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Ferris E, Cummins C, Chiswell C, Jones L. Exploring stakeholder views on intervening in hospital around childhood secondhand smoke exposure (Precedent): a protocol for a qualitative study. BMJ Open 2021; 11:e047817. [PMID: 34706947 PMCID: PMC8552168 DOI: 10.1136/bmjopen-2020-047817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 09/30/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Secondhand smoke exposure (SHSe) in childhood is linked with increased morbidity and mortality. Hospital or secondary care contact may present a 'teachable moment' to provide parents with support to change their home smoking behaviours to reduce children's SHSe. There is a lack of robust qualitative evidence around parents and healthcare professionals (HCPs) views on using this teachable moment to successfully initiate behavioural change. We aim to identify and understand what is important to stakeholders with a view to informing the development of a support package to help parents change their home smoking behaviours. METHODS AND ANALYSIS This qualitative study will be theoretically underpinned by the Capability, Opportunity and Motivation Behaviour (COM-B) model of behavioural change. It will involve semistructured interviews and/or discussion groups with up to 20 parents who smoke and up to 25 HCPs. Stakeholders will be recruited from a single National Health Service children's hospital in England. Interviews and/or discussion groups will be audio recorded, transcribed and anonymised. The transcripts and any field notes will be analysed using the framework method. Initially, we will apply COM-B to the data deductively and will then code inductively within each domain. ETHICS AND DISSEMINATION The protocol for this study received a favourable outcome from the East Midlands Leicester Central Research Ethics Committee (19/EM/0171). Results will be written up as part of a PhD thesis, submitted for publication in peer-reviewed journals and presentation at conferences. TRIAL REGISTRATION NUMBER ISRCTN40084089.
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Affiliation(s)
- Erica Ferris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher Chiswell
- Public Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Laura Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Scheffers-van Schayck T, Hipple Walters B, Otten R, Kleinjan M. Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study. BMC Health Serv Res 2021; 21:973. [PMID: 34530809 PMCID: PMC8444610 DOI: 10.1186/s12913-021-06969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. Methods Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. Results The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. Conclusions Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands. .,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands.
| | - Bethany Hipple Walters
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Roy Otten
- Clinical Developmental Psychology, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands
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Ferris E, Cummins C, Chiswell C, Jones LL. A Mixed-Methods Systematic Review and Synthesis of Secondary Care Interventions to Reduce Secondhand Smoke Exposure Among Children and Young People. Nicotine Tob Res 2021; 23:643-653. [PMID: 33098295 DOI: 10.1093/ntr/ntaa216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/27/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Childhood secondhand smoke exposure (SHSe) is linked with increased morbidity and mortality. Hospital or secondary care contact presents a "teachable moment" to support parents to change their home smoking behaviors to reduce children's SHSe. AIMS AND METHODS This mixed-methods review explores: (1) if existing interventions in this context are effective, (2) if they are reported in sufficient detail to be replicated, (3) the experiences of health care professionals delivering such interventions, and (4) the experiences of parents receiving such interventions. Five electronic databases and the gray literature were searched for relevant literature published and indexed January 1980 to February 2020. Fourteen papers reporting 12 studies (nine quantitative and five qualitative) were included. Aligned with the Joanna Briggs Institute method, a segregated approach was used involving independent syntheses of the quantitative and qualitative data followed by an overall mixed-methods synthesis. RESULTS There was some evidence of effective interventions that resulted in a short-term (<6 months) reduction in children's SHSe when SHSe was subjectively measured. This was not seen in longer-term follow-up (>6 months) or when SHSe was measured objectively. Inconsistencies with reporting make replication challenging. Experiential evidence suggests a mismatch between stakeholder preferences and interventions being offered. CONCLUSIONS The pediatric secondary care interventions included in this analysis failed to show statistically significant evidence of longer-term effectiveness to reduce children's SHSe in all but one low-quality study. There was also inadequate reporting of interventions limiting assessment of effectiveness. It offers further insights into areas to target to develop effective interventions. IMPLICATIONS This review used rigorous methods to explore the current, global literature on how children's exposure to secondhand smoke is being tackled in secondary care. This review identified only one low-quality intervention study showing a statistically significant reduction in children's SHSe beyond 6 months. Synthesis with qualitative research identifies a mismatch between what parents want in an intervention and what has been delivered to date. Reporting quality needs to be improved to ensure that interventions can be replicated and studies conducted within the National Health Service to ensure suitability to this setting.
