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Myers V, Shiloh S, Zucker DM, Rosen LJ. Changing Exposure Perceptions: A Randomized Controlled Trial of an Intervention with Smoking Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3349. [PMID: 32408551 PMCID: PMC7277098 DOI: 10.3390/ijerph17103349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022]
Abstract
Children who live with smokers are at risk of poor health, and of becoming smokers themselves. Misperceptions of the nature of tobacco smoke exposure have been demonstrated among parents, resulting in continued smoking in their children's environment. This study aimed to change parents' perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children's exposure [NIH registry (NCT02867241)]. One hundred and fifty-nine families with a child < 8 years and at least one smoking parent were randomized into intervention (69), control (70), and enhanced control (20) groups. Reported exposure, parental smoking details, and a child hair sample were obtained at the start of the study and 6-8 months later. Parental perceptions of exposure (PPE) were assessed via a questionnaire. The intervention consisted of motivational interviews, feedback of home air quality and child's hair nicotine level, and information brochures. PPE were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = -3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered. By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children.
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Affiliation(s)
- Vicki Myers
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel;
| | - Shoshana Shiloh
- School of Psychological Sciences, Gershon H. Gordon Faculty of Social Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel;
| | - David M. Zucker
- Department of Statistics, Hebrew University, Mount Scopus, Jerusalem 9190501, Israel;
| | - Laura J. Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv 6997801, Israel;
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Behbod B, Sharma M, Baxi R, Roseby R, Webster P. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane Database Syst Rev 2018; 1:CD001746. [PMID: 29383710 PMCID: PMC6491082 DOI: 10.1002/14651858.cd001746.pub4] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Children's exposure to other people's tobacco smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children in child care or educational settings are also at risk of exposure to ETS. Preventing exposure to ETS during infancy and childhood has significant potential to improve children's health worldwide. OBJECTIVES To determine the effectiveness of interventions designed to reduce exposure of children to environmental tobacco smoke, or ETS. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), and the Social Science Citation Index & Science Citation Index (Web of Knowledge). We conducted the most recent search in February 2017. SELECTION CRITERIA We included controlled trials, with or without random allocation, that enrolled participants (parents and other family members, child care workers, and teachers) involved in the care and education of infants and young children (from birth to 12 years of age). All mechanisms for reducing children's ETS exposure were eligible, including smoking prevention, cessation, and control programmes. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies and extracted data. Due to heterogeneity of methods and outcome measures, we did not pool results but instead synthesised study findings narratively. MAIN RESULTS Seventy-eight studies met the inclusion criteria, and we assessed all evidence to be of low or very low quality based on GRADE assessment. We judged nine studies to be at low risk of bias, 35 to have unclear overall risk of bias, and 34 to have high risk of bias. Twenty-one interventions targeted populations or community settings, 27 studies were conducted in the well-child healthcare setting and 26 in the ill-child healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether visits were made to well- or ill-children, and another included visits to both well- and ill-children. Forty-five studies were reported from North America, 22 from other high-income countries, and 11 from low- or middle-income countries. Only 26 of the 78 studies reported a beneficial intervention effect for reduction of child ETS exposure, 24 of which were statistically significant. Of these 24 studies, 13 used objective measures of children's ETS exposure. We were unable to pinpoint what made these programmes effective. Studies showing a significant effect used a range of interventions: nine used in-person counselling or motivational interviewing; another study used telephone counselling, and one used a combination of in-person and telephone counselling; three used multi-component counselling-based interventions; two used multi-component education-based interventions; one used a school-based strategy; four used educational interventions, including one that used picture books; one used a smoking cessation intervention; one used a brief intervention; and another did not describe the intervention. Of the 52 studies that did not show a significant reduction in child ETS exposure, 19 used more intensive counselling approaches, including motivational interviewing, education, coaching, and smoking cessation brief advice. Other interventions consisted of brief advice or counselling (10 studies), feedback of a biological measure of children's ETS exposure (six studies), nicotine replacement therapy (two studies), feedback of maternal cotinine (one study), computerised risk assessment (one study), telephone smoking cessation support (two studies), educational home visits (eight studies), group sessions (one study), educational materials (three studies), and school-based policy and health promotion (one study). Some studies employed more than one intervention. 35 of the 78 studies reported a reduction in ETS exposure for children, irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure but rather sought to reduce symptoms of asthma, and found a significant reduction in symptoms among the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions. AUTHORS' CONCLUSIONS A minority of interventions have been shown to reduce children's exposure to environmental tobacco smoke and improve children's health, but the features that differentiate the effective interventions from those without clear evidence of effectiveness remain unclear. The evidence was judged to be of low or very low quality, as many of the trials are at a high risk of bias, are small and inadequately powered, with heterogeneous interventions and populations.
