Correlates of household smoking bans in low-income families of children with and without asthma

Secondhand and thirdhand smoke: a review on chemical contents, exposure routes, and protective strategies

Secondhand smoke (SHS: a mixture of sidestream and mainstream smoke) and thirdhand smoke (THS: made up of the pollutants that settle indoors after smoking in closed environments) are a significant public health concern. SHS and THS contain various chemicals which can be released into the air or settle on surfaces. At present, the hazards of SHS and THS are not as well documented. In this review, we describe the chemical contents of THS and SHS, exposure routes, vulnerable groups, health effects, and protective strategies. The literature search was conducted for published papers on September 2022 in Scopus, Web of Science, PubMed, and Google Scholar databases. This review could provide a comprehensive understanding of the chemical contents of THS and SHS, exposure routes, vulnerable groups, health effects, protective strategies, and future researches on environmental tobacco smoke.

A cross-sectional study of the relationship of proximal smoking environments and cessation history, plans, and self-efficacy among low-income smokers

Introduction

Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable.

Aims

We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit.

Methods

This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy).

Results

Smokers who lived in homes with more restrictive household smoking rules, and/or reported having 'important others' who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting.

Conclusions

Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.

Correlates of Allowing Alternative Tobacco Product or Marijuana Use in the Homes of Young Adults

BACKGROUND

Given the increases in alternative tobacco product (ATP) and marijuana use, we examined self-reported likelihood of allowing ATP and marijuana use in the home among young adults.

METHODS

We analyzed data from a study of students aged 18 to 25 years (n = 2865) at 7 Georgia colleges and universities. Variables included: personal, household members', and friends' tobacco (cigarettes, little cigars and cigarillos [LCCs], e-cigarettes, hookah) and marijuana use and the perceived harm to health, harm of byproducts, addictiveness, and social acceptability of each. Regression models were specified to examine correlates of the likelihood of allowing use of each product in the home.

RESULTS

Personal use prevalence ranged from 5.5% for e-cigarettes to 12.5% for marijuana. E-cigarettes were most likely to be allowed in the home; cigarettes were least. Regression indicated that others' use and the perceived social acceptability of using each product was correlated with greater likelihood of allowing the use of a product. A greater likelihood of allowing cigarette and LCC use in the home was only associated with cigarette or LCC use, respectively; a greater likelihood of allowing e-cigarette use was associated with current e-cigarette use; greater likelihood of allowing hookah use was associated with using any product except e-cigarettes; and greater likelihood of allowing marijuana use was associated with LCC and marijuana use. Perceived harm to health, byproduct harms, and addictiveness were differentially related to the likelihood of allowing use of different products.

CONCLUSIONS

ATPs and marijuana may undermine efforts to protect against environmental toxins in the home, thus warranting interventions targeting young adults.

Can a minimal intervention reduce secondhand smoke exposure among children with asthma from low income minority families? Results of a randomized trial

We report on the results of a low-intensity behavioral intervention to reduce second hand smoke (SHS) exposure of children with asthma from low income minority households in Los Angeles, California. In this study, 242 child/adult dyads were randomized to a behavioral intervention (video, workbook, minimal counseling) or control condition (brochure). Main outcome measures included child's urine cotinine and parental reports of child's hours of SHS exposure and number of household cigarettes smoked. Implementation of household bans was also considered. No differences in outcomes were detected between intervention and control groups at follow-up. Limitations included high attrition and low rates of collection of objective measures (few children with urine cotinine samples). There continues to be a need for effective culturally and linguistically appropriate strategies that support reduction of household SHS exposure among children with asthma in low income, minority households.

Predictors of Voluntary Home-Smoking Restrictions and Associations with an Objective Measure of In-Home Smoking among Subsidized Housing Tenants

Purpose.

Examine predictors of voluntary home-smoking restrictions (HSRs) and associations with an objective measure of in-home smoking.

Design.

Cross-sectional.

Setting.

Publicly subsidized multiunit housing units managed by private company in Columbus, Ohio, without a smoke-free housing policy.

Subjects.

Probability sample of primary leaseholders (N = 301, 64% response rate).

Measures.

Self-reported knowledge, attitudes, and behaviors collected during face-to-face survey in fall 2011, including individual (e.g., knowledge of health effects), social (e.g., number of friends who smoke), and environmental (e.g., safety) factors hypothesized to be related to having HSRs. Surface nicotine concentration (μg/m2) based on samples collected from wood surface in respondents' living rooms (n = 279).

