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Developing and Selecting Auditory Warnings for a Real-Time Behavioral Intervention. ACTA ACUST UNITED AC 2014; 2:232-238. [PMID: 25745633 DOI: 10.12691/ajphr-2-6-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Real-time sensing and computing technologies are increasingly used in the delivery of real-time health behavior interventions. Auditory signals play a critical role in many of these interventions, impacting not only behavioral response but also treatment adherence and participant retention. Yet, few behavioral interventions that employ auditory feedback report the characteristics of sounds used and even fewer design signals specifically for their intervention. This paper describes a four-step process used in developing and selecting auditory warnings for a behavioral trial designed to reduce indoor secondhand smoke exposure. In step one, relevant information was gathered from ergonomic and behavioral science literature to assist a panel of research assistants in developing criteria for intervention-specific auditory feedback. In step two, multiple sounds were identified through internet searches and modified in accordance with the developed criteria, and two sounds were selected that best met those criteria. In step three, a survey was conducted among 64 persons from the primary sampling frame of the larger behavioral trial to compare the relative aversiveness of sounds, determine respondents' reported behavioral reactions to those signals, and assess participant's preference between sounds. In the final step, survey results were used to select the appropriate sound for auditory warnings. Ultimately, a single-tone pulse, 500 milliseconds (ms) in length that repeats every 270 ms for 3 cycles was chosen for the behavioral trial. The methods described herein represent one example of steps that can be followed to develop and select auditory feedback tailored for a given behavioral intervention.
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Nicholson JS, McDermott MJ, Huang Q, Zhang H, Tyc VL. Full and home smoking ban adoption after a randomized controlled trial targeting secondhand smoke exposure reduction. Nicotine Tob Res 2014; 17:612-6. [PMID: 25324431 DOI: 10.1093/ntr/ntu201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/22/2014] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The current study examined home and full (i.e., home plus car) smoking ban adoption as secondary outcomes to a randomized controlled trial targeting reduced secondhand smoke exposure (SHSe) for children under treatment for cancer. METHODS Families with at least 1 adult smoker who reported SHSe for their children (n = 119) were randomized to control or intervention conditions and followed for 1 year with 5 assessments. Both groups were advised of the negative health outcomes associated with SHSe; the intervention group provided more in-depth counseling from baseline to 3 months. Parents reported on household and car smoking behavior, demographic, psychosocial, and medical/treatment-related information. RESULTS Regardless of group assignment, there was an increase in home (odds ration [OR] = 1.16, p = .074) and full (OR = 1.37, p = .001) smoking ban adoption across time. Families in the intervention group were more likely to adopt a full ban by 3 months, but this difference was nonsignificant by 12 months. Married parents (OR = 2.33, p = .006) and those with higher self-efficacy for controlling children's SHSe (OR = 1.11, p = .023) were more likely to have a home smoking ban; parents who reported smoking fewer cigarettes were more likely to adopt a home (OR = 1.62, p < .0001) or full (OR = 7.32, p = .038) ban. CONCLUSIONS Smoking bans are in-line with Healthy People 2020's tobacco objectives and may be more feasible for parents with medically compromised children for immediate SHSe reduction. Furthermore, interventions targeting full smoking bans may be a more effective for comprehensive elimination of SHSe.
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Affiliation(s)
- Jody S Nicholson
- Department of Psychology, University of North Florida, Jacksonville, FL;
| | | | - Qinlei Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Vida L Tyc
- Department of Pediatrics, University of South Florida, Tampa, FL
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Huh J, Shin H, Leventhal AM, Spruijt-Metz D, Abramova Z, Cerrada C, Hedeker D, Dunton G. Momentary Negative Moods and Being With Friends Precede Cigarette Use Among Korean American Emerging Adults. Nicotine Tob Res 2014; 16:1248-54. [DOI: 10.1093/ntr/ntu063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hovell MF, Adams MA, Hofstetter CR, Martínez-Donate AP, González-Pérez GJ, Rovniak LS, Boman-Davis MC. Complete home smoking bans and antitobacco contingencies: a natural experiment. Nicotine Tob Res 2014; 16:186-96. [PMID: 23999652 PMCID: PMC3880233 DOI: 10.1093/ntr/ntt130] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The California antitobacco culture may have influenced home smoking bans in Mexico. Based on the Behavioral Ecological Model, exposure to socially reinforcing contingencies or criticism may explain adoption of home smoking bans in Tijuana, Mexico, approximating rates relative to San Diego, California, and higher than those in Guadalajara, Mexico. METHODS A representative cross-sectional population survey of Latinos (N = 1,901) was conducted in San Diego, Tijuana, and Guadalajara between June 2003 and September 2004. Cities were selected to represent high-, medium-, and low-level exposure to antitobacco social contingencies of reinforcement in a quasiexperimental analysis of possible cultural influences across borders. RESULTS Complete home smoking ban prevalence was 91% in San Diego, 66% in Tijuana, and 38% in Guadalajara (p < .001). Sample cluster-adjusted logistic regression showed significantly lower odds of complete home smoking bans in Guadalajara (odds ratio [OR] = .048) and in Tijuana (OR = .138) compared to San Diego after control for demographics. Odds of complete home smoking bans in both Guadalajara and Tijuana in comparison with San Diego were weakened when mediators for bans were controlled in predictive models. Direction of association was consistent with theory. When theoretical mediators were explored as possible moderators, weak and nonsignificant associations were obtained for all interaction terms. Bootstrap analyses demonstrated that our multivariable logistic regression results were reliable. CONCLUSIONS Results suggest that California antismoking social contingencies mediate complete home smoking bans in all 3 cities and may account for the greater effects in Tijuana contrasted with Guadalajara.