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Affiliation(s)
- Behrooz Behbod
- University of OxfordNuffield Department of Population HealthOxfordUK
- University of Nicosia Medical SchoolDepartment of Primary Care and Population HealthNicosiaCyprus
| | - Mohit Sharma
- University of OxfordNuffield Department of Population HealthOxfordUK
| | - Ruchi Baxi
- University of OxfordNuffield Department of Population HealthOxfordUK
| | - Robert Roseby
- Monash Children's HospitalClaytonMelbourneVictoriaAustralia
| | - Premila Webster
- University of OxfordNuffield Department of Population HealthOxfordUK
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Rosen LJ, Myers V, Winickoff JP, Kott J. Effectiveness of Interventions to Reduce Tobacco Smoke Pollution in Homes: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:16043-59. [PMID: 26694440 PMCID: PMC4690974 DOI: 10.3390/ijerph121215038] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 12/03/2015] [Accepted: 12/09/2015] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Smoke-free homes can help protect children from tobacco smoke exposure (TSE). The objective of this study was to conduct a meta-analysis to quantify effects of interventions on changes in tobacco smoke pollution in the home, as measured by air nicotine and particulate matter (PM). METHODS We searched MEDLINE, PubMed, Web of Science, PsycINFO, and Embase. We included controlled trials of interventions which aimed to help parents protect children from tobacco smoke exposure. Two reviewers identified relevant studies, and three reviewers extracted data. RESULTS Seven studies were identified. Interventions improved tobacco smoke air pollution in homes as assessed by nicotine or PM. (6 studies, N = 681, p = 0.02). Analyses of air nicotine and PM separately also showed some benefit (Air nicotine: 4 studies, N = 421, p = 0.08; PM: 3 studies, N = 340, p = 0.02). Despite improvements, tobacco smoke pollution was present in homes in all studies at follow-up. CONCLUSIONS Interventions designed to protect children from tobacco smoke are effective in reducing tobacco smoke pollution (as assessed by air nicotine or PM) in homes, but contamination remains. The persistence of significant pollution levels in homes after individual level intervention may signal the need for other population and regulatory measures to help reduce and eliminate childhood tobacco smoke exposure.
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Affiliation(s)
- Laura J Rosen
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv 69978, Israel.
| | - Vicki Myers
- School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, P.O.B. 39040, Ramat Aviv 69978, Israel.
| | - Jonathan P Winickoff
- Massachusetts General Hospital and Harvard Medical School, Boston, MA 02451-1137, USA.
| | - Jeff Kott
- Sackler School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, P.O.B 39040, Ramat Aviv 69978, Israel.
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Interventions to reduce harm from smoking with families in infancy and early childhood: a systematic review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:3091-119. [PMID: 25785496 PMCID: PMC4377954 DOI: 10.3390/ijerph120303091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/03/2015] [Accepted: 03/05/2015] [Indexed: 01/15/2023]
Abstract
Exposure to adult smoking can have deleterious effects on children. Interventions that assist families with smoking cessation/reduction and environmental tobacco smoke (ETS) avoidance can improve child health outcomes and reduce the risk of smoking initiation. The purpose of this review was to describe the state of the science of interventions with families to promote smoke-free home environments for infants and young children, including parent smoking reduction and cessation interventions, ETS reduction, and anti-smoking socialisation interventions, using the socio-ecological framework as a guide. A systematic review of peer-reviewed articles identified from journal databases from 2000 to 2014 was undertaken. Of 921 articles identified, 28 were included in the review. Considerable heterogeneity characterised target populations, intervention types, complexity and intensity, precluding meta-analysis. Few studies used socio-ecological approaches, such as family theories or concepts. Studies in early parenthood (child age newborn to one year) tended to focus on parent smoking cessation, where studies of families with children aged 1-5 years were more likely to target household SHSe reduction. Results suggest that interventions for reduction in ETS may be more successful than for smoking cessation and relapse prevention in families of children aged less than 5 years. There is a need for a range of interventions to support families in creating a smoke free home environment that are both tailored and targeted to specific populations. Interventions that target the social and psychodynamics of the family should be considered further, particularly in reaching vulnerable populations. Consideration is also required for approaches to interventions that may further stigmatise families containing smokers. Further research is required to identify successful elements of interventions and the contexts in which they are most effective.
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Rosen LJ, Myers V, Hovell M, Zucker D, Ben Noach M. Meta-analysis of parental protection of children from tobacco smoke exposure. Pediatrics 2014; 133:698-714. [PMID: 24664094 DOI: 10.1542/peds.2013-0958] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE. METHODS Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed. RESULTS Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20). CONCLUSIONS Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.
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Johansson A, Carlsson N, Almfors H, Rosèn M, Alehagen S. Parents' experiences of participating in an intervention on tobacco prevention in Child Health Care. BMC Pediatr 2014; 14:69. [PMID: 24612749 PMCID: PMC3975308 DOI: 10.1186/1471-2431-14-69] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 02/13/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Child health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents' experiences from participating in a nursebased tobacco prevention intervention. METHODS Eleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process. RESULTS The analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents' smoking. CONCLUSION The clinical implication is that CHC is an important arena for preventive work aiming to minimize children's tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.
