Cent Of Women Research Articles

Barriers to cervical cancer screening attendance in England: a population-based survey

To explore barriers to cervical screening attendance in a population-based sample, and to compare barriers endorsed by women who were up-to-date with screening versus those who were overdue. We also tested the hypothesis that women who were overdue for screening would be more generally disillusioned with public services, as indexed by reported voting behaviour in elections. A population-based survey of women in England. Face-to-face interviews were carried out with 580 women aged 26-64 years, and recruited using stratified random probability sampling as part of an omnibus survey. Questions assessed self-reported cervical screening attendance, barriers to screening, voting behaviour and demographic characteristics. Eighty-five per cent of women were up-to-date with screening and 15% were overdue, including 2.6% who had never had a smear test. The most commonly endorsed barriers were embarrassment (29%), intending to go but not getting round to it (21%), fear of pain (14%) and worry about what the test might find (12%). Only four barriers showed significant independent associations with screening status: difficulty making an appointment, not getting round to going, not being sexually active and not trusting the test. We found support for our hypothesis that women who do not attend for screening are less likely to vote in elections, even when controlling for barrier endorsement and demographic factors. Practical barriers were more predictive of screening uptake than emotional factors such as embarrassment. This has clear implications for service provision and future interventions to increase uptake. The association between voting behaviour and screening uptake lends support to the hypothesis that falling screening coverage may be indicative of a broader phenomenon of disillusionment, and further research in this area is warranted.

Alkohol och äldre

M. Lindén-Boström & C. Persson & M. Berglund: Risk consumption of alcohol among older people – results from a Swedish population study Aim The aim of this study was to describe risk consumption of alcohol among older people and relate it to living conditions, health behaviour, social support and health. Method We used data from Life & Health 2008, a postal questionnaire to inhabitants aged 18–84 in 55 municipalities in central Sweden. The study population included 40 267 respondents aged 18–84 and 21 326 respondents aged 55–84. The overall response rate was almost 60 per cent, a figure that differed between age groups with the highest rate, >70 per cent, among respondents aged 65–79. The first three questions in the AUDIT questionnaire were used to estimate risk consumption. They were also analysed separately to describe different patterns of alcohol consumption. Results In the 65–75 age group, 2.7 per cent of men and 1.9 per cent of women could be defined as risk consumers of alcohol. In the 76–84 age group, the corresponding figure is less than 1 per cent for both sexes. Risk consumption is related to high education, smoking, use of snuff, physical inactivity, psychological distress and use of tranquilisers. Conclusion Targeted preventive strategies need to be developed to tackle risk consumption among older people.

Lateral mammaplasty reconstruction after surgery for breast cancer

Up to 60 per cent of cancers develop laterally in the breast and breast-conserving surgery frequently produces superolateral nipple-areolar complex (NAC) distortion aggravated by postoperative irradiation. Correction is technically demanding and the outcomes are variable. Lateral mammaplasty may allow wider excision margins and prevent such deformities. This was a review of 86 consecutive patients who had lateral mammaplasty: combined wide tumour excision with NAC repositioning on a reliable dermoglandular pedicle. Simultaneous axillary surgery was performed via a separate or combined incision. Aesthetic outcomes were assessed. The median age of the women was 54 (range 29-75) years; 55 (64 per cent) had palpable tumours and 73 (85 per cent) underwent simultaneous axillary surgery. Median radiological and histological tumour sizes were 29.8 and 33.6 mm, respectively, and median weight of excised tumour was 150 g. Two patients required haematoma evacuation. Eleven women required revisional surgery for involved or close margins. Aesthetic outcomes were excellent or good in 93 per cent. Lateral mammaplasty produced clear margins in 87 per cent of women. It is an option when a deformity is anticipated after breast-conserving surgery, and is particularly valuable when neoadjuvant chemotherapy has downgraded a large tumour.