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Affiliation(s)
- Erica Ferris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher Chiswell
- Department of Public Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Mahabee-Gittens EM, Ammerman RT, Khoury JC, Tabangin ME, Ding L, Merianos AL, Stone L, Gordon JS. A Parental Smoking Cessation Intervention in the Pediatric Emergency Setting: A Randomized Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218151. [PMID: 33158230 PMCID: PMC7663571 DOI: 10.3390/ijerph17218151] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 01/05/2023]
Abstract
We examined the efficacy of a pediatric emergency visit-based screening, brief intervention, and referral to treatment (SBIRT) condition compared to a control condition (Healthy Habits Control, HHC) to help parental smokers quit smoking. We enrolled 750 parental smokers who presented to the pediatric emergency setting with their child into a two-group randomized controlled clinical trial. SBIRT participants received brief cessation coaching, quitting resources, and up to 12-weeks of nicotine replacement therapy (NRT). HHC participants received healthy lifestyle coaching and resources. The primary outcome was point-prevalence tobacco abstinence at six weeks (T1) and six months (T2). The mean (SD) age of parents was 31.8 (7.7) years, and 86.8% were female, 52.7% were Black, and 64.6% had an income of ≤$15,000. Overall abstinence rates were not statistically significant with 4.2% in both groups at T1 and 12.9% and 8.3% in the SBIRT and HHC groups, respectively, at T2. There were statistically significant differences in SBIRT versus HHC participants on the median (IQR) reduction of daily cigarettes smoked at T1 from baseline (−2 [−5, 0] versus 0 [−4, 0], p = 0.0008),at T2 from baseline (−4 [−9, −1] vs. −2 [−5, 0], p = 0.0006), and on the mean (SD) number of quit attempts at T2 from baseline (1.25 (6.5) vs. 0.02 (4.71), p = 0.02). Self-reported quitting rates were higher in SBIRT parents who received NRT (83.3% vs. 50.9%, p = 0.04). The novel use of the pediatric emergency visit to conduct cessation interventions helped parents quit smoking. The near equivalent abstinence rates in both the SBIRT and HHC groups may be due to underlying parental concern about their child’s health. Cessation interventions in this setting may result in adult and pediatric public health benefits.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA;
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Correspondence: ; Tel.: +1-513-636-7966
| | - Robert T. Ammerman
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Jane C. Khoury
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Meredith E. Tabangin
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Lili Ding
- College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA; (R.T.A.); (J.C.K.); (M.E.T.); (L.D.)
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229–3026, USA;
| | - Judith S. Gordon
- College of Nursing, University of Arizona, Tucson, AZ 85721, USA;
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Association of secondhand smoke exposure with asthma symptoms, medication use, and healthcare utilization among asthmatic adolescents. J Asthma 2019; 56:369-379. [PMID: 29641269 PMCID: PMC6181790 DOI: 10.1080/02770903.2018.1463379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/27/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the association between secondhand smoke exposure (SHSe) and asthma symptoms, medication use, and emergency department (ED)/urgent care (UC) utilization among adolescents. METHODS We performed a secondary cross-sectional analysis of Population Assessment of Tobacco and Health Study Wave 2 (2014-2015) including asthmatic adolescents (N = 2198). Logistic regression models and Poisson regression models were built. RESULTS Participants with SHSe ≥1 hour in the past 7 days were at increased risk of reporting shortness of breath and harder to exercise aOR, 1.22; 95% CI, 1.04-1.43), wheezing (aOR, 1.26; 95% CI, 1.01-1.56), wheezing disturbing sleep (aOR, 1.88; 95% CI, 1.35-2.63), wheezing during/after exercise (aOR, 1.41; 95% CI, 1.19-1.66), wheezing limiting speech (aOR, 2.11; 95% CI, 1.55-2.86), dry cough at night (aOR, 1.86; 95% CI, 1.54-2.24), and asthma symptoms disturbing sleep (aOR, 2.25; 95% CI, 1.81-2.79). Participants with SHSe ≥1 hour were more likely to take asthma medications (aOR, 1.25; 95% CI, 1.03-1.52), including steroids (aOR, 1.86; 95% CI, 1.19-2.91), oxygen therapy (aOR, 2.88; 95% CI, 1.82-4.54), and controlling medications (aOR, 1.50; 95% CI, 1.24-1.82). Symptoms and medications varied by living with a smoker and home SHSe. Participants with SHSe were at increased risk of having a higher number of asthma attacks that required steroid use. Participants who lived with a smoker and had home SHSe were at increased risk of having higher ED/UC visits for asthma. CONCLUSIONS SHSe reduction efforts are needed for asthmatic adolescents, and EDs/UCs are promising venues.
