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Colston DC, Cruz JL, Simard BJ, Fleischer NL. A Systematic Review Evaluating Disparities in State-Run Quitline Utilization and Effectiveness in the U.S. AJPM FOCUS 2023; 2:100042. [PMID: 37789942 PMCID: PMC10546598 DOI: 10.1016/j.focus.2022.100042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Context Cigarette smoking is a public health problem in the U.S. and is marked by pervasive sociodemographic disparities. State-run quitlines may offer greater access to cessation services that could in turn help to reduce smoking disparities. The aim of this review was to synthesize the body of literature regarding sociodemographic disparities in the utilization and effectiveness of state-run quitlines. Evidence acquisition The PRISMA guidelines were followed in conducting this review. Included articles were published between January 1, 1992 and May 28, 2019 and sourced from PubMed and Web of Science. Studies that evaluated state-run quitline utilization or effectiveness (cessation) by sex, race/ethnicity, sexual or gender identity, or SES (income, education, insurance) were included. Evidence synthesis Our search yielded 2,091 unique articles, 17 of which met the criteria for inclusion. This review found that quitline utilization was higher among Black and Asian/Pacific Islander individuals than among White individuals and among people with lower income and lower education than among people with higher income and higher education. Quitline use was associated with less smoking cessation among females than among males, among American Indian/Alaskan Native individuals than among individuals from all other races and ethnicities, and among individuals of lower than among those of higher income and education. Conclusions This review found that although communities disproportionately affected by smoking utilize quitlines more commonly than their White and more affluent peers, disparities in cessation persist for American Indian/Alaskan Native and individuals from lower SES groups who use quitlines.
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Affiliation(s)
- David C. Colston
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Jennifer L. Cruz
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Bethany J. Simard
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Nancy L. Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
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Studenmund C, Williams J, Hernandez A, Young E, Hui YY, Cruz E, Gribben V. Quality Improvement Approach to Increase Inpatient Pediatric Secondhand Smoke Exposure Screening. Hosp Pediatr 2022; 12:45-53. [PMID: 34866157 DOI: 10.1542/hpeds.2021-005941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering "Quit Kits" with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.
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Affiliation(s)
- Christine Studenmund
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Jazzmin Williams
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Elda Young
- San Francisco Department of Public Health, San Francisco, California
| | - Ying Ying Hui
- San Francisco Department of Public Health, San Francisco, California
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Scheffers-van Schayck T, Hipple Walters B, Otten R, Kleinjan M. Implementation of a proactive referral tool for child healthcare professionals to encourage and facilitate parental smoking cessation in the Netherlands: a mixed-methods study. BMC Health Serv Res 2021; 21:973. [PMID: 34530809 PMCID: PMC8444610 DOI: 10.1186/s12913-021-06969-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/28/2021] [Indexed: 11/18/2022] Open
Abstract
Background Recently, the parent-tailored telephone based smoking cessation counseling program ‘Smoke-free Parents’ was shown to be effective in helping parents to quit smoking. To implement this program in child healthcare settings in the Netherlands, the research team developed a proactive referral tool to refer parents to Smoke-free Parents. The aim of the present implementation study was to explore the facilitators, barriers, and suggestions for improvement in the implementation of this referral tool. Methods Child healthcare professionals (N = 68) were recruited via multiple strategies (e.g., social media, mailings, and word of mouth among healthcare professionals) and invited to complete two online (quantitative and qualitative) questionnaires and to participate in a telephone semi-structured qualitative interview between April 2017 and February 2019. In total, 65 child healthcare professionals were included in the analyses. After inductive coding, thematic analyses were performed on the qualitative data. Descriptive analyses were performed on the quantitative data. Results The data from both questionnaires and the telephone interview revealed that the majority of the child healthcare professionals (92.3 % female; average years of working as a healthcare professional: 23.0) found the Smoke-free Parents referral tool accessible and convenient to use. Yet there were several barriers that limited their use of the tool. The data revealed that one of the main barriers that healthcare professionals experienced was parental resistance to smoking cessation assistance. In addition, healthcare professionals noted that they experienced tension when motivating parents to quit smoking, as they were not the parent’s, but the child’s healthcare provider. Additionally, healthcare professionals reported being concerned about the lack of information about the costs of Smoke-free Parents, which limited professionals referring parents to the service. Conclusions Although healthcare professionals reported rather positive experiences with the Smoke-free Parents referral tool, the use of the tool was limited due to barriers. To increase the impact of the Smoke-free Parents telephone-based smoking cessation counseling program via child healthcare settings, it is important to overcome these barriers. Suggestions for improvement in the implementation of the referral tool in child healthcare settings are discussed.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands. .,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands.
