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Jones DM, Bullock S, Donald K, Cooper S, Miller W, Davis AH, Cottoms N, Orloff M, Bryant-Moore K, Guy MC, Fagan P. Factors associated with smokefree rules in the homes of Black/African American women smokers residing in low-resource rural communities. Prev Med 2022; 165:107340. [PMID: 36370892 PMCID: PMC9727706 DOI: 10.1016/j.ypmed.2022.107340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Little is known about the implementation of voluntary policies in the homes of Black/African American women smokers who live in rural areas where health care access is limited. This paper examines 1) the sample's prevalence of comprehensive smoke-free rules; 2) sociodemographic, social, and smoking characteristics of women by home rule type; and 3) the association of social indicators with the outcome complete ban on smoked tobacco use in the home (n = 191). Families Rising to Enforce Smokefree Homes collected baseline data from 2019 to 2021 prior to randomization to an intervention that aimed to increase comprehensive smokefree policies in the homes African American women living in the rural Delta region of Arkansas. The primary outcome was implementation of a complete ban on all smoked tobacco products anywhere inside the home. Results showed that 26% of women had a rule that completely banned all smoked tobacco products in the home. Women who reported having no ban were more likely to be employed part-time (50.0%), while women with a partial (66.9%) or complete ban (60.0%) were more likely to not currently work for pay. Women who indicated that they just meet basic expenses and meet needs with little left had significantly lower odds of having a complete ban on smoked tobacco in the home than women who indicated that they live comfortably. Perceived financial security may be a motivating factor that helps women keep their homes free from all smoked tobacco products (# NCT03476837).
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Affiliation(s)
- Dina M Jones
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Sandilyn Bullock
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Katherine Donald
- Coalition for a Tobacco Free Arkansas, 1100 N. University Ave, Suite 257, Little Rock, AR 72207, USA.
| | - Sandra Cooper
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Wonda Miller
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Anna Huff Davis
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Naomi Cottoms
- TRI County Rural Health Network, 419 Cherry Street, Helena, AR 72342, USA.
| | - Mohammed Orloff
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Keneshia Bryant-Moore
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
| | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, 816 W. Franklin Street, Room 201, Richmond, VA 23284-3509, United States of America.
| | - Pebbles Fagan
- Department of Health Behavior and Health Education, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St., #820, Little Rock, AR 72205, USA.
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Mekiso AB, Fonkamo TT, Wontamo TE, Liben FE, Turuse EA, Watumo AM, Woiloro LA, Erjino DS, Arficho TT, Mekengo DE. Prevalence of Cigarette Smoking and Associated Factors among Residents of Hossana Town, Southern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2022; 2022:2272281. [PMID: 35097111 PMCID: PMC8794659 DOI: 10.1155/2022/2272281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tobacco is the only legal product that kills a large number of its consumers when used as intended by producers. Information on cigarette smoking and associated factors among adults at the household level is very limited. OBJECTIVE To assess prevalence of cigarette smoking and associated factors among residents of Hossana town, Hadiya zone, Southern Ethiopia, 2020. METHODS AND MATERIALS A cross-sectional study design was performed. A structured questionnaire was used to collect data. Bivariate and multivariable binary logistic regression was used to identify risk factors of cigarette smoking. Variables significant at a p value of less than 0.05 were considered as independent predictors. Hosmer and Lemeshow test statistics were done to test the model fitness for the final model. Similarly, multicollinearity was checked by using collinearity statistics (tolerance and VIf). RESULT In total, 591 people responded to the survey, resulting in a 98.2% response rate. Among the study participants, cigarette smokers were 183 (31.0%). Educational status, alcohol use, and parental smoking were all found to have a significant relationship with cigarette smoking among research participants in Hosanna town. When compared to people with a college education or above, illiterates are approximately nine times more likely to consume cigarettes (95% CI = 9.058 (3.52, 22.469)). Alcoholics are about twice as likely as nondrinkers to smoke cigarettes (95% CI = 2.288 (1.548, 3.383)). Those who have cigarette-smoking parents are approximately twice as likely as their counterparts to smoke cigarettes (95% CI = 2.288 (1.548, 3.383)). CONCLUSION According to this survey, the prevalence of cigarette smoking was high. Furthermore, cigarette smoking was linked to illiteracy, alcohol consumption, and parental smoking in this study.
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Affiliation(s)
- Abera Beyamo Mekiso
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Temesgen Tamirat Fonkamo
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Tekle Ejajo Wontamo
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Fitsum Endale Liben
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Ermias Abera Turuse
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Aregash Mecha Watumo
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Lonsako Abute Woiloro
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Dawit Sullamo Erjino
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Tegegn Tadesse Arficho
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Dejene Ermias Mekengo
- School of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
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Spontaneous Smoking Cessation in Parents. J Smok Cessat 2021; 2021:5526715. [PMID: 34306222 PMCID: PMC8279195 DOI: 10.1155/2021/5526715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose To determine the percentage of parents who report quitting spontaneously and examine the factors associated with these quits. Methods As part of a cluster randomized control trial addressing parental smoking in a pediatric outpatient setting, 12-month follow-up survey data were collected from parents who had self-identified as smokers when exiting from 10 control practices. Parents were considered to have made a spontaneous quit if they reported not smoking a cigarette, even a puff, in the last 7 days and chose the statement "I did not plan the quit in advance; I just did it" when describing how their quit attempt started. Results Of the 981 smoking parents enrolled at baseline, 710 (72%) completed the 12-month follow-up. Of these, 123 (17%) reported quitting, of whom 50 (41%) reported quitting spontaneously. In multivariable analysis, parents who reported smoking on some days vs. every day (OR 3.06 (95% CI 1.42, 6.62)) and that nobody had smoked in their home/car vs. someone had smoked in these settings in the past 3 months (OR 2.19 (95% CI 1.06, 4.54)) were more likely to quit spontaneously. Conclusions This study shows that, of parents who quit smoking, a substantial percentage report quitting spontaneously and that intermittent smoking and smoke-free home/car policies are associated with reports of quitting spontaneously. Promoting smoke-free home/car policies, especially when parents are not willing to make a plan to quit smoking, might increase the likelihood that parents decide to quit without advance planning. Pediatric healthcare providers are uniquely positioned to use the child's visit to motivate parents to quit smoking and eliminate their child's exposure to tobacco smoke, regardless of the frequency of smoking or a readiness to plan a quit attempt. Clinical Trial Registration. This trial is registered with NCT01882348.
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In-Home Secondhand Smoke Exposure Among Urban Children With Asthma: Contrasting Households With and Without Residential Smokers. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 25:E7-E16. [PMID: 29883368 PMCID: PMC6173659 DOI: 10.1097/phh.0000000000000790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Secondhand smoke exposure (SHSe) affects up to half of all children in the United States. Many studies have identified factors associated with in-home SHSe, but few have contrasted these factors between households with and without residential smokers. In the latter case, exposure occurs from only external sources that enter the home, such as visitors or environmental incursion. OBJECTIVE Among children with SHSe at home, to examine demographic and psychosocial differences between households with and without residential smokers. DESIGN Baseline analysis of an observational cohort. SETTING Baltimore City, Maryland. PARTICIPANTS A total of 157 children with asthma, aged 5 to 12 years. MEASURES At-home airborne nicotine, caregiver-reported depression, asthma-related quality of life, functional social support, and demographics. Univariable comparisons were performed between SHS-exposed households with and without residential smokers. Multivariable logistic regression models were fit to examine associations between measured factors and absence of residential smokers. RESULTS Children (78.3%) had at-home SHSe. Of these, 40.7% lived in households without residential smokers. Compared with households with residential smokers, these caregivers endorsed stronger beliefs in SHS harms and also worse functional social support and asthma-related stress, despite no differences in asthma morbidity. In adjusted models, SHS-exposed children with caregivers in the lowest tertile of functional social support (adjusted odds ratio, 3.50; 95% confidence interval, 1.12-10.99), asthma-related quality of life (2.90; 1.06-7.95), and those living alone (5.28; 1.26-22.15) had at least twice higher odds of having exclusively external SHSe than the highest tertile (P trends < .05). CONCLUSIONS In-home SHS exposure remains alarmingly high in urban environments. However, a substantial proportion of this exposure appears to be occurring only from external sources that enter the home. Caregivers in these homes had higher desire but lower agency to avoid SHSe, driven by lack of functional support and physical isolation. Public policies targeting these factors may help remediate exposure in this especially vulnerable population.
