1
|
Paraje G, Valdés N. Changes in parental smoking behavior and children's health status in Chile. Prev Med 2021; 153:106792. [PMID: 34506821 DOI: 10.1016/j.ypmed.2021.106792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 08/26/2021] [Accepted: 09/05/2021] [Indexed: 11/18/2022]
Abstract
Studies on parental smoking behavior have mostly been conducted for developed countries and show that current parental smoking is negatively associated with children's current health. Using four waves of a Chilean longitudinal survey (Encuesta de Protección Social), we estimate probit and ordinary least squares models relating parents' self-report of their children's current health status to several covariates, including current parental smoking status and change (transitions) in parental smoking status across the waves of the survey. The data were collected in the years 2004, 2006, 2009, and 2015. The working sample includes 25,052 observations. The study revealed that parents' self-report of their children's current health status is strongly associated with current and past parental smoking status. Parents who smoke have an increased 11.17% probability of reporting that their children are in fair, poor, or very poor health status, when compared to non-smoking parents. The effect is stronger if the smoker is the mother, and it is exacerbated if she is less educated or unemployed/inactive. In addition, quitting smoking has a significant positive effect on children's reported health status, which is greater if the mother quits smoking. Cessation among mothers who are unemployed or inactive is also associated with a more positive assessment of their children's health status. The findings suggest that cessation programs may have health benefits not only for smoking parents, but also for their children. Improving coverage or establishing a national cessation program may have important present and future effects on population health and well-being.
Collapse
Affiliation(s)
- Guillermo Paraje
- Escuela de Negocios, Universidad Adolfo Ibáñez, Avenida Diagonal Las Torres 2640, Peñalolén, Santiago de Chile, Chile.
| | - Nieves Valdés
- Escuela de Negocios, Universidad Adolfo Ibáñez, Avenida Diagonal Las Torres 2640, Peñalolén, Santiago de Chile, Chile.
| |
Collapse
|
2
|
Kraus L, Uhl A, Atzendorf J, Seitz NN. Estimating the number of children in households with substance use disorders in Germany. Child Adolesc Psychiatry Ment Health 2021; 15:63. [PMID: 34740375 PMCID: PMC8571854 DOI: 10.1186/s13034-021-00415-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/26/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Parental substance misuse is reported to endanger the health and psychological development of children and adolescents. The aim of the present study was to address conceptual and methodological problems in estimating the number of children affected by parental substance misuse (CaPSM) and offer a novel approach based on survey data. METHODS Data came from the 2018 German Epidemiological Survey of Substance Abuse (ESA) among 18- to 64-year-olds (n = 9267) and from population statistics. DSM-IV diagnostic criteria were used to assess substance use disorder (SUD) related to tobacco, alcohol, cannabis, cocaine or amphetamine. Based on the number of household members, the number of children below age 18 years and the information on SUD status of the respondent living in this household, the number of children currently living in households with at least one member with SUD was estimated. RESULTS In 2018, there were 13,597,428 children younger than 18 years living in Germany. Of these, 6.9-12.3% (935,522-1,673,103) were estimated to currently live in households where at least one adult had a tobacco use disorder, 5.1-9.2% (688,111-1,257,345) in households where at least one adult had an alcohol use disorder and 0.6-1.2% (87,817-158,401) in households where at least one adult had a disorder related to the use of illicit drugs. The total number of children currently living with SUD adults in their household was estimated at 11.2-20.2% (1,521,495-2,751,796). CONCLUSIONS Available estimates are difficult to interpret and to compare due to a lack of clear case definitions and methodological approaches with various biases and limitations. Future estimates need to provide precise case definitions and standard approaches.
Collapse
Affiliation(s)
- Ludwig Kraus
- IFT Institut für Therapieforschung, Leopoldstraße 175, 80804, München, Germany. .,Department of Public Health Sciences, Centre for Social Research On Alcohol and Drugs, Stockholm University, Stockholm, Sweden. .,Institute of Psychology, ELTE Eötvös-Loránd-University, Budapest, Hungary.
| | - Alfred Uhl
- grid.502403.00000 0004 0437 2768Austrian Public Health Institute, Vienna, Austria ,grid.263618.80000 0004 0367 8888Sigmund Freud Private University, Vienna, Austria
| | - Josefine Atzendorf
- grid.462523.40000 0004 1794 2504Munich Center for the Economics of Aging (MEA), Max-Planck-Institute for Social Law and Social Policy, Munich, Germany
| | - Nicki-Nils Seitz
- grid.417840.e0000 0001 1017 4547IFT Institut für Therapieforschung, Leopoldstraße 175, 80804 München, Germany
| |
Collapse
|
3
|
Satyanarayana VA, Jackson C, Siddiqi K, Chandra PS, Huque R, Dherani M, Nasreen S, Murthy P, Rahman A. A behaviour change intervention to reduce home exposure to second hand smoke during pregnancy in India and Bangladesh: a theory and evidence-based approach to development. Pilot Feasibility Stud 2021; 7:74. [PMID: 33741080 PMCID: PMC7977562 DOI: 10.1186/s40814-021-00811-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 03/02/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Home exposure to secondhand smoke (SHS) is highly prevalent amongst pregnant women in low- and middle-income countries like India and Bangladesh. The literature on the efficacy of behaviour change interventions to reduce home exposure to SHS in pregnancy is scarce. METHODS We employed a theory and evidence-based approach to develop an intervention using pregnant women as agents of change for their husband's smoking behaviours at home. A systematic review of SHS behaviour change interventions led us to focus on developing a multicomponent intervention and informed selection of behaviour change techniques (BCTs) for review in a modified Delphi survey. The modified Delphi survey provided expert consensus on the most effective BCTs in reducing home exposure to SHS. Finally, a qualitative interview study provided context and detailed understanding of knowledge, attitudes and practices around SHS. This insight informed the content and delivery of the proposed intervention components. RESULTS The final intervention consisted of four components: a report on saliva cotinine levels of the pregnant woman, a picture booklet containing information about SHS and its impact on health as well strategies to negotiate a smoke-free home, a letter from the future baby to their father encouraging him to provide a smoke-free home, and automated voice reminder and motivational messages delivered to husbands on their mobile phone. Intervention delivery was in a single face-to-face session with a research assistant who explained the cotinine report, discussed key strategies for ensuring a smoke-free environment at home and practised with pregnant women how they would share the booklet and letter with their husband and supportive family members. CONCLUSION A theory and evidence-based approach informed the development of a multicomponent behaviour change intervention, described here. The acceptability and feasibility of the intervention which was subsequently tested in a pilot RCT in India and Bangladesh will be published later.