| | - Bethany Hipple Walters
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, USA
| | - Roy Otten
- Clinical Developmental Psychology, Radboud University, P.O. Box 9104, 6500 HE, Nijmegen, The Netherlands
| | - Marloes Kleinjan
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, P.O. Box 735, 3500 AS, Utrecht, the Netherlands.,Department of Interdisciplinary Social Science, Utrecht University, P.O. Box 80125, 3584 CS, Utrecht, the Netherlands
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Scheffers-van Schayck T, Wetter DW, Otten R, Engels RCME, Kleinjan M. Program uptake of a parent-tailored telephone smoking cessation counselling: An examination of recruitment approaches. Tob Prev Cessat 2021; 7:30. [PMID: 33907722 PMCID: PMC8066574 DOI: 10.18332/tpc/133019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/22/2021] [Accepted: 02/02/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Recently, a Dutch proactive parent-tailored telephone smoking cessation counselling program, Smoke-free Parents (SFP), was demonstrated to be effective in helping parents to quit smoking. This study aimed to examine the program’s uptake and the costs of two recruitment approaches (i.e. healthcare vs mass media) for SFP. In addition, parent’s barriers to participating in SFP and the characteristics of participating parents were assessed. METHODS As part of an effectiveness-implementation hybrid trial, 402 smoking parents were recruited via healthcare settings and mass media for an informal, proactive, and free phone call with a smoking cessation counsellor about SFP (the Netherlands, September 2016 – September 2018). Parents were asked whether they wanted to participate in SFP. If parents refused, reasons for decline and additional information (e.g. educational level) were collected. RESULTS Results revealed that 26.4% of the recruited parents participated in SFP. Although the program uptake of parents recruited via mass media was slightly, but not significantly, higher than via healthcare (27.3% vs 26.8%, p=0.92), the healthcare approach resulted in lower costs per participant (€99.62 vs €205.72). Smoking cessation counsellors were unable to reach almost one-third (32.7%) of the parents after they had agreed to be called about SFP. CONCLUSIONS The present study showed that more than a quarter of all recruited parents participated in SFP and that the mass media approach and healthcare approach can be used to recruit parents for SFP. To increase the number of parents participating in SFP, it is important to overcome the identified barriers that prevent parents from participating.
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Affiliation(s)
- Tessa Scheffers-van Schayck
- Epidemiology and Research Support, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.,Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - David W Wetter
- Center for Health Outcomes and Population Equity, Huntsman Cancer Institute, the University of Utah, Salt Lake City, United States
| | - Roy Otten
- Research and Development, Pluryn, Nijmegen, the Netherlands.,Department of Psychology, ASU REACH Institute, Arizona State University, Tempe, United States.,Developmental Psychopathology, Radboud University, Nijmegen, the Netherlands
| | | | - Marloes Kleinjan
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, the Netherlands.,Youth, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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Nabi-Burza E, Drehmer JE, Walters BH, Willemsen MC, Zeegers MPA, Winickoff JP. Smoking Cessation Treatment for Parents Who Dual Use E-Cigarettes and Traditional Cigarettes. J Smok Cessat 2021; 2021:6639731. [PMID: 34306227 PMCID: PMC8279196 DOI: 10.1155/2021/6639731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/15/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION An increasing number of parents use both e-cigarettes and cigarettes (dual users). Previous studies have shown that dual users may have higher rates of contemplating smoking cessation than parents who only smoke cigarettes. This study was aimed to assess the delivery of tobacco cessation treatment (prescription for nicotine replacement therapy and referral to the quitline) among parents who report being dual users vs. cigarette-only smokers. METHODS A secondary analysis of parent survey data