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Affiliation(s)
- AnnaKarin Johansson
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping SE58183, Sweden
| | - Noomi Carlsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Linköping University, Linköping, Sweden
- Department of Public Health and Medical Care, Jönköping County Council, SE-551 11, Box 1024 Jönköping, Sweden
| | - Helena Almfors
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping SE58183, Sweden
| | - Monica Rosèn
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping SE58183, Sweden
| | - Siw Alehagen
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, Linköping SE58183, Sweden
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Baxi R, Sharma M, Roseby R, Polnay A, Priest N, Waters E, Spencer N, Webster P. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane Database Syst Rev 2014:CD001746. [PMID: 24671922 DOI: 10.1002/14651858.cd001746.pub3] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Children's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children are also at risk of exposure to ETS in child care or educational settings. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide. OBJECTIVES To determine the effectiveness of interventions aiming to reduce exposure of children to ETS. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialized Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, CINAHL, ERIC, and The Social Science Citation Index & Science Citation Index (Web of Knowledge). Date of the most recent search: September 2013. SELECTION CRITERIA Controlled trials with or without random allocation. Interventions must have addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0 to 12 years). All mechanisms for reduction of children's ETS exposure, and smoking prevention, cessation, and control programmes were included. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcome measures, no summary measures were possible and results were synthesised narratively. MAIN RESULTS Fifty-seven studies met the inclusion criteria. Seven studies were judged to be at low risk of bias, 27 studies were judged to have unclear overall risk of bias and 23 studies were judged to have high risk of bias. Seven interventions were targeted at populations or community settings, 23 studies were conducted in the 'well child' healthcare setting and 24 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether the visits were to well or ill children, and another included both well and ill child visits. Thirty-six studies were from North America, 14 were in other high income countries and seven studies were from low- or middle-income countries. In only 14 of the 57 studies was there a statistically significant intervention effect for child ETS exposure reduction. Of these 14 studies, six used objective measures of children's ETS exposure. Eight of the studies had a high risk of bias, four had unclear risk of bias and two had a low risk of bias. The studies showing a significant effect used a range of interventions: seven used intensive counselling or motivational interviewing; a further study used telephone counselling; one used a school-based strategy; one used picture books; two used educational home visits; one used brief intervention and one study did not describe the intervention. Of the 42 studies that did not show a significant reduction in child ETS exposure, 14 used more intensive counselling or motivational interviewing, nine used brief advice or counselling, six used feedback of a biological measure of children's ETS exposure, one used feedback of maternal cotinine, two used telephone smoking cessation advice or support, eight used educational home visits, one used group sessions, one used an information kit and letter, one used a booklet and no smoking sign, and one used a school-based policy and health promotion. In 32 of the 57 studies, there was reduction of ETS exposure for children in the study irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure, but rather aimed to reduce symptoms of asthma, and found a significant reduction in symptoms in the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions. AUTHORS' CONCLUSIONS While brief counselling interventions have been identified as successful for adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. Although several interventions, including parental education and counselling programmes, have been used to try to reduce children's tobacco smoke exposure, their effectiveness has not been clearly demonstrated. The review was unable to determine if any one intervention reduced parental smoking and child exposure more effectively than others, although seven studies were identified that reported motivational interviewing or intensive counselling provided in clinical settings was effective.
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Affiliation(s)
- Ruchi Baxi
- Nuffield Department of Population Health, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, UK, OX3 7LG
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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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Chen YT, Hsiao FH, Miao NF, Chen PL. Factors associated with parents’ perceptions of parental smoking in the presence of children and its consequences on children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:192-209. [PMID: 23296207 PMCID: PMC3564137 DOI: 10.3390/ijerph10010192] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 11/08/2012] [Accepted: 12/28/2012] [Indexed: 11/16/2022]
Abstract
Parental smoking is the major source of children’s secondhand smoke exposure and is influenced by parents’ perception of children’s exposure. However, the factors associated with these perceptions remain unclear. The objective of this study was to examine factors associated with parents’ perceptions about parental smoking in the presence of children and its consequences. We conducted a cross-sectional study on parents’ perceptions of parental smoking and measured their evaluations of its consequences using a self-report questionnaire. Other variables include socio-demographic characteristics and smoking-related experience. Results show that parents’ gender, education level, occupational type, smoking status, and agreement on a home smoking ban independently predict parents’ evaluation of the consequences of parental smoking in the presence of children. Parents’ gender, education level, annual family income, smoking status, agreement on a home smoking ban, and evaluation of the consequences of parental smoking independently predicted parents’ perceptions. Findings indicated that a specific group expressed greater acceptance of parental smoking and was less aware of its risks. Motivating parents to create a smoke-free home and increasing awareness of the adverse consequences of parental smoking is beneficial in reinforcing attitudes opposed to parental smoking.