Collapse
Affiliation(s)
- Veena A. Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, 560029 India
| | - Cath Jackson
- Valid Research Limited, Sandown House, Sandbeck Way, Wetherby, West Yorkshire LS22 7DN UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Seebohm Rowntree Building, Heslington, York, Y010 5DD UK
| | - Prabha S. Chandra
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, 560029 India
| | - Rumana Huque
- Department of Economics, University of Dhaka and ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Mukesh Dherani
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, L69 3BX UK
| | - Shammi Nasreen
- ARK Foundation, House No 6, Road NO 109, Gulshan 2, Dhaka, Bangladesh
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, 560029 India
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, L69 3BX UK
| |
Collapse
|
4
|
Dai S, Chan KC. Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong. Tob Induc Dis 2020; 18:02. [PMID: 31966027 PMCID: PMC6964497 DOI: 10.18332/tid/114461] [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: 06/21/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Young children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age. METHODS A secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms. RESULTS The analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016). CONCLUSIONS Household ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.
Collapse
Affiliation(s)
- Siyu Dai
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Kate C Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
5
|
Dai S, Chan KCC. Household environmental tobacco smoke exposure in healthy young children in Hong Kong: Prevalence and risk factors. PLoS One 2020; 15:e0227733. [PMID: 31935251 PMCID: PMC6959553 DOI: 10.1371/journal.pone.0227733] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 12/29/2019] [Indexed: 11/18/2022] Open
Abstract
Background Environmental tobacco smoke (ETS) exposure attributable respiratory illness burden is huge in paediatric population. Understanding the epidemiology of ETS exposure is important to guide health promotion planning. Therefore, we designed this study to determine the prevalence of household ETS exposure in healthy young children under 2 years of age in Hong Kong, and to explore risk factors associated with the exposure. Our secondary goal was to characterise children’s exposure profile to maternal smoking. Methods A secondary analysis was performed based on the data collected from our 2013–2014 territory-wide cross-sectional pneumococcal carriage surveillance study, with a sample size of 1541. We conducted descriptive analysis for exposure prevalence, univariate and multivariate analysis for identification of risk factors. Results 1541 children (mean age: 11.2 ± 6.4 months, male: 50.7%) were included in the analysis. The overall prevalence of current household ETS exposure was 31.5%, prevalence of prenatal and postnatal maternal smoking was 3.5% and 1.6% respectively. Independent factors associated with children’s ETS exposure were: never breastfed (AOR: 1.48, 95% CI: 1.13–1.93, p = 0.004); prenatal maternal smoking (AOR: 7.46, 95% CI: 2.73–20.39, p< 0.001); overcrowding of household living place (AOR: 3.17, 95% CI: 2.02–4.96, P< 0.001); lower household income (AOR: 1.34, 95% CI: 1.04–1.72, p = 0.02). Interestingly, children residing in Kowloon (AOR: 1.66, 95% CI: 1.19–2.33, p = 0.003) and New Territories West (AOR: 1.54, 95% CI: 1.11–2.15, p = 0.01) were associated with exposure compared with children residing in Hong Kong Island. Conclusion Exposure to household ETS is prevalent among Hong Kong young children, particularly in children with maternal unfavourable behaviour and lower socioeconomic status. The identified risk factors should be considered while tobacco control interventions and legislations are planned.
Collapse
Affiliation(s)
- Siyu Dai
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate Ching Ching Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| |
Collapse
|
6
|
Yang HS, Lim H, Choi J, Bae S, Kim Y, Kwon HJ, Ha M. Environmental Tobacco Smoke Exposure at Home and Attributable Problem Behaviors in Korean Children and Adolescents for 2012-2014 in a Nationally Representative Survey. J Korean Med Sci 2018; 33:e229. [PMID: 30181731 PMCID: PMC6115691 DOI: 10.3346/jkms.2018.33.e229] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 05/29/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to examine the environmental tobacco smoke (ETS) exposure at home and associated problem behaviors in Korean children and adolescents. METHODS Approximately 2,167 children aged 3-18 years were included in the study after excluding 163 active smokers from the Korean Environmental Health Survey in Children and Adolescents (2012-2014). ETS data were obtained using a questionnaire; problem behaviors were measured using the Child Behavior Checklist administered to parents. The relationship between ETS exposure and problem behavior was evaluated using a survey regression model adjusted for region, age, sex, income, and father's education. The population-attributable fraction (PAF%) was calculated based on problem behaviors related to ETS exposure at home. RESULTS The rates of ETS exposure at home were 20%, 28%, and 39% in children aged 3-5, 6-11, and 12-18 years, respectively; ETS exposure at home was associated with behavioral problems: the exposed group having higher total behavioral problem score (95% confidence interval [CI]) than the non-exposed by 2.46 (0.60-4.32) and 2.74 (0.74-4.74) in children aged 6-11 and 12-18 years, respectively, with no significant association in those aged 3-5 years. The PAF% (95% CI) of total problem behaviors for ETS exposure at home were 2.68 (-10.11-17.78), 10.66 (3.25-17.55), and 11.62 (3.03-18.96) in children aged 3-5, 6-11, and 12-18 years, respectively. Children with externalizing problems had higher PAF% than those with internalizing problems. CONCLUSION In Korea, ETS exposure at home is associated with problem behaviors in children and adolescents with about more than 10% population attributable fraction.
