Asthma is not enough: continuation of smoking among parents with an asthmatic child

Prevalence and Associated Risk Factors of Bronchial Asthma in Children in Santo Domingo, Dominican Republic

Background

Bronchial asthma is an important health problem worldwide. There is insufficient data on the prevalence of bronchial asthma among school children in Santo Domingo, Dominican Republic.

Objective

The objective of this study is to assess the prevalence of asthma and its related risk factors among school children in Santo Domingo, Dominican Republic.

Materials and methods

A cross-sectional study using a modified questionnaire was conducted in Santo Domingo among 600 children aged three to 11 eleven years. The prevalence of asthma and its associated risk factors such as birth order, family history of asthma, family history of allergy, exposure to pets at home, exposure to tobacco smoke, and source of fuel used at home were collected. The relevant data collected was analyzed using the Statistical Package for the Social Sciences (SPSS) 24.0. (IBM Corp., Armonk, NY) software.

Results

The prevalence of asthma was found to be 22.0%. Age, family history of asthma, family history of allergy, exposure to tobacco smoke, and birth order showed statistical significance. The source of fuel used at home, gender, and exposure to pets were not statistically significant to be considered as risk factors associated with asthma in the population studied.

Conclusion

With an asthma prevalence of 22.0% in the pediatric population, the Dominican Republic has one of the highest national rates of asthma in the pediatric population in Latin America. Proper education, screening, and prevention can help lower the burden of this disease economically and socially.

Motivating parents of kids with asthma to quit smoking: the effect of the teachable moment and increasing intervention intensity using a longitudinal randomized trial design

AIMS

We tested two aims: (1) the teachable moment (TM): whether second-hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma versus parents of healthy children (HC); and (2) whether greater intervention intensity [enhanced-precaution adoption model (PAM)] produces greater cessation than a previously tested intervention (PAM).

DESIGN AND INTERVENTIONS

Aim 1: two home visits (asthma education or child wellness), and cessation induction using motivational interviewing and SHSe feedback. Aim 2: post-home-visits, parents with asthmatic children were randomized to PAM (n = 171; six asthma education calls) or enhanced-PAM (n = 170; six asthma education/smoking cessation calls + repeat SHSe feedback).

SETTING

Rhode Island, USA.

PARTICIPANTS

Parents of asthmatic (n = 341) or healthy (n = 219) children who did not have to want to quit smoking to enroll.

MEASUREMENTS

Measurements were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day point prevalence abstinence (ppa) and SHSe (primary) and asthma morbidity (secondary).

FINDINGS

Aim 1: the TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day [odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.22-5.54] and 7-day ppa (OR = 2.26, 95% CI = 1.13-4.51) at 2 months (primary end-point) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR = 3.60; 95% CI = 1.72-7.55). Aim 2: enhanced-PAM was more likely to achieve 30-day ppa at the primary end-point, 4 months (OR = 2.12, 95% CI 1.09-4.12) and improved asthma outcomes versus PAM.

CONCLUSIONS

Smoking cessation intervention (Motivational Interviewing plus biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes.

Comparison of secondhand smoke exposure in minority and nonminority children with asthma

OBJECTIVE

This study determined if secondhand smoke (SHS) exposure is related to asthma-related functional morbidity by examining racial/ethnic differences in non-Latino White (NLW), African American, and Latino families and whether racial/ethnic SHS exposure differences across families persist when accounting for smoking factors.

METHODS

Participants were 305 caregiver smokers of children with asthma. Two passive dosimeters measured secondhand smoke: one in the home and one worn by the child.

RESULTS

Higher SHS exposure was related to greater asthma-related functional morbidity. African Americans had higher levels of home SHS exposure than did Latinos (p = .003) or NLWs (p = .021). SHS exposure as assessed by the child-worn dosimeter did not differ across race/ethnicity. African American families were less likely to report a household smoking ban (46.4%) compared to Latinos (79.2%) and NLWs (67.9%; p < .05). African Americans were less likely to report having two or more smokers in the home (37.2%) compared to NLWs (53.6%; p < .05). NLWs reported the highest number of cigarettes smoked daily (Mdn = 15.00) compared to Latinos (Mdn = 10.00; p = .001) and African Americans (Mdn = 10.00; p < .001). SHS home exposure levels were regressed on race/ethnicity and relevant covariates. Household smoking ban (p < .001) and only one smoker in the home (p = .005) were associated with lower levels of SHS in the home; race/ethnicity was not significant.

CONCLUSIONS

Differences in SHS exposure across race/ethnicity exist among children with asthma, possibly due to differential presence of a household smoking ban and number of smokers in the home.

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.

Structural and Functional Support in the Prediction of Smoking Cessation in Caregivers of Children with Asthma

Caregivers of children with asthma smoke at rates similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma. Both functional (Interpersonal Support Evaluation List) and structural social support (living with another smoker, partner status, and the proportion of smoking friends) were measured at baseline. Participants received an asthma-education and smoking cessation intervention based on Motivational Interviewing. Biochemically-verified abstinence was assessed at six months post treatment. Results indicated that functional support predicted smoking abstinence even when controlling for relevant covariates and structural support (OR = .896, p = .025). Exploratory analyses revealed that this effect was driven primarily by the self-esteem ISEL subscale. Smoking cessation that focuses on building general functional support, particularly self-esteem support, may be beneficial for smoking cessation in caregivers of children with asthma.

