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Berman T, Rorman E, Groisman L, Keinan-Boker L, Shimony T, Barnett-Itzhaki Z. Association between parental smoking and child exposure to environmental tobacco smoke in Israel. Isr J Health Policy Res 2023; 12:37. [PMID: 38115120 PMCID: PMC10731699 DOI: 10.1186/s13584-023-00585-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/19/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure in children can cause delayed lung development and lifelong cardiovascular damage. The aim of this study was to measure ETS exposure in children in Israel in 2020-2021 using urinary cotinine (UC) measurements and to assess correlates of ETS exposure, including parental smoking. METHODS In the framework of the National Human Biomonitoring Program, spot urine samples and questionnaire data were collected from 166 children aged 4-12 years, during the years 2020-2021. We collected urine samples in 233 adults, 69 of whom were parents of children included in the study. Parents of participating children were asked about parental smoking, child's exposure to ETS and smoking policy at home. Cotinine and creatinine were measured in urine. Creatinine-adjusted and unadjusted urine cotinine (UC) geometric means were calculated. Associations between potential correlates and UC concentrations were analyzed in univariate and multivariate analyses. For 69 child-parent pairs, correlation between child and parental UC was analyzed. RESULTS Based on urinary cotinine measurement, 65.2% of children of smokers are exposed to ETS, compared to 20.7% of children in non-smoking families. Greater numbers of smokers living in the home (beta = 1.27, p < 0.01), and low maternal education (beta = - 2.32, p < 0.01) were associated with higher levels of UC in a multivariate analysis. Spearman correlations showed a positive moderate correlation between UC in 69 child-parent pairs (r = 0.52, p < 0.01). CONCLUSIONS In order to reduce child exposure to ETS, smoking parents should be urgently targeted for smoking cessation and smoke-free home interventions. Further interventions are needed to protect all children from ETS.
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Affiliation(s)
- Tamar Berman
- Public Health Services, Ministry of Health, 39 Yirmiyahu Street, Jerusalem, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Efrat Rorman
- Public Health Services, Ministry of Health, 39 Yirmiyahu Street, Jerusalem, Israel
| | - Luda Groisman
- Public Health Services, Ministry of Health, 39 Yirmiyahu Street, Jerusalem, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Tal Shimony
- Israel Center for Disease Control, Israel Ministry of Health, Gertner Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Zohar Barnett-Itzhaki
- Public Health Services, Ministry of Health, 39 Yirmiyahu Street, Jerusalem, Israel.
- Faculty of Engineering, Ruppin Academic Center, Emek Hefer, Israel.
- Research Group in Environmental and Social Sustainability, Ruppin Academic Center, Emek Hefer, Israel.
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2
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Berg CJ, Dekanosidze A, Hayrumyan V, LoParco CR, Torosyan A, Grigoryan L, Bazarchyan A, Haardörfer R, Kegler MC. Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors. Eur J Public Health 2023; 33:864-871. [PMID: 37500602 PMCID: PMC10567255 DOI: 10.1093/eurpub/ckad129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. METHODS Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. RESULTS In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. CONCLUSIONS SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Cui Y, LoParco CR, Bar-Zeev Y, Duan Z, Levine H, Abroms LC, Wang Y, Khayat A, Berg CJ. Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study. Subst Abuse Treat Prev Policy 2023; 18:54. [PMID: 37674246 PMCID: PMC10483868 DOI: 10.1186/s13011-023-00562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND In the US and Israel, non-medical ('recreational') cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial. METHODS This mixed-methods study of adults in the US (n = 1,128) and Israel (n = 1,094) analyzed: 1) cross-sectional survey data (Fall 2021) to identify theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or among children if non-medical cannabis was legal, using multivariable regression; and 2) qualitative interviews regarding perceptions of cannabis policies and use (US n = 40, Israel n = 44). RESULTS 16.7% reported past-month use; 70.5%, 56.3%, and 82.6% indicated "not at all likely" regarding next-year use and use in the home and among children if legal. Lower perceived risk and greater social norms were associated with past-month use, greater use intentions, and greater intentions to use in the home or among children. Past-month use was more prevalent among US (vs. Israeli) participants (22.0% vs. 11.2%); however, in multivariable regression controlling for past-month use, being from Israel was associated with greater use intentions (next-year; in the home/among children). Qualitative themes indicated: concerns about use (e.g., increasing use, health risks, driving-related risks) and legalization (e.g., impact on society/economy, marketing), and perceived benefits of use (e.g., medical) and legalization (e.g., access/safety, economic, individual rights). CONCLUSIONS Despite differences in cannabis perceptions and use across countries, perceived risk and social norms are relevant intervention targets regardless of sociopolitical context.