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Affiliation(s)
- Yu-Ting Chen
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei City 110, Taiwan; E-Mail:
- School of Nursing, College of Medicine, Chang-Gung University, No. 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan 333, Taiwan
| | - Fei-Hsiu Hsiao
- Department of Nursing, College of Medicine, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 10617, Taiwan; E-Mail:
| | - Nae-Fang Miao
- School of Nursing, College of Nursing, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei City 110, Taiwan; E-Mail:
| | - Ping-Ling Chen
- Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei City 110, Taiwan
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +886-223-771-379; Fax: +886-223-772-842
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Wilson I, Semple S, Mills LM, Ritchie D, Shaw A, O'Donnell R, Bonella P, Turner S, Amos A. REFRESH--reducing families' exposure to secondhand smoke in the home: a feasibility study. Tob Control 2012; 22:e8. [PMID: 22615325 DOI: 10.1136/tobaccocontrol-2011-050212] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To study a novel intervention (REFRESH) aimed at reducing children's exposure to secondhand smoke (SHS) in their homes. DESIGN A randomised feasibility study. SETTING Aberdeen City and Aberdeenshire. PARTICIPANTS A total of 59 smoking mothers with at least one child younger than 6 years. Participation took place between July 2010 and March 2011. INTERVENTION Four home visits over a 1-month period, which involved two 24-h measurements of home air quality (PM2.5) and a motivational interview to encourage changes to smoking behaviour within the home in order to reduce child SHS exposure. The enhanced group received their air quality data as part of their motivational interview at visit 2; the control group received that information at visit 4. MAIN OUTCOME MEASURES The main outcome measures were comparisons of the data from visits 2 and 4 on the 24-h average concentration of PM2.5, the peak concentration of PM2.5, the percentage of time when household PM2.5 concentrations exceeded a health-based threshold of 35 μg/m(3) and child's salivary cotinine (in nanograms per millilitre). The views of the mothers from the enhanced group about their understanding of the intervention and the measures used were also analysed to assess the acceptability and utility of the intervention. RESULTS Of the recruited 54 participants, 48 completed the study: 27 from the control group and 21 from the enhanced group. Both groups experienced reductions in PM2.5 concentrations. When testing paired samples for the enhanced group, there was a significant difference (p<0.05) between visit 2 and visit 4 values for maximum PM2.5 (p=0.006) and for percentage of time over 35 μg/m(3) (p=0.017), with average PM2.5 approaching significance (p=0.056). There was no significant difference for salivary cotinine. The qualitative findings showed that mothers were able to understand the data they were shown and were shocked by the values measured in their homes despite being aware of the effects of SHS exposure. They appreciated the intervention taking place in their homes as it allowed them to have personalised data. Many mothers described how they had changed their smoking behaviours in their home and in particular were motivated to protect their own children as a result of the knowledge they had gained. CONCLUSIONS Providing mothers who smoke with personalised results about the indoor air quality of their homes along with a motivational interview is feasible and has an effect on improving household air quality. Participants found the intervention understandable and acceptable. Taken overall, the results suggest that a future large-scale trial using measurements of indoor air quality as part of a complex intervention to reduce children's SHS exposure should be explored.
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Affiliation(s)
- Inga Wilson
- Department of Environmental and Occupational Medicine, University of Aberdeen, Aberdeen, UK
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Abstract
BACKGROUND Many women stop smoking during pregnancy. Factors associated with relapse are known, but no intervention prevents the return to smoking among pregnant women. The objective of this study was to determine why women return to smoking after prolonged abstinence during pregnancy by examining mothers' intention to smoke at the time of delivery and the perceptions that shape their intention. METHODS We conducted in-depth, semi-structured interviews during their postpartum hospital stay with 24 women who stopped smoking while pregnant. We asked participants whether they intended to resume smoking after pregnancy and why. Transcripts were analyzed using grounded theory-based qualitative methods to identify themes. RESULTS Participants ranged in age from 18 to 36 years, and 63 percent were white. Three themes emerged from the interviews with the mothers: 1) they did not intend to return to smoking but doubted whether they would be able to maintain abstinence; 2) they believed that it would be possible to protect their newborns from the harms of cigarette smoke; and 3) they felt that they had control over their smoking and did not need help to maintain abstinence after pregnancy. CONCLUSIONS Although most participants did not intend to resume smoking, their intentions may be stymied by their perceptions about second-hand smoke and by their overestimation of their control over smoking. Further study should quantify these barriers and determine their evolution over the first year after pregnancy with the goal of informing more successful, targeted interventions.
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Affiliation(s)
- Isabelle Von Kohorn
- Isabelle Von Kohorn is a Program Officer at the Institute of Medicine, Washington, DC, United States of America
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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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Carlsson N, Alehagen S, Andersson Gäre B, Johansson A. "Smoking in Children's Environment Test": a qualitative study of experiences of a new instrument applied in preventive work in child health care. BMC Pediatr 2011; 11:113. [PMID: 22172056 PMCID: PMC3267672 DOI: 10.1186/1471-2431-11-113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 12/15/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite knowledge of the adverse health effects of passive smoking, children are still being exposed. Children's nurses play an important role in tobacco preventive work through dialogue with parents aimed at identifying how children can be protected from environmental tobacco smoke (ETS) exposure. The study describes the experiences of Child Health Care (CHC) nurses when using the validated instrument SiCET (Smoking in Children's Environment Test) in dialogue with parents. METHOD In an intervention in CHC centres in south-eastern Sweden nurses were invited to use the SiCET. Eighteen nurses participated in focus group interviews. Transcripts were reviewed and their contents were coded into categories by three investigators using the method described for focus groups interviews. RESULTS The SiCET was used in dialogue with parents in tobacco preventive work and resulted in focused discussions on smoking and support for behavioural changes among parents. The instrument had both strengths and limitations. The nurses experienced that the SiCET facilitated dialogue with parents and gave a comprehensive view of the child's ETS exposure. This gave nurses the possibility of taking on a supportive role by offering parents long-term help in protecting their child from ETS exposure and in considering smoking cessation. CONCLUSION Our findings indicate that the SiCET supports nurses in their dialogue with parents on children's ETS exposure at CHC. There is a need for more clinical use and evaluation of the SiCET to determine its usefulness in clinical practice under varying circumstances.