Collapse
Affiliation(s)
- Hee sun Yang
- Department of Public Health, Graduate School of Dankook University, Cheonan, Korea
| | - Hyungryul Lim
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Jonghyuk Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Sanghyuk Bae
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Yeni Kim
- Department of Pediatric Psychiatry, National Center for Mental Health, Seoul, Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| | - Mina Ha
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea
| |
Collapse
|
7
|
Daly JB, Freund M, Burrows S, Considine R, Bowman JA, Wiggers JH. A Cluster Randomised Controlled Trial of a Brief Child Health Nurse Intervention to Reduce Infant Secondhand Smoke Exposure. Matern Child Health J 2018; 21:108-117. [PMID: 27487783 DOI: 10.1007/s10995-016-2099-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Exposure to secondhand smoke (SHS) is a significant contributor to ill health in children. A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans. Methods This study was a 3 arm, cluster randomised controlled trial. Clusters were 39 community based well child health clinics in one local area health service. Clinics were stratified according to annual number of client appointments and then randomly assigned in a 1:1:1 ratio, (Intervention 1: Intervention 2: Control), with 13 clinics in each cluster. Parents/carers of infants in the intervention groups received a brief multi-strategic intervention from child health nurses during clinic consultations. Treatment condition 1 included computer delivered risk assessment and feedback and nurse brief advice. Treatment condition 2 included all elements of Treatment condition 1 with the addition of biochemical feedback of infant SHS exposure. Results When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 (OR 1.16, 95 % CI 0.73-1.85, p = 0.53) or Treatment condition 2 (OR 1.30, 95 % CI 0.88-1.92, p = 0.19) Similarly, no significant differences were detected in the proportion of parent/carers who reported that they were smokers (T1:OR 0.95, 95 % CI 0.78-1.15, p = 0.58 and T2:OR 0.97, 95 % CI 0.80-1.18, p = 0.77), or in the proportion of households reported to have a complete smoking ban (T1:OR 1.21, 95 % CI 0.89-1.64, p = 0.23 and T2:OR 1.06, 95 % CI 0.79-1.43, p = 0.68). Conclusions Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.
Collapse
Affiliation(s)
- Justine B Daly
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2289, Australia.
- Faculty of Health, School of Medicine and Population Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia.
| | - Megan Freund
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2289, Australia
- Faculty of Health, School of Medicine and Population Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - Sally Burrows
- School of Medicine and Pharmacology, University of Western Australia, 35 Sterling Highway, Crawley, 6009, Australia
| | - Robyn Considine
- Faculty of Health, School of Medicine and Population Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Jennifer A Bowman
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
- Faculty of Science and Information Technology, School of Psychology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - John H Wiggers
- Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2289, Australia
- Faculty of Health, School of Medicine and Population Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
- Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| |
Collapse
|
8
|
Klitkou ST, Iversen T, Stensvold HJ, Rønnestad A. Use of hospital-based health care services among children aged 1 through 9 years who were born very preterm - a population-based study. BMC Health Serv Res 2017; 17:571. [PMID: 28818072 PMCID: PMC5561635 DOI: 10.1186/s12913-017-2498-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very preterm (VPT) children, with a birth weight below 1500 g or delivered before 32 weeks of gestational age, are at increased risk of poorer long-term health outcomes and higher rates of hospitalization in childhood. However, considerable variation exists in the need for in-hospital care within this population. We assessed the utilization and distribution of hospital-based care from ages 1 through 9 years for a nationwide population. METHODS This was a population-based cohort of VPT children born in the period 2001-2009. We evaluated their utilization of hospital care in 2008-2010, when aged 1-9 years old. Outcomes were the incidence of hospital admissions and outpatient visits. We used Poisson regression models with multiple imputation of missing data. RESULTS Children born VPT had more hospital admissions compared with the general population of children aged 1-9 years. The rates of hospital admissions and outpatient visits were strongly related to clinical characteristics of the child at birth and age at admission/outpatient visit but to only a variable and minor degree to characteristics pertaining to maternal health, the sociodemographic factors, and geographical proximity to hospital services. CONCLUSIONS Prior to this study, hospital utilization during the period 5-9 years old has been poorly documented. We found that excess utilization of hospital resources on average declines with increasing age. We also noted substantial differences in the use of hospital care across age groups and clinical factors for VPT children. The added information from the health status of mothers, social background, and geographic measures of access was limited.
Collapse
Affiliation(s)
- Søren T Klitkou
- Department of Health Management and Health Economics, University of Oslo, P.b. 1089 Blindern, NO 0317, Oslo, Norway.
| | - Tor Iversen
- Department of Health Management and Health Economics, University of Oslo, P.b. 1089 Blindern, NO 0317, Oslo, Norway
| | - Hans J Stensvold
- Clinic for Pediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arild Rønnestad
- Clinic for Pediatric and Adolescent Medicine, Neonatal Intensive Care Unit, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Fallin-Bennett A, Ashford K. Tailoring a NICU-Based Tobacco Treatment Program for Mothers Who Are Dependent on Opioids. J Obstet Gynecol Neonatal Nurs 2017; 46:660-668. [PMID: 28754255 DOI: 10.1016/j.jogn.2017.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To collect formative information to design a tailored tobacco treatment intervention for women with newborns treated or evaluated for neonatal abstinence syndrome and to explore current tobacco use behaviors and facilitators and barriers to smoking cessation. DESIGN Qualitative descriptive study. SETTING An academic medical center in the southern United States. PARTICIPANTS Mothers (N = 11) of newborns who were treated or evaluated for neonatal abstinence syndrome at birth within the preceding 3 months. Women recruited were older than 18 years and reported opioid dependence and smoking during pregnancy. METHODS Participants took part in semistructured individual interviews that lasted approximately 1 hour. Interviews were professionally transcribed and analyzed in MAXQDA using content analysis. RESULTS Five themes emerged from the data: Strategizing to Reduce Risk, Desire to Quit Smoking in the Future, Holding on to Smoking While Working Through Recovery, Feeling Judged by Nurses, and Feeling Supported and Empowered by Nurses. Participants reported that they to reduce risk to their newborns by avoiding second- and thirdhand smoke exposure. Participants wanted to stop smoking but reported many barriers, including multiple life stressors compounded by their newborns' extended stays in the hospital. However, most participants described overall positive experiences and the support of health care providers. CONCLUSION Holistic tobacco treatment programs that incorporate stress relief and social support and are led by trusted health care providers have the potential to be effective to reduce smoking in new mothers with histories of opioid dependence disorders and smoking and whose newborns are in the NICU.