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Affiliation(s)
- Melbourne F. Hovell
- Centre for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA
| | - Marc A. Adams
- Department of Psychology, Graduate School of Public Health, San Diego State University, CA;,Exercise and Wellness, School of Nutrition and Health Promotion, Arizona State University, Phoenix, AZ
| | - C. Richard Hofstetter
- Centre for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA;,Department of Political Science, Graduate School of Public Health, San Diego State University, CA
| | - Ana P. Martínez-Donate
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin, Madison, WI
| | - Guillermo J. González-Pérez
- Departamento de Ciencias Sociales, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, México
| | - Liza S. Rovniak
- Departments of Medicine and Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA
| | - Marie C. Boman-Davis
- Centre for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA
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Nazar GP, Lee JT, Glantz SA, Arora M, Pearce N, Millett C. Association between being employed in a smoke-free workplace and living in a smoke-free home: evidence from 15 low and middle income countries. Prev Med 2014; 59:47-53. [PMID: 24287123 PMCID: PMC3898883 DOI: 10.1016/j.ypmed.2013.11.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/23/2013] [Accepted: 11/17/2013] [Indexed: 10/30/2022]
Abstract
OBJECTIVE To assess whether being employed in a smoke-free workplace is associated with living in a smoke-free home in 15 low and middle income countries (LMICs). METHODS Country-specific individual level analyses of cross-sectional Global Adult Tobacco Survey data (2008-2011) from 15 LMICs was conducted using multiple logistic regression. The dependent variable was living in a smoke-free home; the independent variable was being employed in a smoke-free workplace. Analyses were adjusted for age, gender, residence, region, education, occupation, current smoking, current smokeless tobacco use and number of household members. Individual country results were combined in a random effects meta-analysis. RESULTS In each country, the percentage of participants employed in a smoke-free workplace who reported living in a smoke-free home was higher than those employed in a workplace not smoke-free. The adjusted odds ratios (AORs) of living in a smoke-free home among participants employed in a smoke-free workplace (vs. those employed where smoking occurred) were statistically significant in 13 of the 15 countries, ranging from 1.12 [95% CI 0.79-1.58] in Uruguay to 2.29 [1.37-3.83] in China. The pooled AOR was 1.61 [1.46-1.79]. CONCLUSION In LMICs, employment in a smoke-free workplace is associated with living in a smoke-free home. Accelerated implementation of comprehensive smoke-free policies is likely to result in substantial population health benefits in these settings.
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Affiliation(s)
- Gaurang P Nazar
- Public Health Foundation of India (PHFI), New Delhi, India; London School of Hygiene & Tropical Medicine (LSHTM), UK.
| | | | | | - Monika Arora
- Public Health Foundation of India (PHFI), New Delhi, India
| | - Neil Pearce
- London School of Hygiene & Tropical Medicine (LSHTM), UK
| | - Christopher Millett
- Imperial College London, UK; South Asia Network for Chronic Diseases (SANCD), New Delhi, India
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Tandon M, Lessov-Schlaggar CN, Tillman R, Hovell MF, Luby J. Secondhand Smoke Exposure and Severity of Attention-Deficit/Hyperactivity Disorder in Preschoolers: A Pilot Investigation. Scand J Child Adolesc Psychiatr Psychol 2014; 2:37-40. [PMID: 25133138 PMCID: PMC4131741 DOI: 10.21307/sjcapp-2014-006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Less is known about the effects of secondhand smoke (SHS) on mental health as compared with other medical disorders. OBJECTIVE The aims of this study were to examine the following: 1) the association of SHS exposure with childhood attention-deficit/hyperactivity (ADHD) and disruptive disorders; and 2) the association of maternal recall of a child's SHS exposure and that child's exposure as measured by bioassay. METHOD Sixty children had their saliva collected and assayed for cotinine when they were 4 years old and again when they were 6 years old. Phone interview data were collected to assess maternal recall of the children's exposure to SHS at these ages. The children were assessed annually for ADHD and disruptive disorders. Repeated measures analysis of exposure level by child characteristics was performed. RESULTS Greater ADHD and conduct disorder severity scores were associated with greater child smoke exposure (ADHD severity, P = .043; conduct disorder severity, P = .035). A large proportion of mothers reported that their children had no exposure to SHS, despite high levels of measured cotinine in the children's saliva. CONCLUSIONS An association between SHS exposure and ADHD and conduct disorder symptoms was found. Children and parents may benefit from parent education regarding the deleterious effects of SHS.
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Affiliation(s)
- Mini Tandon
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | | | - Rebecca Tillman
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Melbourne F. Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, Division of Health Promotion & Behavioral Science, San Diego State University, San Diego, CA
| | - Joan Luby
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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Huh J, Sami M, Abramova ZS, Spruijt-Metz D, Pentz MA. Cigarettes, culture, and Korean American emerging adults: an exploratory qualitative study. West J Nurs Res 2013; 35:1205-21. [PMID: 23743507 DOI: 10.1177/0193945913490840] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Korean American emerging adults (KAEA) constitute an understudied, at-risk group for smoking and related health consequences. The cultural meanings of smoking and cessation among KAEA were explored. Sixty-seven KAEA participated in 10 focus groups. Themes from the sessions were identified and domain analysis was conducted. Regarding reasons for smoking, we identified (a) association between the culture of origin and gender identification, (b) access/availability of cigarettes in homes/community, and (c) competing social environments where KAEA adjust their health behaviors. Regarding contexts for cessation, we identified (a) a sense of invincibility/denial, (b) lack of role models or pressure to quit, and (c) lack of significant life events. Using cessation aids represented lacking personal discipline/willpower. The results show that smoking among KAEA is highly contextualized in the culture of origin, despite U.S. tobacco control policies. Implications for culturally sensitive prevention/cessation programs for KAEA include modifying culturally based norms and social spaces regarding cigarettes and cessation.
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Affiliation(s)
- Jimi Huh
- University of Southern California, Los Angeles, CA, USA.
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Yilmaz G, Caylan N, Karacan CD. Brief intervention to preteens and adolescents to create smoke-free homes and cotinine results: a randomized trial. J Trop Pediatr 2013; 59:365-71. [PMID: 23681934 DOI: 10.1093/tropej/fmt034] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Little research has focused on brief and practical strategies for addressing environmental tobacco smoke exposure through interventions focused explicitly on creating a smoke-free home. METHODS We used a two-group (intervention and control groups) repeated-measures randomized controlled trial design. Families were randomized to the intervention (n = 176) or control (n = 176) condition after the baseline interview, with outcome assessments for reported and urine cotinine measures at 2 (post-intervention), 6 (follow-up) and 12 (follow-up) months. RESULTS Baseline urinary cotinine levels of both groups were not statistically significantly different (P > 0.05); however, post-intervention urinary cotinine levels were significantly different at 2, 6 and 12 months after start of the study (P < 0.001). CONCLUSION As a physician-based brief intervention, our intervention was effective. Clinical providers might offer feedback and brief interventions to preteens and adolescents. Because of the ease of intervention on delivery, this intervention has the potential to have significant impact if widely disseminated.
