Study on E-Cigarettes and Pregnancy (STEP) - Results of a Mixed Methods Study on Risk Perception of E-Cigarette Use During Pregnancy.

Introduction E-cigarette use during pregnancy is a risk factor for maternal and fetal health. Early studies on animals showed that in utero exposure to e-cigarettes can have negative health outcomes for the fetus. There has been only limited research into the risk perceptions of e-cigarette use during pregnancy. This study was conducted to comprehensively characterize the constructs of risk perceptions with regard to e-cigarette use during pregnancy using an I ntegrated H ealth B elief M odel (IHBM). Methods Our ST udy on E -cigarettes and P regnancy (STEP) used a mixed methods approach, with the study divided into an initial qualitative part and a quantitative part. A netnographic approach was used for the first part, which consisted of the analysis of 1552 posts from 25 German-language online discussion threads on e-cigarette use during pregnancy. Using these qualitative results, a quantitative questionnaire was developed to explore risk perception constructs about e-cigarette use during pregnancy. This questionnaire was subsequently administered to pregnant women (n = 575) in one hospital in Hamburg, Germany. Descriptive and bivariate analysis was used to examine differences in risk perception according to participants' tobacco and e-cigarette user status before and during pregnancy. While the study design, methods and sample have been extensively described in our recently published study protocol in the January 2020 issue of Geburtshilfe und Frauenheilkunde , this paper is devoted to a presentation of the results of our mixed methods study. Results Themes related to perceived threats identified in the qualitative study part were nicotine-related health risks and potential health risks of additional ingredients . Perceived benefits were possibility and facilitation of smoking cessation and a presumed potential to reduce harm . The subsequent quantitative part showed that nearly all participants (99.3%) perceived e-cigarettes which contained nicotine as constituting a threat to the health of the unborn child. The most commonly perceived barrier was health-related (96.6%), while the most commonly perceived benefit was a reduction in the amount of tobacco cigarettes consumed (31.8%). We found that particularly perceived benefits varied depending on the participant's tobacco and e-cigarette user status. Conclusion When considering future prevention strategies, the potential health risks and disputed effectiveness of e-cigarettes as a tool for smoking cessation need to be taken into account and critically discussed.

Determinants of soft drink consumption among children and adolescents in developed countries - a systematic review.

OBJECTIVES: Soft drinks are a major component of daily caloric and sugar intake. This is especially true for children and adolescents. The WHO as well as many other institutions currently recommend to increase research on the determinants of soft drink consumption. We submit a current systematic review on this topic. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we included all quantitative observational studies that comprise samples from developed countries in the age range 0-18 years and are listed in PubMed, Sociological Abstracts and the Social Sciences Citation Index. Publication period was not limited. The second and the last author screened all 10,392 hits independently with both reviewers being blinded. Interrater reliability (agreement and Cohen's kappa) was 97%/0.73 for the selection of titles, 91%/0.83 for abstracts and 91%/0.80 for full texts. RESULTS: Results of 43 included studies, published between 2001 and 2017, show that children and adolescents consuming soft drinks tend to be older, male and of lower social status. Important contextual factors promoting consumption include constant availability at home, at schools or elsewhere as well as restrictions by parents and rules concerning drinks during meals or generally at home. The association between media consumption and soft drink consumption is particularly striking. Other factors in the food environment (choice of food and alternative drinks at home, having meals together, motivation, knowledge about nutrition and healthy eating) are of minor importance. CONCLUSIONS: When introducing interventions parents should play a major role because they serve as physical and social gatekeepers for this early risk factor of juvenile obesity.

Active and Passive Exposure to Tobacco and e-Cigarettes During Pregnancy.

