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Lim CCW, Rutherford B, Gartner C, McClure-Thomas C, Foo S, Su FY, Scheurer R, Sebayang S, Chan G, Stjepanović D, Fausiah F, Farassania G, Leung J. A systematic review of second-hand smoking mass media campaigns (2002-2022). BMC Public Health 2024; 24:693. [PMID: 38438990 PMCID: PMC10913644 DOI: 10.1186/s12889-024-18222-5] [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: 01/18/2024] [Accepted: 02/27/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Second-hand smoking (SHS) increases the risk of chronic disease in adults and poses a serious health threat to children. Mass media campaigns are instrumental in raising awareness and reducing SHS exposure. There is a need to identify recent SHS mass media campaigns and assess their sustainability in terms of knowledge, attitudes, and behavioural changes. This systematic review summarises the characteristics and outcomes of mass media campaigns on SHS prevention. METHODS PubMed, Embase, Web of Science, and grey literature were searched in November 2022 for SHS campaigns implemented between 2016 and 2022. The eligibility criteria included campaigns on the dangers or effects of SHS with any target group, dissemination medium, study design, or language. The database search identified 1,413 peer-reviewed titles, of which 82 full-texts were screened, with 14 meeting the eligibility criteria. The grey literature search identified 9,807 sources, of which 61 were included. We extracted data on the campaign characteristics, metrics, and smoking-related outcomes. The JBI critical appraisal tool was used to assess the risk of bias of the included studies. RESULTS We found 73 SHS campaigns conducted between 2002 and 2022, across 50 countries. The campaigns reached 378 million people. The reported recall rates range from 8 to 76%. Of the 11 studies that reported smoking-related outcomes, 10 reported increased knowledge in understanding SHS risks (73-85%), five reported an increased prevalence of smoke-free homes, and two reported an increase in number of participants persuading others to quit smoking. Two studies reported a decrease in overall smoking, whereas three studies observed a reduction in smoking in the presence of children. CONCLUSION The available data provide some support for the effectiveness of SHS campaigns in reducing smoking behaviours in homes and around children. However, the certainty of evidence was low due to the lack of a control group and the substantial heterogeneity in the outcomes assessed. Future campaigns need comprehensive evaluation and reporting to reduce publication bias.
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Affiliation(s)
- Carmen C W Lim
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia.
- School of Psychology, The University of Queensland, Brisbane, Australia.
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia.
| | - Brienna Rutherford
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Caitlin McClure-Thomas
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
| | - Shaun Foo
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
| | - Fang-Yi Su
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
| | - Roman Scheurer
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia
| | - Susy Sebayang
- School of Public Health, Universitas Airlangga, Surabaya, Indonesia
| | - Gary Chan
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
| | - Daniel Stjepanović
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
| | - Fitri Fausiah
- School of Psychology, Universitas Indonesia, Depok, Indonesia
| | - Ghea Farassania
- School of Psychology, Universitas Indonesia, Depok, Indonesia
| | - Janni Leung
- National Centre for Youth Substance Use Research, The University of Queensland, 31 Upland Road, 4072, St Lucia, QLD, Australia
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Berg CJ, Haardörfer R, Torosyan A, Dekanosidze A, Grigoryan L, Sargsyan Z, Hayrumyan V, Sturua L, Topuridze M, Petrosyan V, Bazarchyan A, Kegler MC. Examining local smoke-free coalitions in Armenia and Georgia: context and outcomes of a matched-pairs community-randomised controlled trial. BMJ Glob Health 2024; 9:e013282. [PMID: 38325896 PMCID: PMC10859987 DOI: 10.1136/bmjgh-2023-013282] [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: 06/30/2023] [Accepted: 01/10/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION Local coalitions can advance public health initiatives such as smoke-free air but have not been widely used or well-studied in low-income and middle-income countries. METHODS We conducted a matched-pairs community-randomised controlled trial in 28 communities in Armenia and Georgia (N=14/country) in which we helped establish local coalitions in 2019 and provided training and technical assistance for coalition activity promoting smoke-free policy development and enforcement (2019-2021). Surveys of ~1450 households (Fall 2018, May-June 2022) were conducted to evaluate coalition impact on smoke-free policy support, smoke-free home adoption, secondhand smoke exposure (SHSe), and coalition awareness and activity exposure, using multivariable mixed modelling. RESULTS Bivariate analyses indicated that, at follow-up versus baseline, both conditions reported greater smoke-free home rates (53.6% vs 38.5%) and fewer days of SHSe on average (~11 vs ~12 days), and that intervention versus control condition communities reported greater coalition awareness (24.3% vs 12.2%) and activity exposure (71.2% vs 64.5%). Multivariable modelling indicated that intervention (vs control) communities reported greater rates of complete smoke-free homes (adjusted Odds Ratio [aOR] 1.55, 95% confiedence interval [CI] 1.11 to 2.18, p=0.011) and coalition awareness (aOR 2.89, 95% CI 1.44 to 8.05, p=0.043) at follow-up. However, there were no intervention effects on policy support, SHSe or community-based activity exposure. CONCLUSIONS Findings must be considered alongside several sociopolitical factors during the study, including national smoke-free policies implementation (Georgia, 2018; Armenia, 2022), these countries' participation in an international tobacco legislation initiative, the COVID-19 pandemic and regional/local war). The intervention effect on smoke-free homes is critical, as smoke-free policy implementation provides opportunities to accelerate smoke-free home adoption via local coalitions. TRIAL REGISTRATION NUMBER NCT03447912.
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Affiliation(s)
- Carla J Berg
- Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Regine Haardörfer
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Arevik Torosyan
- National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Ana Dekanosidze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Lilit Grigoryan
- National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Zhanna Sargsyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Lela Sturua
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Marina Topuridze
- National Center for Disease Control and Public Health, Tbilisi, Georgia
- Petre Shotadze Tbilisi Medical Academy, Tbilisi, Georgia
| | - Varduhi Petrosyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health Named After Academician Suren Avdalbekyan, Yerevan, Armenia
| | - Michelle C Kegler
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Slattery B, Dimond R, Went G, Ugalde A, Wong Shee A. Cigarette smoke exposure of hospitalised children: Prevalence of smoking in parents or carers and admission practices of health services. J Paediatr Child Health 2023; 59:1135-1139. [PMID: 37522319 DOI: 10.1111/jpc.16469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/02/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
AIM The aim of this study is to understand the exposure to second-hand tobacco smoke in the homes of hospitalised children through: (i) understanding the prevalence of smoking in adults or carers and (ii) examining the health services' approach to identifying parental smoking status. METHODS This prospective observational study consisted of two surveys: one administered to parents/carers of hospitalised children and one to health services. The first cross-sectional survey aimed to elicit the proportion of children requiring admission to a regional Victorian general paediatric unit who live with adults who smoke cigarettes. The survey was delivered to participating parents/carers during the standard nursing admission process. The second survey was administered across 15 public health services to determine if identification of parent/carer's smoking status is a routine part of their standard paediatric admission practice. RESULTS For the parental survey, 453 responses were obtained from 782 consecutive new admissions. Nearly a third (n = 136, 30%) requiring hospital admission were found to be living with at least one parent/carer who identified as a current cigarette smoker. Of the 15 health services surveyed, only four (27%) nursing units reported routinely asking parents/carers about their smoking status as part of their standard admission process. CONCLUSION Admission to hospital provides an opportunity to enhance care for children by addressing nicotine dependence within their families. Findings suggest routine recording of smoking status can be improved, to drive smoking cessation and brief intervention conversations with parents and carers of children admitted to hospital.