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Affiliation(s)
- Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Roman A. Jandarov
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Yao T, Sung HY, Wang Y, Lightwood J, Max W. Healthcare Costs of Secondhand Smoke Exposure at Home for U.S. Children. Am J Prev Med 2019; 56:281-287. [PMID: 30553690 PMCID: PMC6340755 DOI: 10.1016/j.amepre.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this study is to estimate healthcare utilization and healthcare costs due to secondhand smoke exposure at home for children in the U.S. METHODS Using data from the 2000, 2005, and 2010 U.S. National Health Interview Surveys, the authors analyzed the association between secondhand smoke exposure at home and utilization of three types of healthcare services (hospital nights, emergency room visits, and doctor visits) for children aged 3-14 years (N=16,860). A zero-inflated Poisson regression model was used to control for sociodemographic characteristics and the number of months without health insurance. The authors determined excess healthcare utilization attributable to secondhand smoke exposure at home for children and then estimated annual secondhand smoke-attributable healthcare costs as the product of annual excess healthcare utilization and unit costs obtained from the 2014 Medical Expenditures Panel Survey. This study was conducted from 2016 to 2018. RESULTS The prevalence of secondhand smoke exposure at home for children in 2000, 2005, and 2010 was 25.0%, 12.3%, and 9.1%, respectively. Secondhand smoke exposure at home was positively associated with emergency room visits, but was not significantly associated with nights at the hospital or doctor visits for children. Secondhand smoke exposure at home for children resulted in an excess of 347,156 emergency room visits in 2000, 124,412 visits in 2005, and 101,570 visits in 2010, which amounted to $215.1 million, $77.1 million, and $62.9 million in excess annual healthcare costs (2014 dollars) in 2000, 2005, and 2010, respectively. CONCLUSIONS Although U.S. healthcare costs attributable to secondhand smoke exposure at home for children are declining, interventions to reduce secondhand smoke exposure at home for children are still needed to reduce the economic burden attributable to secondhand smoke exposure.
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Affiliation(s)
- Tingting Yao
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California.
| | - Hai-Yen Sung
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California
| | - Yingning Wang
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California
| | - James Lightwood
- Department of Clinical Pharmacy, School of Pharmacy, University of California, San Francisco, San Francisco, California
| | - Wendy Max
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, California
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use. Pediatrics 2018; 142:e20180266. [PMID: 30082449 PMCID: PMC6317548 DOI: 10.1542/peds.2018-0266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our objective was to examine the relationship between distinct tobacco smoke exposure (TSE) measures and TSE-related symptoms and emergency department (ED) and/or urgent care (UC) use among nonsmoking adolescents without asthma diagnoses. METHODS We performed a secondary analysis of 7389 adolescents who completed the Population Assessment of Tobacco and Health Study wave 2. Logistic regression and Poisson regression models were built. RESULTS Adolescents with TSE were at increased risk of reporting: shortness of breath, finding it hard to exercise, wheezing during or after exercise, and dry cough at night. Adolescents who lived with a smoker and had home TSE were at increased odds of reporting wheezing or whistling in the chest, and only adolescents with home TSE were at increased risk of reporting wheezing that disturbed sleep. Adolescents with TSE were less likely to report very good or excellent overall health and physical health but were more likely to report they sometimes, often, or very often missed school because of illness. Participants who lived with a smoker and had TSE ≥1 hour were more likely to have had an ED and/or UC visit. Participants with any TSE were at increased risk of having a higher number of ED and/or UC visits. CONCLUSIONS Different TSE measures uniquely increased the risk of TSE-related symptoms, but any TSE increased the risk of having a higher number of ED and/or UC visits. The providers at these high-volume settings should offer interventions to adolescents who are exposed to tobacco smoke and their families to decrease these symptoms and related morbidity.
