Associations between social support and physical activity among postpartum women: a cohort study

Abstract Background Moderate-to-vigorous physical activity (MVPA) enhances postpartum women’s health, and social support is associated with higher self-reported physical activity (PA) postpartum. It is unknown if this association exist across ethnic groups. Our research questions are: are overall family or friends’ support associated with objectively recorded MVPA postpartum, 2) are specific types of family or friends’ support associated with MVPA and 3) does the association differ across ethnic groups? Methods We used data from 662 women participating in the STORK Groruddalen cohort study (2008-2010). MVPA in bouts ≥ 10 minutes was recorded by SenseWear ArmbandTM Pro3 14 weeks postpartum. Family and friends’ support was measured by the Social Support for Exercise Scale. We used single items and mean score for family (6 items) and friends’ (6-items) support in separate linear regression models, and adjusted for age, ethnicity, education, parity, weeks since birth and body mass index. We tested for interactions between social support and ethnicity. Analyses were performed on complete cases and imputed data due to missing MVPA data. Results Based on imputed data we observed an association between family support and MVPA (β = 4.0, 95% CI, 0.18 to 7.74, p = 0.040). Women reporting high family support on two specific items spent 9 MVPA minutes/day more than women reporting low support (‘discuss PA': β = 8.6, 95% CI: 0.37 to 16.87 and ‘co-participation': β = 8.8, 95% CI: 1.79 to 15.86). Associations were not modified by ethnicity. No statistically significant association between friends’ support and MVPA was observed. Similar results were found in complete case analyses, with few exceptions. Conclusions Overall family support and specific form of family support (i.e., PA discussion and co-participation) were associated with MVPA postpartum across ethnic groups. Friends’ support was not associated with MVPA. Key messages • Postpartum health may be improved across ethnic groups through increased PA facilitated through overall family support for PA and specifically through PA discussions and co-participation from family. • Friends’ support for PA was not associated with PA.


Background:
The prevalence of daily second-hand smoke (SHS) exposure among pregnant non-smoking women and children in Egypt is estimated to be about 50% and 55%, respectively. This study aimed to explore barriers to preventing SHS exposure among pregnant women/children and smoking behavior at home in Egypt.

Methods:
Focus group discussions (FGDs) with pregnant women/ mothers of children residing in urban/rural areas (n = 61). Data were coded and analyzed thematically. Results: 61 participants were recruited, aged 18-49. They reported being never smokers and SHS exposure for themselves and their children was mainly at home. Pregnant women/mothers had some general knowledge of the dangers of SHS, but their knowledge appeared incomplete. The most commonly reported barriers to preventing SHS exposure/adopting a smoke free home or workplace were having men who smoke in the household, doctors not being supportive regarding smoking cessation, SHS exposure is socially accepted and fear among women of damaging a relationship; being nervous about asking smokers to stop, and being worried about disputes and arguments with husband. The majority of interviewees' families were reported to allow smoking anywhere in the home; others implemented some measures to prevent SHS, however, these tended to be inconsistently implemented and unlikely to be effective.

Conclusions:
This study increases our knowledge of the barriers of nonsmoking Egyptian pregnant women/mother of children in creating and maintaining smoke free environment for themselves and their children. There is a need to denormalise SHS exposure and better enforcement of smoke free policies. Key messages: Better enforcement of smoke free policies, and more support for smoking cession services are needed in Egypt.
SHS policy, practice, and research should focus on male family members to increase their effectiveness.

Background:
Childhood obesity is a major public health challenge, and it is recommended to promote healthy weight development already during infancy. It is important to co-create interventions to maximize the feasibility and thus improve the chances of successful implementation. This paper describes the cocreation process of the Danish Bloom Trial -an early intervention to promote healthy weight development among children of first-time parents.

Methods:
Development of the trial is inspired by co-creation frameworks and the Intervention Mapping protocol. The co-creation process comprises three stages: 1) Evidence review, qualitative research with community health nurses (CHNs) and parents, and stakeholder consultations; 2) co-creation of the intervention content including workshops and group meetings with CHNs and other stakeholders and focus group discussions with parents; and 3) prototyping, feasibility-and pilot-testing. Currently, we are in stage 2 and have conducted four workshops with CHNs and one parent group discussion.

Results:
During stage 1, we identified the intervention setting; the unique system of CHNs in Danish municipalities. Furthermore, we identified the need for developing intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security to promote healthy child weight development. The main intervention components are a course for CHNs and guidelines on how to talk to parents about behavioral risk factors. The main components for parents are eight home visits and six telephone consultations from CHNs during pregnancy and until the child is 2½ years old and a video library.

Conclusions:
The description of the development of the Bloom Trial provides an example of how to co-create an intervention balancing evidence, the practical work of the implementers and the needs of the families. Co-creation with relevant stakeholders increases the chances of producing a relevant, successful, and sustainable intervention.