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Affiliation(s)
- Noomi Carlsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Department of Public Health and Medical Care, Jönköping County Council, Box 1024, SE-551 11 Jönköping, Sweden
| | - Siw Alehagen
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
| | - Boel Andersson Gäre
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
- Futurum - the Academy for Healthcare, Jönköping County Council, SE-551 85 Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11 Jönköping, Sweden
| | - AnnaKarin Johansson
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 83 Linköping, Sweden
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Carlsson N, Johansson A, Hermansson G, Andersson-Gäre B. Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care. J Child Health Care 2011; 15:272-86. [PMID: 21078698 DOI: 10.1177/1367493510382243] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to describe parents' attitudes to smoking and their experience of the tobacco preventive work in antenatal care and in Child Health Care (CHC) in Sweden. A population based survey in which 62 percent of 3000 randomly selected parents with 1- and 3-year-old children answered a questionnaire. Fifty-six percent stated that smoking was registered in the health record of the child yet no further discussion regarding passive smoking took place. The parents' educational level and smoking status was related to the attitudes and experiences of the tobacco preventive work. The results indicated that the dialogue with parents regarding children and environmental tobacco smoke (ETS) exposure has to be redesigned and intensified in order to meet the needs of parents with different backgrounds.
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Affiliation(s)
- Noomi Carlsson
- Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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15
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Efraimsson EÖ, Fossum B, Ehrenberg A, Larsson K, Klang B. Use of motivational interviewing in smoking cessation at nurse-led chronic obstructive pulmonary disease clinics. J Adv Nurs 2011; 68:767-82. [DOI: 10.1111/j.1365-2648.2011.05766.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Heard TR, Daly JB, Bowman JA, Freund MAG, Wiggers JH. A cross-sectional survey of the prevalence of environmental tobacco smoke preventive care provision by child health services in Australia. BMC Public Health 2011; 11:324. [PMID: 21575273 PMCID: PMC3121628 DOI: 10.1186/1471-2458-11-324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 05/17/2011] [Indexed: 11/16/2022] Open
Abstract
Background Despite the need for a reduction in levels of childhood exposure to environmental tobacco smoke (ETS) being a recognised public health goal, the delivery of ETS preventive care in child health service settings remains a largely unstudied area. The purpose of this study was to determine the prevalence of ETS preventive care in child health services; differences in the provision of care by type of service; the prevalence of strategies to support such care; and the association between care support strategies and care provision. Method One-hundred and fifty-one (83%) child health service managers within New South Wales, Australia completed a questionnaire in 2002 regarding the: assessment of parental smoking and child ETS exposure; the provision of parental smoking cessation and ETS-exposure reduction advice; and strategies used to support the provision of such care. Child health services were categorised based on their size and case-mix, and a chi-square analysis was performed to compare the prevalence of ETS risk assessment and ETS prevention advice between service types. Logistic regression analysis was used to examine associations between the existence of care support strategies and the provision of ETS risk assessment and ETS exposure prevention advice. Results A significant proportion of services reported that they did not assess parental smoking status (26%), and reported that they did not assess the ETS exposure (78%) of any child. Forty four percent of services reported that they did not provide smoking cessation advice and 20% reported they did not provide ETS exposure prevention advice. Community based child and family health services reported a greater prevalence of ETS preventive care compared to other hospital based units. Less than half of the services reported having strategies to support the provision of ETS preventive care. The existence of such support strategies was associated with greater odds of care provision. Conclusions The existence of major gaps in recommended ETS preventive care provision suggests a need for additional initiatives to increase such care delivery. The low prevalence of strategies that support such care delivery suggests a potential avenue to achieve this outcome.
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Affiliation(s)
- Todd R Heard
- Hunter New England Population Health, New South Wales Department of Health, Australia, Wallsend, NSW, Australia.