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Affiliation(s)
- Breanna Slattery
- Department of Pharmacy, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Renee Dimond
- Department of Pharmacy, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Grace Went
- Deakin Rural Health, Deakin University, Melbourne, Victoria, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Anna Wong Shee
- Deakin Rural Health, Deakin University, Melbourne, Victoria, Australia
- Community and Aged Care, Grampians Health Ballarat, Ballarat, Victoria, Australia
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Wilson KM, Moss A, Lowary M, Holstein J, Gambino J, Juarez-Colunga E, Kerby GS, Klein JD, Hovell M, Winickoff JP. Intervening With Smoking Parents of Inpatients to Reduce Exposure: The INSPIRE Randomized Controlled Trial. Acad Pediatr 2022; 22:997-1005. [PMID: 34818588 PMCID: PMC9123095 DOI: 10.1016/j.acap.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 11/08/2021] [Accepted: 11/13/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Hospitalized children have high rates of tobacco smoke exposure; parents who smoke may be receptive to interventions during their child's hospitalization. OBJECTIVE We tested the efficacy of a smoking cessation intervention for parents of hospitalized children. METHODS We conducted a randomized, single-blind clinical trial from 12/14-5/18 at the Children's Hospital Colorado. Hospitalized children who had a parent who smoked tobacco were eligible. INTERVENTION Intervention participants received motivational interviewing sessions, 2 weeks of nicotine replacement therapy; both groups received referral to the Quitline Consenting parents completed a questionnaire; urine was collected from the child for measurement of cotinine. Our primary outcome was: 1) increase in reporting "no one is allowed to smoke anywhere" in the home (smoke-free home rule). Additional outcomes included: 2) change in child's cotinine from baseline to 1 year, and 3) parental quitting at 1 year. Data were analyzed using Chi-square and t tests for bivariable data, and multivariable logistic and linear regression. RESULTS Of 1641 eligible families approached, 252 were randomized (15%); 149 families had follow-up data at 12 months (59%). In the adjusted analysis, there was no difference between the groups in smoke free home rules, or child cotinine level; in an intention-to-treat analysis, 15% in the intervention group versus 8% of controls reported quit (p=0.07). CONCLUSIONS A smoking cessation intervention can be delivered to parents of hospitalized children. While hospitalization provides an opportunity to help parents quit smoking, more efficient and effective engagement strategies are needed to optimize tobacco control success.
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Affiliation(s)
- Karen M. Wilson
- University of Rochester School of Medicine, Department of Pediatrics, 601 Elmwood Ave., Box 667, Rochester NY 14642.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL, 60143, USA,Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13001 E. 17 Place, Aurora, CO, 80045, USA,Children’s Hospital Colorado, 13001 E. 17 Place, Aurora, CO, 80045 USA
| | - Angela Moss
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13001 E. 17 Place, Aurora, CO, 80045, USA,Children’s Hospital Colorado, 13001 E. 17 Place, Aurora, CO, 80045 USA
| | - Michelle Lowary
- Children’s Hospital Colorado, 13001 E. 17 Place, Aurora, CO, 80045 USA
| | | | - Jessica Gambino
- Children’s Hospital Colorado, 13001 E. 17 Place, Aurora, CO, 80045 USA
| | - Elizabeth Juarez-Colunga
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, 13001 E. 17 Place, Aurora, CO, 80045 USA
| | - Gwendolyn S. Kerby
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 13001 E. 17 Place, Aurora, CO, 80045, USA,Children’s Hospital Colorado, 13001 E. 17 Place, Aurora, CO, 80045 USA
| | - Jonathan D. Klein
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL, 60143, USA,Department of Pediatrics, University of Illinois at Chicago, 1737 W. Polk St. Chicago, IL, 60612, USA
| | - Melbourne Hovell
- Center for Behavioral Epidemiology and Community Health (C-BEACH), Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, California, 92182, USA
| | - Jonathan P. Winickoff
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, 345 Park Blvd, Itasca, IL, 60143, USA,Department of Pediatrics, Mass General Hospital for Children, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
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O'Donnell R, Amos A, Turner SW, Adams L, Henderson T, Lyttle S, Mitchell S, Semple S. 'They only smoke in the house when I'm not in': understanding the limited effectiveness of a smoke-free homes intervention. J Public Health (Oxf) 2021; 43:647-654. [PMID: 32323719 PMCID: PMC8458016 DOI: 10.1093/pubmed/fdaa042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 11/14/2019] [Accepted: 01/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background Children’s second-hand smoke (SHS) exposure in the home is highest in socio-economically disadvantaged areas. Personalized household air-quality measurements can promote changes in smoking that reduce SHS exposure. The ‘First Steps 2 Smoke-free’ (FS2SF) intervention is the first to trial this approach delivered as part of health professionals’ routine work. This paper reports the findings of qualitative interviews with participants that explored their experiences of the intervention and why outcomes varied. Methods 120 women were recruited from the NHS First Steps Programme, which supports disadvantaged mothers. They received either personalized feedback on their home air quality and advice on reducing SHS or standard SHS advice. Qualitative interviews with 15 mothers were analyzed thematically using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Results The intervention increased women’s capability to change home-smoking behaviour, through increasing awareness and salience of SHS risks to their children, and motivation to act. However, taking effective action was constrained by their limited social and environmental opportunities, including others’ smoking in the home. Conclusions The FS2SF intervention was ineffective as it was unable to fully address the precarious, complex life circumstances that make creating a smoke-free home particularly difficult for women experiencing intersecting dimensions of disadvantage.