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Affiliation(s)
- Gonca Yilmaz
- Department of Social and Developmental Pediatrics, Dr. Sami Ulus Children and Maternity Training Hospital, Ankara 06100, Turkey
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Collins BN, Wileyto EP, Hovell MF, Nair US, Jaffe K, Tolley NM, Audrain-McGovern J. Proactive recruitment predicts participant retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers. Transl Behav Med 2013; 1:394-9. [PMID: 24073063 DOI: 10.1007/s13142-011-0059-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Improving smoking intervention trial retention in underserved populations remains a public health priority. Low retention rates undermine clinical advancements that could reduce health disparities. To examine the effects of recruitment strategies on participant retention among 279 low-income, maternal smokers who initiated treatment in a 16-week behavioral counseling trial to reduce child secondhand smoke exposure (SHSe). Participants were recruited using either reactive strategies or methods that included proactive strategies. Logistic regression analysis was used to test associations among retention and recruitment method in the context of other psychosocial and sociodemographic factors known to relate to retention. Backwards stepwise procedures determined the most parsimonious solution. Ninety-four percent of participants recruited with proactive + reactive methods were retained through end of treatment compared to 74.7% of reactive-recruited participants. Retention likelihood was five times greater if participants were recruited with proactive + reactive strategies rather than reactive recruitment alone (odds ration [OR] = 5.36; confidence interval [CI], 2.31-12.45). Greater knowledge of SHS consequences (OR = 1.58; CI, 1.07-2.34) was another significant factor retained in the final LR model. Proactive recruitment may improve retention among underserved smokers in behavioral intervention trials. Identifying factors influencing retention may improve the success of recruitment strategies in future trials, in turn, enhancing the impact of smoking interventions.
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Affiliation(s)
- Bradley N Collins
- Health Behavior Research Clinic, Temple University Department of Public Health, 1301 Cecil B. Moore Avenue, Ritter Annex, Room 929, Philadelphia, PA 19122 USA
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Lepore SJ, Winickoff JP, Moughan B, Bryant-Stephens TC, Taylor DR, Fleece D, Davey A, Nair US, Godfrey M, Collins BN. Kids Safe and Smokefree (KiSS): a randomized controlled trial of a multilevel intervention to reduce secondhand tobacco smoke exposure in children. BMC Public Health 2013; 13:792. [PMID: 23987302 PMCID: PMC3844378 DOI: 10.1186/1471-2458-13-792] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 08/28/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Secondhand smoke exposure (SHSe) harms children's health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers' advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations. METHODS/DESIGN This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status. DISCUSSION This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to "ask, advise, and refer" guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. TRIAL REGISTRATION NCT01745393 (clinicaltrials.gov).
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Affiliation(s)
- Stephen J Lepore
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Jonathan P Winickoff
- Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Beth Moughan
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA
| | - Tyra C Bryant-Stephens
- Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, USA
| | - Daniel R Taylor
- Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, USA
| | - David Fleece
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA
| | - Adam Davey
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Uma S Nair
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Melissa Godfrey
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
| | - Bradley N Collins
- Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA
- Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA
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Klepeis NE, Hughes SC, Edwards RD, Allen T, Johnson M, Chowdhury Z, Smith KR, Boman-Davis M, Bellettiere J, Hovell MF. Promoting smoke-free homes: a novel behavioral intervention using real-time audio-visual feedback on airborne particle levels. PLoS One 2013; 8:e73251. [PMID: 24009742 PMCID: PMC3751871 DOI: 10.1371/journal.pone.0073251] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/19/2013] [Indexed: 12/01/2022] Open
Abstract
Interventions are needed to protect the health of children who live with smokers. We pilot-tested a real-time intervention for promoting behavior change in homes that reduces second hand tobacco smoke (SHS) levels. The intervention uses a monitor and feedback system to provide immediate auditory and visual signals triggered at defined thresholds of fine particle concentration. Dynamic graphs of real-time particle levels are also shown on a computer screen. We experimentally evaluated the system, field-tested it in homes with smokers, and conducted focus groups to obtain general opinions. Laboratory tests of the monitor demonstrated SHS sensitivity, stability, precision equivalent to at least 1 µg/m(3), and low noise. A linear relationship (R(2) = 0.98) was observed between the monitor and average SHS mass concentrations up to 150 µg/m(3). Focus groups and interviews with intervention participants showed in-home use to be acceptable and feasible. The intervention was evaluated in 3 homes with combined baseline and intervention periods lasting 9 to 15 full days. Two families modified their behavior by opening windows or doors, smoking outdoors, or smoking less. We observed evidence of lower SHS levels in these homes. The remaining household voiced reluctance to changing their smoking activity and did not exhibit lower SHS levels in main smoking areas or clear behavior change; however, family members expressed receptivity to smoking outdoors. This study established the feasibility of the real-time intervention, laying the groundwork for controlled trials with larger sample sizes. Visual and auditory cues may prompt family members to take immediate action to reduce SHS levels. Dynamic graphs of SHS levels may help families make decisions about specific mitigation approaches.
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Affiliation(s)
- Neil E Klepeis
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, SDSU Research Foundation, San Diego State University, San Diego, California, USA.
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Tyc VL, Lensing S, Vukadinovich C, Hovell MF. Smoking restrictions in the homes of children with cancer. Am J Health Behav 2013; 37:440-8. [PMID: 23985225 DOI: 10.5993/ajhb.37.4.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine smoking restrictions in households of children with cancer and their effect on biological measures of children's secondhand smoke exposure (SHSe). METHODS A sample of 135 parents of nonsmoking children with cancer who lived with a smoker completed structured interviews. RESULTS Approximately 43% of families prohibited smoking in the home. Children living in homes that prohibited smoking had median cotinine levels that were 71% and 52% lower than did those from homes with no and partial restrictions. CONCLUSIONS Parents should be directed to completely ban all smoking from the home and car to best protect their children from SHSe.
