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Smoking and vaping are especially prevalent among people with experience of psychosis (EoP), potentially increasing their toxicant exposure. Switching from tobacco smoking to vaping e-cigarettes reduces exposure to tobacco-related toxicants and likely associated diseases. We compared levels of nicotine and tobacco-related toxicant exposure among people with versus without EoP.
Cross-sectional study, secondary data analysis of Wave 5 (2018) of the Population Assessment of Tobacco and Health Study.
Data collection took place in the USA at the home of participants.
Data were from 5750 adults (aged >18 years) with and without EoP who smoked, vaped, did both or did neither. EoP was defined as ever being told by a health professional that you have schizophrenia, schizoaffective disorder, psychosis, a psychotic illness or psychotic episode.
Levels of urinary toxicants: nicotine metabolites, metals, volatile organic compounds (VOCs) and tobacco-specific nitrosamines (TSNAs) among people with and without EoP. Analyses were adjusted for demographics, cannabis use and past 30-day smoking/vaping status, and were repeated after stratifying by smoking /vaping status.
Of the 5750 participants, 6.3% (n=361) reported EoP, and 93.7% reported no EoP. Levels of nicotine and TSNA metabolites, cadmium, uranium and some VOCs were significantly higher among participants with EoP compared with those without. However, when smoking, vaping and cannabis use were taken into account, the associations of EoP with nicotine and TSNA metabolites, and most of the VOCs, were attenuated and no longer significant.
Participants with EoP are exposed to more nicotine and tobacco-related toxicants than those without EoP, likely largely due to the high prevalence of smoking, vaping and cannabis use among this population.
Despite the increasing number of doctorally prepared midwives in Europe, particularly after the Bologna Declaration 1999, little is known about the context and experiences of their doctoral education.
To explore European initially qualified midwives' experiences with doctoral education; and the context of their education through their professional associations.
An exploratory descriptive observational survey.
An ethically approved web-based survey was used to collect data from midwifery associations and midwives in 33 European countries between October and December 2024. Descriptive statistics and inductive thematic analysis were used to analyse the responses.
Twenty-two midwifery associations from 19 European countries and 207 midwives from 23 European countries participated. Over the last two decades, there has been an increase in the number of doctorally prepared midwives. Common reasons to gain doctoral qualifications included an interest in research, career progression, in particular in education, and improving healthcare. Midwives reported growing availability of European-wide opportunities for doctoral programmes, alongside an increase in the number of doctoral midwifery programmes and supervisors with midwifery expertise. Although many barriers were reported, effectively combining study with their personal life and support from family, friends and colleagues was highlighted as crucial factors in completing their doctoral studies.
This is the first study exploring the experiences of European midwives pursuing a doctoral degree. The findings highlight a need for universities to improve the collaboration with midwives' supportive networks as well as for the profession to reduce intraprofessional hostilities to enhance doctoral midwifery students' well-being.
Implications for the profession: Acknowledging challenges faced by these midwives is necessary to improve professional and institutional support in academia and midwifery.
Findings of this study inform strategies to improve doctoral education for midwives and, in this way, strengthen the contributions of midwives to maternal evidenced-based care development and healthcare innovations.
The Consensus-Based Checklist for Reporting of Survey Studies (CROSS) was used to guide reporting.
This study did not include patient or public involvement in its design, conduct or reporting.
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