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Berg CJ, Haardörfer R, Wagener TL, Kegler MC, Windle M. Correlates of Allowing Alternative Tobacco Product or Marijuana Use in the Homes of Young Adults. Pediatrics 2018; 141:S10-S20. [PMID: 29292302 PMCID: PMC5884091 DOI: 10.1542/peds.2017-1026e] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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 Given the increases in alternative tobacco product (ATP) and marijuana use, we examined self-reported likelihood of allowing ATP and marijuana use in the home among young adults. METHODS We analyzed data from a study of students aged 18 to 25 years (n = 2865) at 7 Georgia colleges and universities. Variables included: personal, household members', and friends' tobacco (cigarettes, little cigars and cigarillos [LCCs], e-cigarettes, hookah) and marijuana use and the perceived harm to health, harm of byproducts, addictiveness, and social acceptability of each. Regression models were specified to examine correlates of the likelihood of allowing use of each product in the home. RESULTS Personal use prevalence ranged from 5.5% for e-cigarettes to 12.5% for marijuana. E-cigarettes were most likely to be allowed in the home; cigarettes were least. Regression indicated that others' use and the perceived social acceptability of using each product was correlated with greater likelihood of allowing the use of a product. A greater likelihood of allowing cigarette and LCC use in the home was only associated with cigarette or LCC use, respectively; a greater likelihood of allowing e-cigarette use was associated with current e-cigarette use; greater likelihood of allowing hookah use was associated with using any product except e-cigarettes; and greater likelihood of allowing marijuana use was associated with LCC and marijuana use. Perceived harm to health, byproduct harms, and addictiveness were differentially related to the likelihood of allowing use of different products. CONCLUSIONS ATPs and marijuana may undermine efforts to protect against environmental toxins in the home, thus warranting interventions targeting young adults.
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Affiliation(s)
- Carla J. Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and,Address correspondence to Carla J. Berg, PhD, Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Room 524, Atlanta, GA 30322. E-mail:
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Theodore L. Wagener
- Department of Pediatrics and Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Michelle C. Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Michael Windle
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia; and
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Huai Y, Guan X, Liu S, Uyeki TM, Jiang H, Klena J, Huang J, Chen M, Peng Y, Yang H, Luo J, Zheng J, Peng Z, Huo X, Xiao L, Chen H, Zhang Y, Xing X, Feng L, Hu DJ, Yu H, Zhan F, Varma JK. Clinical characteristics and factors associated with severe acute respiratory infection and influenza among children in Jingzhou, China. Influenza Other Respir Viruses 2016; 11:148-156. [PMID: 27465959 PMCID: PMC5304575 DOI: 10.1111/irv.12419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Influenza is an important cause of respiratory illness in children, but data are limited on hospitalized children with laboratory-confirmed influenza in China. METHODS We conducted active surveillance for severe acute respiratory infection (SARI; fever and at least one sign or symptom of acute respiratory illness) among hospitalized pediatric patients in Jingzhou, Hubei Province, from April 2010 to April 2012. Data were collected from enrolled SARI patients on demographics, underlying health conditions, clinical course of illness, and outcomes. Nasal swabs were collected and tested for influenza viruses by reverse transcription polymerase chain reaction. We described the clinical and epidemiological characteristics of children with influenza and analyzed the association between potential risk factors and SARI patients with influenza. RESULTS During the study period, 15 354 children aged <15 years with signs and symptoms of SARI were enrolled at hospital admission. severe acute respiratory infection patients aged 5-15 years with confirmed influenza (H3N2) infection were more likely than children without influenza to have radiographic diagnosis of pneumonia (11/31, 36% vs 15/105, 14%. P<.05). Only 16% (1116/7145) of enrolled patients had received seasonal trivalent influenza vaccination within 12 months of hospital admission. Non-vaccinated influenza cases were more likely than vaccinated influenza cases to have pneumonia (31/133, 23% vs 37/256, 15%, P<.05). severe acute respiratory infection cases aged 5-15 years diagnosed with influenza were also more likely to have a household member who smoked cigarettes compared with SARI cases without a smoking household member (54/208, 26% vs 158/960, 16%, P<.05). CONCLUSIONS Influenza A (H3N2) virus infection was an important contributor to pneumonia requiring hospitalization. Our results highlight the importance of surveillance in identifying factors for influenza hospitalization, monitoring adherence to influenza prevention and treatment strategies, and evaluating the disease burden among hospitalized pediatric SARI patients. Influenza vaccination promotion should target children.
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Affiliation(s)
- Yang Huai
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Xuhua Guan
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Shali Liu
- Jingzhou Central Hospital, Jingzhou, China
| | - Timothy M Uyeki
- Influenza Division, National Center for Immunization and Respiratory Diseases, Atlanta, GA, USA
| | - Hui Jiang
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - John Klena
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Maoyi Chen
- Jingzhou Center for Disease Control and Prevention, Jingzhou, China
| | - Youxing Peng
- Jingzhou First People's Hospital, Jingzhou, China
| | - Hui Yang
- Jingzhou Second People's Hospital, Jingzhou, China
| | - Jun Luo
- Jingzhou Maternal and Children's Hospital, Jingzhou, China
| | - Jiandong Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhibin Peng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xixiang Huo
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Lin Xiao
- Jingzhou Central Hospital, Jingzhou, China
| | - Hui Chen
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Yuzhi Zhang
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China
| | - Xuesen Xing
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Luzhao Feng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Dale J Hu
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.,Vaccine Clinical Research Branch Vaccine Research Program, Division of AIDS, NIAID/NIH, Bethesda, MD, USA
| | - Hongjie Yu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Faxian Zhan
- Hubei Provincial Centre for Disease Control and Prevention, Wuhan, China
| | - Jay K Varma
- China-US Collaborative Program on Emerging and Re-Emerging Infection Disease, Center for Global Health, Centers for Disease Control and Prevention, Beijing, China.,Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Padilla M, Berg CJ, Schauer GL, Lang DL, Kegler MC. Allowing cigarette or marijuana smoking in the home and car: prevalence and correlates in a young adult sample. HEALTH EDUCATION RESEARCH 2015; 30:179-191. [PMID: 25214515 PMCID: PMC4296890 DOI: 10.1093/her/cyu051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 08/06/2014] [Indexed: 06/03/2023]
Abstract
Given the increased marijuana use, negative health consequences of marijuana secondhand smoke exposure (SHSe) and dearth of research regarding marijuana SHSe in personal settings, we examined the prevalence and correlates of allowing marijuana versus cigarette smoking in personal settings among 2002 online survey respondents at two southeastern US universities in 2013. Findings indicated that 14.5% allowed cigarettes in the home, 17.0% marijuana in the home, 35.9% cigarettes in cars and 27.3% marijuana in cars. Allowing cigarettes in the home was associated with younger age, racial/ethnic minority status, living off campus, personal marijuana use, parental tobacco use and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in the home included older age, not having children, living off campus, positive perceptions of marijuana and personal, parental and friend marijuana use (P < 0.05). Correlates of allowing cigarettes in cars included personal cigarette and marijuana use, parental tobacco and marijuana use, more cigarette-smoking friends and positive perceptions of cigarettes (P < 0.05). Correlates of allowing marijuana in cars included being non-Hispanic black; positive perceptions of marijuana; and personal, parental and friend marijuana use (P < 0.05). Interventions must target distinct factors influencing policies regarding cigarette versus marijuana use in personal settings to address the consequences of marijuana and cigarette SHSe.
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Affiliation(s)
- Mabel Padilla
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Gillian L Schauer
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Delia L Lang
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, 1518 Clifton Road, NE, Atlanta, GA 30322, USA
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Kegler MC, Bundy L, Haardörfer R, Escoffery C, Berg C, Yembra D, Kreuter M, Hovell M, Williams R, Mullen PD, Ribisl K, Burnham D. A minimal intervention to promote smoke-free homes among 2-1-1 callers: a randomized controlled trial. Am J Public Health 2015; 105:530-7. [PMID: 25602863 DOI: 10.2105/ajph.2014.302260] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the efficacy of a minimal intervention to create smoke-free homes in low-income households recruited through the United Way of Greater Atlanta 2-1-1, an information and referral system that connects callers to local social services. METHODS We conducted a randomized controlled trial (n=498) from June 2012 through June 2013, with follow-up at 3 and 6 months. The intervention consisted of 3 mailings and 1 coaching call. RESULTS Participants were mostly smokers (79.7%), women (82.7%), African American (83.3%), and not employed (76.5%), with an annual household income of $10,000 or less (55.6%). At 6-months postbaseline, significantly more intervention participants reported a full ban on smoking in the home than did control participants (40.0% vs 25.4%; P=.002). The intervention worked for smokers and nonsmokers, as well as those with or without children. CONCLUSIONS Minimal intervention was effective in promoting smoke-free homes in low income households and offers a potentially scalable model for protecting children and adult nonsmokers from secondhand smoke exposure in their homes.