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Affiliation(s)
- Vida L Tyc
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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de Viron S, Malats N, Van der Heyden J, Van Oyen H, Brand A. Environmental and Genomic Factors as well as Interventions Influencing Smoking Cessation: A Systematic Review of Reviews and a Proposed Working Model. Public Health Genomics 2013; 16:159-73. [DOI: 10.1159/000351453] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 04/18/2013] [Indexed: 11/19/2022] Open
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Determining the burden of secondhand smoke exposure on the respiratory health of Thai children. Tob Induc Dis 2013; 11:7. [PMID: 23506470 PMCID: PMC3607926 DOI: 10.1186/1617-9625-11-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 03/12/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The impact of secondhand smoke (SHS) on Southeast Asian children's health has been assessed by a limited number of studies. The purpose of this study was to determine whether in Thailand, pre- and postnatal exposure to SHS is associated with acute lower respiratory conditions in young children. METHODS We conducted a case control study of 462 children under age five admitted with acute lower respiratory illnesses, including asthma and pneumonia, at a major hospital in Bangkok. We selected 462 comparison controls from the well-child clinic at the hospital and matched them by sex and age. We used a structured questionnaire to collect information about exposure to SHS and other factors. We conducted bivariate and multivariate analyses to identify risk factors for acute lower respiratory conditions. RESULTS The number of cigarettes smoked at home per day by household members was significantly greater among cases. A greater number of household caregivers of cases held and carried children while smoking as compared to controls (26% versus 7%, p <0.05). Cases were more likely to have been exposed to SHS in the household (adjusted OR = 3.82, 95% CI = 2.47-5.9), and outside (adjusted OR = 2.99, 95% CI = 1.45-6.15). Parental lower educational level and low household income were also associated with respiratory illnesses in Thai children under five. CONCLUSIONS Thai children who are exposed to SHS are at nearly 4 times greater risk of developing acute lower respiratory conditions. Continued effort is needed in Thailand to eliminate children's exposure to SHS, especially at home.
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Hovell MF, Robusto KM, Matt GE. When is it appropriate to scream fire in a crowded theater or public housing? Am J Prev Med 2013; 44:93-5. [PMID: 23253657 DOI: 10.1016/j.amepre.2012.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 10/08/2012] [Accepted: 10/08/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
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Barnoya J, Navas-Acien A. Protecting the world from secondhand tobacco smoke exposure: where do we stand and where do we go from here? Nicotine Tob Res 2012; 15:789-804. [PMID: 23072872 DOI: 10.1093/ntr/nts200] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Article 8 of the Framework Convention on Tobacco Control mandates all signatory countries to "protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places." Even though there has been great progress in the implementation of Article 8, still most of the world population remains exposed to secondhand smoke (SHS). In this article, we sought to summarize the research that supports Article 8, where do we stand, and current research gaps and future directions. DISCUSSION Secondhand smoke is an established cause of heart disease and several types of cancer. Additional research is needed to reach final conclusions for diseases where evidence is only suggestive of causality. The only solution to SHS exposure in public places is banning smoking indoors. Research on the gaming industry and nightclubs, particularly in developing countries, needs to be disseminated to support their inclusion in smoke-free laws. Aside from indoor bans, additional research is needed for outdoor and multiunit housing bans and in support of measures that protect children and other vulnerable populations. The impact of smoke-free laws on other health outcomes, besides heart disease and respiratory outcomes, is another area where further research is needed. Thirdhand smoke assessment and health effects are also likely to be a topic of further research. As new tobacco products emerge, evaluating SHS exposure and effects will be vital. CONCLUSIONS Furthering research in support of Article 8 can contribute to reach the final goal of protecting everyone from SHS exposure.
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Affiliation(s)
- Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA.
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Baron-Epel O, Satran C, Cohen V, Drach-Zehavi A, Hovell MF. Challenges for the smoking ban in Israeli pubs and bars: analysis guided by the behavioral ecological model. Isr J Health Policy Res 2012; 1:28. [PMID: 22913392 PMCID: PMC3439387 DOI: 10.1186/2045-4015-1-28] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 05/24/2012] [Indexed: 11/18/2022] Open
Abstract
Background The latest amendment to the ban on smoking in public places in Israel was implemented in 2007, adding pubs and bars (P&B) to the list of public places in which smoking is prohibited. However, smoking in most P&B continued. The aim of the study was to identify the theoretically plausible reasons for the partial success of a public ban on smoking in P&B settings. Explanations provided by P&B owners were interpreted as probable causal factors based on the Behavioral Ecological Model (BEM). Methods Qualitative interviews were performed with 36 P&B owners in Tel-Aviv and 18 Israeli towns and cities of various population size. Results P&B owners reported a variety of situational factors (i.e., contingencies) and reinforcers as likely explanations of the partial failure of the legislated ban on smoking in public places, particularly P&B. The major reinforcers for non-adherence with the law were no or low frequency of inspections and low penalties from authorities. P&B owners also feared loss of customers and revenue if bans were enforced in their own establishment but not in competing establishments. Finally, owners reported social norms prevailing among some Israeli patrons supporting smoking in P&B settings, in part to express opposition to the new law. Conclusions Qualitative assessment can uncover probable social situations that operate to prevent greater adherence to smoking bans. The results warrant confirmation by quantitative analyses. Policies with mandated inspections and penalty requirements that are implemented in all bars without prejudice could lead to greater adherence to smoking bans. Positive reinforcing consequences that encourage adherence (such as publicity and support from non-smokers) would be more likely to generate both greater adherence to the policy and good will toward the government. Principles of behavior outlined in the BEM offer guidance for designing quantitative confirmation analyses of future bans.
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Affiliation(s)
- Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Mount Carmel, Haifa, Israel.
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68
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Collins BN, Ibrahim J. Pediatric Secondhand Smoke Exposure: Moving Toward Systematic Multi-Level Strategies to Improve Health. Glob Heart 2012; 7:161-165. [PMID: 24040587 DOI: 10.1016/j.gheart.2012.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Bradley N Collins
- Associate Professors, Department of Public Health, College of Health Professions and Social Work, Temple University 1301 Cecil B. Moore Avenue, Ritter Annex, 9th Floor Philadelphia, PA 19122, USA
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69
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Tyc VL, Huang Q, Nicholson J, Schultz B, Hovell MF, Lensing S, Vukadinovich C, Hudson MM, Zhang H. Intervention to reduce secondhand smoke exposure among children with cancer: a controlled trial. Psychooncology 2012; 22:1104-11. [PMID: 22684982 DOI: 10.1002/pon.3117] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 05/09/2012] [Accepted: 05/11/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This randomized controlled trial tested the efficacy of parent-based behavioral counseling for reducing secondhand smoke exposure (SHSe) among children with cancer. It also examined predictors of smoking and SHSe outcomes. METHODS Participants were 135 parents or guardians of nonsmoking children with cancer, <18 years, at least 30 days postdiagnosis, and living with at least one adult smoker. Parents were randomized to either a standard care control group or an intervention consisting of six counseling sessions delivered over 3 months. Parent-reported smoking and child SHSe levels were obtained at baseline, 3, 6, 9, and 12 months. Children provided urine samples for cotinine analyses. RESULTS Reductions in parent-reported smoking and exposure were observed in both the intervention and control conditions. There was a significantly greater reduction in parent-reported smoking and child SHSe at 3 months for the intervention group compared with the control group. Child SHSe was significantly lower at 12 months relative to baseline in both groups. Children's cotinine levels did not show significant change over time in either group. Exposure outcomes were influenced by the number of smokers at home, smoking status of the parent participating in the trial, and the child's environment (home versus hospital) the day before the assessment. CONCLUSIONS Children's SHSe can be reduced by advising parents to protect their child from SHSe, combined with routine reporting of their child's exposure and cotinine testing, when delivered in the context of the pediatric cancer setting. More intensive interventions may be required to achieve greater reductions in SHSe.