OBJECTIVES: Active and passive exposure to tobacco cigarettes during pregnancy is associated with multiple negative health outcomes for the fetus. In addition, exposure to e-cigarettes has been progressively discussed as a new threat to fetal health. Until now, there has been a lack of studies examining active and passive exposure to tobacco and e-cigarettes among pregnant women. The objective of our current STudy on E-cigarettes and Pregnancy (STEP) was to advance and complement the current knowledge regarding active and passive exposure to tobacco and e-cigarettes before pregnancy and during early and late pregnancy. METHODS: One element of the STEP study was a quantitative cross-sectional design: A sample of 540 pregnant women recruited at an obstetrician clinic in Hamburg from April 2018 to January 2019 were surveyed once via a standardized questionnaire and provided complete information regarding their consumption of tobacco and e-cigarettes. We performed a descriptive analysis of tobacco and e-cigarette use before pregnancy and during early and late pregnancy, as well as bivariate analysis of these variables with sociodemographic determinants. Passive exposure was assessed by asking the participating pregnant women about the consumption of tobacco and e-cigarettes by their partners, in general, and in their homes. RESULTS: Before pregnancy, 20.0% of the participants used tobacco cigarettes exclusively, 1.3% used e-cigarettes exclusively, and 6.5% were dual users. Educational level was significantly associated with tobacco cigarette use (p < 0.001) and dual use (p = 0.047) before pregnancy. During early (late) pregnancy, 8.7% (2.8%) used tobacco cigarettes and 0.4% (0.0%) used e-cigarettes exclusively. Twenty-point nine percent of women's partners consumed tobacco cigarettes exclusively, 2.7% consumed e-cigarettes exclusively, and 2.7% consumed both. A total of 8.5% (16.7%) of the partners who consumed tobacco cigarettes exclusively (e-cigarettes exclusively) did so in the women's homes. CONCLUSIONS FOR PRACTICE: Among pregnant women, the use of tobacco cigarettes remains prominent before and during pregnancy, while e-cigarette use predominately occurs before pregnancy. Our study shows that pregnant women are frequently exposed to their partners' tobacco and e-cigarette use within their homes. Strategies to reduce such exposure should be further intensified.

STudy on E-Cigarettes and Pregnancy (STEP) - Study Protocol of a Mixed Methods Study on Risk Perception of E-Cigarette Use During Pregnancy and Sample Description.

Introduction During pregnancy, the mother's healthy lifestyle is crucial for the health of the fetus. Potential risk factors for maternal and child health should therefore be identified and reduced as early as possible. The consumption of e-cigarettes represents one of these potential risk factors. Exploring risk perceptions about e-cigarette use during pregnancy can provide early indications of possible user motives. Therefore, our mixed methods ST udy on E -cigarettes and P regnancy (STEP) aimed to comprehensively analyze risk perceptions about e-cigarette use during pregnancy based on an I ntegrated H ealth B elief M odel (IHBM). This paper describes the study design, methods, sample population and limitations of STEP. Methods Our sequential mixed methods study combined qualitative and quantitative approaches. In the qualitative section of the study which preceded the quantitative part of the study, we aimed to characterize risk perceptions about e-cigarette use during pregnancy. We used a netnographic research approach which analyzed discussion threads in online forums dealing with e-cigarette use during pregnancy. The analysis was based on an IHBM. Identified themes were incorporated in the questionnaire which was developed for the quantitative part of the study. The quantitative section aimed to quantify, among other things, perceived threats, barriers and benefits and to explore differences in risk perception according to sociodemographic characteristics and tobacco and e-cigarette usage. Results In the qualitative section, 1552 posts in 25 online discussion threads dealing, inter alia, with e-cigarette use during pregnancy were identified. The quantitative part looked at the responses in the questionnaires handed in by 575 pregnant women who attended a hospital in Hamburg (Germany) from April 2018 to January 2019 (response rate: 27.5%). Conclusion Data collection was successful for both the qualitative and quantitative parts of the study. When interpreting the results of STEP, different limitations should be taken into account. The results of STEP provide starting points for the development of tailored preventive measures for pregnant women.

Attractiveness as a motive for tanning: Results of representative nationwide survey in Germany.

BACKGROUND: In previous research, enhancing attractiveness is reported to be an important aspect of tanning motivation. Our aim was to analyze attractiveness as a reason for tanning in a large representative sample in relation to sociodemographic characteristics, perceived risks of ultraviolet radiation (UVR), and exposure to natural and artificial UVR. METHODS: We analyzed data from 3000 participants (14-45 years) in the German representative National Cancer Aid Monitoring (wave 3). Attractiveness was measured using the General Attractiveness Subscale of the Physical Appearance Reasons for Tanning Scale. Associations were analyzed using chi-square tests and logistic regression analyses. RESULTS: Attractiveness played a larger role for participants aged 18-35, those with an immigrant background, medium educational level, and not in a relationship. Significant associations were also identified with a low risk perception of UVR. For sunbathing, the highest OR (9.96, P < .001) was found for high scores on General Attractiveness Subscale, whereas risk perception of UVR was not related to sunbathing in multivariate analyses. For sunbed use, risk perception also only played a minor role as a preventing factor, while higher associations could be identified for age (OR18-25 years  = 8.21, P < .001) and attractiveness (OR = 3.55, P < .001). CONCLUSION: Our study showed that people who tan to enhance their attractiveness are more likely to perceive fewer risks of UVR and to show higher UVR exposure behavior and are therefore at greater risk of developing skin cancer. Measures for prevention of UVR-related skin damage should therefore focus more on reducing the positive perception of a tanned appearance instead of only emphasizing the risks of UVR.