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Affiliation(s)
- Michelle C Kegler
- Michelle C. Kegler, Regine Haardörfer, Cam Escoffery, and Carla Berg are with the Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA. Lucja Bundy and Debbie Yembra are with the Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta. Matthew Kreuter is with the George Warren Brown School of Social Work, Washington University, St. Louis, MO. Mel Hovell is with the Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA. Rebecca Williams is with the Gillings School of Global Public Health, Chapel Hill, NC. Patricia Dolan Mullen is with the School of Public Health, University of Texas Health Sciences Center, Houston. Kurt Ribisl is with the Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill. Donna Burnham is with the United Way of Greater Atlanta, GA
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Saint Onge JM, Gurley-Calvez T, Orth TA, Okah FA. The association between social stressors and home smoking rules among women with infants in the United States. Am J Public Health 2014; 104:e116-23. [PMID: 25322289 PMCID: PMC4232162 DOI: 10.2105/ajph.2014.302158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the role of social stressors on home-smoking rules (HSRs) among women with infants in the United States, with attention on the moderating role of smoking status and depression. METHODS We analyzed data for 118 062 women with recent births in the United States who participated in the Pregnancy Risk Assessment Monitoring System (2004-2010), which is a population-based surveillance data set. We fit multinomial logistic models to predict the odds of partial or no HSRs by a cumulative index of prenatal social stressors. RESULTS Compared with those with no stressors, mothers with high levels of social stressors had 2.5 times higher odds of partial or no HSRs. Smokers in the 1-2, 3-5, and ≥ 6 stressor categories were 9.0%, 9.6%, and 10.8% more likely to have partial or no HSRs, respectively. Under the highest levels of stress (≥ 6), nonsmokers were almost as likely as smokers to have partial or no HSRs. In addition, the effects of stress on HSRs were more pronounced for nonsmoker, nondepressed mothers. CONCLUSIONS Increases in social stressors represented an important risk factor for partial or no HSRs and might have potential negative implications for infants.
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Affiliation(s)
- Jarron M Saint Onge
- Jarron M. Saint Onge is with the Department of Sociology, University of Kansas, Lawrence, and the Department of Health Policy and Management, University of Kansas Medical Center, Kansas City. Tami Gurley-Calvez is with the Department of Health Policy and Management, University of Kansas Medical Center, Kansas City. Teresa A. Orth is with the Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, School of Medicine, University of Missouri Kansas City. Felix A. Okah is with the Department of Pediatrics, Division of Neonatology, Children's Mercy Hospitals and Clinics, School of Medicine, University of Missouri Kansas City
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Correlates of smoke-free home policies in Shanghai, China. BIOMED RESEARCH INTERNATIONAL 2014; 2014:249534. [PMID: 25061606 PMCID: PMC4100358 DOI: 10.1155/2014/249534] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 06/03/2014] [Accepted: 06/15/2014] [Indexed: 11/24/2022]
Abstract
Background. Approximately 63.7% of nonsmokers in China are exposed to secondhand smoke (SHS) in their homes. The current study documents the prevalence and correlates of smoke-free home policies in Shanghai, as well as reasons for implementing such a policy and places where smoking is most commonly allowed. Methods. We conducted in-person surveys of 500 participants using a multistage proportional random sampling design in an urban and suburban district. Results. Overall, 35.3% had a smoke-free home policy. In the logistic regression, having higher income, not having smokers in the home, having children in the home, having fewer friends/relatives who permit smoking at home, and not being a current smoker were correlates of having a smoke-free home policy (P < 0.05). Concern about the health impact of SHS was reportedly the most important reason for establishing a smoke-free home. Among participants with no or partial bans, the most common places where smoking was allowed included the living room (64.2%), kitchen (46.1%), and bathroom (33.8%). Conclusions. Smoke-free home policies were in place for a minority of households surveyed. Establishing such a policy was influenced by personal smoking behavior and social factors. These findings suggest an urgent need to promote smoke-free home policies through tobacco control programs.
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Tyc VL, Lensing S, Vukadinovich C, Hovell MF. Smoking restrictions in the homes of children with cancer. Am J Health Behav 2013; 37:440-8. [PMID: 23985225 DOI: 10.5993/ajhb.37.4.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To examine smoking restrictions in households of children with cancer and their effect on biological measures of children's secondhand smoke exposure (SHSe). METHODS A sample of 135 parents of nonsmoking children with cancer who lived with a smoker completed structured interviews. RESULTS Approximately 43% of families prohibited smoking in the home. Children living in homes that prohibited smoking had median cotinine levels that were 71% and 52% lower than did those from homes with no and partial restrictions. CONCLUSIONS Parents should be directed to completely ban all smoking from the home and car to best protect their children from SHSe.
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Affiliation(s)
- Vida L Tyc
- Department of Psychology, St. Jude Children's Research Hospital, Memphis, TN, USA.
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12
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Faseru B, Nollen NL, Mayo MS, Krebill R, Choi WS, Benowitz NL, Tyndale RF, Okuyemi KS, Ahluwalia JS, Sanderson Cox L. Predictors of cessation in African American light smokers enrolled in a bupropion clinical trial. Addict Behav 2013; 38:1796-803. [PMID: 23254230 PMCID: PMC3558614 DOI: 10.1016/j.addbeh.2012.11.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 11/08/2012] [Accepted: 11/21/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND This is the first study to examine predictors of successful cessation in African American (AA) light smokers treated within a placebo-controlled trial of bupropion. METHODS We analyzed data from a randomized, double-blind, placebo-controlled trial of bupropion and health education for 540 African American light smokers. African American light smokers (≤10 cigarettes per day, cpd) were randomly assigned to receive 150mg bid bupropion SR (n=270) or placebo (n=270) for 7weeks. All participants received health education counseling at weeks 0, 1, 3, 5 and 7. Using chi-square tests, two sample t-tests, and multiple logistic regression analyses, we examined baseline psychosocial and smoking characteristics as predictors of cotinine-verified 7-day point prevalence smoking abstinence among study participants at the end treatment (Week 7) and at the end of follow-up (Week 26). RESULTS Participants who received bupropion were significantly more likely to quit smoking compared to those who received placebo (OR=2.72, 95% CI=1.60-4.62, P=0.0002). Greater study session attendance (OR=2.47, 95% CI=1.76-3.46, P=0.0001), and smoking non-menthol cigarettes increased the likelihood of quitting (OR=1.84, 95% CI=1.01-3.36, P=0.05); while longer years of smoking (OR=0.98, 95% CI=0.96-1.00, P=0.05) and higher baseline cotinine (OR=0.97, 95% CI=0.95-0.99, P=0.002) significantly reduced the odds of quitting at Week 7. Conversely, at the end of follow-up (Week 26), treatment with bupropion vs. placebo (OR=1.14, 95% CI=0.65-2.02, P=0.64) was not significantly associated with quitting and type of cigarette smoked (menthol vs. non-menthol) did not appear in the final logistic regression model. Greater study session attendance (OR=1.96, 95% CI=1.44-2.66, P=0.0001); BMI (OR=1.03, 95% CI=1.00-1.07, P=0.04); and weight efficacy (OR=1.03, 95% CI=1.01-1.05, P=0.01) increased the likelihood of quitting at Week 26. Similar to our findings at Week 7, longer years of smoking (OR=0.96, 95% CI=0.94-0.99, P=0.01) and higher baseline cotinine (OR=0.97, 95% CI=0.95-0.99, P=0.02) significantly reduced the odds of quitting at Week 26. CONCLUSIONS Baseline cotinine levels, number of years smoked and study session attendance are associated with both short- and long-term smoking cessation, while bupropion and the type of cigarette smoked were associated with quitting on short term only.
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Affiliation(s)
- Babalola Faseru
- Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Kansas City, KS 66160, USA.