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Affiliation(s)
- Vida L Tyc
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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70
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Kegler MC, Escoffery C, Bundy L, Berg CJ, Haardörfer R, Yembra D, Schauer G. Pilot study results from a brief intervention to create smoke-free homes. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:951426. [PMID: 22675374 PMCID: PMC3362929 DOI: 10.1155/2012/951426] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/10/2012] [Accepted: 02/28/2012] [Indexed: 11/26/2022]
Abstract
Very few community-based intervention studies have examined how to effectively increase the adoption of smoke-free homes. A pilot study was conducted to test the feasibility, acceptability, and short-term outcomes of a brief, four-component intervention for promoting smoke-free home policies among low-income households. We recruited forty participants (20 smokers and 20 nonsmokers) to receive the intervention at two-week intervals. The design was a pretest-posttest with follow-up at two weeks after intervention. The primary outcome measure was self-reported presence of a total home smoking ban. At follow-up, 78% of participants reported having tried to establish a smoke-free rule in their home, with significantly more nonsmokers attempting a smoke-free home than smokers (P = .03). These attempts led to increased smoking restrictions, that is, going from no ban to a partial or total ban, or from a partial to a total ban, in 43% of the homes. At follow-up, 33% of the participants reported having made their home totally smoke-free. Additionally, smokers reported smoking fewer cigarettes per day. Results suggest that the intervention is promising and warrants a rigorous efficacy trial.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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71
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Ding D, Hovell MF. Cigarettes, social reinforcement, and culture: a commentary on "Tobacco as a social currency: cigarette gifting and sharing in China". Nicotine Tob Res 2012; 14:255-7. [PMID: 22180592 DOI: 10.1093/ntr/ntr277] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
As Rich and Xiao suggested, cigarette sharing and gifting play an important role in China's smoking epidemic. Understanding the cultural roots, history, and impacts of such practices should be emphasized in tobacco control efforts. "Tobacco as a social currency" is a consequence of the tobacco industry usurping traditional values and cultural customs to make cigarette gifting acceptable, desirable, and socially reinforcing. The cigarettes-social reinforcement link created by the tobacco industry can be broken by deglamorizing smoking and cigarette gifting and by reinforcing alternative healthful behaviors. A behavioral ecological perspective, with an emphasis of understanding and engineering cultures, should guide future health promotion efforts to reduce smoking and other risk practices in China.
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Affiliation(s)
- Ding Ding
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
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72
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Rosen LJ, Noach MB, Winickoff JP, Hovell MF. Parental smoking cessation to protect young children: a systematic review and meta-analysis. Pediatrics 2012; 129:141-52. [PMID: 22201152 DOI: 10.1542/peds.2010-3209] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Young children can be protected from much of the harm from tobacco smoke exposure if their parents quit smoking. Some researchers encourage parents to quit for their children's benefit, but the evidence for effectiveness of such approaches is mixed. OBJECTIVE To perform a systematic review and meta-analysis to quantify the effects of interventions that encourage parental cessation. METHODS We searched PubMed, the Cochrane Library, Web of Science, and PsycINFO. Controlled trials published before April 2011 that targeted smoking parents of infants or young children, encouraged parents to quit smoking for their children's benefit, and measured parental quit rates were included. Study quality was assessed. Relative risks and risk differences were calculated by using the DerSimonian and Laird random-effects model. RESULTS Eighteen trials were included. Interventions took place in hospitals, pediatric clinical settings, well-baby clinics, and family homes. Quit rates averaged 23.1% in the intervention group and 18.4% in the control group. The interventions successfully increased the parental quit rate. Subgroups with significant intervention benefits were children aged 4 to 17 years, interventions whose primary goal was cessation, interventions that offered medications, and interventions with high follow-up rates (>80%). CONCLUSIONS Interventions to achieve cessation among parents, for the sake of the children, provide a worthwhile addition to the arsenal of cessation approaches, and can help protect vulnerable children from harm due to tobacco smoke exposure. However, most parents do not quit, and additional strategies to protect children are needed.
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Affiliation(s)
- Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, Ramat Aviv, Israel.
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73
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Hovell MF, Lessov-Schlaggar CN, Ding D. Smokefree community policies promote home smoking bans. Unknown mechanisms and opportunities for preventive medicine. Am J Prev Med 2011; 41:650-2. [PMID: 22099246 DOI: 10.1016/j.amepre.2011.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 11/16/2022]
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Stotts AL, Evans PW, Green CE, Northrup TF, Dodrill CL, Fox JM, Tyson JE, Hovell MF. Secondhand smoke risk in infants discharged from an NICU: potential for significant health disparities? Nicotine Tob Res 2011; 13:1015-22. [PMID: 21669959 PMCID: PMC3430443 DOI: 10.1093/ntr/ntr116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/29/2011] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated > 12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans. METHODS Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected. RESULTS Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p < .01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p < .05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p < .02). CONCLUSIONS The most disadvantaged families were least likely to have protective health behaviors in place to reduce SHSe and, consequently, are most at-risk for tobacco exposure and subsequent tobacco-related health disparities. Innovative SHSe interventions for this vulnerable population are sorely needed.
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Affiliation(s)
- Angela L Stotts
- Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin, JJL 324, Houston, TX 77030, USA.