Analysis.

Multiple linear and logistic regression were used to identify factors associated with having HSRs and with indoor surface nicotine concentrations.

Results.

Fewer than one-third (29.2%) of tenants had complete HSRs, while more than half (55.8%) had partial restrictions. Several individual and social factors, but no environmental/community factors, were associated with having HSRs. Type of HSRs (p < .001) and smoking status (p < .001) were independently associated with mean surface nicotine concentrations.

Conclusion.

Few subsidized housing tenants voluntarily limit in-home smoking. Partial restrictions could be considered as a harm reduction strategy but may be less effective among smokers. Strategies to change social norms are also needed to modify in-home smoking behavior among subsidized housing tenants.

Smoking restrictions in the homes of children with cancer

OBJECTIVES

To examine smoking restrictions in households of children with cancer and their effect on biological measures of children's secondhand smoke exposure (SHSe).

METHODS

A sample of 135 parents of nonsmoking children with cancer who lived with a smoker completed structured interviews.

RESULTS

Approximately 43% of families prohibited smoking in the home. Children living in homes that prohibited smoking had median cotinine levels that were 71% and 52% lower than did those from homes with no and partial restrictions.

CONCLUSIONS

Parents should be directed to completely ban all smoking from the home and car to best protect their children from SHSe.

Perceived Factors Affecting Asthma Among Adolescents

Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year in an inner-city Chicago high school with high asthma rates and poor asthma morbidity. Students met after school twice a week over 10 weeks. Students were given basic training in research and media production using photovoice participatory research technique and were instructed to identify personally relevant factors affecting asthma through photography and journaling. Students’ journal entries and photographs were qualitatively coded. Relative frequencies of codes were calculated to determine common themes among identified factors. Students worked with a videographer to compile their findings into informational videos, which were used to educate peers and community members about asthma. Results: Fifteen students aged 13 to 18 attended a mean of 11 sessions (out of 20). One hundred eighty photographs (mean = 12 per student) and 112 journal entries (mean = 7.5 per student) were reviewed, with 4 predominant positive and negative factors identified. Reported factors influencing students’ health and asthma included social support (22% of student photos and journal entries), neighborhood environment (17%), and lifestyle (28%), in addition to well-established asthma factors (43%). Conclusions: Results from the Student Asthma Research Team pilot demonstrate that adolescent students, given appropriate instruction and opportunity, are able to identify factors affecting their asthma. Interventions engaging adolescents via self-directed identification and participatory media production techniques hold promise as vehicles for enabling students to own and share health-related experiences through research and peer/community outreach.

Impact of the environment on asthma control

Asthma is a complex condition that requires individualized interventions. The purpose of this article is to describe the relationship between the physical and social environments with asthma symptoms, present evidence that supports environmental interventions in asthma control and the implications for asthma management. There is evidence that indoor and outdoor allergens relate to asthma morbidity. Knowledge about which environmental exposures present risk is essential because many of these exposures can be modified, reduced, or eliminated. The community health nurse should provide care relative to the client's indoor and outdoor environment and existing allergens.

Helpful hints: caregiver-generated asthma management strategies and their relation to pediatric asthma symptoms and quality of life

OBJECTIVE

This mixed-methods study examined the relation between caregiver-generated asthma management strategies and asthma severity in a sample of 200 children with persistent asthma (ages 5-12 years).

METHODS

Caregivers were interviewed about asthma management strategies they found helpful in controlling their child's symptoms. A qualitative content analysis was used to identify household strategies. Indicators of asthma severity included lung functioning (FEV(1)) and functional severity (FSS). Child quality of life was also assessed (PQLQ).

RESULTS

Six primary household strategies were identified: Reactive, Planning Ahead, Social, Emotional, Avoiding Triggers, and Cleaning. In general, strategies offered by caregivers did not differ by socioeconomic status. Caregivers who endorsed Avoiding Triggers as effective strategies had children with better lung functioning. Caregivers who endorsed Planning Ahead or Emotional strategies had children with better asthma-related quality of life.

CONCLUSION

These household strategies hold promise for reducing pediatric asthma symptoms and improving child quality of life.

Secondhand smoke exposure in young people and parental rules against smoking at home and in the car

OBJECTIVES

Secondhand smoke (SHS) exposure is an important cause of morbidity in children. We assessed the impact of family rules about smoking in the home and car on SHS exposure prevalence in students in grades six to 12.