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Affiliation(s)
- R O'Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
| | - A Amos
- Usher Institute, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - S W Turner
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK
| | - L Adams
- NHS Lanarkshire, Airdrie ML6 6DB, UK
| | | | - S Lyttle
- NHS Lanarkshire, Hamilton ML3 0TA, UK
| | | | - S Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK
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Jackson C, Huque R, Ahmed F, Nasreen S, Shah S, Ahluwalia JS, Kanaan M, Sheikh A, Siddiqi K. Children Learning About Second-hand Smoke (CLASS II): a mixed methods process evaluation of a school-based intervention. Pilot Feasibility Stud 2021; 7:112. [PMID: 34030729 PMCID: PMC8142478 DOI: 10.1186/s40814-021-00853-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Children are vulnerable to the effects of second-hand smoke exposure. Creating smoke-free homes is an effective strategy to limit exposure. We developed a smoke-free intervention (SFI) using children as a catalyst for change and teaching skills to negotiate a smoke-free home. In this paper, we present the process evaluation conducted within a pilot trial. METHODS This was a mixed-methods study comprising qualitative interviews and quantitative fidelity assessment of SFI delivery. Interviews in the six intervention schools were conducted with six headteachers and 12 teachers. These explored experiences of delivering the SFI, perceived impact, barriers and facilitators to success, and ideas for improvement and for scaling up. The data were analysed using framework analysis. Delivery of the SFI was observed and fidelity scores calculated. RESULTS The SFI was acceptable to headteachers and teachers. Fidelity scores ranged from 27/40 to 37/40. Didactic components were more fully implemented than interactive components. Time to complete the sessions, timing in the school day and school calendar were key challenges. Embedding the SFI into the curriculum was a potential solution. CONCLUSIONS These findings provide useful information to finalise the content and delivery and inform the scale-up of the SFI for our definitive trial, which is now underway. TRIAL REGISTRATION ISRCTN68690577.
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Affiliation(s)
- Cath Jackson
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Rumana Huque
- Department of Economics, University of Dhaka and ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Farid Ahmed
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Shammi Nasreen
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Sarwat Shah
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Providence, RI 02912 USA
| | - Mona Kanaan
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
| | - Aziz Sheikh
- Usher Institute of Population Health Sciences, The University of Edinburgh, Edinburgh, EH8 9DX UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, ARRC Building, Heslington, York, Y010 5DD UK
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Associations between a smoke-free homes intervention and childhood admissions to hospital in Scotland: an interrupted time-series analysis of whole-population data. LANCET PUBLIC HEALTH 2020; 5:e493-e500. [PMID: 32888442 DOI: 10.1016/s2468-2667(20)30178-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland. METHODS For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD). FINDINGS 740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (-0·48% [-0·85 to -0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5-15 years). Asthma admissions did not change after TiRO among children 0-15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, independent of TiRO, asthma admissions decreased in both younger children (-0·36% [-0·67 to -0·05], p=0·021) and older children (-0·68% [-1·00 to -0·36], p<0·0001), and in children from the most deprived (SIMD 1; -0·49% [-0·87 to -0·11], p=0·011) and intermediate deprived (SIMD 3; -0·70% [-1·17 to -0·23], p=0·0043) area quintiles, but not in those from the least deprived (SIMD 5) area quintile. INTERPRETATION Our findings suggest that smoke-free home interventions could be an important tool to reduce asthma admissions in young children, and that smoke-free public space legislation might improve child health for many years, especially in the most deprived communities. FUNDING University of Aberdeen Research Excellence Framework 2021 Impact Support Award Scheme.
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van Wijk EC, Overberg RI, Kunst AE, Harting J. Opportunities for Tailored Support to Implement Smoke-Free Homes: A Qualitative Study among Lower Socioeconomic Status Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 17:ijerph17010222. [PMID: 31892269 PMCID: PMC6981932 DOI: 10.3390/ijerph17010222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/15/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
Abstract
With the aim of preventing children from being exposed to secondhand smoke, we examined to which level lower socio-economic status (SES) households had implemented home smoking rules and the factors that hampered parents in their process of change toward a complete smoke-free home (SFH). We conducted a qualitative study including semi-structured in-depth interviews with 14 parents of young children living in a lower SES neighborhood of a provincial town in the Netherlands. Interview transcripts were subjected to a qualitative content analysis. Three distinct levels of SFH implementation emerged: complete SFH, flexible SFH, and partial SFH. Differences between parents at these three levels essentially concerned: (1) the role of child-related moral considerations in their motivation for an SFH; (2) whether they felt they had the agency to set and enforce home smoking rules; (3) the difficulties they experienced in changing their smoking habit from smoking indoors to smoking outdoors. Parents also had different opinions about the role their children could play in facilitating the parental process of change. We conclude that the current level of SFH implementation may serve as a starting point for developing tailored interventions. Such interventions should probably address other factors than the commonly used awareness–knowledge–commitment approach.
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Affiliation(s)
- Els C. van Wijk
- Amsterdam UMC, Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.C.v.W.); (A.E.K.)
| | - Regina I. Overberg
- Department of Public Health, Public Health Service Kennemerland, Zijlweg 200, 2015 CK Haarlem, The Netherlands;
| | - Anton E. Kunst
- Amsterdam UMC, Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.C.v.W.); (A.E.K.)
| | - Janneke Harting
- Amsterdam UMC, Department of Public Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.C.v.W.); (A.E.K.)
- Correspondence:
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Rao A, B U, Mithra P, M N, Shenoy R, Rungta N. Effectiveness of a School-Based 'Tobacco Free' Intervention on Adolescents' Knowledge and Exposure to Second Hand Tobacco Smoke - A Multiphase Study. Asian Pac J Cancer Prev 2019; 20:3533-3537. [PMID: 31870091 PMCID: PMC7173383 DOI: 10.31557/apjcp.2019.20.12.3533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/19/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is no safe level of exposure to second hand tobacco smoke (SHS). The World Health Organization has stressed that 100% smoke-free environments are the only effective way to protect the population from the harmful effects of exposure to SHS. DESIGN A multiphase study with a descriptive cross-sectional questionnaire phase 1 and a phase 2 cluster randomized controlled trial (RCT), conceptualized to determine the effectiveness of a school-based 'tobacco free' health education intervention on adolescents' knowledge and attitude towards SHS. METHODS Baseline assessment will include a questionnaire followed by estimation of salivary cotinine levels. The experimental arm will receive the 'tobacco free' intervention, which includes 40 min health education session delivered once a week for 3 consecutive weeks. Participants will also be given 'take home brochures' every week containing messages on the effects of tobacco and how to make their homes smoke-free. The sample of 250 participants, for the Phase 2 RCT, with salivary cotinine levels of > 0.1 ng/mL will be selected from the participants of the Phase 1 study. The effect of the intervention will be quantitatively assessed by estimating the salivary cotinine levels after the intervention. Participants in the control arm will receive conventional standard health education once. CONCLUSION This research will help in assessing if there is any change in the salivary cotinine levels and the knowledge, attitude and behaviour scores after the health educational intervention and help in developing an effective school-based 'tobacco free' intervention program which could be incorporated into the school curriculum. This study has received the Public Health Research Initiative (PHRI) Research Grant of Rs. 18,99,205 and is registered with the Clinical Trial Registry of India (CTRI) with number CTRI/2018/09/015706 (Registered on 13/09/2018). Ethical approval has been obtained from The Institutional Ethics Committee (No.17021 dated 13 march 2017).