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Tyc VL, Puleo E, Emmons K, de Moor JS, Ford JS. Smoking Restrictions Among Households of Childhood and Young Adult Cancer Survivors: Implications for Tobacco Control Efforts. J Adolesc Young Adult Oncol 2013; 2:17-24. [PMID: 23610739 DOI: 10.1089/jayao.2012.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study assessed the prevalence of smoking restrictions among households of survivors of childhood and young adult cancer who smoke. It also examined the relationship between home smoking restrictions and motivation to quit smoking, as well as other smoking, psychosocial, and environmental factors. METHODS Participants included 374 smokers who were childhood or young adult cancer survivors (between the ages of 18 and 55 years) recruited from five cancer centers to participate in a randomized smoking cessation trial. Survivors completed baseline measures about the smoking restrictions in their households, their smoking behavior, and related psychological and environmental factors, which are the focus of the current manuscript. RESULTS Almost 54% of survivors reported that smoking was prohibited in their households. Living with a nonsmoking partner, having a strict smoking policy at work, and not being nicotine dependent all increased the likelihood of having a total home smoking ban. Participants who were older, smoked more cigarettes per day over the prior week, and received prior chemotherapy were less likely to reside in households that adopted total bans. CONCLUSION Findings suggest that socio-environmental factors and current smoking behaviors are associated with complete smoking restrictions in the homes of survivors. These factors should be considered when communicating with survivors about the importance of establishing strict smoking policies in their private residences.
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Affiliation(s)
- Vida L Tyc
- St. Jude Children's Research Hospital , Memphis, Tennessee
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14
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Smoking During Pregnancy Rates Trends in a High Smoking Prevalence State, 1990–2009. South Med J 2012; 105:636-44. [DOI: 10.1097/smj.0b013e318273de96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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St Claire AW, Boyle RG, Schillo BA, Rode P, Taylor KA. Smokefree home rules adoption by smokers and nonsmokers: Minnesota, 1999-2010. Am J Prev Med 2012; 43:S197-204. [PMID: 23079217 DOI: 10.1016/j.amepre.2012.07.042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/26/2012] [Accepted: 07/30/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Smokefree workplace policies have successfully limited indoor exposure to secondhand smoke. However, exposure still exists in other indoor locations, most notably in the home. PURPOSE This paper examines change in the public's awareness of secondhand smoke harm, exposure to secondhand smoke, and prevalence of smokefree home rules between 1999 and 2010 in Minnesota. METHODS The Minnesota Adult Tobacco Survey is a statewide, cross-sectional, random-digit-dial telephone-based survey. The survey measures tobacco use, behaviors, attitudes, and beliefs among adults aged 18 and older in 1999, 2003, 2007, and 2010. Analysis was conducted in 2011. RESULTS There was a significant decrease in self-reported exposure to secondhand smoke among all nonsmokers in Minnesota from 2003 (60.9%) to 2010 (37.7%) (p<0.05). The prevalence of smokefree home rules adoption among all Minnesotans increased significantly between each time point: 1999 (64.5%); 2003 (74.8%); 2007 (83.2%); 2010 (87.2%) (p<0.05). Although smokers tended to adopt smokefree home rules at rates lower than nonsmokers, the percentage of smokefree home rules among smokers nearly doubled between 1999 (31.4%) and 2010 (58.1%) (p<0.05). CONCLUSIONS Over 10 years, Minnesotans reported a significant decline in exposure to secondhand smoke and a significant increase in voluntary smokefree home rules. Such a trend is notable as virtually all public tobacco control efforts were aimed at raising awareness and support for smokefree policies within workplaces. These findings demonstrate positive changes in social norms and suggest that behavior change in public settings might also be translated into practice in private settings.
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Kegler MC, Escoffery C, Bundy L, Berg CJ, Haardörfer R, Yembra D, Schauer G. Pilot study results from a brief intervention to create smoke-free homes. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:951426. [PMID: 22675374 PMCID: PMC3362929 DOI: 10.1155/2012/951426] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/10/2012] [Accepted: 02/28/2012] [Indexed: 11/26/2022]
Abstract
Very few community-based intervention studies have examined how to effectively increase the adoption of smoke-free homes. A pilot study was conducted to test the feasibility, acceptability, and short-term outcomes of a brief, four-component intervention for promoting smoke-free home policies among low-income households. We recruited forty participants (20 smokers and 20 nonsmokers) to receive the intervention at two-week intervals. The design was a pretest-posttest with follow-up at two weeks after intervention. The primary outcome measure was self-reported presence of a total home smoking ban. At follow-up, 78% of participants reported having tried to establish a smoke-free rule in their home, with significantly more nonsmokers attempting a smoke-free home than smokers (P = .03). These attempts led to increased smoking restrictions, that is, going from no ban to a partial or total ban, or from a partial to a total ban, in 43% of the homes. At follow-up, 33% of the participants reported having made their home totally smoke-free. Additionally, smokers reported smoking fewer cigarettes per day. Results suggest that the intervention is promising and warrants a rigorous efficacy trial.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
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Schuck K, Otten R, Engels RCME, Barker ED, Kleinjan M. Bidirectional influences between parents and children in smoking behavior: a longitudinal full-family model. Nicotine Tob Res 2012; 15:44-51. [PMID: 22513800 DOI: 10.1093/ntr/nts082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The present study investigated longitudinal associations and bidirectional influences between family members in smoking behavior using a longitudinal full-family design. Family systems provide a powerful social context in which modeling and imitation take place. In current literature, however, bidirectional associations between parents and children in smoking behavior are seldom considered. METHODS Participants were 426 families, including mothers, fathers, and 2 adolescent children. Associations were assessed over 5 waves with yearly intervals using a cross-lagged model in structural equation modeling. RESULTS Findings demonstrate that families resemble an interactive system affording smoking contagion across family members. Results suggest that associations between parents and children are bidirectional, that is, parental smoking behavior influences adolescent smoking behavior and adolescent smoking behavior influences parental smoking behavior. There is insufficient evidence to conclude that longitudinal associations between family members are generally bidirectional, as only unidirectional longitudinal associations were found between between siblings and partners. CONCLUSIONS The present study extends previous research on the intergenerational transmission of smoking behavior by demonstrating bidirectional influences between parents and children in smoking behavior. Moreover, the present study suggests that family members may be susceptible to adjust their smoking behavior across time in response to smoking behavior within the family.
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Affiliation(s)
- Kathrin Schuck
- Department of Developmental Psychopathology, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands.
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Pahl K, Brook JS, Koppel J, Lee JY. Unexpected benefits: pathways from smoking restrictions in the home to psychological well-being and distress among urban Black and Puerto Rican Americans. Nicotine Tob Res 2011; 13:706-13. [PMID: 21498429 PMCID: PMC3150690 DOI: 10.1093/ntr/ntr062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 03/10/2011] [Indexed: 11/14/2022]
Abstract
INTRODUCTION This study examined the pathways from smoking policies in the home (no ban, partial ban, and total ban on smoking) to psychological well-being (e.g., self-esteem) and psychological symptoms (e.g., depressive symptoms) as mediated by a healthy lifestyle (engaging in exercise, eating healthful foods, and sleeping enough) and cigarette smoking among a sample of urban Black and Puerto Rican Americans. METHODS Questionnaire data were collected from 816 participants (mean age = 32 years). Structural equation modeling (SEM) was employed to examine the pathways of restrictions on smoking in the home to a healthy lifestyle, cigarette smoking, psychological well-being, and psychological distress. RESULTS The SEM showed mediational pathways linking higher levels of restrictions on smoking in the home with a healthy lifestyle, which in turn was related negatively to psychological distress and positively to psychological well-being. Higher levels of restrictions on smoking in the home were also related inversely to cigarette smoking, which was related positively to psychological distress and negatively to psychological well-being. CONCLUSIONS Findings show that higher levels of restrictions on smoking in the home are associated with a healthier lifestyle and less cigarette smoking, which in turn are associated with better psychological functioning. Greater restrictions on smoking in the home may thus support positive lifestyle choices, including exercise and nutrition, as well as psychological functioning.
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Affiliation(s)
- Kerstin Pahl
- Department of Psychiatry, New York University School of Medicine, 215 Lexington Avenue, New York, NY 10016, USA.
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Huang CM, Guo JL, Wu HL, Chien LY. Stage of adoption for preventive behaviour against passive smoking among pregnant women and women with young children in Taiwan. J Clin Nurs 2011; 20:3331-8. [PMID: 21777316 DOI: 10.1111/j.1365-2702.2011.03803.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS This study assessed the applicability of the transtheoretical model to prevent exposure to passive smoking among pregnant women and women with young children in Taiwan. We examined whether women in different stages of change had different knowledge, processes of change, decisional balance and self-efficacy. BACKGROUND Although previous studies have found a positive association between the presence of children and a mother's readiness to prevent exposure to passive smoking, a few studies have systematically examined the mothers' stage of adoption for preventive behaviour against passive smoking. METHODS A cross-sectional survey based on self-reported data was conducted in 2005-2006. A total of 315 women was recruited from perinatal and paediatric clinics at four hospitals. The transtheoretical model measures included knowledge, stages of change, processes of change, decisional balance and self-efficacy towards passive smoking. RESULTS Of the 315 women in the study, 17·1% were at the precontemplation stage, 7·9% were at the contemplation/preparation stage and 74·9% were at the action/maintenance stage. Women at the action/maintenance stage scored the highest in knowledge, process of change, pros of decisional balance and self-efficacy, followed by the women at the contemplation/preparation stage and the women at the precontemplation stage. CONCLUSIONS This study supported the applicability of the transtheoretical model theory for adoption of preventive behaviour against passive smoking among pregnant women and women with young children. RELEVANCE TO CLINICAL PRACTICE Nurses could educate pregnant women and women with young children to adopt preventive behaviours against passive smoking using stage-matched intervention strategies, targeting the transtheoretical model constructs, to promote behavioural change.