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Affiliation(s)
- Ashley L Merianos
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, Ohio
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Mahabee-Gittens EM, Ammerman RT, Khoury JC, Stone L, Meyers GT, Witry JK, Merianos AL, Mancuso TF, Stackpole KMW, Bennett BL, Akers L, Gordon JS. Healthy families: study protocol for a randomized controlled trial of a screening, brief intervention, and referral to treatment intervention for caregivers to reduce secondhand smoke exposure among pediatric emergency patients. BMC Public Health 2017; 17:374. [PMID: 28464887 PMCID: PMC5414142 DOI: 10.1186/s12889-017-4278-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/21/2017] [Indexed: 11/15/2022] Open
Abstract
Background Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers. Methods/design This trial uses a randomized, two-group design in which caregiver-smokers of children 0–17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child’s illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control “5–2–1-0” counseling that focuses on improving the child’s health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed. Discussion This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers’ tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children. Trial registration ClinicalTrials.gov Identifier: NCT02531594. Date of registration: August 4, 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4278-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA. .,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA.
| | - Robert T Ammerman
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Behavioral Medicine & Clinical Psychology, Cincinnati, Ohio, USA
| | - Jane C Khoury
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Biostatistics and Epidemiology, Cincinnati, Ohio, USA
| | - Lara Stone
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - Gabe T Meyers
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - John K Witry
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, PO Box 210002, Cincinnati, OH, 45221, USA
| | - Tierney F Mancuso
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Pediatric Residency Training Program, Cincinnati, Ohio, USA
| | - Kristin M W Stackpole
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Center for Better Health and Nutrition (HealthWorks!), Cincinnati, Ohio, USA
| | - Berkeley L Bennett
- Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA.,Division of Pediatric Emergency Medicine, Cincinnati, Ohio, USA
| | - Laura Akers
- Oregon Research Institute, 1776 Millrace Drive, Eugene, Oregon, 97403, USA
| | - Judith S Gordon
- College of Nursing University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, USA
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Development of a Tobacco Cessation Clinical Decision Support System for Pediatric Emergency Nurses. Comput Inform Nurs 2017; 34:560-569. [PMID: 27379524 DOI: 10.1097/cin.0000000000000267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Almost 50% of children who visit the pediatric emergency department are exposed to tobacco smoke. However, pediatric emergency nurses do not routinely address this issue. The incorporation of a clinical decision support system into the electronic health record may improve the rates of tobacco exposure screening and interventions. We used a mixed-methods design to develop, refine, and implement an evidence-based clinical decision support system to help nurses screen, educate, and assist caregivers to quit smoking. We included an advisory panel of emergency department experts and leaders and focus and user groups of nurses. The prompts include the following: (1) "Ask" about child smoke exposure and caregiver smoking; (2) "Advise" caregivers to reduce their child's smoke exposure by quitting smoking; (3) "Assess" interest; and (4) "Assist" caregivers to quit. The clinical decision support system was created to reflect nurses' suggestions and was implemented in five busy urgent care settings with 38 nurses. The nurses reported that the system was easy to use and helped them to address caregiver smoking. The use of this innovative tool may create a sustainable and disseminable model for prompting nurses to provide evidence-based tobacco cessation treatment.
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Merianos AL, Dixon CA, Mahabee-Gittens EM. Tobacco Smoke Exposure-Related Illnesses Among Pediatric Emergency Department Patients. J Pediatr Health Care 2017; 31:161-166. [PMID: 27542562 PMCID: PMC5313387 DOI: 10.1016/j.pedhc.2016.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 07/08/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study aimed to determine the relationship between patients presenting to the pediatric emergency department (PED) and potential tobacco smoke exposure (TSE)-related illnesses. METHODS A retrospective review of electronic medical records of pediatric emergency department patients (N = 116,084) was conducted. Sociodemographic characteristics, TSE-related illnesses, and TSE documentation were extracted. Logistic regression analyses were performed. RESULTS More than one fifth (21.7%) of patients had TSE-related illnesses. Patients who were younger, male, non-White, or Hispanic; had Medicaid/Medicare insurance, had low triage acuity; or were admitted to any non-intensive care unit or intensive care unit were significantly more likely to have TSE-related illnesses. Twenty-eight percent of patients with TSE documentation had positive TSE status. Although regression models for positive TSE indicated similar findings, no difference was found based on ethnicity. DISCUSSION Pediatric emergency departments, especially those that care for large numbers of children, should offer tobacco interventions that target at-risk populations and caregivers who are most likely not receiving interventions in other health care settings.