Burnout predicts hospitalization for mental and cardiovascular disorders: 10‐year prospective results from industrial sector

AbstractThis study investigated the prospective effect of burnout as a chronic stress reaction, on cause‐specific hospital admissions over 10 years in the forest industry. The data on burnout Maslach Burnout Inventory–General Survey was collected using a questionnaire at baseline (1996) and the data on hospital admissions were taken from the Finnish Hospital Discharge Register between March 1996 and December 2005. The participants consisted of forest industry employees (24 per cent women, 62 percent manual work), with no recent history of a disorder in the same disorder category according to the hospital admission register (January 1986–February 1996) or the registers of prescribed medication (January 1994–February 1996) ( N varied from 4543 to 7521). The results showed an increased risk of future hospitalization due to mental and cardiovascular disorders related to burnout syndrome. They also showed that of the separate burnout dimensions, exhaustion and cynicism were predictive of these hospital admissions. This longitudinal follow‐up study shows that burnout predicts future mental and cardiovascular ill health. The results illustrate the importance of preventing and alleviating burnout as a means to promote employee health. Copyright © 2009 John Wiley & Sons, Ltd.

Epidemiological characteristics of HIV-infected women in the Republic of Korea: A low HIV prevalence country

Greater than 90 per cent of HIV-infected Koreans are men, and therefore the majority of Korean HIV/AIDS studies reflect the male population. We wished to evaluate the characteristics of HIV infection in women, and to compare our results with those in other countries. To better elucidate HIV infection in Korean women, we examined the characteristics of heterosexual transmission and studied the dynamics of HIV infection in heterosexual couples. We evaluated 479 HIV-infected women who were registered with the government during 1985-2007. The median age at registration and median CD4 cell count were 37 years (N = 479), 362 cells/mm(3) (N = 276), respectively. About 68 per cent had a regular sexual partner and 26 per cent were diagnosed because they had HIV-positive male partners. Eighty-five per cent of women of concordant couples were detected because of previously diagnosed male partners (N = 115). We verified that the majority of HIV-infected women were infected by male sexual partners. These results suggest that early and active detection of HIV-positive men will facilitate earlier detection and prevention in women.

Treatment results for ethmoid sinus carcinoma

The aim of this study was to describe the results of treatment in patients with ethmoid sinus carcinoma. We performed a retrospective study of 34 patients with carcinoma of the ethmoid sinus, and collected the following data: age, sex, employment, tobacco and alcohol consumption, tumour-node-metastasis stage, treatment, and survival. The mean patient age was 64 years. Seventy-six per cent of patients were men and 24 per cent women. Squamous cell carcinoma was the most frequent histological tumour type (44 per cent). Eleven patients were classified as T(2), six as T(3), six as T(4a) and 11 as T(4b). Two patients (6 per cent) had nodal metastasis at the time of diagnosis. The anterior skull base was involved in 17 patients (50 per cent) and the anterior orbital contents were affected in seven patients (21 per cent). The five-year actuarial observed survival rate for all patients was 44 per cent. Combined treatment with surgery and post-operative radiotherapy permitted good local control in patients with ethmoid sinus carcinoma. We do not recommend prophylactic neck treatment for ethmoid sinus carcinoma.

Relevance of gastrointestinal symptoms in endometriosis

Endometriosis commonly presents with a range of symptoms none of which are particularly specific for the condition, often resulting in misdiagnosis or delay in diagnosis. To investigate gastrointestinal symptoms in women with endometriosis and compare their frequency with that of the classical gynaecological symptoms. Systematic exploration of symptoms in a consecutive series of 355 women undergoing operative laparoscopy for suspected endometriosis. Endometriosis was confirmed by histology in 290 women (84.5%). Bowel lesions were present in only 7.6%. Ninety per cent of women had gastrointestinal symptoms, of which bloating was the most common (82.8%), but 71.3% also had other bowel symptoms. All gastrointestinal symptoms were similarly predictive of histologically confirmed endometriosis. Seventy-six women (21.4%) had previously been diagnosed with irritable bowel syndrome and 79% of them had endometriosis confirmed. Gastrointestinal symptoms are nearly as common as gynaecological symptoms in women with endometriosis and do not necessarily reflect bowel involvement.