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Affiliation(s)
- Ashwini Rao
- Department of Public Health Dentistry, Manipal College of Dental Sciences,
| | - Unnikrishnan B
- Department of Community Medicine, Kasturba Medical College, Mangalore,
| | - Prasanna Mithra
- Department of Community Medicine, Kasturba Medical College, Mangalore,
| | - Nandini M
- Department of Biochemistry, Kasturba Medical College, Mangalore, A Constituent Unit of Manipal Academy of Higher Education (MAHE), Manipal, India.
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences,
| | - Nikita Rungta
- Department of Public Health Dentistry, Manipal College of Dental Sciences,
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Trisnowati H, Kusuma D, Ahsan A, Kurniasih DE, Padmawati RS. Smoke-free home initiative in Bantul, Indonesia: Development and preliminary evaluation. Tob Prev Cessat 2019; 5:40. [PMID: 32411902 PMCID: PMC7205119 DOI: 10.18332/tpc/113357] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 10/15/2019] [Accepted: 10/24/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tobacco control policies in Indonesia are still limited. This study aims to describe the process of the implementation of the smoke-free home (SFH) program in rural areas in Indonesia and to conduct a preliminary evaluation of its implementation. METHODS The development of SFH (or Rumah Bebas Asap Rokok) applies the theory of diffusion of innovation with the following stages: innovation, dissemination, adoption, implementation, and evaluation. The preliminary evaluation of the SFH program used an observational method combined with a cross-sectional survey. The population of this study was all houses in Karet hamlet, in Bantul district, Yogyakarta province with 378 houses as population, from which 196 houses were selected as sample using the proportional random sampling technique. Quantitative data analysis used multiple linear regression in Stata 15.1. RESULTS SFH is a community-based tobacco control innovation program that began with a community declaration. Preliminary evaluation after one-year implementation showed that 55% and 45% of respondents were smokers and non-smokers, respectively. Among smokers, 95%, 78% and 56% reported not smoking near pregnant women, children, and non-smokers, respectively. Moreover, 52% of respondents reported having a front-door ashtray, and 46% reported guests not smoking; among non-smokers, the corresponding values were 56% and 60%. CONCLUSIONS SFH implementation has an impact on the community's smoking pattern. Awareness of smokers to protect women and children from secondhand smoke is very high. While the results are promising, more political and resource support is needed from the local and national policymakers to support SFH initiatives.
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Affiliation(s)
- Heni Trisnowati
- Division of Health Promotion Program, Public Health Department, Universitas Respati Yogyakarta, Indonesia
- Doctoral Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Dian Kusuma
- Centre for Health Economics and Policy Innovations, Imperial College Business School, London, United Kingdom
| | - Abdillah Ahsan
- Faculty of Economy and Business, Universitas Indonesia, Depok, Indonesia
| | - Dwi E. Kurniasih
- Division of Health Policy and Administration Program, Public Health Department, Universitas Respati Yogyakarta, Indonesia
| | - Retna S. Padmawati
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center of Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Padmawati RS, Prabandari YS, Istiyani T, Nichter M, Nichter M. Establishing a community-based smoke-free homes movement in Indonesia. Tob Prev Cessat 2018; 4:36. [PMID: 32411862 PMCID: PMC7205137 DOI: 10.18332/tpc/99506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 10/22/2018] [Accepted: 11/01/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Indonesia has one of the highest male smoking rates in the world (67%) and secondhand smoke (SHS) exposure occurs in over 70% of households. To date, little research has investigated community recognition of the harms of secondhand smoke and support for a smoke-free homes (SFH) policy. This work discusses the development and implementation of a community-based SFH intervention attempting to establish SFH as a new social norm. METHODS Research was conducted in Yogyakarta, Java. A proof-of-concept study ascertained the feasibility of mounting a community-based SFH initiative in urban neighborhoods. Educational materials on SHS were developed and pretested. An intervention was piloted and evaluated in the homes of 296 smokers residing in 4 communities. Health educators and community health volunteers were trained to implement SFH. RESULTS Prior to the intervention, 11% of smokers did not smoke inside their home; post-intervention 54% of smokers did not smoke inside their home. The Yogyakarta District Health Office has supported large scale implementation of smoke-free homes. To date, 135 urban communities have declared themselves as having SFH. CONCLUSIONS This is the first community-based SFH initiative to be carried out in South-East Asia. The SFH movement redefines smoking cessation as a health issue of women and children, ties family welfare to core cultural values, and offers women a leadership role in tobacco control. The sustainability of SFH in Yogyakarta has been achieved by working closely with multiple levels of government and has contributed to shifts in tobacco control policy in Indonesia.