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Affiliation(s)
- Chiu-Mieh Huang
- Department of Nursing, National Yang-Ming University, Taipei, Taiwan
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20
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Hawkins SS, Berkman L. Parental home smoking policies: the protective effect of having a young child in the household. Prev Med 2011; 53:61-3. [PMID: 21679724 DOI: 10.1016/j.ypmed.2011.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 05/30/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To examine selected social determinants of a home smoking policy among US households with children and whether these associations vary by the presence of a smoker and children's ages. METHODS In the 2006/2007 US Tobacco Use Supplement to the Current Population Survey there were 30,874 parents with 0-17-year-olds. RESULTS 83.9% of parents reported that no one was allowed to smoke inside the home. However, a no smoking policy varied by the presence of a smoker (93.6% of non-smoking households; 55.8% of smoking households) and children's ages (87.1% of parents with any 0-5-year-olds; 82.1% with 6-17-year-olds only; 79.2% with 14-17-year-olds only). In smoking and non-smoking households, parents of 6-17-year-olds were 25%-46% less likely to have a no smoking policy than parents of younger children. Among smoking households, Hispanic and Asian parents were over twice as likely to not allow smoking inside the home as white parents, while Black parents were half as likely. Parents from more disadvantaged circumstances were less likely to have a no smoking policy. CONCLUSIONS Parents of 6-17-year-olds are less likely to have a no smoking policy than parents of younger children. Parents with children of all ages should enact a smoking policy that promotes a smoke-free home.
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Affiliation(s)
- Summer Sherburne Hawkins
- Harvard Center for Population and Development Studies, Harvard School of Public Health, 9 Bow Street, Cambridge, MA 02138, USA.
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21
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Yang T, Xu X, Rockett IRH, Guo W, Zhou H. Effects of household, workplace, and public place smoking restrictions on smoking cessation. Health Place 2011; 17:954-60. [PMID: 21550837 DOI: 10.1016/j.healthplace.2011.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 04/04/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study was to evaluate the association between environmental smoking restrictions, distinguished by site, and smoking cessation by Chinese urban residents. Recruited through multi-stage quota-sampling, residents in six Chinese cities were surveyed. Data were both individual-level and city-level. Among 4735 respondents, 715 were identified as successful quitters and 405 as unsuccessful. Multilevel logistic regression analysis showed smoking cessation to be associated with city-level public place and workplace restrictions and individual-level workplace and household restrictions. Results offer justification for decision-makers to implement environmental tobacco control policies and related public health interventions aimed at markedly diminishing the high smoking prevalence in China.
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Affiliation(s)
- Tingzhong Yang
- Center for Tobacco Control Research, Zhejiang University School of Medicine, Hangzhou 310058, China.
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22
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Baxter S, Blank L, Everson-Hock ES, Burrows J, Messina J, Guillaume L, Goyder E. The effectiveness of interventions to establish smoke-free homes in pregnancy and in the neonatal period: a systematic review. HEALTH EDUCATION RESEARCH 2011; 26:265-282. [PMID: 21273185 DOI: 10.1093/her/cyq092] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This review considers the effectiveness of interventions to encourage the establishment of smoke-free homes during pregnancy and the neonatal period. A comprehensive search of the literature was undertaken to find relevant studies via electronic databases, citations and reference lists of included studies. The searches identified 17 papers that met the inclusion criteria. These were quality assessed and data extracted. Due to heterogeneity of the papers, a narrative synthesis was completed. Interventions were categorized in terms of those based on counselling, counselling plus additional elements, individually adapted programmes and motivational interviewing. The findings suggest inconclusive evidence relating to these intervention types, with a range of outcome measures reported. There were limitations throughout the papers in terms of study quality (especially sample size) and poor reporting of results in relation to effectiveness. The review was limited by its very specific population; however, it suggests that currently there is mixed evidence for the effectiveness of interventions to reduce parental environmental tobacco smoke in early infancy.
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Affiliation(s)
- Susan Baxter
- Section of Public Health, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK.
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Thomas JL, Scherber RM, Stewart DW, Lynam IM, Daley CM, Ahluwalia JS. Targeting African American nonsmokers to motivate smokers to quit: a qualitative inquiry. HEALTH EDUCATION & BEHAVIOR 2010; 37:680-93. [PMID: 20930132 DOI: 10.1177/1090198110363881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African Americans bear a disproportionate health burden from smoking but are less likely than other populations to engage in cessation treatment. Intervening on adult nonsmokers residing with a smoker might represent an innovative approach to motivate smokers to engage in smoking behavior change. Twelve focus groups were conducted with African American smokers (four groups, n = 27), nonsmokers (four groups, n = 26) and pairs of cohabitating smokers and nonsmokers (four groups, n = 22) to assess attitudes and/or beliefs regarding engaging a nonsmoker in the home in smoking behavior change efforts. Participants ( N = 75) were middle-aged (45.1 ±3.7 years) females (68.0%) with 11.8 ±1.5 years of education. Smokers smoked 14.9 ±11.3 cigarettes per day, made 3.0 ±4.4 quit attempts in the past year, and are interested in receiving cessation assistance from a nonsmoker in their home. African American nonsmokers living with a smoker may be an appropriate target group to motivate smoking behavior change in the smoker. Suggestions for future research considerations are provided.
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Kabir Z, Alpert HR, Goodman PG, Haw S, Behm I, Connolly GN, Gupta PC, Clancy L. Effect of smoke-free home and workplace policies on second-hand smoke exposure levels in children: an evidence summary. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/phe.10.41] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Second-hand smoke (SHS) is a major avoidable cause of developmental and respiratory disease and premature death among children worldwide. SHS is a ‘Class A’ carcinogen, and there is no safe level of SHS exposure. Almost 700 million children worldwide are exposed daily to SHS at home. This article reviews and summarizes evidence based on available studies that report on ‘voluntary’ home smoking restrictions and their effects on SHS exposure levels in children aged 0–17 years. All potentially relevant publications within a 10-year period (January 2000–April 2010) were identified (n = 19 full-text articles) through comprehensive database searches. In general, voluntary household smoking restrictions reported a significant reduction in childhood SHS exposure ranging between 20–50% reductions, using both self-reported and biological measures. Mandated comprehensive workplace and enclosed public smoke-free policies also suggested an apparent benefit in some specific pediatric health encounters, namely, decreased preterm birth risks and reduced emergency hospital visits owing to asthma.
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Affiliation(s)
| | - Hillel R Alpert
- Division of Public Health Practice, Harvard School of Public Health, MA, USA
| | - Patrick G Goodman
- TobaccoFree Research Institute (RIFTFS), The Digital Depot, Thomas Street, Dublin 8, Ireland
- Dublin Institute of Technology, Dublin, Ireland
| | - Sally Haw
- Scottish Collaboration for Public Health Research & Policy, Edinburgh & NHS Health Scotland, Edinburgh, UK
| | - Ilan Behm
- Division of Public Health Practice, Harvard School of Public Health, MA, USA
| | - Gregory N Connolly
- Division of Public Health Practice, Harvard School of Public Health, MA, USA
| | - Prakash C Gupta
- Healis Sekhsaria Institute for Public Health, Navi Mumbai, India
| | - Luke Clancy
- TobaccoFree Research Institute (RIFTFS), The Digital Depot, Thomas Street, Dublin 8, Ireland
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Warren JR, Okuyemi KS, Guo H, Thomas JL, Ahluwalia JS. Predicting home smoking restrictions among African American light smokers. Am J Health Behav 2010; 34:110-8. [PMID: 19663758 DOI: 10.5993/ajhb.34.1.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine home smoking restrictions (HSR) predictors among African American light smokers (smoke <or= 10 cigarettes per day). METHODS Data were obtained from a clinical trial testing the efficacy of nicotine gum and counseling among 755 African American light smokers. RESULTS Forty percent reported adopting HSR at week 26. Implementing HSR increased with higher baseline confidence to quit (P <0.0001) and female gender (P = 0.019) and decreased with older age (P = 0.016) and reduced confidence to quit between baseline and week 26 (P <0.0001). CONCLUSIONS Confidence to quit, gender, and age are important factors to incorporate into interventions enhancing the adoption of HSR.