The impact of social relations on the incidence of severe depressive symptoms among infertile women and men

The present study investigates anticipated support and perceived appreciation as well as perceived negative aspects of social relations as determinants of the incidence of severe depressive symptoms among women and men in unsuccessful fertility treatment. A prospective cohort study of consecutively recruited, new couples in fertility treatment completed questionnaires immediately before initiating treatment (T1) and at 1-year follow-up (T2) (response rates 80%, 88%). The study population included 695 participants (355 women and 340 men) who had no severe depressive symptoms at T1, who had no child together at T1 and whose treatment had failed. We measured severe depressive symptoms with Mental Health Inventory 5 from Short-Form 36, functional aspects of general social relations and of infertility-specific social relations. Fifteen per cent of women and 6% of men in unsuccessful treatment reported severe depressive symptoms at T2. Among men, low emotional support, low appreciation and high excessive demands from the partner were significant determinants of the incidence of severe depressive symptoms. Among women and men, low appreciation from the family, many conflicts and high excessive demands from family, friends and neighbours were significant determinants of severe depressive symptoms. The analyses were controlled for gender. Duration of infertility, infertility diagnosis and socio-economic position did not confound the associations. More women than men report severe depressive symptoms after 1 year of unsuccessful treatment. It is important to be aware of the possible negative impact of relational strain among fertility patients in unsuccessful treatment.

WITHDRAWN: Corticosteroids for HELLP syndrome in pregnancy.

Hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome is a severe form of pre-eclampsia. Pre-eclampsia is a multi-system disease of pregnancy associated with an increase in blood pressure and increased perinatal and maternal morbidity and mortality. Eighty per cent of women with HELLP syndrome present before term. There are suggestions from observational studies that steroid treatment in HELLP syndrome may improve disordered maternal hematological and biochemical features and perhaps perinatal mortality and morbidity. To summarise the evidence on the effects of corticosteroids on maternal and neonatal mortality and morbidity in women with HELLP syndrome. We searched the Cochrane Pregnancy and Childbirth Group trials register (October 2003). We scanned lists of references from review articles and primary studies. Randomised and quasi-randomised trials evaluating the effects of adjunctive corticosteroids in patients diagnosed with HELLP syndrome were sought. The two authors independently applied inclusion criteria, assessed trial quality and extracted relevant data. Of the five studies reviewed (n = 170), three were conducted antepartum and two postpartum. Four of the studies randomised participants to standard therapy or dexamethasone. One study compared dexamethasone with betamethasone. Dexamethasone versus control There were no significant differences in the primary outcomes of maternal mortality and morbidity due to placental abruption, pulmonary oedema and liver hematoma or rupture. Of the secondary maternal outcomes, there was a tendency to a greater platelet count increase over 48 hours, statistically significantly less mean number of hospital stay days (weighted mean difference (WMD) -4.50, 95% confidence interval (CI) -7.13 to -1.87), mean interval (hours) to delivery (41 +/- 15) versus (15 +/- 4.5) (p = 0.0068) in favour of women allocated to dexamethasone.There were no significant differences in perinatal mortality or morbidity due to respiratory distress syndrome, need for ventilatory support, intracerebral hemorrhage, necrotizing enterocolitis and a five minute Apgar less than seven. The mean birthweight was significantly greater in the group allocated to dexamethasone (WMD 247.00, 95% CI 65.41 to 428.59).Dexamethasone versus betamethasone There were no significant differences in all the maternal and perinatal mortality and in primary morbidity outcomes.Women randomised to dexamethasone fared significantly better for: oliguria, mean arterial pressure, mean increase in platelet count, mean increase in urinary output and liver enzyme elevations. There is insufficient evidence to determine whether adjunctive steroid use in HELLP syndrome decreases maternal and perinatal mortality, major maternal and perinatal morbidity.