Collapse
|
10
|
Jackson C, Huque R, Satyanarayana V, Nasreen S, Kaur M, Barua D, Bhowmik PN, Guha M, Dherani M, Rahman A, Siddiqi K, Chandra PS. "He Doesn't Listen to My Words at All, So I Don't Tell Him Anything"-A Qualitative Investigation on Exposure to Second Hand Smoke among Pregnant Women, Their Husbands and Family Members from Rural Bangladesh and Urban India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111098. [PMID: 27834841 PMCID: PMC5129308 DOI: 10.3390/ijerph13111098] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/01/2016] [Accepted: 11/02/2016] [Indexed: 11/16/2022]
Abstract
Second hand smoke (SHS) exposure during pregnancy is associated with poor pregnancy and fetal outcomes. To design interventions to reduce exposure, an in depth understanding of social and cultural factors of smoking behavior at home is important, especially in South Asia where SHS exposure is high. This study aimed to explore pregnant women's, their husbands' and other family members' knowledge, attitudes and practices regarding home SHS exposure. Semi-structured interviews were conducted with 33 participants in Comilla, Bangladesh and 31 in Bangalore, India (36 pregnant women, 18 husbands, and 10 family members). Data were analyzed using the Framework approach. Husbands smoked in various living areas inside the home, often in the presence of their pregnant wives. Most had never tried to stop smoking at home. Knowledge of the risks was generally poor. Most women had repeatedly asked their husband to smoke outside with little success and only few family members had reprimanded the husbands. Husbands who had stopped did so because of requests from children and their mother. Potential strategies to decrease SHS exposure at home were educating the husband about risks and supporting the pregnant women in negotiation. Interventions must also enlist family support to enhance the woman's self-efficacy.
Collapse
Affiliation(s)
- Cath Jackson
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK.
| | - Rumana Huque
- ARK Foundation, House 130, Road 21, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Veena Satyanarayana
- National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Shammi Nasreen
- ARK Foundation, House 130, Road 21, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Manpreet Kaur
- National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| | - Deepa Barua
- ARK Foundation, House 130, Road 21, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | | | - Mithila Guha
- ARK Foundation, House 130, Road 21, New DOHS, Mohakhali, Dhaka 1206, Bangladesh.
| | - Mukesh Dherani
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK.
| | - Atif Rahman
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK.
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York YO10 5DD, UK.
| | - Prabha S Chandra
- National Institute of Mental Health and Neurosciences, Bangalore 560029, India.
| |
Collapse
|
11
|
Blaakman SW, Borrelli B, Wiesenthal EN, Fagnano M, Tremblay PJ, Stevens TP, Halterman JS. Secondhand Smoke Exposure Reduction After NICU Discharge: Results of a Randomized Trial. Acad Pediatr 2015. [PMID: 26210908 DOI: 10.1016/j.acap.2015.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Premature infants are at high risk for respiratory disease, and secondhand smoke (SHS) exposure further increases their risk for developing respiratory illness and asthma. Yet, SHS exposure remains problematic in this vulnerable population. Our objective was to evaluate the effects of brief asthma education plus motivational interviewing counseling on reducing SHS exposure and improving respiratory outcomes in premature infants compared to asthma education alone. METHODS Caregivers and their infants ≤32 weeks' gestational age were enrolled after discharge from a neonatal intensive care unit in Rochester, New York, from 2007 to 2011. Participants (N = 165, 61% Medicaid insurance, 35% Black, 19% Hispanic, 59% male) were stratified by infant SHS exposure and randomly assigned to treatment or comparison groups. RESULTS Caregivers in the treatment group reported significantly more home smoking bans (96% vs 84%, P = .03) and reduced infant contact with smokers after the intervention (40% vs 58%, P = .03), but these differences did not persist long term. At study end (8 months after neonatal intensive care unit discharge), treatment group infants showed significantly greater reduction in salivary cotinine versus comparison (-1.32 ng/mL vs -1.08 ng/mL, P = .04), but no significant differences in other clinical outcomes. CONCLUSIONS A community-based intervention incorporating motivational interviewing and asthma education may be helpful in reducing SHS exposure of premature infants in the short term. Further efforts are needed to support sustained protections for this high-risk group and ultimately, prevent acute and chronic respiratory morbidity. Strategies for successfully engaging families during this stressful period warrant attention.
Collapse
Affiliation(s)
- Susan W Blaakman
- Department of General Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY; University of Rochester School of Nursing, Rochester, NY.
| | - Belinda Borrelli
- Department of Psychiatry and Human Behavior, Brown University, and the Miriam Hospital, Centers for Behavioral and Preventive Medicine, Providence, RI
| | - Elise N Wiesenthal
- Department of General Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Maria Fagnano
- Department of General Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Paul J Tremblay
- Department of General Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Timothy P Stevens
- Department of Neonatology, University of Rochester School of Medicine and Dentistry, Rochester, NY
| | - Jill S Halterman
- Department of General Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY
| |
Collapse
|
12
|
Walker N, Johnston V, Glover M, Bullen C, Trenholme A, Chang A, Morris P, Segan C, Brown N, Fenton D, Hawthorne E, Borland R, Parag V, Von Blaramberg T, Westphal D, Thomas D. Effect of a family-centered, secondhand smoke intervention to reduce respiratory illness in indigenous infants in Australia and New Zealand: a randomized controlled trial. Nicotine Tob Res 2015; 17:48-57. [PMID: 25156527 PMCID: PMC4282121 DOI: 10.1093/ntr/ntu128] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 06/27/2014] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) is a significant cause of acute respiratory illness (ARI) and 5 times more common in indigenous children. A single-blind randomized trial was undertaken to determine the efficacy of a family centered SHS intervention to reduce ARI in indigenous infants in Australia and New Zealand. METHODS Indigenous mothers/infants from homes with ≥ 1 smoker were randomized to a SHS intervention involving 3 home visits in the first 3 months of the infants' lives (plus usual care) or usual care. The primary outcome was number of ARI-related visits to a health provider in the first year of life. Secondary outcomes, assessed at 4 and 12 months of age, included ARI hospitalization rates and mothers' report of infants' SHS exposure (validated by urinary cotinine/creatinine ratios [CCRs]), smoking restrictions, and smoking cessation. RESULTS Two hundred and ninety-three mother/infant dyads were randomized and followed up. Three quarters of mothers smoked during pregnancy and two thirds were smoking at baseline (as were their partners), with no change for more than 12 months. Reported infant exposure to SHS was low (≥ 95% had smoke-free homes/cars). Infant CCRs were higher if one or both parents were smokers and if mothers breast fed their infants. There was no effect of the intervention on ARI events [471 intervention vs. 438 usual care (reference); incidence rate ratio = 1.10, 95% confidence intervals (CI) = 0.88-1.37, p = .40]. CONCLUSIONS Despite reporting smoke-free homes/cars, mothers and their partners continue to smoke in the first year of infants' lives, exposing them to SHS. Emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal.