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Affiliation(s)
- Retna Siwi Padmawati
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Center for Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Yayi Suryo Prabandari
- Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Center for Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Tutik Istiyani
- Center for Health Behavior and Promotion, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, Arizona, United States
| | - Mimi Nichter
- School of Anthropology, University of Arizona, Tucson, Arizona, United States
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Escoffery C, Mullen P, Genkin B, Bundy L, Owolabi S, Haard�rfer R, Williams R, Savas L, Kegler M. Coaching to create a smoke-free home in a brief secondhand smoke intervention. HEALTH EDUCATION RESEARCH 2017; 32:555-568. [PMID: 29253133 PMCID: PMC5914313 DOI: 10.1093/her/cyx072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Few community interventions exist to reduce secondhand exposure to tobacco smoke in the home. This study presents the coaching process of a larger intervention to promote smoke-free homes across an efficacy and 2 effectiveness trials. It furthers assesses the coaching call's reach and participants' satisfaction with the call across three intervention sites. The sources of the data were from baseline and 3-month follow-up surveys, coaching forms or online tracking system and interviews with coaches. Reach for the coaching call across trials was fairly high from 72% to 92%. Overall, the majority of participants were highly satisfied with the intervention (M = 3.76) and found it useful in creating a smoke-free home (M = 3.63). Common goals set were changing the environment to support a home smoking ban (e.g. putting up signs, removing ashtrays) (82%) or picking a date (60%). Challenges to a smoke-free home were consistent with other literature on barriers related to household smoking restrictions, including need for assistance in quitting, outside weather and smokers who do not want to quit. Additional research is needed to explore differential reach and reactions to the coaching call as it is disseminated and the impact of coaching call on the outcome of a smoke-free home.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Patricia Mullen
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Brooke Genkin
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Lucja Bundy
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Shade Owolabi
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Regine Haard�rfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention , University of North Carolina at Chapel Hill, Chapel Hill, Carrboro, NC 27510, USA
| | - Lara Savas
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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Alagiyawanna AMAAP, Rajapaksa-Hewageegana N, Gunawardena N. The impact of multiple interventions to reduce household exposure to second-hand tobacco smoke among women: a cluster randomized controlled trial in Kalutara district, Sri Lanka. BMC Public Health 2017; 17:810. [PMID: 29037230 PMCID: PMC5644088 DOI: 10.1186/s12889-017-4820-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 10/04/2017] [Indexed: 11/29/2022] Open
Abstract
Background Second-hand smoke (SHS) in households remains a serious public health problem in Sri Lanka, partly due to a lack of voluntary prohibitions of tobacco smoking inside houses. Women are especially at risk of being exposed. Effective community based interventions to reduce the SHS in households targeting women is scarce. The objective of this study was to examine the impact of a multi-component intervention on household SHS exposure among Sri Lankan women. Methods Thirty clusters of 25 women (aged 18–65) from 750 households were randomized into the intervention and control groups. Women in the intervention group were exposed to activities which focused on improving knowledge on the health effects of SHS, attitudes towards SHS exposure, right to a smoke-free living and women empowerment against smoking. The duration of the intervention was six months. The comparison group received no intervention. The primary outcome of interest was self-reported SHS exposure in the household within 7 days prior to data collection. The secondary outcomes were exposure in the past 30 days, knowledge of the health risks of exposure, attitudes towards exposure, right to smoke-free living, women empowerment against smoking, and smoking inside the homes. Results Final assessment was in 329 (89.6%) in the intervention group and 309 (85.8%) in the comparison group. Following the intervention, significantly lower proportion of women in the intervention group as compared to the control group reported SHS exposure in their households within 7-days (9.2% vs. 15.3%, p = 0.02) and 30-days (13.6% vs. 21.6%, p = 0.008) prior to the post survey. As compared to the control group, significantly higher median scores were observed in the intervention group on the knowledge of the health risks of exposure to SHS (p < 0.001), attitudes on exposure to SHS (p = 0.004), right to smoke free living (p = 0.001) and women empowerment (p < 0.001). Conclusion Multi-component intervention activities were effective in reducing household exposure to SHS among women. Trial registration Sri Lanka Clinical Trials Registry SLCTR/2014/033. Electronic supplementary material The online version of this article (10.1186/s12889-017-4820-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A M A A P Alagiyawanna
- Ministry of Healthcare and Indigenous Medicine, Health Promotion Bureau, No 02, Kynsey Road, Colombo, 08, Sri Lanka.
| | - N Rajapaksa-Hewageegana
- Ministry of Healthcare and Indigenous Medicine, Health Promotion Bureau, No 02, Kynsey Road, Colombo, 08, Sri Lanka
| | - N Gunawardena
- Department of Community Medicine, University of Colombo, No.25, PO Box, 271 Kynsey Road, Colombo-08, Colombo, Western Province, Sri Lanka
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Huong LTT, Long TK, Anh LV, Cook M, Capra M. Decreasing In-home Smoking of Adults-Results from a School-based Intervention Program in Viet Nam. AIMS Public Health 2016; 3:863-879. [PMID: 29546200 PMCID: PMC5690410 DOI: 10.3934/publichealth.2016.4.863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/18/2016] [Indexed: 11/18/2022] Open
Abstract
It is indicated that children are involuntarily exposed to secondhand smoke from adults, mainly at their home environment. This study aimed at describing the effectiveness of the school-based intervention to decrease the in-home smoking situation of adults so as to decrease children's exposure to secondhand smoke at home during the year 2011–2012 in a rural district in Hanoi, Viet Nam. This school-based intervention program (intervention and control group) involved 804 children aged 8 to 11 years from August 2011 to May 2012 in a rural district of Hanoi, Viet Nam. Children were taught in class about the harmful effects of secondhand smoke and about how to negotiate with fathers not to smoke in-home. Then children applied what they learnt, including staying away from secondhand smoke and persuading fathers not to smoke in-home in order to decrease children's exposure to secondhand smoke. Chi square test, t-test and multinominal logistic regression were applied in data analysis. The results showed that children's reported their father's in-home smoking decreased from 83.0% pre-intervention to 59.8% post-intervention (p < 0.001) in the intervention school while no change happened in the control school. The study found that the better changed smoking location of adult smokers as reported by children associated with the school who received intervention activities (adjusted OR = 2.04; 95% CI: 1.28–3.24). Poorer changed attitudes towards secondhand smoke of children associated with a lower percentage of better change in smoking location of their fathers/other adult smokers (aOR = 0.51, 95% CI: 0.28–0.96). Children's poorer changed knowledge towards secondhand smoke also associated with poorer changed smoking location of adult smokers (aOR = 2.88, 95% CI: 1.07–7.76). It is recommended by this study that similar school based intervention approaches should be applied in primary schools in Viet Nam to increase children's awareness on the adverse health effects of secondhand smoke and to help them to be able to avoid their exposure to secondhand smoke at their home environment.
