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- Carlsson, Noomi
(author)
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A Zero-vision for Children’s Tobacco Smoke Exposure : Tobacco prevention in Child Health Care
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Adverse health effects in children caused by environmental tobacco smoke (ETS) are well known. Children are primarily exposed by their parents’ smoking in their homes. A comprehensive evidence base shows that parental smoking during pregnancy and ETS exposure in early childhood are associated with an increased risk for a range of adverse health problems. Child Health Care nurses, who meet nearly all families in Sweden with children aged 0-6 years, have thus an important role in tobacco preventive work in order to support parents in their ambitions to protect their children from ETS exposure.The overall aim of this thesis was to develop, test and evaluate a new model for tobacco preventive work in Child Health Care (CHC) with special focus on areas with a high prevalence of parental smoking. In a first step CHC nurses’ and parents’ views on tobacco preventive work were analysed in two studies based on questionnaires.The intervention was performed during the second step, based on the results from nurses’ and parents’ experience of the tobacco preventive work in CHC, and with methods from Quality Improvement. An “intervention bundle” was developed which included evidence based methods for prevention of ETS exposure, and four learning sessions for the nurses. The instrument “Smoking in Children’s Environment Test” (SiCET) included in the bundle was evaluated with focus group interviews with the CHC nurses who participated in the intervention. Two urine samples were analysed to measure cotinine levels in children which provide an estimate for ETS exposure. Parents’ answers from the SiCET questionnaire, measurements of cotinine, and data from the nurses’ log-books were used in the evaluation of the effects of the intervention. In areas with a high prevalence of parental smoking 22 nurses recruited 86 families of whom 72 took part for the entire one-year period of the intervention.The results showed that parents wanted to have information on the harmful effects tobacco smoke have on their children and how they can protect their children from ETS exposure. The nurses saw tobacco preventive work as important but they experienced difficulties to reach certain groups such as fathers, foreign-born parents, and those who are socio-economically disadvantaged. The SiCET instrument provided a basis for dialogue with parents. The main results from the intervention showed that ten parents (11%) quit smoking, thirty-two families (44%) decreased their cigarette consumption in the home, and fewer children were exposed to tobacco smoke. Consequently, more children showed levels of urinary cotinine less than 6 ng/ml (base-line n=43, follow up n=54; p=0.05). The total number of outdoor smokers did not change. Seven of the nurses (30%) had successful results in their areas with a decrease of smokers in families with a child of 8 months, from 20% in 2009 to 12% in 2011. The corresponding figures for the whole county as well as the country did not decrease during the same period.The sustainability of the intervention has to be followed and thus measures should be followed prospectively over time. The SiCET instrument was found useful and might be applicable in other arenas where children’s ETS exposure is discussed. The development of an instant cotinine test using dipsticks would make it possible to give parents immediate feedback on the effectiveness of taken protective actions. This could work as a pedagogic resource in the dialogue with parents.
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| 2. |
- Olofsson, Niclas
(author)
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Violence through the life cycle : A public health problem
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Background: Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution , declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course — deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse — but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society.Methods: Three different data sources were used in the four articles, three cross-sectional studies (“Life and Health in Norrland” and “Health on Equal Terms 2004 and 2006”) and one longitudinal (“Level-of-Living Survey”).Results: We present an important picture of the strong association between exposure to violence and ill health through the life cycle. A population-based study showed an increased risk of poorer physical and psychological health among boys and girls aged 0-18, as reported by their mothers exposed to violence. Further, a strong association between those exposed to violence and physical and mental ill health was demonstrated in young adults aged 18-25, also after adjusting for possible confounders, specifically for women. Even in an elder group aged 65-84, representative results showed an extensive negative health outcome panorama caused by fear of crime and exposure to abuse both in elderly men and women. Lastly, in trying to provide additional empirical support for the association between exposure to violence and ill health the prospective study demonstrated that violence exposure in adolescence and young adulthood presented a negative association to severe illness burden in adulthood for women but not men.Conclusion: Exposure to violence among both men and women is an important risk factor for ill health and should receive greater attention in public health work. A strong association between violence and various health outcomes was demonstrated in different time periods through the life cycle.
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| 3. |
- Mindedal, Annika, 1958-
(author)
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Texter i NO - finns de? : En studie om textanvändning och textrelaterade samtal i ett fysiktema i skolår 5
- 2011
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Licentiate thesis (other academic/artistic)abstract
- This thesis describes a field study in which one teacher and one class in Grade 5, with special focus on four pupils, are observed throughout four lessons of about 80-minutes in Physics. The lessons together deal with a project on Magnetism. The main aim of the thesis is to investigate how the teacher uses texts as a resource when designing and implementing Science lessons (Learning Design Sequences). A further aim is to study what texts are used and produced by both the teacher and the pupils, and how these texts are used. The four lessons were recorded with a video camera and the recordings supplemented by field notes and interviews. All the texts used were copied or photographed. A design theoretical frame and a sociocultural perspective have been applied to analyse both the presence of texts during different stages (activities) of the lessons, and to analyse the text-related interaction and communication that has taken place in the classroom. The results confirm several previous studies and show that the teacher is the main producer and consumer of texts before and during the Science lessons. Textbooks, and texts on the Internet, are only used by the teacher to design the lessons, and are then mediated by the teacher during classroom interaction. The pupils mainly read questions, which they write brief answers to, and also read and copy texts written by the teacher on the white board. One interesting finding is that dialogue concerning texts increases the scientific content, which means more empirical or theoretical descriptions and explanations. To become scientifically literate it is therefore argued that pupils need more practice reading and writing in combination with dialogue and activities in the science classroom.
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