Collapse
Affiliation(s)
- Natalie Walker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;
| | - Vanessa Johnston
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
| | - Marewa Glover
- Centre for Tobacco Control Research, Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Christopher Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Adrian Trenholme
- Kidz First and Women's Health Division, Counties Manukau District Health Board, Auckland, New Zealand
| | - Anne Chang
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia; Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Peter Morris
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
| | - Catherine Segan
- Centre for Health Policy, Programs and Economics, University of Melbourne, Victoria, Australia
| | - Ngiare Brown
- Department of Medicine, University of Wollongong, Wollongong, Australia
| | - Debra Fenton
- Kidz First and Women's Health Division, Counties Manukau District Health Board, Auckland, New Zealand
| | | | - Ron Borland
- VicHealth Center for Tobacco Control, Cancer Council Victoria, Victoria, Australia
| | - Varsha Parag
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Taina Von Blaramberg
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Darren Westphal
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia
| | - David Thomas
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia; Lowitja Institute, Charles Darwin University, Darwin, Australia
| |
Collapse
|
13
|
Predictors of children's secondhand smoke exposure at home: a systematic review and narrative synthesis of the evidence. PLoS One 2014; 9:e112690. [PMID: 25397875 PMCID: PMC4232519 DOI: 10.1371/journal.pone.0112690] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Children's exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children's SHS exposure in the home. AIM To identify by systematic review, the factors which are associated with children's SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter. METHODS Electronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted. FINDINGS Forty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children's SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS. CONCLUSION Multiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial.
Collapse
|
14
|
Begun AL, Barnhart SM, Gregoire TK, Shepherd EG. If mothers had their say: research-informed intervention design for empowering mothers to establish smoke-free homes. SOCIAL WORK IN HEALTH CARE 2014; 53:446-459. [PMID: 24835089 DOI: 10.1080/00981389.2014.888125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The Empowering Mothers to Establish Smoke-free Homes (EMESH) project developed in response to an interdisciplinary health team seeking effective interventions for reducing/eliminating the environmental tobacco smoke exposure of infants with compromised respiratory status. Two study phases that informed the EMESH intervention design are described. Phase I involved semi-structured interviews with 20 caretakers of infants diagnosed with Bronchopulmonary Dysplasia (BPD). In Phase II, 75 randomly selected medical records of infants with BPD were reviewed to explore the family demographics and staff behavior regarding environmental tobacco smoke (ETS) interventions. Interview results suggest that families are open to partnering with social workers and interdisciplinary team members in addressing infants' ETS exposure, families' unique circumstances indicate a need for tailored interventions, and the use of self-efficacy and decisional balance tools are feasible options. Results from the medical records review indicate that many families are economically vulnerable and reside in regions where smoking is common. There is a paucity of staff documentation regarding ETS conversations and interventions, indicating that these conversations may not take place. Together these results suggest a two-pronged approach in the next phases of EMESH: staff training in hosting and documenting ETS conversations and a tailored, parent-driven set of intervention options.
Collapse
Affiliation(s)
- Audrey L Begun
- a College of Social Work , Ohio State University , Columbus , Ohio , USA
| | | | | | | |
Collapse
|
15
|
Abstract
Tobacco exposure increases mortality and morbidity of the fetus, the child, the adolescent, and their children in turn. Nearly half the children in the world are exposed. Smoking is not merely personal choice or personal responsibility; those subtle phrases undermine those who have no choice in the matter. Tobacco control must take a multi-pronged attack. Smoking cessation by adults in childbearing years must take center stage of these efforts, because it is the only way to ensure a smoke-free environment for children. Smoke-free parents provide a role model for smoke-free young people, and erode the image of smoking as a desirable adult behavior to emulate. Pediatricians and pediatric pulmonologists have a key role to play here. This goal will reduce morbidity and mortality among adults and children. Legislation regarding taxation, environments, tobacco constituents, product placement and display, packaging, and media education are all key to this core goal. Smoke-free policy must be protected from attack based on trade agreements. Research is needed into more effective ways to attract and help people give up smoking, and into educating and re-deploying tobacco industry workers in emerging and developed countries.
Collapse
|
16
|
Abstract
For the purpose of this article, Asia refers to WHO's combined South-East Asia and Western Pacific regions and thus includes Australia and New Zealand. Asia has the highest number of tobacco users and is the prime target of transnational tobacco companies. The future of global tobacco control rests in this region and the challenges are clear. China, India, and Indonesia are key markets and Asia is a frontrunner in tobacco control measures, such as plain packaging of cigarettes. Some countries in Asia have a long history of tobacco control activities beginning in the 1970s, and WHO's Western Pacific Region is still the only region where all countries have ratified WHO's Framework Convention on Tobacco Control. We reviewed the history, research, epidemiology, tobacco control action, obstacles, and potential responses and solutions to the tobacco epidemic in this region. Levels of development, systems of government, and population size are very different between countries, with population size ranging from 1500 to 1·3 billion, but similarities exist in aspects of the tobacco epidemic, harms caused, obstacles faced, and tobacco control actions needed.