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Affiliation(s)
- Ashley L. Merianos
- University of Cincinnati, School of Human Services, University of Cincinnati, PO Box 210068, Cincinnati, OH, USA,
| | - Cinnamon A. Dixon
- Kaiser Permanente, Department of Pediatrics, 100535 E. Dakota Avenue, Denver, CO, 80247, USA,
| | - E. Melinda Mahabee-Gittens
- Cincinnati Children’s Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA,
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Merianos AL, Odar Stough C, Nabors LA, Mahabee-Gittens EM. Tobacco Smoke Exposure and Health-Care Utilization Among Children in the United States. Am J Health Promot 2017; 32:123-130. [PMID: 29214835 DOI: 10.1177/0890117116686885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to assess patterns of health-care utilization among children who potentially had tobacco smoke exposure (TSE) compared to those who were not exposed. DESIGN A secondary data analysis of the 2011 to 2012 National Survey on Children's Health was performed. SETTING Households nationwide were selected. PARTICIPANTS A total of 95 677 children aged 0 to 17 years. MEASURES Sociodemographic characteristics, TSE status, and health-care visits were measured. ANALYSIS Multivariable logistic regression models were performed. RESULTS A total of 24.1% of children lived with smokers. Approximately 5% had home TSE. Participants who lived with a smoker were significantly more likely to have had a medical care visit (odds ratio [OR] = 1.22, confidence interval [CI] = 1.21-1.22) and were more likely to seek sick care or health advice at an emergency department (OR = 1.23, CI = 1.23-1.24) but were less likely to have had a dental care visit (OR = 0.82, CI = 0.82-0.83) than those who did not live with a smoker. Similar findings were found among participants who had home TSE. CONCLUSION TSE is a risk factor for increased use of pediatric medical care. Based on the high number of children who potentially had TSE and received sick care or health advice at an emergency emergency department, this setting may be a venue to deliver health messages to caregivers.
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Affiliation(s)
- Ashley L Merianos
- 1 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Cathy Odar Stough
- 2 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura A Nabors
- 1 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- 3 Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Joseph CLM, Lu M, Stokes-Bruzzelli S, Johnson DA, Duffy E, Demers M, Zhang T, Ownby DR, Zoratti E, Mahajan P. Initiating an online asthma management program in urban emergency departments: the recruitment experience. Ann Allergy Asthma Immunol 2015; 116:43-8. [PMID: 26596405 DOI: 10.1016/j.anai.2015.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/30/2015] [Accepted: 10/19/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The emergency department could represent a means of identifying patients with asthma who could benefit from asthma interventions. OBJECTIVE To assess the initiation of a Web-based tailored asthma intervention in the emergency department of 2 urban tertiary care hospitals. METHODS In addition to awareness strategies for emergency department staff (eg, attending nursing huddles, division meetings, etc), recruitment experiences are described for 2 strategies: (1) recruitment during an emergency department visit for acute asthma and (2) recruitment from patient listings (mail or telephone). Patient enrollment was defined as baseline completion, randomization, and completion of the first of 4 online sessions. RESULTS Of 499 eligible patients 13 to 19 years old visiting the emergency department for asthma during the study period, 313 (63%) were contacted in the emergency department (n = 65) or by mail or telephone (n = 350). Of these, 121 (38.6%) were randomized. Mean age of the study sample was 15.4 years and 88.4% were African American. Refusal rates for emergency department recruitment and mail or telephone were 18.5% (12 of 65) and 16.6% (58 of 350), respectively. On average, emergency department enrollment took 44 to 67 minutes, including downtime. When surveyed, emergency department providers were more positive about awareness activities and emergency department recruitment than were research staff. CONCLUSION Emergency department recruitment was feasible but labor intensive. Refusal rates were similar for the 2 strategies. Targeting patients with acute asthma in the emergency department is one way of connecting with youth at risk of future acute events.
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Affiliation(s)
- Christine L M Joseph
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan.