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Affiliation(s)
- Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
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Theitler N, Rees VW, Peled-Raz M, Bitan M, Rosen LJ. Tobacco smoke incursion into private residences in Israel: a cross-sectional study examining public perceptions of private rights and support for governmental policies. Isr J Health Policy Res 2023; 12:25. [PMID: 37480100 PMCID: PMC10362702 DOI: 10.1186/s13584-023-00573-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/06/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND Tobacco smoke incursion (TSI) into private residences is a widespread problem in many countries. We sought to assess the prevalence of self-reported TSI and public attitudes about TSI in Israel, a country with a relatively high smoking prevalence and high population density. METHODS We conducted a random digit dial survey among residents in Israel (N = 285) in 2017, which examined the frequency, source, correlates of, and attitudes towards TSI and potential regulatory options. The cooperation rate was 63.9%. RESULTS Among respondents, 44.7% reported ever experiencing home TSI, with higher exposure among residents of multi-unit housing (MUH) (MUH versus private homes: aOR (Adjusted Odds Ratio): 3.60, CI (Confidence Interval): [1.96, 6.58], p < .001). Most respondents (69.8%), including nearly half of smokers, prioritized the right of individuals to breath smoke-free air in their apartments over the right of smokers to smoke in their apartments. Women and non-smokers were more likely to support the right to breathe smoke-free air (Women versus men: aOR: 2.77 CI: [1.48, 5.16], p = .001; Nonsmokers versus smokers: aOR: 3.21 CI [1.59, 6.48], p = .001). However, only about a quarter (24.8%) of respondents who ever experienced TSI raised the issue with the neighbor who smoked, the neighbor's landlord, or the building committee. The vast majority (85.2%) of all respondents, including three-quarters of smokers, supported smoke-free legislation for multi-unit housing (MUH), with those ever-exposed to TSI and non-smokers more likely to support legislation (ever-exposed versus never-exposed aOR = 2.99, CI [1.28, 6.97], p = 0.011; nonsmokers versus smokers aOR = 3.00, CI [1.28, 7.01], p = 0.011). CONCLUSIONS Among study participants, tobacco smoke incursion was a common, yet unwelcome experience. Most respondents believed that the right to breathe smoke-free air in one's apartment superseded that of neighbors to smoke anywhere in their home, and most supported legislation to prevent TSI. Though further study is needed to understand better TSI and effective methods for its prevention, our findings suggest that policy interventions, including legal action at the level of the Supreme Court and/or the Knesset, are needed. Regulation, policy initiatives and campaigns to denormalize smoking in proximity to other people and private residences globally could reduce the scope of this widespread problem, protect individuals from home TSI, and improve population health.
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Affiliation(s)
- Noa Theitler
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, POB 39040, 69978, Ramat Aviv, Israel
- Israel Ministry of Education, Tel Aviv, Israel
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maya Peled-Raz
- School of Public Health, University of Haifa, Haifa, Israel
| | - Michal Bitan
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, POB 39040, 69978, Ramat Aviv, Israel
- School of Computer Science, College of Management, 7502501, Rishon LeZion, Israel
| | - Laura J Rosen
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, POB 39040, 69978, Ramat Aviv, Israel.
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Kreuter MW, Garg R, Fu Q, Caburnay C, Thompson T, Roberts C, Sandheinrich D, Javed I, Wolff JM, Butler T, Grimes LM, Carpenter KM, Pokojski R, Engelbrecht K, Howard V, McQueen A. Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100529. [PMID: 37408953 PMCID: PMC10319314 DOI: 10.1016/j.lana.2023.100529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023]
Abstract
Background Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT03194958. Funding National Cancer Institute: R01CA201429.
