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Cycle 5 (2016 Deadline)
Capacity building of health care providers in Egypt to counsel pregnant women and their families regarding smoking cessation and secondhand smoking avoidance
PI: Wagida Anwar (wagidaanwar@gmail.com), Ain Shams University School of Medicine
U.S. Partners: Scott Sherman, New York University, and Cheryl Oncken, University of Connecticut
Project Dates: January 2017 - February 2023
Project Overview
Exposure of pregnant women to secondhand smoke (SHS) is a significant public health concern, especially in developing countries with relatively high adult male smoking rates. There is an urgent need for interventions to create smoke-free home environments. This PEER project developed and disseminated an evidence-based healthcare professional training program on counseling smokers (both men and women) to stop smoking and establish smoke-free homes, specifically focusing on physicians and nurses who counsel pregnant women in the greater Cairo area.
The researchers held training sessions for healthcare professionals and undertook pre- and post-intervention surveys for a target group of pregnant mothers in households with a current smoker. The project team sought to create capacity for widespread dissemination of this work by developing and testing a train-the-trainer program and creating a network of professionals and organizations, including the Ministry of Health. The proposed intervention capitalizes on the “teachable moment” concept with health professionals providing advice in a situation where men and women alike are likely more receptive for behavioral change interventions that can affect the health of their unborn baby. Through a partnership between the Ministry of Health, the Syndicates of Physicians and of Nurses, and prominent universities, the research team hopes that the results of this project will lead to policy changes to promote its sustainability.
Final Summary of Project Activities
The PEER team conducted seven training sessions at El Demerdash Hospital in 2022. Participants included physicians, nurses, and health educators. Beforehand, team members had surveyed 1,002 pregnant women attending maternal care clinics across Cairo, Egypt. Up to three months after the training intervention, a follow-up survey with a similar sample size was conducted to compare how pregnant women were receiving secondhand smoke avoidance counseling and how smoke exposure levels differed from those found in the pre-intervention survey.
Participant characteristics of each survey were similar. Among the whole sample, 85% of participants answered all six knowledge-related questions about secondhand smoke and smoking harms correctly. Participants who lived with current smokers who smoked at home experienced an average secondhand smoke exposure for 18 hours per week, while those living in smoke-free homes (whether or not there was a smoker in the household) reported less than 8.3 hours per week on average.
Between the two surveys, an increased number of women reported being asked about secondhand smoke exposure (22.81% to 54.98%) and receiving secondhand smoke avoidance advice (28.46% to 60.32%). While pregnant women in the study seemed knowledgeable about the harms of smoking and secondhand smoke exposure, those living at homes with a current smoker reported being exposed at a level beyond a high risk for pregnant women and babies. The intervention's results demonstrated success in changing providers' behavior in counseling pregnant women, but whether this helped change the behavior of pregnant women needs further follow-up.
To expand this project, the PEER team established communication with the Egyptian Ministry of Social Affairs and the Childhood, Mothers, and Childhood Sector in the Ministry of Health and Population. These ministries provided the project with a list of NGOs working in the same sector. The research team selected and met with the NGOs from that list, which will join their project activities to discuss approaches to promoting smoking avoidance. The team’s final report was also disseminated to the Tobacco Control Program in the Ministry of Health.
The researchers presented their work and findings at several workshops and other events in Egypt, including No Tobacco Day 2023. They also organized a two-day conference on using implementation science to guide tobacco control in the Middle East and have several academic publications in process.
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