Socio Economic Profile of Rural Women and the Role of Animal Husbandry Intervention in a Suicide Affected District of Kerala

There have been reports of farmer suicides in the Wayanad district in the south Indian state of Kerala and an investigation was undertaken to assess the socio economic profile of rural women and explore the possible role of animal husbandry in this district. The three taluks in Wayanad district were purposively selected from which a total of 103 women from self help groups functioning under the government sponsored poverty eradication programme were selected at random. Data was collected using a pre tested interview schedule in October 2006. Nearly one third of respondents indicated that their primary occupation was agriculture with some animal husbandry component. Availability of latrine, type of roof and walls of home, as well as domestic source of water were the three variables which used in this study to determine the quality of life of the sample population. Nearly 15 per cent of women did not have separate latrine facilities on their homestead and nearly seven per cent lived in make shift houses. More than half of the respondents were in the age group 25 - 35 years and their average yearly income was reported by them to be Rs 3768. Over three fourths (75.7%) of these households kept livestock along with crops. The paper emphasizes the importance of exploring alternate employment and income generating activities such as animal husbandry in order to improve the socio economic conditions of these women since the family background variables have a vital role in the development of personality traits in children which could affect quality of human capital in the future generation of the district.

Good Health Status of Older and Oldest Elderly in Jamaica: Are there Differences between Rural and Urban Areas?

The aim of the current study was to examine the good health status of older and oldest elderly Jamaicans as well as to determine predictors of this health status. A sub-sample of 1,069 respondents (42.4 percent men and 57.6 per- cent women) who indicated being 75 years and older were used for this study. This is extracted from a larger nationally cross-sectional survey of 25,018 respondents in 2002. The stratified multistage probability sampling technique was used to draw the survey respondents, which reflects the socio-demographic characteristic of the Jamaican population, and makes the sample generalizable on the population. A self-administered questionnaire was used to collect the data from the sample; and the interviewers were trained to collect data. The data were entered, stored and retrieved in SPSS 16.0. De- scriptive statistics were used to examine the demographic characteristics of the sample; chi-square was used to investigate non-metric variables, and logistic regression was the multivariate technique chosen to determine predictors of good health status. Two factors were found to be statistically significant predictors of good health status of older and oldest elderly re- spondents. These were area of residence and sex of respondents. Older and oldest elderly men reported a greater good health status than old and oldest elderly women (OR = 1.410; 95% CI: 1.048-1.897). On the other hand, there was no sta- tistical difference between the self-reported diagnosed (chronic) recurring illness and age cohort of the sample. Rural older and oldest elderly respondents indicated the lowest good health status (OR = 1.00) compared to other residents (ur- ban: OR = 1.670; 95% CI: 1.071-2.606; and other town dwellers: OR = 1.847; 95% CI: 1.327-2.572). Good health of this age cohort is not influenced by income or social standing, and there is a need to examine lifestyle risk factors; disease in- dicators and psychological conditions, as this may provide more answers to the good health of Jamaicans 75 years and older. A quantitative assessment has provided us with answers, but it is clear from the findings that more information is needed on this age cohort. The researcher recommends the use of qualitative methodologies to provide in-depth under- standing of those factors that determine good health of this age cohort.

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Effect of domestic violence on pregnancy outcome.

