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Dai S, Chan MHM, Kam RKT, Li AM, Au CT, Chan KCC. Monthly Motivational Interview Counseling and Nicotine Replacement Therapy for Smoking Parents of Pediatric Patients: A Randomized Controlled Trial. Front Pediatr 2022; 10:798351. [PMID: 35498786 PMCID: PMC9045057 DOI: 10.3389/fped.2022.798351] [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: 10/20/2021] [Accepted: 03/14/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Parental smoking is the dominant source of passive smoke exposure in the pediatric population. The current randomized controlled trial (RCT) study aimed to evaluate the effectiveness of a multi-component smoking reduction intervention in parental smoking reduction and children's environmental tobacco smoke exposure reduction in clinical settings. METHODS A single-blinded, 6-month randomized controlled trial recruited smoking parents (N = 210) of children who attended the pediatric wards or clinics at the Prince of Wales Hospital. Participants allocated to the intervention group (n = 105) received monthly motivational interviews on smoking reduction with emphasis on health hazards related to children's passive smoke exposure, 8-week nicotine replacement therapy, and referral to smoking cessation service if the parents preferred. The control group (n = 105) received simple verbal advice on smoking cessation. Primary outcomes were parental urine cotinine validated and self-reported ≥50% smoking reduction rates at 6 months. RESULTS Smoking parents in the intervention group had significantly more biochemically validated ≥50% smoking reduction than the control: 27.1 vs. 10.0% (OR = 3.34, 95% CI: 1.16-9.62, P = 0.02). The rate of self-reported ≥50% smoking reduction was also significantly higher in the intervention group than the control: 51.9 vs. 20.2% (OR = 4.40, 95% CI: 2.38-8.12, P < 0.001). For secondary outcomes, the rate of parental self-reported smoking cessation was higher in the intervention arm: 10.5 vs. 1.0% (OR = 12.17, 95% CI: 1.54-96.07, P < 0.001), however, no differences were detected in biochemically validated cessation and changes in children's passive smoke exposure between the groups. CONCLUSION Monthly smoking reduction counseling together with nicotine replacement therapy is more effective than simple verbal cessation advice in the smoking reduction for parents of pediatric patients. However, this study did not demonstrate differences in smoking cessation or reduction in children's passive smoke exposure with a 6-month follow-up. Achievement of a smoke-free environment remains challenging. TRIAL REGISTRATION Clinicaltrials.gov, identifier: NCT03879889.
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Affiliation(s)
- Siyu Dai
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China.,School of Clinical Medicine, Hangzhou Normal University, Hangzhou, China
| | - Michael Ho Ming Chan
- Department of Chemical Pathology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Richard Kin Ting Kam
- Department of Chemical Pathology, Prince of Wales Hospital, Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Chun Ting Au
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Kate Ching-Ching Chan
- Department of Pediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Ferris E, Cummins C, Chiswell C, Jones LL. A Mixed-Methods Systematic Review and Synthesis of Secondary Care Interventions to Reduce Secondhand Smoke Exposure Among Children and Young People. Nicotine Tob Res 2021; 23:643-653. [PMID: 33098295 DOI: 10.1093/ntr/ntaa216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/27/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Childhood secondhand smoke exposure (SHSe) is linked with increased morbidity and mortality. Hospital or secondary care contact presents a "teachable moment" to support parents to change their home smoking behaviors to reduce children's SHSe. AIMS AND METHODS This mixed-methods review explores: (1) if existing interventions in this context are effective, (2) if they are reported in sufficient detail to be replicated, (3) the experiences of health care professionals delivering such interventions, and (4) the experiences of parents receiving such interventions. Five electronic databases and the gray literature were searched for relevant literature published and indexed January 1980 to February 2020. Fourteen papers reporting 12 studies (nine quantitative and five qualitative) were included. Aligned with the Joanna Briggs Institute method, a segregated approach was used involving independent syntheses of the quantitative and qualitative data followed by an overall mixed-methods synthesis. RESULTS There was some evidence of effective interventions that resulted in a short-term (<6 months) reduction in children's SHSe when SHSe was subjectively measured. This was not seen in longer-term follow-up (>6 months) or when SHSe was measured objectively. Inconsistencies with reporting make replication challenging. Experiential evidence suggests a mismatch between stakeholder preferences and interventions being offered. CONCLUSIONS The pediatric secondary care interventions included in this analysis failed to show statistically significant evidence of longer-term effectiveness to reduce children's SHSe in all but one low-quality study. There was also inadequate reporting of interventions limiting assessment of effectiveness. It offers further insights into areas to target to develop effective interventions. IMPLICATIONS This review used rigorous methods to explore the current, global literature on how children's exposure to secondhand smoke is being tackled in secondary care. This review identified only one low-quality intervention study showing a statistically significant reduction in children's SHSe beyond 6 months. Synthesis with qualitative research identifies a mismatch between what parents want in an intervention and what has been delivered to date. Reporting quality needs to be improved to ensure that interventions can be replicated and studies conducted within the National Health Service to ensure suitability to this setting.