collected between April and October 2017 at 10 pediatric primary care practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was conducted. Parents were considered to be dual users of cigarettes and e-cigarettes if they reported smoking a cigarette, even a puff, in the past seven days and using an e-cigarette within the past 30 days. Parents were asked if they received a prescription for nicotine replacement therapy and referral to the quitline to help them quit from their child's clinician. Multivariable logistic regression examined factors (dual use, insurance status, relationship to the child, race, and education status of the parent) associated with delivery of smoking cessation treatment (receiving prescriptions and/or enrollment in quitline) to smoking parents. Further, we compared the rates of tobacco cessation treatment delivery to dual users in the usual-care control practices vs. intervention practices. RESULTS Of 1007 smokers or recent quitters surveyed in the five intervention practices, 722 parents reported current use of cigarettes-only and 111 used e-cigarettes. Of these 111 parents, 82 (73.9%) reported smoking cigarettes. Parents were more likely to report receiving any treatment if they were dual users vs. cigarette-only smokers (OR 2.43, 95% CI 1.38, 4.29). Child's insurance status, parents' sex, education, and race were not associated with parental receipt of tobacco cessation treatment in the model. No dual users in the usual-care control practices reported receiving treatment. Discussion. Dual users who visited CEASE intervention practices were more likely to receive treatment than cigarette-only smokers when treatments were discussed. An increased uptake of tobacco cessation treatments among dual users reinforces the importance of discussing treatment options with this group, while also recognizing that cigarette-only smokers may require additional intervention to increase the acceptance rate of cessation assistance. This trial is registered with ClinicalTrials.gov, Identifier: NCT01882348.
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Affiliation(s)
- Emara Nabi-Burza
- Massachusetts General Hospital for Children, Division of General Academic Pediatrics, Boston, MA, USA
- Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, USA
| | - Jeremy E. Drehmer
- Massachusetts General Hospital for Children, Division of General Academic Pediatrics, Boston, MA, USA
- Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, USA
| | - Bethany Hipple Walters
- Massachusetts General Hospital for Children, Division of General Academic Pediatrics, Boston, MA, USA
- Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, USA
| | - M. C. Willemsen
- Department of Health Promotion, Maastricht University, Maastricht, Netherlands
- Dutch Alliance for a Smokefree Society, The Hague, NL, Netherlands
| | - Maurice P. A. Zeegers
- Nutrition and Translational Research in Metabolism (School NUTRIM), Maastricht University, Maastricht, Netherlands
- Care and Public Health Research Institute (School CAPHRI), Maastricht University, Maastricht, Netherlands
| | - Jonathan P. Winickoff
- Massachusetts General Hospital for Children, Division of General Academic Pediatrics, Boston, MA, USA
- Massachusetts General Hospital, Tobacco Research and Treatment Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Itasca, IL, USA
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Atorkey P, Paul C, Bonevski B, Wiggers J, Mitchell A, Byrnes E, Lecathelinais C, Tzelepis F. Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial. J Med Internet Res 2021; 23:e19737. [PMID: 33404504 PMCID: PMC7817359 DOI: 10.2196/19737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/22/2020] [Accepted: 11/11/2020] [Indexed: 01/21/2023] Open
Abstract
Background A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. Objective The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. Methods Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. Results Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5% (59/406) for fruit and vegetables, 12.7% (29/228) for physical activity, 6.8% (13/191) for smoking, and 5.5% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95% CI 0.06-0.56) of signing up for support services for at least two behaviors. Conclusions Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001.