To determine the causes and type of domestic violence endured by pregnant women and their effect on pregnancy, in terms of maternal and neonatal outcome. Cohort study. The study was conducted in Sir Syed Trust Hospital, Karachi, from March 2007 to February 2008. All the antenatal patients were screened for domestic violence, using a self-made questionnaire and abuse assessment screen. All the pregnant patients, who had language barrier or those who declined to be interviewed were excluded. All the pregnant patients with positive response, according to the abuse assessment screen were included in the group A, while every 4th patient with negative response was taken as control. SPSS 10 was used for statistical analysis. Logistic regression analysis was performed to determine the effect of domestic violence on delivery outcome. Relative risk was also calculated. Statistical significance was taken at p (2) 0.05. Four hundred and ten (n=410) antenatal patients were interviewed. The factors associated with domestic violence included addiction in 32 (39%), allegedly aggressive nature of husband in 21 (25.6%) and unemployment of husband in 6 (7.31%) cases (p=0.001). Fifty two per cent women had been victims to more than one form of violence. Antenatal complications were not observed in a statistically significant number in either group. Depression was identified in 25.60% of group A and in 3.65% of group B (p=0.001; RR=2.01; 95%CI=1.58-2.56). Various factors leading to domestic violence were identified among the husbands of women subjected to violence during pregnancy. The differences between the two groups, with regard to neonatal outcome (except depression), did not reach statistical significance. However, depression was significantly higher in the women enduring violence.

The influence of the welfare state on the number of young old persons

ABSTRACTMany current discussions of welfare state reforms focus on the ‘young old’, a group now generally perceived as healthy people past retirement age without a legal responsibility for dependent persons in need of care. For the welfare state, they constitute a resource whose activities are hard to steer. This article focuses on the influence of the welfare state on the number of ‘young old’ people. It describes different ways in which the welfare state influences the number of young old persons, and investigates whether variations in the regulations for the ages of normal, early and late retirement are the prime cause. The paper also estimates the share of the young old among those aged 50–90 years in 10 European countries in 2004 using comparable survey data. These shares ranged between 36 and 49 per cent for men and between 35 and 52 per cent for women. High shares were found in continental European countries, and low shares in Scandinavian countries and the United Kingdom. The shares in southern European countries varied among the countries and by gender. To explain the variations in the share, country differences in retirement regulations proved helpful but insufficient. When the overall influence of the welfare state on the share of young old persons in the population was analysed, a country-characteristic pattern emerged.

Twenty-nine per cent Women Councillors after a Mere 100 Years

Just over 100 years ago, 5 pioneering women and 1 quite exceptional one became the first legitimately elected female members of English county and county borough councils. While obviously important, the Qualification of Women Act 1907 that enabled their election was far from the only one to have influenced women's electoral involvement in local government. Their first real opportunity had come in 1870, when the remarkably female-friendly electoral system introduced in Forster's Education Act enabled women to become elected members of school boards — one of the very first being the `quite exceptional' woman mentioned above, Elizabeth Garrett Anderson. The first part of this article examines the rules governing women's 19th-century voting and candidacy rights, and concludes that they were a decisive factor in determining both the extent and nature of women's participation in public life. The second part examines the comparable modern-day rules surrounding electoral systems and gender quotas and suggests that they are similarly influential in determining — or limiting — the representational diversity in our elected governmental bodies. With women comprising just 29 per cent of English councillors after more than a century, the time has surely come, the article concludes, to follow other countries in their utilization of electoral quotas.