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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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Baxter S, Blank L, Everson-Hock ES, Burrows J, Messina J, Guillaume L, Goyder E. The effectiveness of interventions to establish smoke-free homes in pregnancy and in the neonatal period: a systematic review. HEALTH EDUCATION RESEARCH 2011; 26:265-282. [PMID: 21273185 DOI: 10.1093/her/cyq092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This review considers the effectiveness of interventions to encourage the establishment of smoke-free homes during pregnancy and the neonatal period. A comprehensive search of the literature was undertaken to find relevant studies via electronic databases, citations and reference lists of included studies. The searches identified 17 papers that met the inclusion criteria. These were quality assessed and data extracted. Due to heterogeneity of the papers, a narrative synthesis was completed. Interventions were categorized in terms of those based on counselling, counselling plus additional elements, individually adapted programmes and motivational interviewing. The findings suggest inconclusive evidence relating to these intervention types, with a range of outcome measures reported. There were limitations throughout the papers in terms of study quality (especially sample size) and poor reporting of results in relation to effectiveness. The review was limited by its very specific population; however, it suggests that currently there is mixed evidence for the effectiveness of interventions to reduce parental environmental tobacco smoke in early infancy.
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Affiliation(s)
- Susan Baxter
- Section of Public Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Ortega G, Castellà C, Martín-Cantera C, Ballvé JL, Díaz E, Saez M, Lozano J, Rofes L, Morera C, Barceló A, Cabezas C, Pascual JA, Pérez-Ortuño R, Saltó E, Valverde A, Jané M. Passive smoking in babies: the BIBE study (Brief Intervention in babies. Effectiveness). BMC Public Health 2010; 10:772. [PMID: 21171981 PMCID: PMC3019194 DOI: 10.1186/1471-2458-10-772] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 12/20/2010] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is evidence that exposure to passive smoking in general, and in babies in particular, is an important cause of morbimortality. Passive smoking is related to an increased risk of pediatric diseases such as sudden death syndrome, acute respiratory diseases, worsening of asthma, acute-chronic middle ear disease and slowing of lung growth.The objective of this article is to describe the BIBE study protocol. The BIBE study aims to determine the effectiveness of a brief intervention within the context of Primary Care, directed to mothers and fathers that smoke, in order to reduce the exposure of babies to passive smoking (ETS). METHODS/DESIGN Cluster randomized field trial (control and intervention group), multicentric and open. SUBJECT Fathers and/or mothers who are smokers and their babies (under 18 months) that attend pediatric services in Primary Care in Catalonia.The measurements will be taken at three points in time, in each of the fathers and/or mothers who respond to a questionnaire regarding their baby's clinical background and characteristics of the baby's exposure, together with variables related to the parents' tobacco consumption. A hair sample of the baby will be taken at the beginning of the study and at six months after the initial visit (biological determination of nicotine). The intervention group will apply a brief intervention in passive smoking after specific training and the control group will apply the habitual care. DISCUSSION Exposure to ETS is an avoidable factor related to infant morbimortality. Interventions to reduce exposure to ETS in babies are potentially beneficial for their health.The BIBE study evaluates an intervention to reduce exposure to ETS that takes advantage of pediatric visits. Interventions in the form of advice, conducted by pediatric professionals, are an excellent opportunity for prevention and protection of infants against the harmful effects of ETS. TRIAL REGISTRATION Clinical Trials.gov Identifier: NCT00788996.
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Affiliation(s)
- Guadalupe Ortega
- Fundació Atenció Primaria, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | | | - Carlos Martín-Cantera
- ABS Barcelona, Pg. St. Joan, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Grupo Cardiocat de la Red REDIAPP, Barcelona, Spain
- USR Barcelona, IDIAP Jordi Gol, Barcelona, Spain
| | | | | | - Marc Saez
- Grup de Recerca en Estadística, Economía Aplicada i Salut (GRECS), Universitat de Girona, Girona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Juan Lozano
- Fundació Atenció Primaria, Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Lourdes Rofes
- Hospital Universitari de Sant Joan de Reus, Reus, Spain
| | - Concepció Morera
- Àrea d'Avaluació. Direcció d'Atenció Primària. ICS. Girona, Spain
| | - Antònia Barceló
- Grup de Recerca en Estadística, Economía Aplicada i Salut (GRECS), Universitat de Girona, Girona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Carmen Cabezas
- Direcció General de Salut Pública. Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Jose A Pascual
- Grup de Recerca en Bioanàlisi i Serveis analítics, IMIM, Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Grup de Recerca en Bioanàlisi i Serveis analítics, IMIM, Barcelona, Spain
| | - Esteve Saltó
- Direcció General de Salut Pública. Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Araceli Valverde
- Direcció General de Salut Pública. Department of Health, Generalitat de Catalunya, Barcelona, Spain
| | - Mireia Jané
- Direcció General de Salut Pública. Department of Health, Generalitat de Catalunya, Barcelona, Spain
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Effect of Postpartum Lifestyle Interventions on Weight Loss, Smoking Cessation, and Prevention of Smoking Relapse: A Systematic Review. Obstet Gynecol Surv 2010; 65:631-52. [DOI: 10.1097/ogx.0b013e3182077f64] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Zusammenfassung. Zur Erklärung von nichtraucherschützendem Verhalten wurde ein erweitertes Normaktivationsmodell angewendet und an einer Stichprobe von 131 rauchenden Studierenden als Strukturgleichungsmodell geprüft. Die Modellgütekriterien zeigen, dass das Modell die empirischen Daten befriedigend beschreibt. Neben den wahrgenommenen Fähigkeiten zum Nichtraucherschutz sind für die Erklärung von selbstberichtetem rücksichtsvollem Rauchverhalten auch persönliche Normen signifikante Prädiktoren. Persönliche Normen werden hauptsächlich durch Problemwahrnehmung und Bewusstheit von Handlungskonsequenzen sowie die wahrgenommenen Verhaltenskosten beeinflusst. Die Ergebnisse werden im Hinblick auf Interventionen diskutiert.