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Affiliation(s)
- Jennifer R Warren
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55414, USA.
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Liles S, Hovell MF, Matt GE, Zakarian JM, Jones JA. Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships. Nicotine Tob Res 2009; 11:1395-406. [PMID: 19875763 PMCID: PMC2784488 DOI: 10.1093/ntr/ntp149] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 08/07/2009] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This study explored predictors of smoking quit attempts in a sample of low-income smoking mothers who participated in a randomized trial of a 6-month, 14-session counseling intervention to decrease their children's secondhand smoke exposure (SHSe) and eliminate smoking. METHODS Measures were taken at baseline and at 3, 6, 12, and 18 months on 150 mothers who exposed their children (aged <4 years) to > or = 10 cigarettes/week in the home. Reported 7-day quits were verified by saliva cotinine or urine anabasine and anatabine levels. RESULTS There were few quits longer than 6 months. Mothers in the counseling group reported more 24-hr quits (p = .019) and more 7-day quits (p = .029) than controls. Multivariate modeling revealed that having quit for at least 24 hr in the year prior to baseline and the number of alternative cessation methods ever tried were predictive of the longest quit attempt during the 18-month study. Mothers in the counseling group who at baseline felt SHSe posed a health risk for their children or who at baseline had more permissive home smoking policies had longer quit attempts. DISCUSSION Results confirm that attempts to quit smoking predict additional quit attempts. This suggests that practice may be necessary for many people to quit smoking permanently. Findings of interaction analyses suggest that participant factors may alter the effects of treatment procedures. Failure to account for or employ such factors in the analysis or design of community trials could confound the results of intervention trials.
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Affiliation(s)
- Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA 92123, USA
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Home smoking bans in an urbanizing community in China. Am J Prev Med 2009; 37:132-6. [PMID: 19524393 PMCID: PMC2756453 DOI: 10.1016/j.amepre.2009.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Revised: 04/06/2009] [Accepted: 04/16/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Secondhand smoke (SHS) is a major threat to public health worldwide. Previous studies have suggested that home smoking bans effectively reduce SHS exposure to nonsmokers in the home. In China, the world's largest tobacco producer and consumer, more than 540 million nonsmokers are exposed to SHS. However, to our knowledge, no published studies have examined the prevalence or correlates of home smoking bans in mainland China. This paper presents a quantitative study on home smoking bans in an urbanizing community in Shanghai, China. METHODS In 2006, a cross-sectional survey based on probability sampling (N=243) was conducted in Changqiao, an urbanizing community in Shanghai, China. Interviews were conducted in person in Mandarin Chinese by trained interviewers. The behavioral ecologic model, which emphasizes the multilevel environmental contingencies of behavior, was applied as the theoretical model. Data were analyzed in 2008 using logistic regression to explore correlates of complete home smoking bans. RESULTS In this community, only 26% of respondents reported having complete home smoking bans. Smoking respondents and families were less likely to have complete smoking bans in the home. Home smoking bans were positively associated with the perceived density of smoke-free homes in the community, and with the perceived likelihood of community reprimand for smoking in the home. CONCLUSIONS Home smoking bans were not widely adopted in this community in China. Future interventions should focus on the community and social environment in order to promote home smoking bans.
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Mills AL, Messer K, Gilpin EA, Pierce JP. The effect of smoke-free homes on adult smoking behavior: a review. Nicotine Tob Res 2009; 11:1131-41. [PMID: 19633273 DOI: 10.1093/ntr/ntp122] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smoke-free homes are known to reduce exposure to harmful secondhand smoke. Recent studies suggest that they may also positively affect smoking behavior among smokers themselves. METHODS We review the literature on the effect of smoke-free homes on adult smoking behavior. The literature search included database (PubMed) and manual searches of related articles and reference lists for English-language studies published from 1 January 1990 to 16 November 2008. RESULTS We identified 16 cross-sectional and 7 longitudinal studies of the population-level association of smoke-free homes with adult smoking behavior. Additional studies provided population estimates of trends in and correlates of smoke-free homes. Prevalence of smoke-free homes varies but has been increasing over time in the countries studied and was greater among smokers who were younger, of higher income or educational attainment, smoked fewer cigarettes per day, or lived with a nonsmoking adult or child. Both longitudinal and cross-sectional studies showed that smokers who had or who newly implemented a smoke-free home were significantly more likely to make a quit attempt and to be abstinent, after controlling for confounding factors. In longitudinal studies, those who continued to smoke had a modest, but significant, decrease in cigarette consumption at follow-up. DISCUSSION There is strong and consistent population-level evidence that a smoke-free home is associated with increased smoking cessation and decreased cigarette consumption in adult smokers. As they not only reduce exposure to secondhand smoke but also increase cessation rates, promotion of smoke-free homes should be a key element in tobacco control programs.
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Affiliation(s)
- Alice L Mills
- Cancer Prevention and Control Program, Moores UCSD Cancer Center, University of California, San Diego, CA 92093-0901, USA
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Harris JK, Luke DA, Zuckerman RB, Shelton SC. Forty years of secondhand smoke research: the gap between discovery and delivery. Am J Prev Med 2009; 36:538-48. [PMID: 19372026 DOI: 10.1016/j.amepre.2009.01.039] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Revised: 12/15/2008] [Accepted: 01/31/2009] [Indexed: 11/24/2022]
Abstract
CONTEXT Public health initiatives often focus on the discovery of risk factors associated with disease and death. Although this is an important step in protecting public health, recently the field has recognized that it is critical to move along the continuum from discovery of risk factors to delivery of interventions, and to improve the quality and speed of translating scientific discoveries into practice. EVIDENCE ACQUISITION To understand how public health problems move from discovery to delivery, citation network analysis was used to examine 1877 articles on secondhand smoke (SHS) published between 1965 and 2005. Data were collected and analyzed in 2006-2007. EVIDENCE SYNTHESIS Citation patterns showed discovery and delivery to be distinct areas of SHS research. There was little cross-citation between discovery and delivery research, including only nine citation connections between the main paths. A discovery article was 83.5% less likely to cite a delivery article than to cite another discovery article (OR=0.165 [95% CI=0.139, 0.197]), and a delivery article was 64.3% less likely (OR=0.357 [95% CI=0.330, 0.386]) to cite a discovery article than to cite another delivery article. Research summaries, such as Surgeon General reports, were cited frequently and appear to bridge the discovery-delivery gap. CONCLUSIONS There was a lack of cross-citation between discovery and delivery, even though they share the goal of understanding and reducing the impact of SHS. Reliance on research summaries, although they provide an important bridge between discovery and delivery, may slow the development of a field.
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Affiliation(s)
- Jenine K Harris
- School of Public Health, Saint Louis University, Saint Louis, Missouri 63104, USA.
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Blake SM, Murray KD, El-Khorazaty MN, Gantz MG, Kiely M, Best D, Joseph JG, El-Mohandes AAE. Environmental tobacco smoke avoidance among pregnant African-American nonsmokers. Am J Prev Med 2009; 36:225-34. [PMID: 19215848 PMCID: PMC2711691 DOI: 10.1016/j.amepre.2008.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 09/16/2008] [Accepted: 10/31/2008] [Indexed: 11/24/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) exposure during pregnancy contributes to adverse infant health outcomes. Limited previous research has focused on identifying correlates of ETS avoidance. This study sought to identify proximal and more distal correlates of ETS avoidance early in pregnancy among African-American women. METHODS From a sample of low-income, black women (n=1044) recruited in six urban, prenatal care clinics (July 2001-October 2003), cotinine-confirmed nonsmokers with partners, household/family members, or friends who smoked (n=450) were identified and divided into two groups: any past-7-day ETS exposure and cotinine-confirmed ETS avoidance. Bivariate and multivariate logistic regression analyses identified factors associated with ETS avoidance. Data were initially analyzed in 2004. Final models were reviewed and revised in 2007 and 2008. RESULTS Twenty-seven percent of pregnant nonsmokers were confirmed as ETS avoiders. In multivariate logistic regression analysis, the odds of ETS avoidance were increased among women who reported household smoking bans (OR=2.96; 95% CI=1.83, 4.77; p<0.0001), that the father wanted the baby (OR=2.70; CI=1.26, 5.76; p=0.01), and that no/few family members/friends smoked (OR=3.15; 95% CI=1.58, 6.29; p<0.001). The odds were decreased among women who had a current partner (OR=0.42; 95% CI=0.23, 0.76; p<0.01), reported any intimate partner violence during pregnancy (OR=0.43; 95% CI=0.19, 0.95; p<0.05), and reported little social support to prevent ETS exposure (OR=0.50; 95% CI=0.30, 0.85; p=0.01). Parity, emotional coping strategies, substance use during pregnancy, partner/household member smoking status, and self-confidence in avoiding ETS were significant in bivariate, but not multivariate analyses. CONCLUSIONS Social contextual factors were the strongest determinants of ETS avoidance during pregnancy. Results highlight the importance of prenatal screening to identify pregnant nonsmokers at risk, encouraging household smoking bans, gaining support from significant others, and fully understanding the interpersonal context of a woman's pregnancy before providing behavioral counseling and advice to prevent ETS exposure.