| | - Mei Lu
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | | | - Dayna A Johnson
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Elizabeth Duffy
- Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
| | - Michele Demers
- Center for Health Communications Research, University of Michigan, Ann Arbor, Michigan
| | - Talan Zhang
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Dennis R Ownby
- Division of Allergy and Clinical Immunology, Georgia Regents University, Augusta, Georgia
| | - Edward Zoratti
- Division of Allergy and Clinical Immunology, Henry Ford Health System, Detroit, Michigan
| | - Prashant Mahajan
- Pediatric Emergency Medicine, Children's Hospital of Michigan, Detroit, Michigan
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A smoking cessation intervention for low-income smokers in the ED. Am J Emerg Med 2015; 33:1056-61. [PMID: 25976268 DOI: 10.1016/j.ajem.2015.04.058] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/23/2015] [Accepted: 04/24/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There is a high prevalence of smoking among caregivers who bring their children to the pediatric emergency department (PED) and even higher rates of tobacco smoke exposure (TSE) and related morbidity among their children. The PED visit presents an opportunity to intervene with caregivers, but it is unknown whether they are more likely to quit if their child has a TSE-related illness. We sought to examine a PED-based smoking cessation intervention and compare outcomes based on children's TSE-related illness. METHODS A single-arm, prospective trial, with baseline, 3, and 6 month assessments was used in this study. Caregivers whose child had either a TSE-related (n=100) or non-TSE-related illness (n=100) were given a brief intervention consisting of counseling, referral to the Quitline, and free nicotine replacement therapy. RESULTS Participants were 91.5% female, 50.5% African American, 100% Medicaid recipients, 30.8 years old, child age mean of 5.5 years, 90% highly nicotine dependent, and 60.3% and 75.8% allowed smoking in the home and car, respectively. At follow-up (65% retention), 80% reported quit attempts at 3 months and 89% between 3 and 6 months. There were significant decreases in number of cigarettes smoked, time to first cigarette, and smoking in the home and car. Quit rates were 12.2% at 3 months, 14.6% at 6 months, and 7.3% at both time points (50% biochemically confirmed). There were no significant differences in outcomes based on children's illness. CONCLUSIONS A brief PED-based smoking cessation intervention resulted in quit attempts and successful quits. However, the presence of a TSE-related illness did not result in different cessation outcomes.
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Abstract
OBJECTIVE To examine if motivation to quit is associated with parental smoker's perceived presence of a personal or child health illness or risk due to tobacco use. DESIGN/METHODS This was a cross-sectional study of a convenience sample of 218 parental smokers who presented to the pediatric emergency department with their child. We assessed factors related to motivation to quit, including personal and child smoking-related illness, perceived personal and child health risk, smoking behaviors, and demographic characteristics. Motivation to quit was measured using the Contemplation Ladder score. RESULTS The mean score on the Contemplation Ladder was 6.2 (SD, 2.5), representing the response: thinking about cutting down or quitting . Eighty-four participants (39%) had high motivation to quit (Contemplation Ladder score 8). Bivariate analysis showed significant associations between high motivation to quit and perceived child health risk with continued smoking and perceived personal and child health benefit following smoking cessation. Parents with high motivation to quit were more likely to have high perceived self-efficacy and confidence in their ability to quit, prior quit attempts, and lower nicotine dependence. With the exception of race/ethnicity, demographic variables were not associated with motivation to quit. CONCLUSIONS A significant proportion of parental smokers who present to the pediatric emergency department endorse strong motivation to quit. Parents who endorse health risk or quitting-related health benefits in their child are more likely to have high motivation to quit smoking. Future studies are needed to determine if high motivation translates into smoking cessation.
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Pelletier JH, Strout TD, Baumann MR. A systematic review of smoking cessation interventions in the emergency setting. Am J Emerg Med 2014; 32:713-24. [DOI: 10.1016/j.ajem.2014.03.042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 11/17/2022] Open
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Mahabee-Gittens EM, Chen C, Huang B, Gordon JS. The acceptability of incorporating a youth smoking prevention intervention in the pediatric emergency department. J Health Care Poor Underserved 2014; 25:787-800. [PMID: 24858886 DOI: 10.1353/hpu.2014.0091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The pediatric emergency department (PED) is under-utilized as a setting in which to provide tobacco prevention interventions for at-risk children. We sought to determine the acceptability and feasibility of incorporating a brief, parental tobacco prevention intervention to 520 parents during the PED visit. Mean age (SD) of parents and children was 38.6 (7.1) and 11.5 (1.1), respectively; 47% of children were female; 45% were African American; 36% of parents had an annual income less than $25,000; 28.8% of parents were current smokers. Over 90% of parents said the intervention provided "useful" and "easy to understand" information and 97% of practitioners said it did not "interfere with clinical care." Given the high prevalence of parental smoking in the PED, there is a high likelihood that their children will initiate smoking in the future. Thus, the use of the PED as a venue to providing tobacco prevention interventions warrants further evaluation.