Collapse
|
17
|
Chan SSC, Wong DCN, Lam TH. Will mothers of sick children help their husbands to stop smoking after receiving a brief intervention from nurses? Secondary analysis of a randomised controlled trial. BMC Pediatr 2013; 13:50. [PMID: 23565835 PMCID: PMC3626671 DOI: 10.1186/1471-2431-13-50] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 03/27/2013] [Indexed: 05/27/2023] Open
Abstract
Background Second-hand smoke is a severe health hazard for children. Clinical guidelines suggest that nurses advise smoking parents to quit when they accompany their sick children to paediatric settings, but the guidelines did not mention what nurses can do if the parents are not with the children. This study examines the effectiveness of a low-intensity, nurse-led health instructional initiative for non-smoking mothers, to motivate them to take action to help their husbands stop smoking. Methods This was a randomised controlled trial and 1,483 non-smoking women, who were living with husbands who do smoke, were recruited when they accompanied with their sick children on hospital admission in general paediatic wards/outpatient departments of four hospitals in Hong Kong. The women were randomly allocated into intervention and control groups. The former received brief health education counselling from nurses, a purpose-designed health education booklet, a “no smoking” sticker, and a telephone reminder one week later; the control group received usual care. The primary outcome was the women”s action to help their smoking husbands stop smoking at 3-, 6- and 12-month follow-ups. Results A higher proportion of women in the intervention than the control group had taken action to help their husbands stop smoking at the 3-month (76% vs. 65%, P < .001), 6-month (66% vs. 49%, P < .001) and 12-month (52% vs. 40%, P < .001) follow-ups. Women who had received the intervention, had better knowledge of the health hazards of smoking, higher intention to take action, perceived their husbands’ willingness to stop/reduce smoking, had previously advised their husbands to give up smoking, were aware of their husbands’ history of smoking and, were aware that their husbands had made an earlier quit attempt and intended to help them stop smoking at the follow-ups. Conclusions A brief health education intervention by nurses in paediatric settings can be effective in motivating the mothers of sick children to take action to help their husbands quit smoking. We recommend adding the following to the clinical practice guidelines on treating tobacco use and dependence: ‘Nurses should offer every non-smoking mother of a sick child brief advice to encourage their husbands to stop smoking’. Trial registration Current Controlled Trials ISRCTN72290421.
Collapse
Affiliation(s)
- Sophia S C Chan
- School of Nursing, University of Hong Kong, 4/F William M W Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong.
| | | | | |
Collapse
|
18
|
Lee SL, Lam TH, Leung TH, Wong WHS, Schooling M, Leung GM, Lau YL. Foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema. ScientificWorldJournal 2012; 2012:542983. [PMID: 22927783 PMCID: PMC3425811 DOI: 10.1100/2012/542983] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 04/14/2012] [Indexed: 11/23/2022] Open
Abstract
Objective. We examined the hypothesis that foetal exposure to maternal passive smoking is associated with childhood asthma, allergic rhinitis, and eczema. Methods. The study was a population-based cross-sectional survey of Hong Kong Chinese children aged ≤14 years carried out in 2005 to 2006. Results. Foetal exposure to maternal passive smoking was significantly associated with wheeze ever (OR 2.05; 95% CI 1.58–2.67), current wheeze (OR 2.06; 95% CI 1.48–2.86), allergic rhinitis ever (OR 1.22; 95% CI 1.09–1.37), and eczema ever (OR 1.61; 95% CI 1.38–1.87). Foetal exposure to maternal active smoking was significantly associated with asthma ever (OR 2.10; 95% CI 1.14–3.84), wheeze ever (OR 2.46; 95% CI 1.27–4.78), and current wheeze (OR 2.74; 95% CI 1.24–6.01) but not with allergic rhinitis ever (OR 1.01; 95% CI 0.70–1.46) or eczema ever (OR 1.38; 95% CI 0.87–2.18). The dose response relationship between wheeze ever and current wheeze with increasing exposure, from no exposure to maternal passive smoking and then to maternal active smoking, further supports causality. Conclusion. There is significant association between foetal exposure to maternal passive smoking and maternal active smoking with childhood asthma and related atopic illnesses. Further studies are warranted to explore the potential causal relationship.
Collapse
Affiliation(s)
- S L Lee
- Department of Paediatrics & Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | | | | | | | | | | | | |
Collapse
|
19
|
Stotts AL, Evans PW, Green CE, Northrup TF, Dodrill CL, Fox JM, Tyson JE, Hovell MF. Secondhand smoke risk in infants discharged from an NICU: potential for significant health disparities? Nicotine Tob Res 2011; 13:1015-22. [PMID: 21669959 PMCID: PMC3430443 DOI: 10.1093/ntr/ntr116] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 04/29/2011] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Secondhand smoke exposure (SHSe) threatens fragile infants discharged from a neonatal intensive care unit (NICU). Smoking practices were examined in families with a high respiratory risk infant (born at very low birth weight; ventilated > 12 hr) in a Houston, Texas, NICU. Socioeconomic status, race, and mental health status were hypothesized to be related to SHSe and household smoking bans. METHODS Data were collected as part of The Baby's Breath Project, a hospital-based SHSe intervention trial targeting parents with a high-risk infant in the NICU who reported a smoker in the household (N = 99). Measures of sociodemographics, smoking, home and car smoking bans, and depression were collected. RESULTS Overall, 26% of all families with a high-risk infant in the NICU reported a household smoker. Almost half of the families with a smoker reported an annual income of less than $25,000. 46.2% of families reported having a total smoking ban in place in both their homes and cars. Only 27.8% families earning less than $25,000 reported having a total smoking ban in place relative to almost 60% of families earning more (p < .01). African American and Caucasian families were less likely to have a smoking ban compared with Hispanics (p < .05). Mothers who reported no smoking ban were more depressed than those who had a household smoking ban (p < .02). CONCLUSIONS The most disadvantaged families were least likely to have protective health behaviors in place to reduce SHSe and, consequently, are most at-risk for tobacco exposure and subsequent tobacco-related health disparities. Innovative SHSe interventions for this vulnerable population are sorely needed.