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Affiliation(s)
- Susan M Blake
- Department of Prevention and Community Health, School of Public Health and Health Services, The George Washington University Medical Center, Washington, DC 20037, USA.
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Binns HJ, O'Neil J, Benuck I, Ariza AJ. Influences on parents' decisions for home and automobile smoking bans in households with smokers. PATIENT EDUCATION AND COUNSELING 2009; 74:272-276. [PMID: 18938054 DOI: 10.1016/j.pec.2008.09.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 08/29/2008] [Accepted: 09/07/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To understand clinician influence on use of home and automobile smoking bans in homes of children living with a smoker. METHODS Parents were surveyed on tobacco use, smoking bans, demographics and opinions about tobacco, including harm from environmental tobacco smoke (ETS). Responses from 463 diverse households with smokers were analyzed. RESULTS 42% of respondents smoked; 50% had a home smoking ban and 58% an automobile smoking ban. Nonsmokers living with a smoker, those who strongly agreed in ETS harm, and those having a child < or = 5 years more often had a home smoking ban. Those recalling their child's doctor ever asking the respondent about their smoking status and African American respondents less frequently had a home ban. Automobile smoking bans were more often held by those with strong agreement in ETS harm and less often found in families having a child receiving Medicaid/uninsured. CONCLUSIONS Having a strong perception of harm from ETS exposure was associated with having smoking bans. Aspects of health encounters not measured by this study may be negatively influencing adoption of home smoking bans or lead to recall bias. PRACTICE IMPLICATIONS Clinicians should examine the strength, focus, and response to their messages to parents about tobacco.
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Affiliation(s)
- Helen J Binns
- Department of Pediatrics, Children's Memorial Hospital, Chicago, IL 60614, United States.
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Escoffery C, Kegler MC, Butler S. Formative research on creating smoke-free homes in rural communities. HEALTH EDUCATION RESEARCH 2009; 24:76-86. [PMID: 18222939 PMCID: PMC2721667 DOI: 10.1093/her/cym095] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 11/20/2007] [Indexed: 05/25/2023]
Abstract
The home is a significant place for exposure to secondhand smoke for children and non-smoking adults. This study explored factors that would convince families to adopt household smoking bans and actions to create and maintain smoke-free homes. Interviews were conducted with adults in 102 households in rural Georgia. Participating families had a young adolescent and included households with a mix of smokers and non-smokers and smoking ban status. Families reported they would consider a total ban to protect children from secondhand smoke and protect family members if they got sick. Few described difficulties in enforcement with over half of smokers accepting the rules. Situations that made it hard to enforce restrictions were if there was a visitor who smoked, a smoker who had cravings, and bad weather outside when the smoker desired to smoke. Smokers explained that family members could assist them in quitting by talking to them, not purchasing cigarettes for them, not smoking around them, and supporting them. Ideas for promoting smoke-free homes were having a no smoking sign, saying no to visitors who want to smoke, removing ashtrays, and creating a place outside for smokers. These findings can inform interventions designed to create and maintain smoke-free households.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences.ealth Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Mak YW, Loke AY, Abdullah AS, Lam TH. Household smoking practices of parents with young children, and predictors of poor household smoking practices. Public Health 2008; 122:1199-209. [DOI: 10.1016/j.puhe.2008.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2007] [Revised: 03/05/2008] [Accepted: 04/04/2008] [Indexed: 11/11/2022]
Affiliation(s)
- Y W Mak
- Department of Nursing Studies, The University of Hong Kong, 4/F William MW Mong Block, LKS Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China.
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Farber HJ, Knowles SB, Brown NL, Caine L, Luna V, Qian Y, Lavori P, Wilson SR. Secondhand tobacco smoke in children with asthma: sources of and parental perceptions about exposure in children and parental readiness to change. Chest 2008; 133:1367-1374. [PMID: 18339788 DOI: 10.1378/chest.07-2369] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Secondhand smoke triggers childhood asthma. Understanding sources of exposure, parental beliefs about exposure, and readiness to change that exposure are important for designing smoke exposure reduction interventions. METHODS As part of screening for a clinical trial of a smoke exposure reduction intervention, 519 smoke-exposed children 3 to 12 years old with asthma provided urine specimens for cotinine testing, and their primary caregivers completed questionnaires. RESULTS The urine cotinine to creatinine ratio (CCR) was lowest if neither the primary caregiver nor day-care provider smoked (mean CCR, 14.0; SD, 14.4), greater if either smoked (mean CCR, 22.2; SD, 21.3; and mean, CCR, 26.3; SD, 22.2, respectively), and greatest if both smoked (mean CCR, 39.6; SD, 27.5; p < 0.01). Parental perception of their child's exposure was weakly associated with the child's CCR (r(2) = 0.11, p < 0.001). Most parents (58.3%) reported that tobacco smoke exposure had small/no negative effect on their child's asthma. Substantial proportions of those for whom a specific exposure reduction action was relevant were classified as contemplating, preparing, or had recently taken action to reduce their child's exposure, including smoking cessation (61.3%), keeping the child out of smoke-exposed places (72.7%), and making the child's home (49.2%) and areas out of the home smoke free (66.9%). CONCLUSIONS Smoking by the primary caregiver and day-care provider are important sources of exposure for children with asthma. Parental assessment of their child's exposure is associated with biologically confirmed exposure but cannot be relied on to assess that exposure. Although the harm of smoke exposure was frequently underestimated, many parents appeared receptive to considering action to reduce their child's exposure. TRIAL REGISTRATION (Clinicaltrials.gov). Identifier: NCT00217958.
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Affiliation(s)
- Harold J Farber
- Section of Pediatric Pulmonology, Baylor College of Medicine, Houston, TX.
| | - Sarah B Knowles
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Nancy L Brown
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Lisa Caine
- Department of Pediatrics, Kaiser Permanente Vallejo Medical Center, Vallejo, CA
| | - Veronica Luna
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Yinge Qian
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Phil Lavori
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA
| | - Sandra R Wilson
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
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Kegler MC, Escoffery C, Groff A, Butler S, Foreman A. A qualitative study of how families decide to adopt household smoking restrictions. FAMILY & COMMUNITY HEALTH 2007; 30:328-41. [PMID: 17873639 DOI: 10.1097/01.fch.0000290545.56199.c9] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Household smoking bans reduce exposure to secondhand smoke in adult nonsmokers and children. To explore the process families go through in adopting voluntary household smoking restrictions, qualitative interviews were conducted with rural African American and White adults in 102 households. The study investigated how families decide to restrict smoking in the home, who has significant influence in the decision-making process, the kinds of disagreements families have about household smoking restrictions, and reasons some families never consider household smoking policies. These findings have implications for designing intervention strategies and messages to promote household smoking bans and help family members negotiate smoke-free homes.
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Affiliation(s)
- Michelle Crozier Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Ga 30322, USA.
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Chen CM, Lee PH, Chou YH, Kuo SF, Hsu YH. Avoidance of environmental tobacco smoke among pregnant Taiwanese women: knowledge, self-efficacy, and behavior. J Womens Health (Larchmt) 2007; 16:869-78. [PMID: 17678457 DOI: 10.1089/jwh.2006.0198] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The issue of active and passive cigarette smoking among pregnant women at home has become a major source of debate. The purpose of this study was to explore the knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke and related factors among pregnant women in Taiwan. METHODS A cross-sectional research design was used. Women (n = 281) visiting the outpatient antenatal clinics of one regional hospital and two medical centers in Taipei for routine obstetrical care volunteered to fill out questionnaires. RESULTS Participants on average had little knowledge of this issue and felt less than "very confident" in resisting environmental tobacco smoke and indicated that it was only "usually true" that they practiced avoidance behaviors. The knowledge of, self-efficacy with, and behavior toward avoiding environmental tobacco smoke were all related to both the woman and her partner's educational levels. There were significant differences in mean knowledge, self-efficacy, and avoidance of environmental tobacco smoke scores among different household smoking groups. A multiple regression revealed that overall avoidance of environmental tobacco smoke was positively associated with self-efficacy, with a no-smoking policy at home, and with both a woman and her partner's educational levels. CONCLUSIONS The high prevalence of subjects suffering from active (6.05%) and passive smoking (58.72%) suggests that clinicians can target interventions designed to increase pregnant women's self-efficacy and to advise them to try to set up their own smoking policy at home.