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Carlsson N, Johansson A, Hermansson G, Andersson-Gäre B. Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure. J Clin Nurs 2010; 19:507-16. [PMID: 19686317 DOI: 10.1111/j.1365-2702.2009.02847.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfare's national evaluation in 1997. BACKGROUND Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied. DESIGN Survey. METHODS In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study. RESULTS Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups. CONCLUSIONS Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions. RELEVANCE TO CLINICAL PRACTICE This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.
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Affiliation(s)
- Noomi Carlsson
- Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Connor Gorber S, Schofield-Hurwitz S, Hardt J, Levasseur G, Tremblay M. The accuracy of self-reported smoking: a systematic review of the relationship between self-reported and cotinine-assessed smoking status. Nicotine Tob Res 2009; 11:12-24. [PMID: 19246437 DOI: 10.1093/ntr/ntn010] [Citation(s) in RCA: 758] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Smoking is a leading cause of premature mortality and preventable morbidity. Surveillance is most often based on self-reported data, but studies have shown that self-reports tend to underestimate smoking status. METHODS This study systematically reviewed the literature to measure the concordance between self-reported smoking status and smoking status determined through measures of cotinine in biological fluids. Four electronic databases were searched to identify observational and experimental studies on adult populations over the age of 18 years. RESULTS Searching identified 67 studies that met the eligibility criteria and examined the relationship between self-reported smoking and smoking confirmed by cotinine measurement. Overall, the data show trends of underestimation when smoking prevalence is based on self-report and varying sensitivity levels for self-reported estimates depending on the population studied and the medium in which the biological sample is measured. Sensitivity values were consistently higher when cotinine was measured in saliva instead of urine or blood. Meta-analysis was not appropriate because of the substantial heterogeneity among the cutpoints used to define smokers and the poor reporting on outcomes of interest. DISCUSSION Further research in this field would benefit from the standardization of cutpoints to define current smokers and the implementation of standard reporting guidelines to enhance comparability across studies. Accurate estimation of smoking status is important as data from population studies such as those included in this review are used to generate regional and national estimates of smoking status and in turn are used to allocate resources and set health priorities.
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Affiliation(s)
- Sarah Connor Gorber
- Health Measures Analysis Section, Health Information and Research Division, Statistics Canada, 24th Floor R.H. Coats Building, 100 Tunney's Pasture Driveway, Ottawa, ON, Canada K1A 0T6.
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Johnson-Kozlow M, Hovell MF, Rovniak LS, Sirikulvadhana L, Wahlgren DR, Zakarian JM. Fidelity issues in secondhand smoking interventions for children. Nicotine Tob Res 2008; 10:1677-90. [PMID: 19023822 PMCID: PMC3533496 DOI: 10.1080/14622200802443429] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This paper reviews methodological and theoretical fidelity of secondhand smoking (SHS) intervention studies (n = 29) that target protection of children in their home. In 2005, interventions were evaluated in terms of treatment fidelity according to guidelines provided by Borrelli et al. of the National Institutes of Health Behavior Change Consortium. The degree of fidelity was evaluated based on the percentage of criteria met; the inter-rater reliability based on percent agreement across independent raters was 0.78. Analysis indicated that studies with higher treatment fidelity were more likely to obtain statistically significant results (p = .003) with the average fidelity rating of 0.74 for statistically significant studies vs. 0.50 for statistically non-significant studies. Higher treatment fidelity was also significantly associated with being a more recent investigation (year 2000 or later), an efficacy as compared to effectiveness trial, more intensive as compared to less intensive intervention, a trial in the U.S. as compared to foreign nations, and having a theoretical basis. After taking all other variables into account, only treatment fidelity was significantly related to study outcome (p = .052). Ratings of treatment fidelity were ranked and compared to previous rankings based on 342 behavioral change interventions; the rank-ordered correlation between previous and current ratings was 0.84, although median fidelity ratings were 0.10 points lower in the previous than in the present study (0.52 vs. 0.62; intraclass correlation = 0.79). Improvements to the treatment fidelity evaluation guidelines were suggested, including the consideration of theoretical fidelity. Enhancing methodological and theoretical fidelity will speed identification of valid theoretical precepts that will, in turn, guide effective public health prevention programs.