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75
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Hovell MF, Wahlgren DR, Liles S, Jones JA, Hughes SC, Matt GE, Ji M, Lessov-Schlaggar CN, Swan GE, Chatfield D, Ding D. Providing coaching and cotinine results to preteens to reduce their secondhand smoke exposure: a randomized trial. Chest 2011; 140:681-689. [PMID: 21474574 PMCID: PMC3168853 DOI: 10.1378/chest.10-2609] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 03/08/2011] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Secondhand smoke exposure (SHSe) poses health risks to children living with smokers. Most interventions to protect children from SHSe have coached adult smokers. This trial determined whether coaching and cotinine feedback provided to preteens can reduce their SHSe. METHODS Two hundred one predominantly low-income families with a resident smoker and a child aged 8 to 13 years who was exposed to two or more cigarettes per day or had a urine cotinine concentration ≥ 2.0 ng/mL were randomized to control or SHSe reduction coaching groups. During eight in-home sessions over 5 months, coaches presented to the child graphic charts of cotinine assay results as performance feedback and provided differential praise and incentives for cotinine reductions. Generalized estimating equations were used to determine the differential change in SHSe over time by group. RESULTS For the baseline to posttest period, the coaching group had a greater decrease in both urine cotinine concentration (P = .039) and reported child SHSe in the number of cigarettes exposed per day (child report, P = .003; parent report, P = .078). For posttest to month 12 follow-up, no group or group by time differences were obtained, and both groups returned toward baseline. CONCLUSIONS Coaching preteens can reduce their SHSe, although reductions may not be sustained without ongoing counseling, feedback, and incentives. Unlike interventions that coach adults to reduce child SHSe, programs that increase child avoidance of SHSe have the potential to reduce SHSe in all settings in which the child is exposed, without requiring a change in adult smoking behavior.
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Affiliation(s)
- Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA.
| | - Dennis R Wahlgren
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA
| | - Jennifer A Jones
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA
| | - Suzanne C Hughes
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA
| | - Georg E Matt
- Graduate School of Public Health, Department of Psychology, San Diego State University, San Diego, CA
| | - Ming Ji
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, CA
| | | | - Gary E Swan
- Center for Health Sciences, SRI International, Menlo Park, CA
| | - Dale Chatfield
- Department of Chemistry, San Diego State University, San Diego, CA
| | - Ding Ding
- Center for Behavioral Epidemiology and Community Health, San Diego State University, San Diego, CA
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76
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Baheiraei A, Kharaghani R, Mohsenifar A, Kazemnejad A, Alikhani S, Milani HS, Mota A, Hovell MF. Reduction of secondhand smoke exposure among healthy infants in Iran: randomized controlled trial. Nicotine Tob Res 2011; 13:840-7. [PMID: 21504887 DOI: 10.1093/ntr/ntr085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The objective of this study was to assess whether counseling both mothers and fathers reduces their infants' exposure to secondhand smoke (SHS). METHODS Participants were 130 nonsmoking children aged less than 1 year, exposed to their fathers' or mothers' smoking, and recruited from a health center in southern Tehran. Eligible families were randomly assigned to intervention or control group. Infant urine samples were collected, and parents were interviewed at baseline and at a 3-month follow-up in each of the 2 groups. Mothers of the intervention group were provided 3 counseling sessions, one of which was face to face and 2 of which were by telephone. Fathers were provided 3 counseling sessions by telephone. Parents were also given an educational pamphlet and a sticker depicting a smoke-free home. The control group received usual care. Changes in infant urinary cotinine levels, parental cigarette consumption in the presence of the child, and home- and car-smoking bans were assessed. RESULTS The intervention was effective in reducing infant urinary cotinine levels (1-tailed p = .029). There was a greater decrease in the total daily cigarette consumption in the presence of the child in the intervention group compared with the control group, and the differences between the 2 groups were statistically significant (1-tailed p = .03). While the differences between home-smoking bans in the 2 groups were statistically significant (1-tailed p = .049), the differences between car-smoking bans did not reach significance. CONCLUSION Counseling similar to that employed in other countries can reduce infant exposure to SHS, suggesting generalizability.
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Affiliation(s)
- Azam Baheiraei
- Department of Reproductive Health, Tehran University of Medical Sciences, Tehran, Iran.
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Lessov-Schlaggar CN, Wahlgren DR, Liles S, Jones JA, Ji M, Hughes SC, Swan GE, Hovell MF. Sensitivity to secondhand smoke exposure predicts smoking susceptibility in 8-13-year-old never smokers. J Adolesc Health 2011; 48:234-40. [PMID: 21338893 PMCID: PMC3052940 DOI: 10.1016/j.jadohealth.2010.06.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2010] [Revised: 06/23/2010] [Accepted: 06/24/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the sensitivity to secondhand smoke exposure (SHSe) in preteens aged 8-13 years who have never smoked, and to determine whether it predicts smoking susceptibility. METHODS We assessed the sensitivity to SHSe using reactions commonly used for the assessment of sensitivity to the first-smoked cigarette (e.g., feeling dizzy), and investigated the factor structure of these reactions for the purpose of data reduction. We examined the association of each reaction measure and summary score with demographic characteristics and smoking susceptibility, using logistic regression and ordinal logistic regression. RESULTS One factor was identified that captured the physical and/or unpleasant reactions. Older preteens and preteens with more highly educated parents reported fewer reactions to SHSe. More African American preteens reported feeling relaxed or calm compared with all other racial/ethnic groups. Experiencing physical and/or unpleasant reactions to SHSe predicted lower risk for smoking susceptibility. CONCLUSIONS This was the first study to extend analytical methodology for sensitivity to active smoking to sensitivity to SHSe in youth who had never smoked. Results suggest a desensitization process with age and lower sensitivity to some reactions in preteens from more highly educated households. Preteens who have more aversive experiences with SHSe tend to be less susceptible to smoking than those who experience fewer aversive reactions. Assessment of sensitivity to SHSe is a novel approach to the study of cigarette use etiology and may contribute to better prediction of smoking initiation.