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Affiliation(s)
- Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Dominique Sandheinrich
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer M. Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Robin Pokojski
- Community Partnerships, United Way of Greater St. Louis, St. Louis, MO, USA
| | | | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Self-Brown S, Perry EW, Recinos M, Cotner MA, Guastaferro K, Owolabi S, Spears CA, Whitaker DJ, Huang J, Kegler MC. Systematic braiding of Smoke-Free Home SafeCare to address child maltreatment risk and secondhand smoke exposure: findings from a pilot study. Pilot Feasibility Stud 2023; 9:81. [PMID: 37173799 PMCID: PMC10175921 DOI: 10.1186/s40814-023-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Exposure to secondhand tobacco smoke (SHS) and child maltreatment are preventable threats to child health. Few evidence-based interventions target both SHS and child maltreatment risk. The purpose of this paper is to describe the systematic braiding process of two evidence-based programs to address child SHS in the home and maltreatment perpetration risk, and present results from the formative work and pilot study. METHODS The first 4 steps of the systematic braiding process were completed, including the following: (1) the identification of core elements of both programs, (2) the development of an initial draft of the braided curriculum (Smoke-Free Home SafeCare - SFH-SC), (3) an acceptability and feasibility pilot of SFH-SC with caregivers of young children who reported a smoker living in the home (N = 8), and (4) feedback collection on the braided curriculum from SafeCare Providers (N = 9). RESULTS Experts identified common pedagogical and theoretical underpinnings for the two programs and braided Smoke-Free Homes: Some Things Are Better Outside into two SafeCare modules. Caregiver feedback from the pilot demonstrated that participants were engaged with SFH-SC and felt supported and comfortable discussing SHS intervention content with the SFH-SC Provider. Caregiver self-reports indicated a slight increase in smoke-free home rules from baseline to follow-up and a notable reduction in parent stress on the Parent Stress Index of 5.9 points (SD = 10.2). SafeCare Provider feedback following intensive review of the curriculum indicated high feasibility for SFH-SC delivery. CONCLUSIONS Parent and Provider findings suggest SFH-SC is a viable intervention that has potential to reduce the public health impact of SHS and child maltreatment for at-risk families. PROTOCOL The protocol for the pilot is not published elsewhere; however, the full protocol for the hybrid trial can be found here: https://clinicaltrials.gov/ct2/show/NCT05000632 . TRIAL REGISTRATION NCT, NCT05000632. Registered 14 July 2021, there is not a separate registration number for the pilot.
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Affiliation(s)
- Shannon Self-Brown
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA.
| | - Elizabeth W Perry
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Manderley Recinos
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michaela A Cotner
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Kate Guastaferro
- New York University - School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Shadé Owolabi
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| | - Claire A Spears
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Daniel J Whitaker
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Jidong Huang
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michelle C Kegler
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
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Garg R, McQueen A, Roberts C, Butler T, Grimes LM, Thompson T, Caburnay C, Wolff J, Javed I, Carpenter KM, Wartts JG, Charles C, Howard V, Kreuter MW. Stress, depression, sleep problems and unmet social needs: Baseline characteristics of low-income smokers in a randomized cessation trial. Contemp Clin Trials Commun 2021; 24:100857. [PMID: 34849423 PMCID: PMC8609143 DOI: 10.1016/j.conctc.2021.100857] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/20/2021] [Accepted: 11/09/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Low-income Americans smoke cigarettes at higher rates and quit less than other groups. METHODS To increase their engagement in and success using evidence-based cessation methods, we tested two interventions using a 2x2 randomized factorial design: (1) telephone navigation to reduce financial strain and address social needs such as food, rent and utility payment; and (2) a specialized tobacco quitline designed for low-income smokers. From June 2017 to November 2020, we enrolled 1,944 low-income smokers in Missouri, USA, recruited through the Missouri 2-1-1 helpline, into the trial. This paper describes recruitment, key characteristics and life circumstances of this high-risk population. RESULTS After eligibility screening, 1,944 participants completed baseline and were randomized. Participants were racially diverse (58% African American), poor (51% < $10,000 annual pre-tax household income) and many reported less than high school education (30%). They reported a mean of 2.5 unmet social needs, especially childcare and paying bills, had high rates of stress, depressive symptoms and sleep problems, and most were in fair or poor health. There were few differences between these variables, and no differences between tobacco use and cessation variables, across the four study groups and between participants recruited pre and during the COVID-19 pandemic. CONCLUSIONS Trial recruitment through the 2-1-1 helpline is feasible for reaching a population of low-income smokers. Low-income smokers face myriad daily challenges beyond quitting smoking. Cessation interventions need to account for and address these life circumstances. TRIAL REGISTRATION Clinicaltrials.gov NCT03194958.