Collapse
Affiliation(s)
- Angela L Stotts
- Family and Community Medicine, University of Texas Medical School at Houston, 6431 Fannin, JJL 324, Houston, TX 77030, USA.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Kwok MK, Leung GM, Lam TH, Schooling CM. Early life infections and onset of puberty: evidence from Hong Kong's children of 1997 birth cohort. Am J Epidemiol 2011; 173:1440-52. [PMID: 21558410 DOI: 10.1093/aje/kwr028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
As economic development increases, puberty occurs at younger ages, and this could contribute to an increase in the incidence of cardiovascular diseases and hormone-related cancers. The factors that determine pubertal timing are poorly understood. The growth axis that is active during puberty is active in the first 6 months of life and interacts with the immune system. The authors examined whether prior infections, proxied by number of hospital admissions for infections at different ages, were associated with age at pubertal onset (Tanner stage II) using interval-censored regression in the Children of 1997 cohort, which is a population-representative Chinese birth cohort (n = 7,527). Mediation by growth was also examined. Girls, but not boys, who were hospitalized for infections at least twice in the first 6 months of life experienced pubertal onset about 8 months later (mean = 10.3 years, time ratio = 1.08, 95% confidence interval: 1.04, 1.12) than did those without such hospitalizations (mean = 9.6 years) after adjustment for infant characteristics and socioeconomic position (sex interaction: P = 0.02). There were no such associations for infections at 6 months to ≤8 years of age. Growth did not mediate the association. Early infectious morbidity in girls may be associated with later puberty, perhaps via suppression of the gonadotropic axis. The lowering of the number of infections in early life that accompanies economic development could be an additional factor that contributes to earlier puberty.
Collapse
Affiliation(s)
- Man Ki Kwok
- School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | | | | |
Collapse
|
21
|
Schooling CM, Hui LL, Ho LM, Lam TH, Leung GM. Cohort profile: 'children of 1997': a Hong Kong Chinese birth cohort. Int J Epidemiol 2011; 41:611-20. [PMID: 21224275 DOI: 10.1093/ije/dyq243] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- C Mary Schooling
- Life Course and Lifestyle Epidemiology Group, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, People's Republic of China
| | | | | | | | | |
Collapse
|
22
|
Kwok MK, Schooling CM, Lam TH, Leung GM. Paternal smoking and childhood overweight: evidence from the Hong Kong "Children of 1997". Pediatrics 2010; 126:e46-56. [PMID: 20587672 DOI: 10.1542/peds.2009-2642] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study examined, in a non-Western sociohistorical context, whether prenatal or postnatal secondhand smoke (SHS) exposure for children of nonsmoking mothers was associated with higher childhood BMI, and it clarified whether the observed associations were biologically mediated or socioeconomically confounded. METHODS A total of 6710 and 6519 children of nonsmoking mothers (N = 7924) with BMI data at approximately 7 and approximately 11 years, respectively, from a population-representative (N = 8327), Hong Kong Chinese birth cohort ("Children of 1997"), born in April or May 1997, were included in the analysis. RESULTS Compared with no SHS exposure, daily paternal smoking increased mean BMI z scores, but not height, at 7 years (difference: 0.10 [95% confidence interval: 0.02-0.19]) and at 11 years (difference: 0.16 [95% confidence interval: 0.07-0.26]), with adjustment for gender, birth order, socioeconomic position, mother's place of birth, breastfeeding, serious morbidity, and pubertal status. CONCLUSIONS Our findings, although preliminary, suggest that the association of paternal smoking with child overweight might be biologically mediated. Given the known harms of smoking, reducing SHS exposure from conception as a precautionary action for childhood overweight might be warranted.
Collapse
Affiliation(s)
- Man Ki Kwok
- University of Hong Kong, Li Ka Shing Faculty of Medicine, Department of Community Medicine and School of Public Health, Hong Kong, China
| | | | | | | |
Collapse
|
23
|
Yang L, Tong EK, Mao Z, Hu TW. Exposure to secondhand smoke and associated factors among non-smoking pregnant women with smoking husbands in Sichuan province, China. Acta Obstet Gynecol Scand 2010; 89:549-557. [PMID: 20367430 DOI: 10.3109/00016341003713851] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) exposure harms pregnant women and the fetus. China has the world's largest number of smokers and a high male smoking prevalence rate. OBJECTIVE To compare exposure to SHS among rural and urban Chinese non-smoking pregnant women with smoking husbands, and analyze factors associated with the level of SHS exposure and hair nicotine concentration. SETTING Sichuan province, China. POPULATION In all 1,181 non-smoking pregnant women with smoking husbands recruited from eight district/county Women and Children's hospitals. METHODS The women completed a questionnaire in April and May 2008. Based on systematic sampling, 186 pregnant women were selected for sampling the nicotine concentration in their hair. Ordinal logistic regression analysis was conducted to examine correlates with self-reported SHS exposure (total and at home); linear regression was conducted for the sub-sample of hair nicotine concentrations. MAIN OUTCOME MEASURES Secondhand smoking exposure rates, hair nicotine levels. RESULTS About 75.1% of the non-smoking pregnant women with smoking husbands reported regular SHS exposure. The major source of exposure was through their husband. In the multivariate analysis, the risk of greater SHS exposure (total and at home) and hair nicotine concentration was increased for women who were rural, had a husband with greater cigarette consumption, less knowledge about SHS, less negative attitudes about SHS, and no smoke-free home rules. CONCLUSIONS The high prevalence rate of SHS exposure suggests that it is important for non-smoking pregnant women, especially rural women, to establish smoke-free home rules and increase knowledge and negative attitudes towards SHS.