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78
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Matt GE, Quintana PJE, Zakarian JM, Fortmann AL, Chatfield DA, Hoh E, Uribe AM, Hovell MF. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tob Control 2011; 20:e1. [PMID: 21037269 PMCID: PMC3666918 DOI: 10.1136/tc.2010.037382] [Citation(s) in RCA: 134] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND This study examined whether thirdhand smoke (THS) persists in smokers' homes after they move out and non-smokers move in, and whether new non-smoking residents are exposed to THS in these homes. METHODS The homes of 100 smokers and 50 non-smokers were visited before the residents moved out. Dust, surfaces, air and participants' fingers were measured for nicotine and children's urine samples were analysed for cotinine. The new residents who moved into these homes were recruited if they were non-smokers. Dust, surfaces, air and new residents' fingers were examined for nicotine in 25 former smoker and 16 former non-smoker homes. A urine sample was collected from the youngest resident. RESULTS Smoker homes' dust, surface and air nicotine levels decreased after the change of occupancy (p<0.001); however dust and surfaces showed higher contamination levels in former smoker homes than former non-smoker homes (p<0.05). Non-smoking participants' finger nicotine was higher in former smoker homes compared to former non-smoker homes (p<0.05). Finger nicotine levels among non-smokers living in former smoker homes were significantly correlated with dust and surface nicotine and urine cotinine. CONCLUSIONS These findings indicate that THS accumulates in smokers' homes and persists when smokers move out even after homes remain vacant for 2 months and are cleaned and prepared for new residents. When non-smokers move into homes formerly occupied by smokers, they encounter indoor environments with THS polluted surfaces and dust. Results suggest that non-smokers living in former smoker homes are exposed to THS in dust and on surfaces.
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Affiliation(s)
- Georg E Matt
- Department of Psychology, San Diego State University, San Diego, California 92182-4611, USA.
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79
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Calabro KS, Costello TC, Prokhorov AV. Denormalization of Tobacco Use and the Role of the Pediatric Health-Care Provider. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2010. [DOI: 10.1089/ped.2010.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Karen S. Calabro
- Division of Cancer Prevention and Population Studies, Department of Behavioral Science, M.D. Anderson Cancer Center, Houston, Texas
| | - Tamara C. Costello
- Department of Behavioral Science, M.D. Anderson Cancer Center, Houston, Texas
| | - Alexander V. Prokhorov
- Tobacco Outreach Education Program, Department of Behavioral Science, The UT M.D. Anderson Cancer Center, Houston, Texas
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80
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Ding D, Wahlgren DR, Liles S, Jones JA, Hughes SC, Hovell MF. Secondhand smoke avoidance by preteens living with smokers: to leave or stay? Addict Behav 2010; 35:989-94. [PMID: 20634003 PMCID: PMC2951386 DOI: 10.1016/j.addbeh.2010.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 05/04/2010] [Accepted: 06/14/2010] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is hazardous to children's health. Designing interventions to reduce exposure requires understanding children's behavior in the presence of smokers, yet little is known about this behavior. PURPOSE To determine whether children's avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model. METHOD Preteens aged 8-13 (N=358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person's smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multiple Logistic Regression was used to determine predictors of SHS avoidance. RESULTS Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking. DISCUSSION Most SHS exposure reduction interventions have targeted changes in smokers' behavior. Reductions can also be achieved by changing exposed nonsmokers' behavior, such as avoiding the exposure. Future studies should measure young people's SHS avoidance and test interventions to increase their avoidance practices.
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Affiliation(s)
- Ding Ding
- Center for Behavioral Epidemiology & Community Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, USA, 92123-4388
| | - Dennis R. Wahlgren
- Center for Behavioral Epidemiology & Community Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, USA, 92123-4388
| | - Sandy Liles
- Center for Behavioral Epidemiology & Community Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, USA, 92123-4388
| | - Jennifer A. Jones
- Center for Behavioral Epidemiology & Community Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, USA, 92123-4388
| | - Suzanne C. Hughes
- Center for Behavioral Epidemiology & Community Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, USA, 92123-4388
| | - Melbourne F. Hovell
- Center for Behavioral Epidemiology & Community Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA, USA, 92123-4388
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81
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Lin PL, Huang HL, Lu KY, Chen T, Lin WT, Lee CH, Hsu HM. Second-hand smoke exposure and the factors associated with avoidance behavior among the mothers of pre-school children: a school-based cross-sectional study. BMC Public Health 2010; 10:606. [PMID: 20942977 PMCID: PMC2972241 DOI: 10.1186/1471-2458-10-606] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2010] [Accepted: 10/14/2010] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Second-hand Smoke (SHS) exposure is a significant public health problem that may be responsible for serious health hazards for child. This study aimed to examine the exposure status of SHS and the factors associated with SHS avoidance behavior among the mothers of pre-school children. METHODS A cross-sectional study was used to obtain a sample of the mothers of pre-school children (n = 1,020) in 30 registered kindergartens in eastern Taiwan. Overall, 919 (a response rate of 90%) completed the questionnaires. Regression models were used to identify factors with respect to the avoidance behavior of SHS. RESULTS The prevalence of exposure to SHS was 70% and 50% for the mothers and their children, respectively. After adjusting for other variables, mothers who were current smokers (β = -0.260, p < 0.001), had spouses who smoked (β = -0.060, p < 0.05), SHS exposure (β = -0.138, p < 0.001), and/or children with exposure to SHS (β = -0.084, p < 0.05) were found to be less likely to avoid SHS, whereas mothers with a high knowledge score about SHS (β = 0.082, p < 0.01), positive attitudes (β = 0.274, p < 0.001) and a high self-efficacy level in regard to the avoidance of SHS (β = 0.397, p < 0.001) were observed to be more likely to avoid SHS. Regression analyses confirmed that the significantly factors associated with the avoidance behavior of SHS were self-efficacy, being a current smoker, and the attitude toward the avoidance of SHS to be that of 55.5% of the total variance explained (p < 0.001). CONCLUSIONS The high prevalence rate of exposure to SHS for mothers and their children suggests that a well-designed future intervention program should be implemented in regard to pre-school children's mothers in order to prevent these mothers and their children from SHS exposure hazards, more particularly, to strengthen the knowledge base, to enhance self-efficacy and to foster a more positive attitude toward the avoidance of SHS in the mothers.