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Affiliation(s)
- Le Thi Thanh Huong
- Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Viet Nam
| | - Tran Khanh Long
- Hanoi University of Public Health, 1A Duc Thang Road, Duc Thang Ward, North Tu Liem District, Hanoi, Viet Nam
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Szatkowski L, Taylor J, Taylor A, Lewis S, Britton J, McNeill A, Bauld L, Wu Q, Parrott S, Jones L, Bains M. Development and evaluation of an intervention providing insight into the tobacco industry to prevent smoking uptake: a mixed-methods study. PUBLIC HEALTH RESEARCH 2016. [DOI: 10.3310/phr04090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSmokers who start smoking at an early age are less likely to quit and more likely to die from their habit. Evidence from the USTruth®campaign suggests that interventions focusing on tobacco industry practices and ethics may be effective in preventing smoking uptake.ObjectivesIn an exploratory study, to develop, pilot and provide preliminary evidence of the acceptability and effectiveness of Operation Smoke Storm, a school-based intervention based on the premise of theTruth®campaign, to prevent smoking uptake.DesignMixed-methods, non-randomised controlled study. Component 1 was delivered to Year 7 students, and student focus groups and teacher interviews were conducted to refine the lessons and to develop components 2 and 3. The revised Year 7 lessons and accompanying family booklet were delivered to new Year 7 students 1 year later in one school only; Year 8 students in both schools received the booster session.Setting and participantsStudents in Years 7–8 (aged 11–13 years) in two UK schools.InterventionA three-component intervention comprising (1) three 50-minute classroom-based sessions in Year 7 in which students acted as secret agents to uncover industry practices through videos, quizzes, discussions and presentations; (2) an accompanying family booklet containing activities designed to stimulate discussions about smoking between parents and students; and (3) a 1-hour interactive classroom-based booster session for Year 8 students, in which students learnt about tobacco marketing strategies from the perspectives of an industry executive, a marketing company and a health campaigner.Main outcome measuresOdds ratios to compare the self-reported prevalence of ever smoking and susceptibility to smoking in Year 8 students after the delivery of the booster session in study schools compared with students in local control schools. Qualitative data on acceptability of the intervention.ResultsThe combined prevalence of ever smoking and susceptibility increased from 18.2% in Year 7 to 33.8% in Year 8. After adjusting for confounders there was no significant difference in the odds of a Year 8 student in an intervention school being an ever smoker or susceptible never smoker compared with controls [adjusted odds ratio (aOR) 1.28, 95% confidence interval (CI) 0.83 to 1.97;p = 0.263] and no significant difference in the odds of ever smoking (aOR 0.82, 95% CI 0.42 to 1.58;p = 0.549). Students mostly enjoyed the intervention and acquired new knowledge that appeared to strengthen their aversion to smoking. Teachers liked the ‘off-the-shelf’ nature of the resource, although they highlighted differences by academic ability in the extent to which students understood the messages being presented. Use of the family component was low but it was received positively by those parents who did engage with it.LimitationsLogistical difficulties meant that students’ responses in Year 7 and Year 8 could not be linked; however, baseline smoking behaviours differed little between intervention and control schools, and analyses were adjusted for confounders measured at follow-up.ConclusionsOperation Smoke Storm is an acceptable resource for delivering smoking-prevention education but it does not appear to have reduced smoking and susceptibility.Future workThe lack of a strong signal for potential effectiveness, considered alongside logistical difficulties in recruiting and working with schools, suggests that a fully powered cluster randomised trial of the intervention is not warranted.FundingThe National Institute for Health Research (NIHR) Public Health Research programme.
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Affiliation(s)
- Lisa Szatkowski
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - John Taylor
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Amy Taylor
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - John Britton
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Linda Bauld
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Qi Wu
- Department of Health Sciences, University of York, York, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Laura Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Manpreet Bains
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
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Intarut N, Chongsuvivatwong V, McNeil E. Effects of a School-based Intervention Program on Attitude and Knowledge of Household Members Towards a Smoke-free Home: a Cluster Controlled Trial. Asian Pac J Cancer Prev 2016; 17:1235-42. [PMID: 27039753 DOI: 10.7314/apjcp.2016.17.3.1235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A school-based smoke free home (SFH) program is useful in empowering the mother and child to reduce secondhand smoke exposure but the effects of pretesting on knowledge and attitude has been largely ignored. We aimed to test whether such a program can be effective in Southern Thailand with an additional assessment of the net effect of the pretest. MATERIALS AND METHODS A Solomon four-group design was used. Twelve rural primary schools were assigned to one of the four conditions (each with 3 schools): intervention with and without a pretest, control with and without the same pretest. The intervention was performed in the classroom and home over a period of 1 month. Outcomes were assessed at baseline and 3 months after the intervention on whether the home was smoke free and related knowledge and attitude. RESULTS The intervention could lead to a smoke-free home without statistical significance. Attitude, knowledge and self-confidence on creating a smoke-free home, and self-confidence in avoidance of secondhand smoke exposure and persuading smokers to not smoke in their home were significantly improved. No pretest effect was observed. CONCLUSIONS Gain in attitude, knowledge and self-confidence among family members from the brief school-based education should be enhanced by other measures.
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Affiliation(s)
- Nirun Intarut
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand E-mail :
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Luh DL, Chen HH, Yen AMF, Wang TT, Chiu SYH, Fann CY, Chen SLS. Effect of self-reported home smoking restriction on smoking initiation among adolescents in Taiwan: a prospective cohort study. BMJ Open 2015; 5:e007025. [PMID: 26116613 PMCID: PMC4486945 DOI: 10.1136/bmjopen-2014-007025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The aims of this study were to investigate the influence of home smoking restriction (HSR) and the modified effect of parental smoking on smoking initiation among adolescents. DESIGN Prospective Cohort Study. SETTING Junior high school in Keelung City, Taiwan. PARTICIPANTS This study collected and evaluated primary data from the Adolescent Smoking and Other Health-Related Behaviour Survey conducted in Keelung City, which aimed to investigate smoking and health-related behaviours in junior high school students (2008-2009). Data on students free of smoking in 2008 and following them until 2009 (n=901) to ascertain whether they had started smoking were analysed with logistic regression mode to examine the proposed postulates. MAIN OUTCOME MEASURE The outcome variable was smoking initiation, which was defined as smoking status (yes/no) in the 2009 follow-up questionnaire. The main independent variable was HSR obtained from an adolescent self-reported questionnaire. Information on parental smoking was measured by adolescents self-reporting the smoking behaviour of their father and mother. RESULTS The rate of HSR was 29.79% among 7th grade adolescents. The effect of HSR on smoking initiation in adolescents was statistically significantly modified by paternal smoking (p=0.04) but not by maternal smoking (p=0.54). The effect of HSR on smoking initiation was small for fathers with the habit of smoking (OR=0.89, 95% CI (0.42 to 1.88)), but the corresponding effect size was 3.2-fold (OR=2.84, 95% CI 1.19 to 6.81) for fathers without the habit of smoking. CONCLUSIONS Paternal smoking behaviour may play an interactive role with HSR in preventing smoking initiation among Taiwanese adolescents.
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Affiliation(s)
- Dih-Ling Luh
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ting-Ting Wang
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Yuan Fann
- Department of Health Industry Management, School of Healthcare Management, Kainan University, Taoyuan, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
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Nichter M, Padmajam S, Nichter M, Sairu P, Aswathy S, Mini GK, Bindu VC, Pradeepkumar AS, Thankappan KR. Developing a smoke free homes initiative in Kerala, India. BMC Public Health 2015; 15:480. [PMID: 25958109 PMCID: PMC4429826 DOI: 10.1186/s12889-015-1815-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 05/01/2015] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. METHODS Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. RESULTS At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. CONCLUSIONS The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.
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Affiliation(s)
- Mimi Nichter
- University of Arizona, School of Anthropology, Tucson, AZ, USA.
| | - Sreedevi Padmajam
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India.
| | - Mark Nichter
- University of Arizona, School of Anthropology, Tucson, AZ, USA.
| | - P Sairu
- Additional Professor, Department of Community Medicine, TD Medical College Alappuzha, Kerala, India.
| | - S Aswathy
- Professor, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
| | - G K Mini
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India.
| | - V C Bindu
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India.
| | - A S Pradeepkumar
- Additional Director of Health Services, Kerala State Health Services, Trivandrum, Kerala, India.
| | - K R Thankappan
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Trivandrum, Kerala, India.