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Affiliation(s)
- Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Jordyn G. Wartts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Cindy Charles
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
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Ma C, Heiland EG, Li Z, Zhao M, Liang Y, Xi B. Global trends in the prevalence of secondhand smoke exposure among adolescents aged 12-16 years from 1999 to 2018: an analysis of repeated cross-sectional surveys. LANCET GLOBAL HEALTH 2021; 9:e1667-e1678. [PMID: 34571047 DOI: 10.1016/s2214-109x(21)00365-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Secondhand smoke exposure can cause morbidity and premature mortality. However, the global prevalence of, and trends in, secondhand smoke exposure among adolescents are poorly documented. We aimed to assess the prevalence of, and trends in, secondhand smoke exposure among adolescents from 1999 to 2018. METHODS We did an analysis of the most recent data from the Global Youth Tobacco Survey (GYTS), a nationally representative, self-administered, school-based cross-sectional survey of tobacco use and related factors among adolescents aged 12-16 years worldwide. Data from 142 countries and territories that had done a GYTS between 2010 and 2018, comprising 711 366 participants, were used to assess the prevalence of secondhand smoke exposure. Data from 131 countries and territories that had done two or more surveys between 1999 and 2018, comprising 1 405 458 participants, were used to assess trends in secondhand smoke exposure. The frequency of secondhand smoke exposure at home, in public places, or in any place was defined as follows, based on students' responses: 1 or more days, 3 or more days, 5 or more days, or daily during the past 7 days. FINDINGS Based on the most recent surveys done in 142 countries between Jan 1, 2010, and Dec 31, 2018, the global prevalence of secondhand smoke exposure in any place was 62·9% (95% CI 61·7-64·1) on 1 or more days, 51·0% (49·8-52·1) on 3 or more days, 40·1% (38·9-41·2) on 5 or more days, and 32·5% (31·5-33·6) daily during the past 7 days. The prevalence of secondhand smoke exposure at home was 33·1% (95% CI 32·1-34·1) on 1 or more days, 20·1% (19·3-20·9) on 3 or more days, 14·9% (14·2-15·7) on 5 or more days, and 12·3% (11·7-13·0) daily during the past 7 days; and in public places the prevalence of secondhand smoke exposure was 57·6% (56·4-58·8) on 1 or more days, 43·4% (42·2-44·6) on 3 or more days, 30·3% (29·2-31·5) on 5 or more days, and 23·5% (22·5-24·5) daily during the past 7 days. Between Jan 1, 1999, and Dec 31, 2018, the prevalence of secondhand smoke exposure (on ≥1 day during the past 7 days) in any place decreased in 57 (43·5%) of 131 countries, increased in 27 (20·6%), and remained unchanged in 47 (35·9%). Although the prevalence of secondhand smoke exposure at home decreased in 86 (65·6%) countries, the prevalence in public places did not change in 46 (35·1%) countries and increased in 40 (30·5%). INTERPRETATION Secondhand smoke exposure among adolescents remains a serious public health challenge worldwide. Although the prevalence of secondhand smoke exposure at home decreased in most countries, the prevalence in public places increased or remained unchanged in most countries between 1999 and 2018. These findings emphasise the need to strengthen smoke-free policies, especially in public places. FUNDING Youth Team of Humanistic and Social Science of Shandong University, Jinan, China. TRANSLATION For the Chinese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Chuanwei Ma
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Emerald G Heiland
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences (GIH), Stockholm, Sweden
| | - Zilin Li
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Min Zhao
- Department of Nutrition and Food Hygiene, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yajun Liang
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Bo Xi
- Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Mazzucca S, Arredondo EM, Hoelscher DM, Haire-Joshu D, Tabak RG, Kumanyika SK, Brownson RC. Expanding Implementation Research to Prevent Chronic Diseases in Community Settings. Annu Rev Public Health 2021; 42:135-158. [PMID: 33467924 PMCID: PMC9152846 DOI: 10.1146/annurev-publhealth-090419-102547] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Chronic disease prevention continues to be inadequate, overall and in achieving health equity, in spite of the many evidence-based practices and policies (EBPPs) available to address risk behaviors such as unhealthful eating, lack of physical activity, and tobacco use. Although clinical settings are needed for EBPPs that involve medical procedures such as immunization or early detection, dissemination of EBPPs can be effective in a variety of settings such as schools and childcare centers, worksites, social service organizations, and religious organizations. More implementation research is needed to meet challenges of effective application of EBPPs in such community settings, in which primary missions, capacity, cultures, and values do not focus on health services delivery. To address health equity, consideration of social and economic contexts of people reached in these settings is essential. This review presents lessons learned from past studies to guide future implementation research and practice across diverse settings and geographies.