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Blaine K, Rogers J, Winickoff JP, Oppenheimer SC, Timm A, Ozonoff A, Geller AC. Engaging in secondhand smoke reduction discussions with parents of hospitalized pediatric patients: a national survey of pediatric nurses in the United States. Prev Med 2014; 62:83-8. [PMID: 24502846 DOI: 10.1016/j.ypmed.2014.01.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 01/22/2014] [Accepted: 01/27/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To identify individual- and system-level predictors and barriers associated with US pediatric nurses' routine counseling about child secondhand smoke exposure for parents of hospitalized children. METHODS In 2008, members of the Society of Pediatric Nurses completed a questionnaire assessing demographic, hospital systems, and work attitudes related to the following outcomes: asking about child secondhand smoke exposure, informing about sources of secondhand smoke exposure, counseling about the dangers of secondhand smoke exposure, and advising a smoke-free home policy. RESULTS Of 1475 eligible nurses, 888 completed the survey. We found that 39% asked, 43% informed, 29% counseled, and 25% advised parents. Nurses working in hospitals with mandatory prompts in the medical record to assess child secondhand smoke exposure, the availability of written materials for parent smokers, and regular secondhand smoke counseling training for nurses had increased odds of routinely engaging parents in secondhand smoke reduction best practices. Nurses reported parents' resistance to discussions about smoking, short hospital stays, and non-standardized care as the most common barriers to counseling parents. CONCLUSION System supports in hospitals significantly increases the odds of nurses engaging in child secondhand smoke reduction practices. Strengthening existing systems and introducing new policies are critical for nurses' engagement of parents in discussions about reducing child secondhand smoke exposure.
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Choo EK, Sullivan AF, LoVecchio F, Perret JN, Camargo CA, Boudreaux ED. Patient preferences for emergency department-initiated tobacco interventions: a multicenter cross-sectional study of current smokers. Addict Sci Clin Pract 2012; 7:4. [PMID: 22966410 PMCID: PMC3414814 DOI: 10.1186/1940-0640-7-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 03/15/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The emergency department (ED) visit provides a great opportunity to initiate interventions for smoking cessation. However, little is known about ED patient preferences for receiving smoking cessation interventions or correlates of interest in tobacco counseling. METHODS ED patients at 10 US medical centers were surveyed about preferences for hypothetical smoking cessation interventions and specific counseling styles. Multivariable linear regression determined correlates of receptivity to bedside counseling. RESULTS Three hundred seventy-five patients were enrolled; 46% smoked at least one pack of cigarettes per day, and 11% had a smoking-related diagnosis. Most participants (75%) reported interest in at least one intervention. Medications were the most popular (e.g., nicotine replacement therapy, 54%), followed by linkages to hotlines or other outpatient counseling (33-42%), then counseling during the ED visit (33%). Counseling styles rated most favorably involved individualized feedback (54%), avoidance skill-building (53%), and emphasis on autonomy (53%). In univariable analysis, age (r=0.09), gender (average Likert score=2.75 for men, 2.42 for women), education (average Likert score=2.92 for non-high school graduates, 2.44 for high school graduates), and presence of smoking-related symptoms (r=0.10) were significant at the p<0.10 level and thus were retained for the final model. In multivariable linear regression, male gender, lower education, and smoking-related symptoms were independent correlates of increased receptivity to ED-based smoking counseling. CONCLUSIONS In this multicenter study, smokers reported receptivity to ED-initiated interventions. However, there was variability in individual preferences for intervention type and counseling styles. To be effective in reducing smoking among its patients, the ED should offer a range of tobacco intervention options.
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Affiliation(s)
- Esther K Choo
- Injury Prevention Center, Department of Emergency Medicine, Rhode Island Hospital, Warren Alpert Medical School of Brown University, 55 Claverick Street, 2nd Floor, Providence, RI 02903, USA
| | - Ashley F Sullivan
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
| | - Frank LoVecchio
- Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ 85006, USA
| | - John N Perret
- Department of Emergency Medicine, LSU Health Sciences Center/Earl K. Long Medical Center, 5825 Airline Highway, Baton Rouge, LA 70805, USA
| | - Carlos A Camargo
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
| | - Edwin D Boudreaux
- Emergency Medicine Network, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA
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Current world literature. Addictive disorder. Curr Opin Psychiatry 2009; 22:331-6. [PMID: 19365188 DOI: 10.1097/yco.0b013e32832ae253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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