consumo de tabaco e álcool durante a gestação pode acarretar problemas tais como prematuridade, baixo peso ao nascer, aborto e distúrbios no desenvolvimento infantil. Essa associação tem sido recentemente objeto de diversos estudos, porém os resultados são contraditórios devido aos métodos e amostras distintos. Objetivo: Estudar a associação entre o consumo de tabaco e/ou álcool pela gestante e o desenvolvimento infantil entre 13 e 30 meses de idade. Método: Estudo descritivo e analítico, prospectivo, de uma coorte de conveniência iniciada no pré-natal (2010), avaliada no nascimento e a partir do início do segundo ano de vida (2011/2013) no município de Ribeirão Preto, SP. A variável dependente foi o escore médio do desempenho dos filhos nas cinco subescalas da Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). A variável exploratória foi o consumo de tabaco e/ou álcool na gestação, classificado como nenhum consumo, consumo isolado de tabaco ou álcool e consumo concomitante das substâncias. As diferenças entre as médias nos escores das cinco subescalas foram comparadas por meio de regressão linear, em quatro modelos: ajustado pelas faixas etárias de aplicação do teste, propostas no manual técnico da escala (modelo 1); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e características da mãe, da gestação e do parto (modelo 2); ajustado pelas faixas etárias, por consumo de tabaco e/ou álcool na gestação e variáveis do seguimento das crianças (modelo 3); ajustado por todas as variáveis dos modelos anteriores (modelo 4). Resultados: Foram estudadas 998 mulheres, das quais 121 (12,1%) fumaram e 246 (24,6%) referiram ter consumido bebida alcoólica na gravidez. O consumo isolado de álcool foi três vezes maior (18,6%) do que o consumo apenas de tabaco (6,1%). O consumo combinado de tabaco e álcool durante a gestação foi de 6,0%, sem diferença segundo a faixa etária das crianças avaliadas (p>0.05). Não houve diferença nas médias do escore cognitivo segundo o consumo das substâncias em nenhum modelo. Consumo concomitante foi associado a menor média dos escores em ambas as subescalas de comunicação (diferença de 1,12 pontos para comunicação receptiva, IC95% 0,45 a 1,79; 1,19 pontos para comunicação expressiva, IC95% 0,31 a 2,07) e motoras (diferença de 1,20 pontos na subescala motora fina, IC95% 0,55 a 1,85; 0,70 pontos para subescala motora grossa, IC95% 0,13 a 1,28), em torno de um ponto em média, comparado com nenhum consumo de tabaco e álcool. Conclusão: Consumo concomitante de tabaco e álcool teve efeito significativo, porém pequeno, na média dos escores de comunicação e motores, mas não na subescala cognitiva. / Introduction: Fetal exposure to large amounts of toxic compounds resulting from the consumption of tobacco and alcohol during pregnancy can lead to problems such as preterm birth, low birth weight, miscarriage and disorders in child development. This association has recently been the subject of several studies, but the results are contradictory due to differences in methods and samples. Objective: To study the association between the consumption of tobacco and/or alcohol by pregnant women and child development between 13 and 30 months of age. Methods: This is a descriptive and analytical, prospective study of a cohort of convenience initiated prenatally (2010), assessed at birth and from the beginning of the second year of life (2011-2013) in the city of Ribeirão Preto, Brazil. The dependent variable was the mean score of the performance of children in the five subscales of the Bayley Scales of Infant and Toddler Development ® third edition - screening test (Bayley - III®). The explanatory variable was the use of tobacco and/or alcohol during pregnancy rated as no consumption, isolated consumption of tobacco and alcohol and concomitant consumption of the substances. The differences between the mean scores in the five subscales were compared using linear regression in four models: adjusted for age of test application proposed in the technical manual of the scale (model 1); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and maternal characteristics of pregnancy and childbirth (model 2); adjusted by age groups, for tobacco and/or alcohol use during pregnancy and variables related to children in the follow-up (model 3); adjusted for all the variables of the previous models (model 4). Results: 998 women were studied, 121 of them (12.1%) smoked and 246 (24.6%) reported having consumed alcohol in pregnancy. The isolated alcohol consumption was three times higher (18.6%) than the consumption of tobacco only (6.1%). The combined use of tobacco and alcohol during pregnancy was 6.0%, with no difference according to the child\'s age group (p> 0.05). There was no difference in mean cognitive score based on consumption of substances in any model. Concomitant intake was associated with lower mean scores in both communication subscales (1.12 points difference for receptive communication, 95% CI 0.45 to 1.79; 1.19 points for expressive communication, 95% CI 0.31 to 2.07) and motor subscale (1.20 points difference in the fine motor subscale, 95% CI 0.55 to 1.85; 0.70 points for gross motor subscale, 95% CI 0.13 to 1.28), around a point on average compared with no consumption of tobacco and alcohol. Conclusion: concomitant consumption of tobacco and alcohol had a significant effect, however small, in the mean score of the communication and motor subscales, but not in the cognitive subscale.

<p>Due to the great transitions and turmoil uniquely attributed to the period of adolescence, youth experience a greater risk for substance use and the multitude of concerns that coincide with the early onset of substance use. Many biological and environmental factors have been investigated as predictors of adolescent substance use. Executive function and disruptive behaviors are two important individual characteristics linked to adolescent substance use. Both smoking during pregnancy and sibling relationships are separate contexts that can mitigate or exacerbate the associations of executive function and adolescent substance use. The present study focuses on development of substance use through executive function deficits and disruptive behavior, while considering smoking during pregnancy and sibling relationships as unique moderators of these pathways. This work addresses a novel, interrelated set of questions with a series of three studies. The central hypothesis driving this program of research is that smoking during pregnancy and sibling relationships are under-studied contexts that can mitigate or exacerbate the associations of executive function, disruptive behavior, and adolescent substance use. This dissertation examines whether: (1) executive function mediates the smoking during pregnancy-disruptive behavior association and smoking during pregnancy exacerbates the executive function-disruptive behavior association, (2) smoking during pregnancy exacerbates the association between executive function and disruptive behavior during adolescence using a sibling comparison design, and (3) sibling relationship quality moderates developmental trajectories of executive function on the transition from disruptive problems to adolescent substance use using a high-risk, longitudinal sample. Findings challenge the link between exposure to smoking during pregnancy and both executive function and disruptive behavior. Further, these findings reinforce the need to utilize genetically-informed designs when examining potential effects of smoking during pregnancy. Additionally, this dissertation found support for the link between executive function and disruptive behavior, but not executive function and substance use. </p>