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Priest N, Roseby R, Waters E, Polnay A, Campbell R, Spencer N, Webster P, Ferguson-Thorne G. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane Database Syst Rev 2008:CD001746. [PMID: 18843622 DOI: 10.1002/14651858.cd001746.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide. OBJECTIVES To determine the effectiveness of interventions aiming to reduce exposure of children to ETS. SEARCH STRATEGY We searched the Cochrane Tobacco Addiction Group trials register and conducted additional searches of two health and education databases not included in this specialised register. Date of the most recent search: October 2007. SELECTION CRITERIA Interventions tested using controlled trials with or without random allocation were included in this review if the interventions addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children's environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes were included. These include smoke-free policies and legislation, health promotion, social-behavioural therapies, technology, education and clinical interventions. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries. MAIN RESULTS Thirty-six studies met the inclusion criteria. Four interventions were targeted at populations or community settings, 16 studies were conducted in the 'well child' healthcare setting and 13 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics do not make clear whether the visits are to well or ill children, and another includes both well and ill child visits. Nineteen of these studies are from North America and 12 in other high income countries. Five studies are from low- or middle-income countries. In 17 of the 36 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only 11 of the 36 studies was there a statistically significant intervention effect. Four of these successful studies employed intensive counselling interventions targeted to smoking parents. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. One successful intervention was in the school setting, targeting the ETS exposure of children from smoking fathers. AUTHORS' CONCLUSIONS While brief counselling interventions have been identified as successful ifor adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. However, there is limited support for more intensive counselling interventions for parents in such contexts. There is no clear evidence of differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children's ETS exposure.
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Affiliation(s)
- Naomi Priest
- McCaughey Centre, Melbourne School of Population Health, University of Melbourne, 5/207 Bouverie St, Parkville, VIC, Australia, 3052.
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Hyde J, Hankins M, Deale A, Marteau TM. Interventions to increase self-efficacy in the context of addiction behaviours: a systematic literature review. J Health Psychol 2008; 13:607-23. [PMID: 18519435 DOI: 10.1177/1359105308090933] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article describes the effectiveness of interventions aimed at increasing self-efficacy and consequently, changing addiction behaviours. Electronic databases were searched and bibliographies of retrieved references scanned. Ten studies targeting tobacco smoking, alcohol and illicit drug use met the inclusion criteria. The interventions ranged from computer-generated tailored letters to intensive group-based interventions. Seven of the 10 studies reported positive effects of interventions upon self-efficacy. The two that assessed behaviour change reported a significant effect but as neither performed mediation analyses, behaviour change could not reliably be attributed to self-efficacy change. In conclusion, self-efficacy can be increased using a range of methods. There is, however, little evidence to determine whether such increases change behaviour.
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Affiliation(s)
- J Hyde
- King's College London, UK
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Córdoba-García R, García-Sánchez N, Suárez López de Vergara RG, Galván Fernández C. [Exposure to environmental tobacco smoke in childhood]. An Pediatr (Barc) 2007; 67:101-3. [PMID: 17692253 DOI: 10.1016/s1695-4033(07)70568-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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28
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Levitt C, Shaw E, Wong S, Kaczorowski J. Systematic review of the literature on postpartum care: effectiveness of interventions for smoking relapse prevention, cessation, and reduction in postpartum women. Birth 2007; 34:341-7. [PMID: 18021150 DOI: 10.1111/j.1523-536x.2007.00194.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many women stop smoking during pregnancy and relapse again either later in the pregnancy or in the postpartum period. Smoking is harmful to mothers, and environmental tobacco smoke is harmful for children. This systematic review examined the published evidence for the effectiveness of postpartum interventions that prevent relapse (current persons who have stopped but start smoking again), improve cessation rates (current smokers who stop smoking), and reduce smoking (number of cigarettes smoked per day) in postpartum women. METHODS MEDLINE, CINAHL, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postpartum women. The initial literature search was done in 1999 and enhanced in 2003 and 2005. Randomized controlled trials that examined relapse prevention, smoking cessation, or smoking reduction interventions in the postpartum period were reviewed in this report. Data were extracted in a systematic manner, and the quality of each study was reviewed. RESULTS Five papers were published based on three trials for which data were extracted and summarized. Our review of these trials showed no statistically significant benefits of advice materials and counseling interventions in hospital (Vancouver), pediatricians' offices (Portland), or child health centers (Stockholm) on relapse prevention, cessation rates, or smoking reduction in the postpartum period. Although the interventions had little effect on the major smoking outcomes, some positive attitudinal and knowledge changes were reported. CONCLUSION This review found no evidence from the randomized controlled trial literature to date to support implementing postpartum smoking cessation interventions, such as providing advice materials and counseling, insofar as they were delivered in the trials reviewed.
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Affiliation(s)
- Cheryl Levitt
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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du Prel X, Krämer U, Ranft U. Time trends in exposure to environmental tobacco smoke and parental educational level for 6-year-old children in Germany. J Public Health (Oxf) 2006. [DOI: 10.1007/s10389-006-0054-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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30
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Evans W. Bibliography. HEALTH COMMUNICATION 2004; 16:507-515. [PMID: 15465693 DOI: 10.1207/s15327027hc1604_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- William Evans
- Department of Telecommunication & Film, University of Alabama, Tuscaloosa 35487-0172, USA.
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