Safety of Combination Laser or Intense Pulsed Light Therapies and Doxycycline for the Treatment of Rosacea.

BACKGROUND: Current treatment options for rosacea include topical agents, oral therapies, phototherapy using lasers, or intense pulsed light (IPL). Combination therapy for rosacea often yields better results than monotherapy. The safety of laser/light treatments in combination with systemic doxycycline has been questioned because of the theoretical risk of photosensitivity. OBJECTIVE: The purpose of this study was to assess the incidence of phototoxicity or photosensitivity in rosacea patients receiving concomitant laser or light treatments and systemic doxycycline. METHODS: Treatment records of 36 patients receiving laser/light treatments while also being treated with standard dose or anti-inflammatory dose of doxycycline were retrospectively reviewed. RESULTS: No adverse reactions related to doxycycline combined with laser/light therapy were reported. Specifically, no photosensitivity or sensitivity to wavelengths in the pulsed dye laser (PDL), or IPL range was observed in this cohort. All patients achieved some degree of clearance. CONCLUSION: The results of this retrospective study demonstrate that doxycycline used in conjunction with laser or nonlaser light therapy is a valid combination therapy for improving signs and symptoms of rosacea. No photosensitivity reactions were observed to commonly used IPL or PDL devices.

Perceived threats, benefits and barriers of e-cigarette use during pregnancy. A qualitative analysis of risk perception within existing threads in online discussion forums.

OBJECTIVE: Previous studies have shown that e-cigarettes are perceived as being less harmful than tobacco cigarettes by pregnant women and might be used to quit smoking during pregnancy. Our aim was to further explore and characterise perceived threats, benefits and barriers of e-cigarette use during pregnancy. METHODS: Our STudy on E-cigarettes and Pregnancy (STEP) was, among others, based on a netnographic approach of analysing existing threads in German-speaking online discussion forums dealing with perceived threats and benefits of e-cigarette use during pregnancy. For the analysis, we used an inductive-deductive qualitative content analysis. FINDINGS: Based on 25 online discussion threads containing 1552 posts, we identified perceived threats, perceived benefits and perceived barriers to e-cigarette use during pregnancy, among others, as main themes. Subthemes identified within the main theme perceived threats were severe nicotine related health risks, potential health risks of additional ingredients, relative risks and lack of knowledge and research studies. As perceived benefits, we identified possibility and facilitation of smoking cessation, harm reduction and financial benefits. Perceived barriers were lack of satisfaction and social stigma. CONCLUSION: Our qualitative results suggest that the perception of the health threats related to e-cigarette use during pregnancy varies according to the nicotine content and the perception of relative risks compared with tobacco cigarettes. In addition to this, risk perception is defined through further health and non-health related barriers and benefits (e.g. suitability of e-cigarettes as a smoking cessation aid, social stigma).

Optimistically biased perception of one's own skin cancer risk: Representative nationwide findings.

BACKGROUND: Previous research has shown that individuals tend to have unrealistic comparative optimism (UCO) for different diseases and health outcomes. Our aim was to analyze UCO in relation to skin cancer for the first time in a representative nationwide sample. The results will be important for planning future prevention. METHODS: The National Cancer Aid Monitoring on Sunbed Use (NCAM, wave 3) is a representative nationwide German survey (n = 3,000, 14-45 years). We assessed UCO in relation to skin cancer and analyzed its association with sociodemographics, tanning and health-related risk behaviors, skin cancer risk, and skin cancer risk awareness. RESULTS: Four out of ten (43.3 %) respondents believed themselves to have a lower risk of developing skin cancer than other people of the same age and sex. Younger individuals were more likely to be optimistic. Individuals with an increased risk of skin cancer were more likely to perceive this higher risk. CONCLUSION: While it is realistic for those who actually have a higher risk of skin cancer to perceive it that way, the findings for the general population (and specifically for younger individuals) are concerning. It seems important to explain to people that their perception of their own risk of skin cancer is unrealistic, as this may affect their individual screening and prevention behavior.

Evolution of the Picosecond Laser: A Review of Literature.