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Affiliation(s)
- Pi-Li Lin
- Department of Public Health, Tzu Chi University, Hualien, 97004, Taiwan
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Ayers JW, Hofstetter CR, Hughes SC, Park H, Paik HY, Irvin VL, Lee J, Juon HS, Latkin C, Hovell MF. Smoking on both sides of the pacific: home smoking restrictions and secondhand smoke exposure among Korean adults and children in Seoul and California. Nicotine Tob Res 2010; 12:1142-50. [PMID: 20924042 DOI: 10.1093/ntr/ntq164] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study, informed by ecological frameworks, compared the prevalence, predictors, and association of home smoking restrictions with secondhand smoke exposure (SHSe) between Koreans in Seoul, South Korea, and Korean Americans in California, United States. METHODS A cross-sectional survey was drawn from telephone interviews with Korean adults in Seoul (N = 500) and California (N = 2,830) during 2001-02. Multivariable regressions were used for analyses. RESULTS Koreans, compared with Korean Americans, had significantly fewer complete home smoking bans, 19% (95% CI: 16-23) versus 66% (95% CI: 64-68), and were more likely to not have a home smoking restriction, 64% (95% CI: 60-69) versus 5% (95% CI: 4-6). Home smoking restrictions were associated with lower home SHSe; however, the impact was consistently larger among Korean Americans. Households with more SHSe sources were less likely to have the strongest home smoking restrictions, where the difference in complete bans among Korean Americans versus Koreans was largely among those at low risk of SHSe, 82% (95% CI: 76-86) versus 36% (95% CI: 17-57), while high-risk Korean American and Koreans had similar low probabilities, 10% (95% CI: 7-13) versus 7% (95% CI: 3-13). CONCLUSIONS Consistent with ecological frameworks, exposure to California's antismoking policy and culture was associated with stronger home smoking restrictions and improved effectiveness. Interventions tailored to Korean and Korean American SHSe profiles are needed. Behavioral interventions specifically for high-risk Korean Americans and stronger policy controls for Koreans may be effective at rapidly expanding home smoking restrictions.
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Affiliation(s)
- John W Ayers
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bandiera FC, Caban-Martinez AJ, Arheart KL, Davila EP, Fleming LE, Dietz NA, Lewis JE, Fabry D, Lee DJ. Secondhand smoke policy and the risk of depression. Ann Behav Med 2010; 39:198-203. [PMID: 20354832 DOI: 10.1007/s12160-010-9174-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Banning smoking in work and public settings leads to immediate reductions in disease burden. However, no previous studies have looked specifically at the impact smoking bans may have on depression. METHODS The 2006 Behavioral Risk Factor Surveillance System (BRFSS) uses a cross-sectional design representative of the non-institutionalized civilian US population. Never smoker survey participants > or =18 years of age were selected from the BRFSS (n = 41,904) with their self-report of depressive symptoms in the last 2 weeks, as assessed by the Patient Health Questionnaire. Models with adjustment for survey design, sociodemographics, alcohol consumption, and work and home smoking policies were considered. RESULTS Following covariate adjustment, the risk of major depression was significantly higher for those living where smoking was allowed anywhere in the home versus those living in homes with complete smoking bans and in those who indicated that smoking was permitted in their work areas versus those reporting complete workplace smoking bans. CONCLUSIONS Findings from the present analysis support policies that ban smoking in all workplace settings. Interventions designed to eliminate smoking in the home are also needed.
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Affiliation(s)
- Frank C Bandiera
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, P.O. Box 016069 (D-4-11), Miami, FL 33101, USA
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Ayers JW, Hofstetter CR, Hughes SC, Park HR, Paik HY, Song YJ, Irvin V, Hovell MF. Gender modifies the relationship between social networks and smoking among adults in Seoul, South Korea. Int J Public Health 2010; 55:609-17. [PMID: 20217178 PMCID: PMC2992131 DOI: 10.1007/s00038-010-0126-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 10/19/2009] [Accepted: 01/20/2010] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the interaction of gender with social network mechanisms and smoking behaviors in Seoul, South Korea, where smoking is common among men but not women. METHODS During 2002, telephone surveys were completed with 500 adults drawn from a probability sample in Seoul. Respondents described their smoking status, smoking rate (number of cigarettes smoked per day) and social networks by assessing who discouraged or encouraged smoking (smoking support) or smoked (smoking models). Multivariable regressions were used for analyses. RESULTS Women encountered significantly less smoking support than men, 88% (95% confidence interval [95% CI], 85-91) versus 70% (95% CI 66-73) net discouragement of smoking in their network. A difference in smoking support from 25 to 75% net discouragement was associated with a 27% (95% CI 9-49) lower probability of smoking among women, significantly stronger (z = 3.18, p < 0.01) than among men who had a 19% (95% CI 8-27) lower probability of smoking. A similar difference in smoking support was associated with male smokers smoking 6.38 (95% CI 0.86-12.30) fewer cigarettes per day, or 2,329 (95% CI 314-4,490) fewer cigarettes per year. The later association could not be observed among women due to the small proportion of female smokers. Smoking models were not significantly associated with any smoking behaviors across genders. CONCLUSIONS Social network mechanisms were differentially associated with the high smoking prevalence among men and low prevalence among women and should be targeted by interventions tailored to these differences.
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Affiliation(s)
- John W Ayers
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
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Liles S, Hovell MF, Matt GE, Zakarian JM, Jones JA. Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships. Nicotine Tob Res 2009; 11:1395-406. [PMID: 19875763 PMCID: PMC2784488 DOI: 10.1093/ntr/ntp149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 08/07/2009] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This study explored predictors of smoking quit attempts in a sample of low-income smoking mothers who participated in a randomized trial of a 6-month, 14-session counseling intervention to decrease their children's secondhand smoke exposure (SHSe) and eliminate smoking. METHODS Measures were taken at baseline and at 3, 6, 12, and 18 months on 150 mothers who exposed their children (aged <4 years) to > or = 10 cigarettes/week in the home. Reported 7-day quits were verified by saliva cotinine or urine anabasine and anatabine levels. RESULTS There were few quits longer than 6 months. Mothers in the counseling group reported more 24-hr quits (p = .019) and more 7-day quits (p = .029) than controls. Multivariate modeling revealed that having quit for at least 24 hr in the year prior to baseline and the number of alternative cessation methods ever tried were predictive of the longest quit attempt during the 18-month study. Mothers in the counseling group who at baseline felt SHSe posed a health risk for their children or who at baseline had more permissive home smoking policies had longer quit attempts. DISCUSSION Results confirm that attempts to quit smoking predict additional quit attempts. This suggests that practice may be necessary for many people to quit smoking permanently. Findings of interaction analyses suggest that participant factors may alter the effects of treatment procedures. Failure to account for or employ such factors in the analysis or design of community trials could confound the results of intervention trials.
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Affiliation(s)
- Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA 92123, USA
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