METHODS

We studied never-smoking young people (n = 1,698) in the random sample cross-sectional South Carolina Youth Tobacco Survey, a 2006 survey of middle and high school students in South Carolina.

RESULTS

Overall, 40% of the students reported SHS exposure in either the home or car in the past week; among these, 85% reported exposure in cars. Subsequent analyses focused on students who lived with a smoker (n = 602). Compared with those whose families prohibited smoking in the home or car, SHS exposure prevalence was 30% (p < 0.0001) higher for households with smoke-free rules for only one place (home or car) and 36% (p < 0.0001) higher for households with no rules. Compared with students from households with strict rules, SHS exposure prevalence was 48% greater (p < 0.0001) among those with only partial rules against smoking in the home or car, and 55% (p < 0.0001) greater among those from households with no rules. Similarly, compared with students with strict family rules for home and car that were adhered to, SHS exposure prevalence was significantly higher (p < 0.0001) among students when only one or no rules were followed.

CONCLUSIONS

Young people from families that made and enforced strong rules against smoking in homes and cars were much less likely to report SHS exposure. Parents would be wise to endorse and enforce strong smoke-free policies for both homes and cars.

A second reporter matters: agreement between parents' and children's reports of smoking bans in families

BACKGROUND

Home and car smoking bans implemented by caregivers are important approaches to reducing children's secondhand smoke (SHS) exposure and attendant health risks. Such private smoking bans are usually informal and are subject to individuals' interpretation, observation, and recall. Relying on a single reporter may lead to misclassification of bans in families.

PURPOSE

To determine (1) proportion of families with discordant reports of bans; (2) association between parent-child report agreement and SHS exposure; and (3) whether including a second reporter of bans improves prediction of child SHS exposure.

METHODS

In each of 386 participating families a preteen and a parent reported separately on their home and car smoking bans, and agreement was determined. ANOVA, chi-square, and multiple linear regression were used to determine relationships between SHS exposure (measured by urine cotinine and reported exposure) and home/car smoking bans reported by preteens and parents.

RESULTS

In 19% of families, reports disagreed for home smoking bans; 30%, for car smoking bans. Families who agreed on the presence of a ban had the lowest exposure, families who agreed on the absence of a ban had the highest exposure, and intermediate exposure for those who disagreed. Parent and child reports of bans each explained significant, unique variance in child SHS exposure.

CONCLUSIONS

Due to relatively high prevalence of discordant reporting, a more accurate classification of home/car smoking bans may result from including multiple reporters.

Recent contributions of air- and biomarkers to the control of secondhand smoke (SHS): a review

Since the publication of the US Surgeon General Reports in 1996 and 2006 and the report of the California Environmental Protection Agency in 1999, many reports have appeared on the contribution of air and biomarkers to different facets of the secondhand smoke (SHS) issue, which are the targets of this review. These recent studies have allowed earlier epidemiological surveys to be biologically validated, and their plausibility demonstrated, quantified the levels of exposure to SHS before the bans in various environments, showed the deficiencies of mechanical control methods and of partial bans and the frequently correct implementation of the efficient total bans. More stringent regulation remains necessary in the public domain (workplaces, hospitality venues, transport sector, etc.) in many countries. Personal voluntary protection efforts against SHS are also needed in the private domain (homes, private cars). The effects of SHS on the cardiovascular, respiratory and neuropsychic systems, on pregnancy and fertility, on cancers and on SHS genotoxicity are confirmed through experimental human studies and through the relationship between markers and prevalence of disease or of markers of disease risk.

Relationships between household smoking restrictions and intention to quit smoking among Korean American male smokers in California

This cross-sectional study examined the relationships between household smoking restrictions and intentions to quit smoking among Korean American male smokers in California. We used data from the California Korean American Tobacco Use Survey (CKATUS), which was conducted in 2004 using computer-assisted telephone interviewing. Among the 2,545 respondents who participated in the CKATUS, the 387 male smokers who answered a question assessing their intention to quit smoking were included in the final analyses. In univariable analyses, smokers who reported having household smoking restrictions were more likely to intend to quit smoking as compared with those who did not (P<0.01). Other independent correlates of having an intention to quit smoking were being less than 50 yr of age, having spent more than 50% of one's life in the US, being assimilated, and having other smokers in the household. In a multiple logistic regression analysis, the significant correlates of having an intention to quit smoking were household smoking restrictions (complete or partial restriction vs. no restriction on smoking; odds ratio, 2.54; 95% confidence interval, 1.22-5.28) and absence of other smokers in the household. In conclusion, smoking restrictions in the household are associated with an intention to quit smoking among Korean American male smokers in California.