BACKGROUND: Picosecond pulse duration lasers (PS) have altered the field of dermatology. PS were initially used in tattoo removal, to optimize efficacy and reduce side effects with nanosecond domain lasers. More recently, they have been demonstrated to be effective in the treatment of pigmentary disorders, acne scarring, and photoaging. OBJECTIVE: In this article, we critically analyze the published data on the many uses of picosecond lasers in dermatology. MATERIALS AND METHODS: A systematic review of PubMed was conducted using the following search terms: "picosecond," "picosecond laser," "picosecond laser dermatology," "picosecond laser pigment/pigmentation," and "picosecond laser tattoo removal." Articles ranged from 1988 until 2017. RESULTS: Forty-one articles were identified, and 27 met inclusion criteria for review. Indications for the PS included a variety of dermatologic applications include tattoo removal, benign pigmented lesions/pigmentary disorders, acne scarring, and photoaging. Most studies demonstrated safe and effective treatment. CONCLUSION: The development of the picosecond pulse duration is a breakthrough innovation in laser technology, changing the scope of laser treatment. Encouraging findings in tattoo pigment clearance spurred the use of PS in a wider array of dermatologic issues. The increasingly positive results and low incidence of adverse effects further substantiates PS efficacy for a variety of dermatologic uses.

Identification of starting points to promote health and wellbeing at the community level - a qualitative study.

BACKGROUND: As health is influenced by the social, economic and environmental conditions in which individuals live, local communities are an ideal setting to promote health and wellbeing. However, up to now various health promotion interventions at the community level have had limited success, perhaps related to an incomplete understanding of local contexts and priorities. We therefore aimed to develop a broader and deeper understanding of topics or issues that were most salient to residents of a South-West German community by exploring their perceptions of needs, challenges, barriers and existing resources related to health and well-being. METHODS: As an initial step of a multi-year community-based participatory research project, we conducted semi-structured interviews with key informants (n = 30) from various community settings (e.g., child care, elderly care, businesses, non-profit organizations, village councils, and local government). The terms "health" and "wellbeing" were included in the stem of each question in the semi-structured interview guide to enable a focus on related perceived needs, challenges, barriers and existing resources. Interviews were audiotaped, transcribed verbatim and analyzed using qualitative content analysis techniques. RESULTS: Themes emerging from our interviews appeared to center primarily in three distinct areas: natural resources and built environment, access to services, and social cohesion including subthemes on the importance of social engagement and volunteerism, sense of community, and shared identity. CONCLUSIONS: That health and wellbeing were not identified explicitly as a priority by key informants suggests that these should not be presented as the primary focus of a community-wide initiative. Instead themes with a higher priority should be addressed in ways that can lead to better health and wellbeing as a secondary goal.

Profile of sunless tanning product users: Results from a nationwide representative survey.

BACKGROUND: Sunless tanning products (STPs) are often seen as "healthy alternative" to sunbathing and indoor tanning. However, STP use may entail indirect risks such as overestimating an individual's natural skin type, resulting in risky (natural and artificial) tanning behavior. We aimed to explore STP use in combination with other health-related risk behaviors (eg, smoking), skin cancer risk, risk awareness of ultraviolet radiation, and preventive behavior. METHODS: We used data from the NCAM, a nationwide representative cross-sectional sample (n = 3000, aged 14-45, 48.6% female) interviewed via telephone. Differences between STP users and nonusers regarding the abovementioned aspects were identified using chi²-test. RESULTS: The 1-year prevalence of STP use was 7.5%. Tanning bed users showed a higher prevalence of STP use than past and never users (16.1% vs 9.6% vs 5.8%, P < 0.05). Although STP users had a higher skin cancer risk based on individual characteristics, they were less likely to have participated in a skin cancer screen. CONCLUSION: The identified parallel use of STPs and tanning beds can have severe health consequences, since the "fake tan" of STPs may lead to an overestimation of the individual's skin type, which may result in overdosed UV exposure. The lower risk awareness among STP users accompanied with their higher skin cancer risk calls for target group-specific prevention.

Vaginal rejuvenation: whose turf?

Many medical conditions can cross over the territories of various specialties. These conditions may benefit from, or even require, a multidisciplinary approach. While ideally this leads to a collaborative and coveted patient-centered care model, it can also give rise to competitive turf wars. A popular topic that has entered the turf wars is vaginal rejuvenation. Vaginal rejuvenation through light- and energy-based devices is a rapidly expanding field, quickly gaining the attention of dermatologists and gynecologists alike. Dermatology has the most experience and expertise with lasers and energy-based devices for rejuvenation, whereas gynecology has the advanced knowledge of the vaginal anatomy, tissue structure, and function. We herein argue that a collaborative effort between dermatology and gynecology is most appropriate for proper care of our patients and for the advancement of this growing niche.