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Affiliation(s)
- Erica Ferris
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Carole Cummins
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher Chiswell
- Department of Public Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Zhou YH, Mak YW, Ho GWK. Effectiveness of Interventions to Reduce Exposure to Parental Secondhand Smoke at Home among Children in China: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010107. [PMID: 30609776 PMCID: PMC6339015 DOI: 10.3390/ijerph16010107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
There are health consequences to exposure to secondhand smoke (SHS). About two-thirds of children in China live with at least one person, usually a parent, who smokes at home. However, none of the reviews of interventions for reducing SHS have targeted children in China. The purpose of this study was to review the effectiveness of interventions for reducing parental SHS exposure at home among children in China. We searched various electronic databases for English and Chinese publications appearing between 1997 and 2017. Thirteen relevant studies were identified. Common strategies used in intervention groups were non-pharmacological approaches such as counseling plus self-help materials, and attempting to persuade fathers to quit smoking. Family interactions and follow-up sessions providing counseling or using text messages could be helpful to successful quitting. Several encouraging results were observed, including lower cotinine levels in children (n = 2), reduced tobacco consumption (n = 5), and increased quit rates (n = 6) among parents. However, the positive effects were not sustained 3~6 months after the interventions. Self-reported quitting without bio-chemical validation was the most common outcome measure. A study design using biochemical validations, a longer follow-up period, and targeting all people living with children in the same household is recommended.
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Affiliation(s)
- Yan Hua Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310051, China.
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 999077, China.
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 999077, China.
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Abdullah AS, Guangmin N, Kaiyong H, Jing L, Yang L, Zhang Z, Winickoff JP. Implementing Tobacco Control Assistance in Pediatric Departments of Chinese Hospitals: A Feasibility Study. Pediatrics 2018; 141:S51-S62. [PMID: 29292306 DOI: 10.1542/peds.2017-1026i] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Evidence-based tobacco control strategies delivered through pediatric settings could encourage parental smoking cessation and reduce children's exposure to second hand smoke (SHS) in the United States. The extent to which these tobacco control strategies could be routinely implemented in the pediatric setting of a developing country is not known. We tested the feasibility and efficacy of implementing an evidence-based intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE), in a Chinese hospital to address the second hand smoke exposure of children in the home and car and to address parental smoking. METHODS We conducted a quasi-experimental trial of CEASE implementation in the pediatric inpatient departments of 2 Chinese hospitals, 1 assigned as the intervention hospital and another assigned as the control hospital. Data were collected through pre- and postsurveys of parents and clinicians, implementation process surveys, and chart review. RESULTS In the intervention hospital, pediatricians' rates of delivering different types of tobacco control assistance to smoking parents were all significantly (P < .0001) higher during the post-CEASE implementation period than in the pre-CEASE implementation period. During the post-CEASE implementation period, pediatricians' rates of delivery for all aspects of tobacco control assistance were significantly higher (all P < .0001) in the intervention hospital than in the control hospital, whereas there was no difference during the pre-CEASE period. CONCLUSIONS The findings of this study suggest that it is feasible to implement a system-level intervention of CEASE in the pediatric inpatient department of a major hospital in southern China. A large-scale trial incorporating measures to increase quit rates and including a long-term follow-up is needed to examine the effectiveness of CEASE implementation in China.
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Affiliation(s)
- Abu S Abdullah
- Department of Medicine, School of Medicine, Boston University and Boston Medical Center, Boston, Massachusetts; .,Global Health Program, Duke Kunshan University, Kunshan, Jiangsu Province, China.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Nong Guangmin
- Department of Pediatrics, First Affiliated Hospital, and
| | - Huang Kaiyong
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Liao Jing
- Department of Pediatrics, First Affiliated Hospital, and
| | - Li Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Zhiyong Zhang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Jonathan P Winickoff
- Division of General Pediatrics, Massachusetts General Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts; and.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Illinois
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Huang K, Yang L, Winickoff JP, Liao J, Nong G, Zhang Z, Liang X, Liang G, Abdullah AS. The Effect of a Pilot Pediatric In-Patient Department-Based Smoking Cessation Intervention on Parental Smoking and Children's Secondhand Smoke (SHS) Exposure in Guangxi, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E1109. [PMID: 27834840 PMCID: PMC5129319 DOI: 10.3390/ijerph13111109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 10/20/2016] [Accepted: 11/02/2016] [Indexed: 11/25/2022]
Abstract
Children's exposure to secondhand smoke (SHS) at home has numerous adverse health effects. This study evaluated the effects of a pediatric in-patient department-based pilot smoking cessation intervention for household members to reduce children's SHS exposure and encourage smoking cessation. A pre-post test design study was designed to assess the effectiveness of a telephone counseling intervention on household members of hospitalized children in pediatric departments. Data were collected with a standardized Chinese language questionnaire. At the three-month follow-up survey, the proportions of household members who reported adopting complete smoking restriction at home (55%), did not smoke at home at all (37%), did not allow others to smoke in the car (70%), or did not allow others to smoke around the child (57%) were significantly higher than the self-reported responses at the baseline survey. The proportions of household members who reported smoking at home (49%) and in the car (22%) were significantly lower than the baseline survey. Overall, 7% of the participants had reported quitting smoking after three months. Pediatric in-patient department-based telephone counseling for smoking cessation was found to be acceptable to Chinese parents. The intervention encouraged few parents to quit smoking, but encouraged more parents to take measures to reduce children's SHS exposure.