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Huque R, Dogar O, Cameron I, Thomson H, Amos A, Siddiqi K. Children Learning About Second-Hand Smoking: A Feasibility Cluster Randomized Controlled Trial. Nicotine Tob Res 2015; 17:1465-72. [PMID: 25634936 DOI: 10.1093/ntr/ntv015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/13/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Exposure to second-hand smoke is a threat to children's health. We developed a school-based smoke-free intervention (SFI) to support families in implementing smoke-free homes in Bangladesh, and gathered preliminary evidence of its effectiveness. METHODS A feasibility cluster randomized controlled trial of SFI was conducted in 24 schools in Mirpur, an urban area within Dhaka. Using simple stratified randomization, schools were allocated to: Arm A (SFI only), Arm B (SFI plus reminders), and Arm C (the control group). A total of 781 year-5 children (10-12 years old) in the consenting schools, participated in the study. Outcomes including "smoke-free homes" and "social visibility" that is, not smoking in front of children at home were assessed through questionnaire-based children's surveys, administered by researchers, at baseline and at weeks 1, 12, 27, and 52 in all arms. RESULTS "Smoke-free homes" were significantly higher in Arm A (odds ratio [OR] = 4.8; 95% CI = 2.6-9.0) and in Arm B (OR = 3.9; 95% CI = 2.0-7.5) than in Arm C, when controlled for the baseline levels, at year 1. Similarly, "social visibility" was significantly reduced in Arm A (OR = 5.8; 95% CI = 2.8-11.7) and in Arm B (OR = 7.2; 95% CI = 3.3-15.9) than Arm C, when controlled for the baseline levels, at year 1. We observed an increasing trend (Cochrane Armitage test statistic [Z] = 3.8; p < .0001) in homes becoming smoke-free with increasing intensity of the intervention (control < Arm A < Arm B), and a decreasing trend (Z = -5.13; p < .0001) in social visibility at homes. CONCLUSION SFI has the potential to encourage children to negotiate a smoke-free environment in their homes.
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Affiliation(s)
- Rumana Huque
- Department of Economics, University of Dhaka, Dhaka, Bangladesh;
| | - Omara Dogar
- Department of Health Sciences, University of York, York, UK
| | | | - Heather Thomson
- Office of the Director of Public Health, Leeds City Council, Leeds, UK
| | - Amanda Amos
- Centre for Population Health Sciences Medical School, University of Edinburgh, Edinburgh, UK
| | - Kamran Siddiqi
- Department of Health Sciences/Hull York Medical School, University of York, York, UK
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20
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Fenton B, Thankappan KR, Champagne B, Lv J, Anthony D. Increased knowledge of the effects of smoking and second-hand smoke encourages smoke-free homes. J Res Nurs 2014. [DOI: 10.1177/1744987114525963] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To establish the drivers for smoke-free homes among current daily smokers. Design A cross-sectional study employing interviews (adults) and self-completed surveys (schoolchildren). Sample Children aged 12 and 14 in schools in four cities in China, India, Mexico and England. Adults in the community. Measurements Knowledge, attitude, beliefs and behaviour relevant to second-hand smoke in home. Intervention None. Results A total of 8994 adults and 14,756 children were surveyed. Knowledge of some of the effects of tobacco is high, but other effects are poorly understood in all cities. In Thiruvananthapuram, there is a lack of awareness of the addictiveness of tobacco, and Hangzhou has poor knowledge in general. Conclusions Messages about reducing tobacco usage are effective in support of smoke-free homes in the city with poorest knowledge (Hangzhou) but other factors are more important where knowledge is high.
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Affiliation(s)
- Brenda Fenton
- Director, Community-based Research and Evaluation, MATRIX Public Health Solutions Inc., USA
| | - Kavumpurathu Raman Thankappan
- Professor, Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, India
| | | | - Jun Lv
- Associate Professor, Department of Epidemiology & Biostatistics, School of Public Health, Peking University Health Science Center, China
| | - Denis Anthony
- Statistical consultant, Oxford Health Alliance, UK; Chair in Applied Health Research, University of Leeds, UK
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Yücel U, Ocek ZA, Ciçeklioğlu M. Evaluation of an intensive intervention programme to protect children aged 1-5 years from environmental tobacco smoke exposure at home in Turkey. HEALTH EDUCATION RESEARCH 2014; 29:442-455. [PMID: 24718082 DOI: 10.1093/her/cyu005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The aim of this randomized-controlled trial was to evaluate the effectiveness of an intensive intervention to reduce children's environmental tobacco smoke (ETS) exposure at their home compared with a minimal intervention. The target population of the study was the mothers of children aged 1-5 who lived in the Cengizhan district of Izmir in Turkey, who smoked and/or whose spouses smoked. It was found that at least one parent of a total of 182 children smoked and 80 of these mothers were taken into stratified sampling based on the number of the smoking parents. Mothers were visited at their homes. During the initial visit, they were educated and urine samples were taken from their children. Following this initial visit, mothers were randomized to the intensive intervention (n = 38) or the minimal intervention group (n = 40). The levels of cotinine in the intensive intervention (P = 0.000) and minimal intervention (P = 0.000) groups in the final follow-up were significantly lower than the initial levels. The proportion of mothers reporting a complete smoking ban at home in the final follow-up was higher in the intensive intervention group than the minimal intervention group (P = 0.000). The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children's exposure to ETS at their home.
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Affiliation(s)
- U Yücel
- Department of Midwifery, Ege University Izmir Atatürk School of Health, Izmir 35100, Turkey and Faculty of Medicine, Department of Public Health, Ege University, Izmir 35100, Turkey
| | - Z A Ocek
- Department of Midwifery, Ege University Izmir Atatürk School of Health, Izmir 35100, Turkey and Faculty of Medicine, Department of Public Health, Ege University, Izmir 35100, Turkey
| | - M Ciçeklioğlu
- Department of Midwifery, Ege University Izmir Atatürk School of Health, Izmir 35100, Turkey and Faculty of Medicine, Department of Public Health, Ege University, Izmir 35100, Turkey
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Spangler J, Csákányi Z, Rogers T, Katona G. Parental ease in asking others not to smoke and respiratory symptoms and illness among children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1747-55. [PMID: 24503972 PMCID: PMC3945565 DOI: 10.3390/ijerph110201747] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 01/24/2014] [Accepted: 01/26/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Childhood exposure to secondhand tobacco smoke (SHS) increases a child's burden of respiratory conditions, but parental smoking bans may reduce such morbidity. This study evaluated household smoking bans and their relationship to respiratory illness in an outpatient otolaryngology clinic. METHODS The study was performed at the Heim Pal National Children's Hospital, Ear, Nose and Throat (ENT) Department (Budapest, Hungary) from July to November, 2010. A consecutive series of children's caregivers were approached to participate in a survey measuring household smoking bans, upper and lower respiratory tract symptoms and illnesses, and socioeconomic factors. Bivariate and multivariate logistic regression analyses were performed. RESULTS Of the 215 caregivers recruited for the study, 208 agreed to participate (response rate of 96.7%). More than half of the children were male (54%), and 39% lived in a household with at least one member who smoked. Smoking was frequently banned inside the car (91.3%) and home (85.1%). Respondents felt it easiest to ask friends (97.1%) and family members not living in the household (98.1%) to refrain from smoking inside the home. Respondents also found it easier to ask a stranger (81.7%) or a family member (61.1%) not to smoke around the child. Logistic regression showed that respondents for children with a history of pneumonia found it less difficult to ask visitors in the home not to smoke compared to children without pneumonia (OR = 0.23, 95% CI = 0.06-0.98). Conversely, respondents for children who had had adenoidectomy found it over three times more difficult to ask strangers not to smoke near the child compared to those of children without adenoidectomy (OR = 3.20, 95% CI = 1.43-6.38). CONCLUSIONS In a population of children visiting an outpatient ENT clinic in Budapest, Hungary, we found a high degree of exposure to SHS. The ease with which caregivers felt towards asking others not to smoke predicted specific respiratory conditions. Since the ENT clinic offers a wonderful opportunity for clinicians to counsel parents on tobacco cessation, increased tobacco education of these providers is needed.