Key messages:
The co-creation process resulted in development of intervention content focusing on nutrition, physical activity, sleep, screen time and sense of security from pregnancy to child age 2½ years. Involving parents and stakeholders in the development of an intervention increases the chances of producing a relevant, successful, and sustainable intervention.

Background:
Moderate-to-vigorous physical activity (MVPA) enhances postpartum women's health, and social support is associated with higher self-reported physical activity (PA) postpartum. It is unknown if this association exist across ethnic groups. Our research questions are: are overall family or friends' support associated with objectively recorded MVPA postpartum, 2) are specific types of family or friends' support associated with MVPA and 3) does the association differ across ethnic groups? Methods: We used data from 662 women participating in the STORK Groruddalen cohort study (2008)(2009)(2010). MVPA in bouts 10 minutes was recorded by SenseWear ArmbandTM Pro3 14 weeks postpartum. Family and friends' support was measured by the Social Support for Exercise Scale. We used single items and mean score for family (6 items) and friends' (6-items) support in separate linear regression models, and adjusted for age, ethnicity, education, parity, weeks since birth and body mass index. We tested for interactions between social support and ethnicity. Analyses were performed on complete cases and imputed data due to missing MVPA data.

Results:
Based on imputed data we observed an association between family support and MVPA (b = 4.0, 95% CI, 0.18 to 7.74, p = 0.040). Women reporting high family support on two specific items spent 9 MVPA minutes/day more than women reporting low support ('discuss PA': b = 8.6, 95% CI: 0.37 to 16.87 and 'co-participation': b = 8.8, 95% CI: 1.79 to 15.86). Associations were not modified by ethnicity. No statistically significant association between friends' support and MVPA was observed. Similar results were found in complete case analyses, with few exceptions.

Conclusions:
Overall family support and specific form of family support (i.e., PA discussion and co-participation) were associated with MVPA postpartum across ethnic groups. Friends' support was not associated with MVPA. Key messages: Postpartum health may be improved across ethnic groups through increased PA facilitated through overall family support for PA and specifically through PA discussions and co-participation from family. Friends' support for PA was not associated with PA.

Background:
There is an important interaction between sexuality and many life factors. A good sexual education at school can improve knowledge and behaviour in young people giving them a healthy sexual life. Unlike most European countries, sexual education in Italy is not compulsory in the school curriculum, so this study explored the Italian regional initiatives realised over a span of 15 years.

Methods:
A review of grey literature was conducted on Public Health Administrations/Regions websites of each Italian region, focusing on official documents containing training catalogues for schools. The search was conducted in December 2021, including documents produced between 2006 and 2021. We used the topics recommended by UNESCO as quality markers for the projects found.

Results:
Among the 20 Italian regions, 12 had at least one programme. A total of 39 projects were found. All UNESCO topics were covered, with notable differences between north, centre and south of Italy, which had the lowest number of projects. Most of the projects (23) were carried out only once, the others were repeated at least for two years in a row. Contraception, along with love, marriage, partnerships, and family, were the main topics discussed during sexual education programs in schools (92%), followed by biological aspects, body awareness, and anatomy (83%); birth, disability, human rights, and online media were less common (33%). Regarding the target, disability, human rights, and mutual consent were deepened only for middle and high school students.

Conclusions:
Considering the fundamental importance of sexual education, there is an important lack in promotion and planning in Italy.
There is a large discrepancy between the northern and southern regions and it is necessary to implement and standardize the offer of sexual education programs in schools.

Key messages:
Unlike the European average, In Italy there is an important lack on sexual education, whit large discrepancies between the northern and southern regions, putting the latter at disadvantage. Contraception, marriage, couples, and family were the main topics discussed during sexual education programs in schools; birth, disability, human rights, and online media the least.

Objective:
A healthy diet during pregnancy is crucial for the health of both mother and child, but pregnant women often do not meet the nutritional requirements. Empowering pregnant women to improve their diet quality could play a significant role in improving maternal nutrition and health. However, empowerment has been rarely used in nutritional interventions. Based on research and input from stakeholders, we developed Power 4 a Healthy Pregnancy (P4HP). P4HP consists of four additional consults by the midwife or dietician to discuss nutrition with the pregnant women from an empowerment perspective. This study aims to evaluate the effectiveness of P4HP on diet quality, empowerment, and health of pregnant women.

Methods:
A cluster randomized controlled trial started in January 2022 in 14 Dutch midwifery practices, with a total of 175 pregnant women in both the control and intervention groups (N = 350). Women in the intervention group follow P4HP in addition to their usual birth care. Measurements are carried out at the beginning and end of pregnancy. Diet quality is measured using the Dutch Healthy Diet index 2015, specifically adapted for pregnancy. Empowerment is assessed using the Pregnancy-Related Empowerment Scale, Sense of Coherence (SOC) using the SOC-3 scale, Self-Rated Health using a General Self-Rated Health question, and Quality of Life using a Visual Analogue Scale. Results will be analyzed using Linear Mixed Models to analyze the treatment effect of clustered data.