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AbstractHigher autism risk with valproate in pregnancy?Data from the north‐west of England suggest that use of sodium valproate during pregnancy is associated with an increased risk of autism spectrum disorders in infants (Neurology 2008;71: 1923–4).In a cohort of 632 children born between 2000 and 2006, 249 were exposed to an antiepileptic drug (AED) in early pregnancy. Ten children were diagnosed with autism, of whom seven were exposed to AEDs; four of these were exposed to valproate monotherapy and one to valproate plus lamotrigine. The incidence of autism in the control group was 0.9 per cent. The authors caution that their study was small and that the children are relatively young for a definitive diagnosis of autism.• The charity Epilepsy Action cautions many women with epilepsy are not receiving advice about AED use during pregnancy. Its evidence shows that 25 per cent of women who gave birth in the last five years did not receive preconception counselling and 68 per cent did not receive the joint care recommended by NICE. About 5000 women with epilepsy become pregnant each year.Pill over the counter?Pharmacies in south London will be supplying oral contraceptives without a prescription in a pilot scheme to start next summer (Pharm J 2008; 281:687).The DoH is keen to cut the number of unwanted pregnancies by increasing access to contraception. In a scheme planned by Southwark PCT, oral contraceptives will be supplied under a patient group direction. The RCGP said it would feel ‘more comfortable’ if GPs initiate supplies after taking a history, choosing a product and reviewing treatment options.MHRA safety concernsThe latest issue of the MHRA's Drug Safety Update (December 2008) includes warnings of the risk neurotoxicity associated with prolonged use of nitrous oxide, and progressive multifocal leucoencephalopathy with rituximab (Mabthera) and efalizumab (Raptiva).It also reminds prescribers that the tacrolimus brands Prograf and Advagraf have different dose schedules and are not interchangeable.Adding rituximab improves CLL survivalAdding rituximab (Mabthera) to standard chemotherapy increases median progression‐free survival in patients with chronic lymphocytic leukaemia (CLL) by 35–40 per cent, according to data presented at the Annual Meeting of the American Society of Hematology in San Francisco.Rituximab is a monoclonal antibody against the B‐cell protein CD20. The CLL8 trial in 817 previously untreated patients with CD20‐positive CLL showed that adding rituximab to treatment with fludarabine (Fludara) and cyclophosphamide increased progression‐free survival to 42.8 months compared with 32.3 months with chemotherapy alone. Complete remission rates were 52 and 27 per cent respectively.The REACH trial, in 552 previously‐treated patients, reported median progression‐free survival of 30.6 months with rituximab plus chemotherapy and 20.6 months with chemotherapy alone. Complete remission rates were 24 and 13 per cent.Tamsulosin POM to P?Consultations are underway on rescheduling tamsulosin to pharmacy‐only status under the brand Flomax Relief. Boehringer‐Ingelheim wants up to 10 weeks' supply at a dose of 400µg per day to be made available to men aged over 45 following a pharmacy assessment, continuing up to one year after confirmation of the diagnosis by a doctor.More data on fracture risk with glitazonesLong‐term treatment with rosiglitazone or pioglitazone doubles the risk of fracture in women with type 2 diabetes, say Canadian investigators (CMAJ 2009;180(1). DOI:10.1503/cmaj.080486).Their meta‐analysis comprised 10 RCTs and two observational studies. The overall odds ratio (OR) for fracture associated with at least one year's treatment was 1.45, but in five RCTs the OR was 2.23 for women and 1.00 for men. The observational studies showed a reduction in bone mineral density in the lumbar spine and hip, with a greater effect in women than men. The number needed to harm after one year's treatment was 55 for women aged 56 and 21 for women aged 72. Copyright © 2009 Wiley Interface Ltd

Addressing RTI/STI and HIV/AIDS, and Gender Discrimination in Treatment in India

In this article an attempt is made to demonstrate the level of awareness of Reproductive Tract Infection (RTI)/Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) and the extent of discrimination in treatment seeking behaviour among men and women who have got symptoms of RTI/STI in India. The awareness about RTI among women is higher than that among men by 8 percentage points, but the level of awareness about STI among men is higher than that among women by 7 percentage points. The awareness about HIV/AIDS among men is higher than that among women by 18 percentage points. Among both men and women awareness about HIV/AIDS is substantially higher than that of RTI and STI. The level of education and work participation rates among men and women have a direct relationship with the level of awareness of HIV/AIDS. In India, about 30 per cent of women of age 15–44 years had symptoms of RTI/STI as against 12.3 per cent of men of age 20–54 years. However, only about 38 per cent of the women sought treatment as against 55 per cent of men.