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Affiliation(s)
- John Spangler
- Department of Family and Community Medicine, Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA.
| | - Zsuzsanna Csákányi
- Department of Otorhinolaryngology, Heim Pal Children's Hospital, ENT Department Üllói út 86. H-1089 Budapest, Hungary.
| | - Todd Rogers
- RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, USA.
| | - Gábor Katona
- Department of Otorhinolaryngology, Heim Pal Children's Hospital, ENT Department Üllói út 86. H-1089 Budapest, Hungary.
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Ainsworth H, Shah S, Ahmed F, Amos A, Cameron I, Fairhurst C, King R, Mir G, Parrott S, Sheikh A, Torgerson D, Thomson H, Siddiqi K. Muslim communities learning about second-hand smoke (MCLASS): study protocol for a pilot cluster randomised controlled trial. Trials 2013; 14:295. [PMID: 24034853 PMCID: PMC3847687 DOI: 10.1186/1745-6215-14-295] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/06/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK, 40% of Bangladeshi and 29% of Pakistani men smoke cigarettes regularly compared to the national average of 24%. As a consequence, second-hand smoking is also widespread in their households which is a serious health hazard to non-smokers, especially children. Smoking restrictions in households can help reduce exposure to second-hand smoking. This is a pilot trial of 'Smoke Free Homes', an educational programme which has been adapted for use by Muslim faith leaders, in an attempt to find an innovative solution to encourage Pakistani- and Bangladeshi-origin communities to implement smoking restrictions in their homes. The primary objectives for this pilot trial are to establish the feasibility of conducting such an evaluation and provide information to inform the design of a future definitive study. METHODS/DESIGN This is a pilot cluster randomised controlled trial of 'Smoke Free Homes', with an embedded preliminary health economic evaluation and a qualitative analysis. The trial will be carried out in around 14 Islamic religious settings. Equal randomisation will be employed to allocate each cluster to a trial arm. The intervention group will be offered the Smoke Free Homes package (Smoke Free Homes: a resource for Muslim religious teachers), trained in its use, and will subsequently implement the package in their religious settings. The remaining clusters will not be offered the package until the completion of the study and will form the control group. At each cluster, we aim to recruit around 50 households with at least one adult resident who smokes tobacco and at least one child or a non-smoking adult. Households will complete a household survey and a non-smoking individual will provide a saliva sample which will be tested for cotinine. All participant outcomes will be measured before and after the intervention period in both arms of the trial. In addition, a purposive sample of participants and religious leaders/teachers will take part in interviews and focus groups. DISCUSSION The results of this pilot study will inform the protocol for a definitive trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN03035510.
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Affiliation(s)
- Hannah Ainsworth
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire YO10 5DD, England
| | - Sarwat Shah
- Department of Health Sciences, University of York, York, North Yorkshire YO10 5DD, England
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, England
| | - Amanda Amos
- UKCTCS, Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland
| | - Ian Cameron
- Leeds City Council, Civic Hall, Calverley Street, Leeds LS1 1UR, England
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire YO10 5DD, England
| | - Rebecca King
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, England
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds LS2 9LJ, England
| | - Steve Parrott
- Department of Health Sciences, University of York, York, North Yorkshire YO10 5DD, England
| | - Aziz Sheikh
- Allergy & Respiratory Research Group, Centre for Population Health Sciences, University of Edinburgh, Medical School, Teviot Place, Edinburgh EH8 9AG, Scotland
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, North Yorkshire YO10 5DD, England
| | - Heather Thomson
- Leeds City Council, Civic Hall, Calverley Street, Leeds LS1 1UR, England
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, North Yorkshire YO10 5DD, England
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Carlsson N, Johansson A, Abrahamsson A, Andersson Gäre B. How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas. BMC Pediatr 2013; 13:76. [PMID: 23672646 PMCID: PMC3660282 DOI: 10.1186/1471-2431-13-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 05/02/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.
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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
| | - AnnaKarin Johansson
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Agneta Abrahamsson
- Department of Health and Society, University College of Kristianstad, SE-291 88, Kristianstad, 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
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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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Hipple B, Lando H, Klein J, Winickoff J. Global teens and tobacco: a review of the globalization of the tobacco epidemic. Curr Probl Pediatr Adolesc Health Care 2011; 41:216-30. [PMID: 21821205 DOI: 10.1016/j.cppeds.2011.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Worldwide, the burden of suffering to children caused by tobacco does not just originate from exposure to tobacco smoke or smoking, but includes exposure to tobacco-friendly media, poverty associated with money spent on tobacco, increased incidence of tobacco-related fires, and the harms related to child labor in tobacco cultivation. Despite global efforts through human rights acts, the Framework Convention on Tobacco Control, and the MPOWER report, tobacco use continues to accelerate in most countries. While the efforts that have been taken, such as smoking bans in public, are worthy actions, not enough is being done to protect children and teens. More can be done at the policy level, by individuals, and by health care providers.
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Affiliation(s)
- Bethany Hipple
- Center for Child and Adolescent Health Policy, Massachusetts General Hospital for Children, Boston, MA, USA
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Allmark P, Tod AM, McDonnell A, Al-Alawy K, Mann K, Hollis E, Qutishat D, Williamson M, Iliff A. Evaluation of the impact of a smoke-free home initiative in Rotherham, a deprived district in Northern England. Eur J Public Health 2011; 22:248-51. [DOI: 10.1093/eurpub/ckr072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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