Collapse
Affiliation(s)
- Lian Yang
- Department of Health Economics, Huaxi School of Public Health, University of Sichuan, Chengdu, China.,Department of Health Economics, School of Public Health and Administration, Chengdu University of Traditional Chinese Medicine, China
| | - Elisa K Tong
- Department of Internal Medicine, University of California, Davis, USA
| | - Zhengzhong Mao
- Department of Health Economics, Huaxi School of Public Health, University of Sichuan, Chengdu, China
| | - Teh-Wei Hu
- School of Public Health, University of California, Berkeley, USA
| |
Collapse
|
24
|
Dietert RR, Zelikoff JT. Identifying patterns of immune-related disease: use in disease prevention and management. World J Pediatr 2010; 6:111-8. [PMID: 20490766 DOI: 10.1007/s12519-010-0026-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2008] [Accepted: 08/23/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Childhood susceptibility to diseases linked with immune dysfunction affects over a quarter of the pediatric population in some countries. While this alone is a significant health issue, the actual impact of immune-related diseases extends over a lifetime and involves additional secondary conditions. Some comorbidities are well known (e.g., allergic rhinitis and asthma). However, no systematic approach has been used to identify life-long patterns of immune-based disease where the primary condition arises in childhood. Such information is useful for both disease prevention and treatment approaches. DATA SOURCES Recent primary research papers as well as review articles were obtained from PubMed, Chem Abstracts, Biosis and from the personal files of the authors. Search words used were: the diseases and conditions shown Figs. 1 and 2 in conjunction with comorbid, comorbidities, pediatric, childhood, adult, immune, immune dysfunction, allergy, autoimmune, inflammatory, infectious, health risks, environment, risk factors. RESULTS Childhood diseases such as asthma, type-1 diabetes, inflammatory bowel disease, respiratory infections /rhinitis, recurrent otitis media, pediatric celiac, juvenile arthritis and Kawasaki disease are examples of significant childhood health problems where immune dysfunction plays a significant role. Each of these pediatric diseases is associated with increased risk of several secondary conditions, many of which appear only later in life. To illustrate, four prototypes of immune-related disease patterns (i.e., allergy, autoimmunity, inflammation and infectious disease) are shown as tools for: 1) enhanced disease prevention; 2) improved management of immune-based pediatric diseases; and 3) better recognition of underlying pediatric immune dysfunction. CONCLUSIONS Identification of immune-related disease patterns beginning in childhood provides the framework for examining the underlying immune dysfunctions that can contribute to additional diseases in later life. Many pediatric diseases associated with dysfunctional immune responses have been linked with an elevated risk of other diseases or conditions as the child ages. Diseases within a pattern may be interlinked based on underlying immune dysfunctions and/or current therapeutic approaches for managing the entryway diseases. It may be beneficial to consider treatment options for the earliest presenting diseases that will concomitantly reduce the risk of immune-linked secondary conditions. Additionally, improved disease prevention is possible with more relevant and age-specific immune safety testing.
Collapse
Affiliation(s)
- Rodney R Dietert
- Department of Microbiology and Immunology, Cornell University, Ithaca, NY, 14853, USA.
| | | |
Collapse
|
25
|
Johnston V, Walker N, Thomas DP, Glover M, Chang AB, Bullen C, Morris P, Brown N, Vander Hoorn S, Borland R, Segan C, Trenholme A, Mason T, Fenton D, Ellis K. The study protocol for a randomized controlled trial of a family-centred tobacco control program about environmental tobacco smoke (ETS) to reduce respiratory illness in Indigenous infants. BMC Public Health 2010; 10:114. [PMID: 20205950 PMCID: PMC2846866 DOI: 10.1186/1471-2458-10-114] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 03/07/2010] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Acute respiratory illness (ARI) is the most common cause of acute presentations and hospitalisations of young Indigenous children in Australia and New Zealand (NZ). Environmental tobacco smoke (ETS) from household smoking is a significant and preventable contributor to childhood ARI. This paper describes the protocol for a study which aims to test the efficacy of a family-centred tobacco control program about ETS to improve the respiratory health of Indigenous infants in Australia and New Zealand. For the purpose of this paper 'Indigenous' refers to Australia's Aboriginal and Torres Strait Islander peoples when referring to Australian Indigenous populations. In New Zealand, the term 'Indigenous' refers to Māori. METHODS/DESIGN This study will be a parallel, randomized, controlled trial. Participants will be Indigenous women and their infants, half of whom will be randomly allocated to an 'intervention' group, who will receive the tobacco control program over three home visits in the first three months of the infant's life and half to a control group receiving 'usual care' (i.e. they will not receive the tobacco control program). Indigenous health workers will deliver the intervention, the goal of which is to reduce or eliminate infant exposure to ETS. Data collection will occur at baseline (shortly after birth) and when the infant is four months and one year of age. The primary outcome is a doctor-diagnosed, documented case of respiratory illness in participating infants. DISCUSSION Interventions aimed at reducing exposure of Indigenous children to ETS have the potential for significant benefits for Indigenous communities. There is currently a dearth of evidence for the effect of tobacco control interventions to reduce children's exposure to ETS among Indigenous populations. This study will provide high-quality evidence of the efficacy of a family-centred tobacco control program on ETS to reduce respiratory illness. Outcomes of our study will be important and significant for Indigenous tobacco control in Australia and New Zealand and prevention of respiratory illness in children.
Collapse
Affiliation(s)
- Vanessa Johnston
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Building 58, Royal Darwin Hospital, Darwin 0810, Australia
| | - Natalie Walker
- Clinical Trials Research Unit, School of Population Health, University of Auckland, 261 Morrin Road, Glen Innes, Auckland 1072, New Zealand
| | - David P Thomas
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Building 58, Royal Darwin Hospital, Darwin 0810, Australia
| | - Marewa Glover
- Centre for Tobacco Control Research, School of Population Health, University of Auckland, 261 Morrin Road, Glen Innes, Auckland 1072, New Zealand
| | - Anne B Chang
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Building 58, Royal Darwin Hospital, Darwin 0810, Australia
| | - Chris Bullen
- Clinical Trials Research Unit, School of Population Health, University of Auckland, 261 Morrin Road, Glen Innes, Auckland 1072, New Zealand
| | - Peter Morris
- Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Building 58, Royal Darwin Hospital, Darwin 0810, Australia
| | - Ngiare Brown
- The Poche Centre for Indigenous Health, University of Sydney, Edward Ford Building A27, Sydney 2006, Australia
| | - Stephen Vander Hoorn
- Clinical Trials Research Unit, School of Population Health, University of Auckland, 261 Morrin Road, Glen Innes, Auckland 1072, New Zealand
| | - Ron Borland
- Cancer Council Victoria, 100 Drummond Street, Melbourne 3053, Australia
| | - Catherine Segan
- Centre for Health Policy, Programs and Economics, University of Melbourne, 207 Bouverie St, Melbourne 3053, Australia
| | - Adrian Trenholme
- Kidz First and Women's Health Division, Counties Manukau District Health Board, Zealand Building 43, Western Campus Middlemore Hospital, Auckland, New Zealand
| | - Toni Mason
- Quit Victoria, 100 Drummond Street, Melbourne 3053, Australia
| | - Debra Fenton
- Kidz First and Women's Health Division, Counties Manukau District Health Board, Zealand Building 43, Western Campus Middlemore Hospital, Auckland, New Zealand
| | - Kane Ellis
- Danila Dilba Aboriginal Health Service, 32-34 Knuckey Street, Darwin 0910, Australia
| |
Collapse
|