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Affiliation(s)
- Stephanie Mazzucca
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Elva M Arredondo
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, San Diego, California 92123-4311, USA;
| | - Deanna M Hoelscher
- Michael & Susan Dell Center for Healthy Living, UTHealth School of Public Health, University of Texas, Austin, Texas 78701, USA;
| | - Debra Haire-Joshu
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Rachel G Tabak
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
| | - Shiriki K Kumanyika
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | - Ross C Brownson
- Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , , ,
- Department of Surgery, Division of Public Health Sciences; and Alvin J. Siteman Cancer Center, School of Medicine, Washington University in St. Louis, St. Louis, Missouri 63110, USA
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Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186787. [PMID: 32957658 PMCID: PMC7559315 DOI: 10.3390/ijerph17186787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/21/2022]
Abstract
Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars), and secondhand smoke (SHS) exposure remains prevalent among children and low-socioeconomic status (SES) populations. This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children. The pilot was implemented through Minnesota’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDPs provide cancer prevention services to low-income individuals experiencing health disparities. We successfully utilized and adapted the Smoke-Free Homes Program (SFHP) to address comprehensive smoke-free rules among households with children. We used two recruitment methods: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. We used descriptive statistics to assess implementation outcomes and hierarchical logistic regression models (HLM) to assess change in smoke-free rules and SHS exposure over the study period. There was no comparison group, and HLM was used to examine within-person change. A total of 64 participants were recruited. Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route. Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.
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A cross-sectional study of the relationship of proximal smoking environments and cessation history, plans, and self-efficacy among low-income smokers. J Smok Cessat 2019; 14:229-238. [PMID: 33777240 DOI: 10.1017/jsc.2019.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable. Aims We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit. Methods This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy). Results Smokers who lived in homes with more restrictive household smoking rules, and/or reported having 'important others' who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting. Conclusions Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
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Kegler MC, Haardörfer R, Melanson T, Allen L, Bundy LT, Kreuter MW, Williams RS, Hovell MF, Mullen PD. Steps Toward Scalability: Illustrations From a Smoke-Free Homes Program. HEALTH EDUCATION & BEHAVIOR 2019; 46:773-781. [PMID: 31165637 DOI: 10.1177/1090198119848767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scalable interventions remain effective across a range of real-world settings and can be modified to fit organizational and community context. "Smoke-Free Homes: Some Things are Better Outside" has been effective in promoting smoke-free home rules in low-income households in efficacy, effectiveness, generalizability, and dissemination studies. Using data from a dissemination study in collaboration with five 2-1-1 call centers in Ohio, Florida, Oklahoma, and Alabama (n = 2,345 households), this article examines key dimensions of scalability, including effectiveness by subpopulation, secondary outcomes, identification of core elements driving effectiveness, and cost-effectiveness. Evaluated by 2-1-1 staff using a pre-post design with self-reported outcomes at 2 months postbaseline, the program was equally effective for men and women, across education levels, with varying number of smokers in the home, and whether children were present in the home or not. It was more effective for nonsmokers, those who smoked fewer cigarettes per day, and African Americans. Creating a smoke-free home was associated with a new smoke-free vehicle rule (odds ratio [OR] = 3.38, confidence interval [CI 2.58, 4.42]), decreased exposure to secondhand smoke among nonsmokers (b = -2.33, p < .0001), and increased cessation among smokers (OR = 5.8, CI [3.81, 8.81]). Use of each program component was significantly associated with success in creating a smoke-free home. Using an intent-to-treat effect size of 40.1%, program benefits from 5 years of health care savings exceed program costs yielding a net savings of $9,633 for delivery to 100 households. Cost effectiveness, subpopulation analyses, and identification of core elements can help in assessing the scalability potential of research-tested interventions such as this smoke-free homes program.
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