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Affiliation(s)
- Kaiyong Huang
- School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Li Yang
- School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, MA 02115, USA.
| | - Jing Liao
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Zhiyong Zhang
- School of Public Health, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Xia Liang
- Foreign Language School, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Gang Liang
- Pharmaceutical School, Guangxi Medical University, Nanning 530021, Guangxi, China.
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Kunshan 215316, Jiangsu, China.
- Duke Global Health Institute, Duke University, Durham, NC 27708, USA.
- Boston University School of Medicine, Boston Medical Center, Boston, MA 02118, USA.
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Chinese Pediatrician Attitudes and Practices Regarding Child Exposure to Secondhand Smoke (SHS) and Clinical Efforts against SHS Exposure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:5013-25. [PMID: 26006117 PMCID: PMC4454951 DOI: 10.3390/ijerph120505013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 04/27/2015] [Accepted: 04/28/2015] [Indexed: 11/16/2022]
Abstract
Background: Secondhand Smoke (SHS) exposure is a leading cause of childhood illness and premature death. Pediatricians play an important role in helping parents to quit smoking and reducing children’s SHS exposure. This study examined Chinese pediatricians’ attitudes and practices regarding children’s exposure to SHS and clinical efforts against SHS exposure. Methods: A cross-sectional survey of pediatricians was conducted in thirteen conveniently selected hospitals in southern China, during September to December 2013. Five hundred and four pediatricians completed self-administered questionnaires with a response rate of 92%. χ2 tests were used to compare categorical variables differences between smokers and non-smokers and other categorical variables. Results: Pediatricians thought that the key barriers to encouraging parents to quit smoking were: lack of professional training (94%), lack of time (84%), resistance to discussions about smoking (77%). 94% of the pediatricians agreed that smoking in enclosed public places should be prohibited and more than 70% agreed that smoking should not be allowed in any indoor places and in cars. Most of the pediatricians thought that their current knowledge on helping people to quit smoking and SHS exposure reduction counseling was insufficient. Conclusions: Many Chinese pediatricians did not have adequate knowledge about smoking and SHS, and many lacked confidence about giving cessation or SHS exposure reduction counseling to smoking parents. Lack of professional training and time were the most important barriers to help parents quit smoking among the Chinese pediatricians. Intensified efforts are called for to provide the necessary professional training and increase pediatricians’ participation in the training.
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Huang K, Abdullah AS, Liao J, Huo H, Yang L, Zhang Z, Winickoff JP, Nong G. Chinese pediatrician beliefs about counseling and medications for parents who smoke: a survey in southern China. Tob Induc Dis 2015; 13:10. [PMID: 25866497 PMCID: PMC4392465 DOI: 10.1186/s12971-015-0035-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 03/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background Pediatricians play an important role in promoting smoking cessation among the parents of young children as more behavioral counseling and cessation treatment are made available in the Chinese healthcare system. However, beliefs about the effectiveness of these interventions can influence pediatricians’ recommendations to their patients. This study examined pediatricians’ beliefs regarding effectiveness of counseling and medications for smoking cessation. Methods A cross-sectional survey of pediatricians was conducted in thirteen conveniently selected southern Chinese hospitals, during September to December 2013. A self-administered questionnaire was used for data collection. We used chi square tests and multinomial logistic regression analysis to identify factors associated with beliefs regarding effectiveness of counseling and medications for smoking cessation. Results Beliefs of the respondents (504/550; 92% response rate) were divided regarding the effectiveness of counseling and medications for smoking cessation. Sixty percent believed that physician counseling is effective for smoking cessation; 53% believed pharmacological products (or medications) are effective. Factors that were associated with positive beliefs towards the effectiveness of counseling included: believing about the professional responsibility to discuss smoking cessation, being confident in discussing smoking cessation or SHS exposure reduction with patients’ parents, believing that health professionals should routinely ask about their patients smoking habits, believing that health professionals should routinely advise their smoking patients to quit smoking, possessing adequate knowledge in quitting smoking, and being able to assess smokers different stages of readiness to quit. Most of the above factors were also associated with the belief that medication is effective for smoking cessation. Conclusions A substantial proportion of Chinese pediatricians believed that cessation counseling and medications are not effective, which is not supported by current evidence in the field. Several factors including individual, practice level and health system level characteristics were associated with their belief. Training efforts are needed to influence pediatricians’ beliefs regarding the effectiveness of cessation counseling and medications.
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Affiliation(s)
- Kaiyong Huang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Abu S Abdullah
- Global Health Program, Duke Kunshan University, Duke Avenue, Kunshan, Jiangsu 215316 China ; Duke Global Health Institute, Duke University, Durham, North Carolina USA ; Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts USA
| | - Jing Liao
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Haiying Huo
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Li Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Zhiyong Zhang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi 530021 China
| | - Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, USA
| | - Guangmin Nong
- Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 China
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