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PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER)
Cycle 5 (2016 Deadline)


Capacity building of health care providers in Egypt to counsel pregnant women and their families regarding smoking cessation and second hand smoking avoidance


PI: Wagida Anwar (wagidaanwar@gmail.com), Ain Shams University School of Medicine
U.S. Partner: Scott Sherman, New York University
U.S. Partner: Cheryl Oncken, University of Connecticut
Project Dates: January 2017 - February 2023

Project Overview:

The overarching aim of this project is to develop and disseminate an evidence-based healthcare professional training program to counsel smokers (both men and women) to stop smoking and establish smoke-free homes via developing the capacity of physicians and nurses who counsel pregnant women in greater Cairo. The intervention target group includes pregnant mothers in households with a current smoker. This will help to achieve better maternal and child health outcomes through women either quitting smoking and/or establishing a smoke-free home. The project team also aims to create capacity for widespread dissemination 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 is capitalizing 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. The intervention includes the following activities: (1) developing and implementing a core training curriculum for physicians and nurses to be implemented in antenatal care visits; (2) creating capacity for dissemination by developing a train-the-trainer model and adapting a health/social service-based follow-up protocol to be implemented by the nursing staff; and (3) developing a monitoring and evaluation plan for core program activities and follow-up activities by the trainers.

This project has multiple development implications in Egypt. The direct improvement in the health and well-being of pregnant women and children should have a positive economic impact . Tobacco use has indirect effects on health by increasing the risk of poverty at the individual, household, and national levels. The capacity building components of this project are also directed towards empowering young investigators in the field of science and research to help prepare future leaders in those fields. 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.

Summary of Overall Activities:

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 project conducted an intervention targeting pregnant women SHS exposure through training clinical providers on counselling pregnant women on SHS avoidance in Greater Cairo, Egypt.

The project team collected data for pregnant women pre- and post-intervention implementation (2018 to 2022), surveying a total of 2003 pregnant women attending maternal care clinics (N=24) across different regions in Great Cairo, Egypt (1002 pre-intervention sample and 1001 in post-sample). Up to three months after the intervention, a follow-up survey was conducted to compare receipt of SHS avoidance counselling and SHS smoke exposure with that of pre-intervention.

Between the pre-and post-surveys, there were no differences between participant characteristics; 53.8% (pre) and 57.8% (post) were aged between 21 to 30. Similarly, 72.4% (pre) and 69.2% (post) have had a primary or secondary education. Among the whole sample, 85% of participants answered all six knowledge-related questions about SHS and smoking harms correctly. Regarding SHS exposure, 65% had smokers in their households. Overall, 46% reported being exposed to secondhand smoke at home, leaving 19% not exposed despite living with smokers albeit in smoke-free homes, while there were 35% living with no adult smokers in the household. Participants who lived with current smokers who smoked at home experienced an average SHS exposure for 18 hours per week, while those living in smoke-free homes (whether there was a smoker in the household) reported less than 8.3 hours per week on average. Regarding counseling against SHS exposure, those reporting being asked about SHS exposure increased from 22.81% to 54.98% (p < 0.001), and receiving SHS avoidance advice increased from 28.46% to 60.32% (p < 0.001).

While pregnant women in our study seemed knowledgeable about harms of smoking and SHS exposure, those living at homes with a current smoker reported being exposed to twice the SHS level indicating a high risk for pregnant women and babies. However, the intervention's results demonstrated success in changing providers' behavior in counseling pregnant women's on SHS avoidance. Whether this helped change the behavior of pregnant women needs further follow-up. To realize the objective of establishing smoke-free households, more widespread implementation of this type of intervention is essential.


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