Barriers to Using a Nationwide Skin Cancer Screening Program: Findings from Germany.

BACKGROUND: In 2008, a nationwide standardized and systematic skin cancer screening (SCS) service, which is globally unique, was implemented in Germany. We aimed to provide current data on SCS use, to explore barriers to SCS usage, and to identify population groups with lower rates of SCS use. METHODS: We analyzed data from 2,635 participants (18-45 years) in the National Cancer Aid Monitoring on Sunbed Use. Data on SCS use, barriers to SCS, and sociodemographic characteristics were obtained. Chi-square tests and logistic regression analyses were performed to analyze the data. Data was weighted by age, sex, educational level, and federal state. RESULTS: In total, 39.0% of participants reported having been screened for skin cancer at least once in their lifetime. The subjective importance of different barriers varied depending on the participants' educational level. SCS use was negatively associated with male sex (odds ratio (OR) = 0.63, p < 0.001), low level of education (OR = 0.83, not significant), immigrant background (OR = 0.63; p < 0.001), and having no employment. CONCLUSION: Although the SCS is part of the regular healthcare services offered in Germany, our data showed lower usage among certain population groups. Barriers relevant for these groups should be considered when developing measures to increase SCS use.

"Lost in the sun"-The key role of perceived workplace support for sun-protective behavior in outdoor workers.

BACKGROUND: Previous studies show that workplace support for sun-protective behaviors plays an important role in the actual sun-protective behavior of outdoor workers. Therefore, our aim was to examine perceived workplace support (organizational and social support) in relation to different sun-protective behaviors. METHODS: A Germany-wide sample of outdoor workers (n = 485) was surveyed via telephone. We analyzed associations of workplace support with sun-protective behaviors, sociodemographic, and occupational characteristics, occupational sun exposure, and concerns about sun. RESULTS: A large number of outdoor workers perceived no workplace support for sun protection (eg, 17.8% agreed that sun protection is enforced at their workplace). We found that those who do not get any support are less likely to show sun-protective behaviors. CONCLUSIONS: A starting point for a better organizational support is the implementation of mandatory sun protection policies in the workplace. Social support for protection against solar UV exposure can be promoted through safety training and education.

Occupational UV Exposure and Sun-Protective Behaviour in German Outdoor Workers: Results of a Nationwide Study.

OBJECTIVE: The aim of the National Cancer Aid Monitoring (NCAM) was to investigate which occupational groups (1) show higher sun exposure time, (2) suffer from sunburn, and (3) use recommended protective measures. METHODS: In 2016, a total of 485 individuals were classified as outdoor workers in accordance with ISCO-08 and asked about exposure time, prevalence of sunburn, and personal sun-protective measures on a sunny summer day. RESULTS: Outdoor workers were exposed to ultraviolet (UV) radiation for a mean time of 23.6 ±â€Š15.3 hours per week. The 12-month prevalence of getting sunburnt at work was 19%. Only one-third of outdoor workers reported using five of the most important protective measures "often" or "always." CONCLUSION: The NCAM revealed a number of high-risk groups, whose sun-protective behavior has scarcely been studied up to now.

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects.

The development of fractional photothermolysis has revolutionized the treatment of skin scarring, rejuvenation, and tightening. By creating targeted microthermal zones and leaving surrounding tissue intact, this concept has provided the field with efficacious results, with less downtime and a better safety profile. This has started to change the paradigm of what is considered first-line treatment for scarring and rejuvenation. While originally applied to nonablative lasers, fractionation has now been employed in ablative, quality-switched, picosecond, and novel hybrid fractional lasers. Furthermore, other energy-based technologies, such as radiofrequency, have adopted the concept of fractionation in an attempt to optimize the balance of efficacy, downtime, and side effects. Herein, we describe how the ever-expanding repertoire of fractional devices is applied to the treatment of scarring, skin rejuvenation, and tightening. In addition, newer applications, such as transdermal drug delivery, are being developed by using fractional devices. Growing experience with these devices has broadened their relevance to more skin types and body sites than ever. Ultimately, the knowledge of appropriate treatment parameters is paramount and allows for the safe and effective treatment of a variety of patients with numerous devices.