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Affiliation(s)
- Prince Atorkey
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Christine Paul
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - John Wiggers
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
| | - Aimee Mitchell
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia
| | - Emma Byrnes
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christophe Lecathelinais
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia.,Hunter New England Population Health, Hunter New England Local Health District, Newcastle, Australia.,Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia.,Priority Research Centre for Health Behaviour, Faculty of Health and Medicine, University of Newcastle, Newcastle, Australia
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7
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Abstract
BACKGROUND Tobacco smoke exposure (TSE) and inappropriate sleep position/environments contribute to preventable infant deaths. The objective of our quality improvement (QI) program was to increase primary care provider (PCP) screening and counseling for TSE and safe sleep risks at well-child visits (WCVs) and to assess caregiver behavior changes at subsequent visits. METHODS Pediatric practices, recruited from the Ohio Chapter, American Academy of Pediatrics' database, self-selected to participate in this TSE and safe sleep PCP QI program. At every WCV over a 10-month period, caregivers with children < 1 year old were to be screened and counseled by providers. Caregiver demographics, TSE, and safe sleep practices were assessed. Individual PCP results were paired with subsequent family screening tools at follow up visits to determine changes in TSE and safe sleep practices. Differences in frequencies were determined and paired t-tests were used to compare means. RESULTS Fourteen practices (60 providers) participated; 7289 screens were completed: 3972 (54.5%) initial screens and 1769 (24.3%) subsequent WCV screens. Caregivers on the initial screen were primarily white (61.7%), mothers (86.0%) with public insurance (41.7%). Within the first month after QI program initiation, PCPs TSE screening was during 80% of WCVs, which increased to > 90% by end of the QI program. A total of 637 /3953 (16.1%) screened positive for home TSE on the initial visit: 320/3953 (8.1%) exposed by at least the primary caregivers, and 317/3953 (8.0%) exposed by a home adult smoker (not the identified caregiver). Of caregivers receiving smoking counseling with subsequent follow-up WCV (n = 100), the mean number of cigarettes smoked daily decreased significantly from 10.6 to 4.6 (p = 0.03). Thirty-four percent of caregivers (34/100) reported they quit smoking at their second visit. A total of 1072 (27%) infants screened at risk for inappropriate sleep position or environment at their initial visit. Of these at-risk infants whose caregivers received safe sleep counseling, 49.1% practiced safer sleep behaviors at follow-up. CONCLUSIONS PCPs participating in a QI program increased screening at WCVs for infant mortality risks. After counseling and providing resources about TSE and safe sleep, many caregivers reported practicing safer behaviors at their next WCV.
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Drehmer JE, Ossip DJ, Nabi-Burza E, Hipple Walters B, Gorzkowski JA, Winickoff JP. Pediatric Office Delivery of Smoking Cessation Assistance for Breast-Feeding Mothers. Nicotine Tob Res 2020; 22:346-353. [PMID: 30521040 DOI: 10.1093/ntr/nty247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Accepted: 11/13/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION National and international organizations have done an excellent job of advocating and promoting breast feeding for all mothers. This study assessed to what extent an intervention increased delivery of cessation assistance to breast-feeding mothers who smoke. METHODS Data were collected between April and October 2015 in five US states as part of a cluster randomized controlled trial in 10 pediatric practices. Practices were randomized to the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care control arms. Mothers were asked about their smoking status and breast-feeding history during a screening interview upon exiting the practice and eligible mothers who agreed to participate in an enrollment interview were asked if they received smoking cessation assistance during their child's visit. Mothers with a child 1 year old and younger were included in the analyses. RESULTS Current breast feeding was associated with a reduced likelihood of current smoking (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [95% CI] = 0.25 to 0.57) and a greater likelihood of quitting smoking (aOR = 2.33, 95% CI = 1.29 to 4.21) after controlling for known confounders. Mothers who concurrently smoked and breast-fed were more likely to be asked about smoking (66.7% vs. 28.6%, p = .01), advised to quit (61.1% vs. 21.4%, p < .01), prescribed nicotine replacement therapy (50.0% vs. 0%, p < .001), and enrolled into the quitline (27.8% vs. 0%, p < .01) at CEASE practices compared to control practices. CONCLUSION Breast-feeding mothers were less likely to be current smokers and more likely to have recently quit smoking. Among mothers who continue to smoke and breast feed, the CEASE intervention enhances delivery of smoking cessation assistance. IMPLICATIONS Breast feeding and eliminating infants' exposure to tobacco smoke are important protective factors for serious pediatric health risks including sudden infant death. This study shows that breast feeding was positively associated with desirable tobacco control outcomes, specifically that breast feeding was associated with a lower likelihood of smoking among ever smokers and a greater likelihood of recently quitting smoking. This is also the first study to look specifically at delivery of smoking cessation assistance to breast-feeding mothers seen at pediatric offices and demonstrates the effectiveness of delivering evidence-based smoking cessation assistance to them in this context. TRIAL REGISTRATION www.ClinicalTrials.gov (identifier NCT01882348).