Changes in risk perception following a smoking cessation intervention: the role of acculturation in a sample of Latino caregivers

The present exploratory study examined the role of acculturation in the perception of the risks of smoking following a smoking cessation induction intervention among Latino caregivers of children with asthma. The sample consisted of 131 Latino smokers (72.9% female; 18.3% born in the U.S.) who were caregivers of a child with asthma. Caregivers were randomized to one of two smoking cessation interventions that were part of a home-based asthma program. Self-report measures of risk-perception were assessed at baseline, end of treatment (2 months after baseline), and 2- and 3-months post-treatment. At baseline, caregivers, regardless of level of acculturation, reported moderate to high levels of concern about the effects of secondhand smoke on their child's health as well as perceived risk regarding the effect of smoking on their own health. However, caregivers who were low in acculturation had a greater increase in concern about the effects of smoking on their child from pre-to post treatment compared to those who were high in acculturation (p = .001). Lastly, level of acculturation moderated the association between caregivers' concern about smoking on their child's health and their motivation to quit smoking (p < .05), but not cessation rates or reduced secondhand smoke exposure (p > .05). Specifically, motivation to quit at 3 months was greater for those with low acculturation. Though exploratory, these findings suggest that risk perception may be more easily influenced in low versus high acculturated populations and this should be considered in the design of clinical interventions and potentially mass media campaigns seeking to influence risk of caregiver behavior on child health with ethnic and racial minorities.

Children with asthma versus healthy children: differences in secondhand smoke exposure and caregiver perceived risk

INTRODUCTION

Secondhand smoke (SHS) exposure remains a public health problem. Few, if any, studies include both children with and without asthma to assess differences in caregiver smoking behavior, risk perception, and SHS.

METHODS

Participants were 738 daily U.S. smokers (443 caregivers of children with asthma [CG-AC] and 295 caregivers of healthy children [CG-HC]; 50.9% White, 25% Black, 15% Latino). Data are cross-sectional; SHS was measured through self-report and passive dosimetry.

RESULTS

Compared with CG-HC, CG-AC had fewer risk factors for exposing children to SHS (lower nicotine dependence, higher motivation to quit, greater perceived benefits of cessation on child's health, and lower optimistic bias; all p values < .05). Specifically, 60.6% of CG-AC reported a household smoking ban versus 40.1% of CG-HC (p < .05), though >95% of both groups had detectable levels of SHS in their home. CG-AC self-reported lower SHS than CG-HC, but both groups had nearly equivalent SHS when measured objectively. CG-AC were almost twice as likely as CG-HC to report a home smoking ban when they had detectable levels of household SHS as measured by passive dosimetry (OR = 1.71; 95% CI = 1.2, 2.4; p = .003).

CONCLUSIONS

Caregivers of children with chronic health conditions, such as asthma, may be motivated to self-report lower levels of SHS. Child health status (e.g., asthma) may cue practitioners to inquire about SHS, but given the low proportion of household bans and high levels of actual exposure among both groups, SHS exposure assessment and reduction/elimination counseling should be prompted to occur for all children.

Correlates of smoking during an economic recession among parents of children with asthma

OBJECTIVE

We describe the correlates of smoking among parents who have a child with asthma and examine whether the correlates changed from 2008 to 2010, when the United States experienced a severe recession and a sharp increase in unemployment, a stressor that could influence smoking behavior.

METHODS

Data are from the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey of U.S. adults age 18 and older. Separate logistic regressions estimated the association between unemployment and smoking in 2008 and 2010, adjusting for sociodemographic and other characteristics of parents of a child with asthma.

RESULTS

Being unemployed was a significant predictor of smoking in 2010 (AOR = 1.80; 95% CI: 1.24-2.61), but was not a significant predictor in 2008 (AOR = 1.26, 95% CI: 0.82-1.95). One central component of well-being, as measured by being dissatisfied with one's life, was significantly associated with parental smoking in 2010 (AOR = 2.06, 95% CI: 1.00-4.27), but not in 2008 (AOR = 1.62, 95% CI: 0.85-3.11). Several covariates had similar associations with parental smoking in both survey years, including low education, not being currently married, not having health insurance, and binge drinking.

CONCLUSIONS

Our results support the idea that during hard economic times unemployment and related stressors may be strong determinants of parental smoking when a child in the home has asthma. Given that the BFRSS is a cross-sectional survey, definitive conclusions cannot be drawn regarding the causal pathway connecting unemployment, global well-being, and parental smoking.

Environmental tobacco smoke and its effect on the symptoms and medication in children with asthma

Environmental tobacco smoke (ETS) worsens asthmatic symptoms. We analyzed the relationship between levels of ETS and asthmatic symptoms and medication. We asked parents of 282 asthmatic children about the general condition, smoke exposure and medication. Patients were classified into three groups: no-ETS (no smoking), mild-ETS (smoking in the house but not in the same room as patient), and heavy-ETS (smoking in the same room as patient). We classified 116 children in no-ETS group, 124 children in mild-ETS group and 42 children in heavy-ETS group. The symptoms were worst and prevalence of leukotriene receptor antagonist and long-acting beta(2)-agonist use were highest in heavy-ETS group. However, there was no statistical difference between no-ETS and mild-ETS groups in prevalence of anti-asthmatic drug use and symptoms. We conclude that a smoking ban in rooms used by asthmatic children is an easy way to reduce ETS, asthmatic symptoms and the use of anti-asthmatic drugs.