Evaluation of family functioning and anxiety-depression parameters in mothers of children with asthma

BACKGROUND

Psychological problems are more commonly observed in mothers of children with asthma when compared to the general population. Smoking in the house and parental cooperation are the other factors which influence psychological status in mothers of children with asthma. In our study, we aimed to investigate family functioning and frequency of psychological symptoms in mothers of children with asthma.

METHODS

The study group consisted of 160 mothers of 4-15 year old children with asthma and the control group consisted of 90 mothers of healthy children. Beck's inventory, continuous anxiety inventory and family assessment device were administered to each group of mothers.

RESULTS

Results indicated that levels of depression and anxiety symptoms were higher and perception of family functioning was less healthy in mothers of children with asthma compared to those in the control group (p<0.0001). Smoking status at home and level of communication with the father were found to have a significant impact on the evaluation scale in mothers in the case group.

DISCUSSION

Psychiatric symptoms observed in mothers of asthmatic children might be associated to influencing the functioning of the entire family rather that of the mother alone. Therefore, evaluation of family functioning in mothers of children with asthma might be beneficial in terms of follow-up and control of disease.

Psychological stress and family functioning in mothers of children with allergic rhinitis

OBJECTIVE

Psychiatric symptoms are observed more commonly in mothers of children with allergic disease compared to the general population. In our study, we aimed to compare family functioning and anxiety parameters in mothers of children diagnosed allergic rhinitis and healthy controls.

METHODS

Study group consisted of 82 mothers of 7-15 years old children with allergic rhinitis. Control group consisted of 70 mothers of children with no chronic diseases. State-Trait Anxiety Inventory (STAI) and McMaster Family Assessment Device (FAD) scales was obtained from participants.

RESULTS

Anxiety scores in mother of children with allergic rhinitis were significantly higher than the ones in the control group (50+/-7.54, 32+/-5.44, p=0.02, respectively). Family assessment scores were higher in mother of children with allergic rhinitis when compared to the control group but did not reach statistical significance (1.89+/-0.12, 1.87+/-0.95, p=0.19, respectively). Smoking status at home and jobless father were found to have a significant impact on the evaluation scale in mothers in the case group.

CONCLUSION

Psychiatric symptoms observed in mothers of children with allergic rhinitis might be associated with child disease and the functioning of the entire family rather than features of the mother alone. Having a child with allergic rhinitis does not affect family functions according to the mother's aspect.

Influences on parents' decisions for home and automobile smoking bans in households with smokers

OBJECTIVE

To understand clinician influence on use of home and automobile smoking bans in homes of children living with a smoker.

METHODS

Parents were surveyed on tobacco use, smoking bans, demographics and opinions about tobacco, including harm from environmental tobacco smoke (ETS). Responses from 463 diverse households with smokers were analyzed.

RESULTS

42% of respondents smoked; 50% had a home smoking ban and 58% an automobile smoking ban. Nonsmokers living with a smoker, those who strongly agreed in ETS harm, and those having a child < or = 5 years more often had a home smoking ban. Those recalling their child's doctor ever asking the respondent about their smoking status and African American respondents less frequently had a home ban. Automobile smoking bans were more often held by those with strong agreement in ETS harm and less often found in families having a child receiving Medicaid/uninsured.

CONCLUSIONS

Having a strong perception of harm from ETS exposure was associated with having smoking bans. Aspects of health encounters not measured by this study may be negatively influencing adoption of home smoking bans or lead to recall bias.

PRACTICE IMPLICATIONS

Clinicians should examine the strength, focus, and response to their messages to parents about tobacco.

Breathing life into family processes: introduction to the special issue on families and asthma

This introduction to the special issue dedicated to families and asthma proposes that the study of asthma highlights general systems topics such as integration of individual needs into the group, developmental trajectories of risk and resilience, supportive and destructive patterns of interaction, and the cultural adaptation of family therapy. It briefly introduces papers in the special issue and concludes that asthma can serve as an exemplar in the study of family health due to its comorbidity with mental health problems, potential to affect multiple members of the family, disproportionate influence on low-income and minority families, and multiple avenues for intervention.