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Affiliation(s)
- Jeremy E Drehmer
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY
| | - Emara Nabi-Burza
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Bethany Hipple Walters
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA
| | - Julie A Gorzkowski
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA.,Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL
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Wolfenden L, Ezzati M, Larijani B, Dietz W. The challenge for global health systems in preventing and managing obesity. Obes Rev 2019; 20 Suppl 2:185-193. [PMID: 31317659 DOI: 10.1111/obr.12872] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 12/12/2022]
Abstract
Few health crises have been as predictable as the unfolding obesity pandemic. Clinical and public health services remain the front line of efforts to reduce the burden of obesity. While a range of clinical practice guidelines exist, the need for clinical interventions exceeds the capacity of health systems to provide care for those affected with obesity, and routine clinical practices fall far short of guidelines recommendations even in high-income countries. In this manuscript, we discuss current recommendations regarding obesity interventions and key challenges facing global health systems in managing the health needs of people with obesity. Improving the provision of obesity-related health care is a considerable challenge and will require changing existing perceptions of obesity as a matter of personal failure to its recognition as a disease, innovative approaches to health system reform, clinician capacity building and implementation support, a focus on prevention, and wise resource allocation. Leadership from governments, the medical profession, and patient and community groups to address the issues raised in this manuscript is urgently needed to address the growing health concern.
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Affiliation(s)
- Luke Wolfenden
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter New England Local Health District, Hunter New England Population Health, Wallsend, New South Wales, Australia
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.,MRC-PHE Centre for Environment and Health, Imperial College London, London, UK.,WHO Collaborating Centre on NCD Surveillance and Epidemiology, Imperial College London, London, UK
| | - Bagher Larijani
- Diabetes Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Centre, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - William Dietz
- Redstone Global Centre for Prevention and Wellness, George Washington University, Washington, DC, US
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Jenssen BP, Muthu N, Kelly MK, Baca H, Shults J, Grundmeier RW, Fiks AG. Parent eReferral to Tobacco Quitline: A Pragmatic Randomized Trial in Pediatric Primary Care. Am J Prev Med 2019; 57:32-40. [PMID: 31122792 PMCID: PMC6644070 DOI: 10.1016/j.amepre.2019.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 03/14/2019] [Accepted: 03/15/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Quitlines are effective in helping smokers quit, but pediatrician quitline referral rates are low, and few parents who smoke use the service. This study compared enrollment of parents who smoke in the quitline using electronic referral with that using manual referral. STUDY DESIGN The study was designed as a pragmatic RCT. SETTING/PARTICIPANTS Participants were recruited from one large, urban pediatric primary care site in Philadelphia, Pennsylvania with a high percentage of low-income families. Participants included adult parents who smoked and were present at their child's healthcare visit. INTERVENTION Pediatricians screened for tobacco use; smokers were given brief advice to quit and, if interested in quitting, were referred to the quitline. The eReferral ("warm handoff") involved electronically sending parent information to the quitline (parent received a call within 24-48 hours). Control group procedures were identical to eReferral, except the quitline number was provided to the parent. Data were collected between March 2017 and February 2018 and analyzed in 2018. MAIN OUTCOME MEASURES The primary outcome was the proportion of parents enrolled in quitline treatment. Secondary outcomes included parent factors (e.g., demographics, nicotine dependence, and quitting motivation) associated with successful enrollment. Number of quitline contacts was also explored. RESULTS During the study period, in the eReferral group, 10.3% (24 of 233) of parents who smoked and were interested in quitting enrolled in the quitline, whereas only 2.0% (5 of 251) of them in the control group enrolled in the quitline-a difference of 8.3% (95% CI=4.0, 12.6). Parents aged ≥50 years enrolled in the quitline more frequently. Although more parents in the eReferral group connected to the quitline, among parents who had at least one quitline contact, there was no significant difference in the mean number of quitline contacts between eReferral and control groups (mean, 2.04 vs 2.40 calls; difference, 0.36 [95% CI=0.35, 1.06]). CONCLUSIONS Smoking parent eReferral from pediatric primary care may increase quitline enrollment and could be adopted by practices interested in increasing rates of parent treatment. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02997735.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania; PolicyLab and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Naveen Muthu
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania; PolicyLab and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Mary Kate Kelly
- PolicyLab and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert W Grundmeier
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania; PolicyLab and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexander G Fiks
- Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania; PolicyLab and the Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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