Antenatal Pulmonary Embolism: Risk Factors, Management, and Outcomes

Objectives To estimate the incidence of antenatal pulmonary embolism and describe the risk factors, management and outcomes. Design A national matched case–control study using the UK Obstetric Surveillance System (UKOSS). Setting All hospitals with consultant-led maternity units in the UK. Participants A total of 143 women who had an antenatal pulmonary embolism between February 2005 and August 2006. Two hundred and fifty nine matched control women. Methods Prospective case and control identification through the UKOSS monthly mailing. Main outcome measures Incidence and case fatality rates with 95% CIs. Adjusted odds ratio estimates. Results One hundred per cent of UK consultant-led obstetric units contributed data to UKOSS. A total of 143 antenatal pulmonary embolisms were reported, representing an estimated incidence of 1.3 per 10 000 maternities (95% CI 1.1–1.5). Seventy per cent of women had identifiable classical risk factors for thromboembolic disease. The main risk factors for pulmonary embolism were multiparity (adjusted odds ratio [aOR] 4.03, 95% CI 1.60–9.84) and body mass index ≥ 30 kg/m2 (aOR 2.65, 95% CI 1.09–6.45). Nine women who had a pulmonary embolism should have received antenatal thromboprophylaxis with low-molecular-weight heparin (LMWH) according to national guidelines; only three (33%) of them did. Six women (4%) had a pulmonary embolism following antenatal prophylaxis with LMWH; three of these women (50%) were receiving lower than recommended doses. Two women had recurrent pulmonary emboli (1.4%, 95% CI 0.2–5.1%). Five women died (case fatality 3.5%, 95% CI 1.1–8.0%). Conclusions Significant severe morbidity from thromboembolic disease underlies the maternal deaths from pulmonary embolism in the UK. This study has shown some cases where thromboprophylaxis was not provided according to national guidelines, and there may be scope for further work on guideline implementation.

Intelligence in girls and their subsequent smoking behaviour as mothers: the 1958 National Child Development Study and the 1970 British Cohort Study

Exposure to tobacco smoke either in utero or postnatally can have substantial adverse effects on child health, yet many women continue to smoke during pregnancy and after the birth. How women's intelligence in childhood affects their smoking behaviour as mothers is unclear. The participants were from two British national birth cohorts: 3325 women aged 33 years from the 1958 National Child Development Study and 1971 women aged 34 years from the 1970 British Cohort Study. We used structural equation modelling to examine the direct and indirect effects of intelligence measured at age 10-11 years, parental and current social class, educational attainment and age at first birth on smoking during pregnancy and current smoking status. Forty per cent of women in the 1958 cohort smoked during pregnancy, compared with 28% of those from the 1970 cohort. In both cohorts, women with lower IQ in childhood were more likely as adults to smoke during pregnancy and to be a smoker currently. Structural equation modelling showed that the effects of childhood IQ on smoking behaviour were indirect, as they were statistically mediated by educational attainment and age at first birth. There was some effect of educational attainment and age at first birth on smoking behaviour over and above the effect of intelligence. Childhood intelligence influenced women's smoking behaviour as mothers primarily through its contributions to educational attainment and age at first birth.

Fifty/Fifty by 20201

During the last two decades large numbers of women have entered parliaments in several east and southern African countries. In late 2007, Mozambique, Namibia and South Africa in southern Africa and Rwanda, Tanzania and Uganda in east Africa all had national legislatures ranging from 25 to nearly 50 per cent women, placing them in the top 26 worldwide. This is far above the Sub-Saharan African and world averages of about 17 per cent women in a single or lower house of parliament. This development is part of a global trend whereby women are using electoral gender quotas to take a ‘fast track’ to equal legislative representation. The six countries identified here share a set of common characteristics explaining women's electoral success, with one important difference. The three southern African cases have all increased their percentages of women in parliament using a proportional representation electoral system and voluntary political party based quotas. The three east African cases have done the same through the use of a mix of electoral systems and mandatory ‘special’ or ‘reserved’ seats for women. This article describes the two alternatives, discusses their impact on women's descriptive and substantive representation in these six African countries and concludes with a comparison of the advantages and disadvantages of each type of electoral gender quota.