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Affiliation(s)
- Ching-Min Chen
- Taipei Medical University College of Nursing, Taipei, Taiwan, R.O.C.
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Halterman JS, Fagnano M, Conn KM, Lynch KA, DelBalso MA, Chin NP. Barriers to reducing ETS in the homes of inner-city children with asthma. J Asthma 2007; 44:83-8. [PMID: 17454320 DOI: 10.1080/02770900601180545] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study assessed knowledge regarding the harm of environmental tobacco smoke (ETS) exposure and barriers to reducing ETS from the point-of-view of urban parents of asthmatic children. We conducted in-depth interviews with 15 mothers of children with asthma. All parents had good knowledge regarding the harmful effects of ETS. While all children of smoking parents were exposed to ETS, parents described using various strategies to keep ETS away from children. Many parents experienced significant stress in their lives and used smoking to relieve their stress. Barriers to a smoke-free home included stress, addiction, and the use of ineffective strategies to reduce ETS exposure.
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Affiliation(s)
- Jill S Halterman
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry and the Strong Children's Research Center, Rochester, New York 14642, USA.
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Martinez-Donate AP, Hovell MF, Hofstetter CR, González-Pérez GJ, Adams MA, Kotay A. Correlates of home smoking bans among Mexican-Americans. Am J Health Promot 2007; 21:229-36. [PMID: 17375488 DOI: 10.4278/0890-1171-21.4.229] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study examines the individual and environmental correlates of home smoking bans among a population-based sample of Mexican-Americans. Design. A telephone survey on tobacco use and home policies was conducted using stratified, random sampling of listed phone numbers. SETTING Surveys were completed by telephone in San Diego, California. SUBJECTS The sample consisted of San Diego adult residents of Mexican descent (N=1103). MEASURES The interview included questions on home rules regarding smoking in the household and a number of potential correlates, based on the Behavioral Ecological Model (BEM). This model emphasizes the influence of family, social, and cultural factors on health behaviors. RESULTS Overall, 90.6% of all respondents reported a ban on smoking in the home. Multivariate analyses indicated that home bans on smoking are more likely among individuals that do not smoke, live with children, are more acculturated to U.S. society, report greater aversion to ETS, and/or report more social pressure against indoor smoking. In contrast, smoking bans are less likely among Mexican Americans who live with smokers. CONCLUSIONS Individual and environmental factors play a protective role by increasing the likelihood of smoking bans in the home of Mexican-descent individuals. These factors should be considered for the design of interventions to sustain and promote the adoption of smoking bans in the home among this and other populations.
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Affiliation(s)
- Ana P Martinez-Donate
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA.
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Berg CJ, Cox LS, Nazir N, Mussulman LM, Ahluwalia JS, Ellerbeck EF. Correlates of home smoking restrictions among rural smokers. Nicotine Tob Res 2007; 8:353-60. [PMID: 16801293 DOI: 10.1080/14622200600670132] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The prevalence of smoking is greater and smoking restrictions are less common in rural areas in comparison to urban areas. Consequently, rural smokers and their families are at increased risk for adverse health consequences from smoking. The presence of home smoking restrictions (i.e., limiting or banning cigarette smoking in the home) can be a mediator for smoking cessation and can reduce health risks for those who live with smokers. The purpose of the present study was to identify correlates of home smoking restrictions among rural smokers. We surveyed 472 smokers from 40 rural Kansas primary care practices who were enrolled in a smoking cessation intervention study. We assessed the prevalence of home smoking restrictions and examined the relationship between such restrictions, demographic variables, comorbid diagnoses, and psychosocial measures of smoking abstinence self-efficacy and motivation to quit. Complete home smoking restrictions were found among 25.4% of rural smokers with an additional 28.3% reporting some restrictions. Restrictions were associated with younger age, higher controlled motivation to quit (i.e., motivation from external pressure), the presence of children under age 6 years living in the home, fewer friends who smoke, and a partner who does not smoke. Smokers with a comorbid diagnosis of high cholesterol, chronic lung disease, or heart disease were less likely to have restrictions. Most smokers in rural primary care practices do not have home smoking restrictions, particularly those without children or a nonsmoking partner and those with significant risk factors for smoking-related illnesses. These patients may be critical targets for broaching issues of home smoking restrictions.
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Affiliation(s)
- Carla J Berg
- Department of Psychology, University of Kansas, Lawrence, KS 66160, USA
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Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: a cross-sectional study of U.S.- and Mexico-born Hispanic women with young children. BMC Public Health 2006; 6:265. [PMID: 17069652 PMCID: PMC1636637 DOI: 10.1186/1471-2458-6-265] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 10/27/2006] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Detrimental effects of environmental tobacco smoke (ETS) exposure on child health are well documented. Because young children's primary exposure to ETS occurs in homes and automobiles, voluntary smoking restrictions can substantially reduce exposure. We assessed the prevalence of home and automobile smoking bans among U.S.- and Mexico-born Hispanics in the southwestern United States, and examined the influence of mother's country of birth and smoking practices on voluntary smoking bans and on child ETS exposure. METHODS U.S.- and Mexico-born Hispanic mothers of children aged 2 through 12 years were systematically sampled from health clinics in Albuquerque, New Mexico. In-person interviews were conducted with 269 mothers (75.4% response rate) to obtain information on main study outcomes (complete versus no/partial home and automobile smoking bans; child room and automobile ETS exposure) and risk factors (mother's country of birth, maternal and household smoking behaviors). Data were analyzed with chi square tests and logistic regression models. RESULTS Three-fourths (74-77%) of U.S.-born and 90-95% of Mexico-born mothers reported complete automobile and home smoking bans. In multivariate analyses, mother's U.S nativity, mother's current smoking, and presence of other adult smokers in the home were associated with significantly increased odds of not having a complete home or automobile smoking ban. Mother's smoking was associated with child ETS exposure both indoors (odds ratio [OR] = 3.31) and in automobiles (OR = 2.97). Children of U.S.-born mothers had increased odds of exposure to ETS indoors (OR = 3.24; 95% confidence interval [CI]: 1.37-7.69), but not in automobiles. Having complete smoking bans was associated with substantially reduced odds of child ETS exposure both indoors (OR = 0.10; 95% CI: 0.04-0.27) and in automobiles (OR = 0.14; 95% CI: 0.05-0.36). CONCLUSION This study of Hispanic mothers in the southwestern U.S. indicates that there are substantial differences between U.S.- and Mexico-born mothers in the prevalence of home and automobile smoking bans, and resulting child ETS exposure. Tobacco interventions to increase smoke-free environments for U.S. Hispanic children should focus on both home and automobile smoking practices, especially among U.S.-born mothers, and utilize strategies that impact smoking practices of all household members.
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Meeker JD, Missmer SA, Cramer DW, Hauser R. Maternal exposure to second-hand tobacco smoke and pregnancy outcome among couples undergoing assisted reproduction. Hum Reprod 2006; 22:337-45. [PMID: 17053002 DOI: 10.1093/humrep/del406] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Exposure to second-hand tobacco smoke is preventable, yet common. This study assessed relationships between maternal exposure to second-hand tobacco smoke and adverse pregnancy outcomes. METHODS We measured cotinine (a biomarker of tobacco smoke) in urine from 921 women undergoing assisted reproductive technologies (ARTs) between 1994 and 1998. We also collected information on self-reported exposure to second-hand smoke at home or at work, in addition to parental smoking during the women's childhood. RESULTS In crude analysis, creatinine-adjusted cotinine levels were associated with a slight decrease in implantation rate among non-smoking women (11.1% in the lowest cotinine quintile versus 8.2% in the highest cotinine quintile; P=0.13). However, in multivariate logistic regression, cotinine levels above the median were not associated with failed fertilization, failed implantation or spontaneous abortion, nor was there evidence of a dose-response relationship among cotinine quintiles. After excluding women in couples diagnosed with male factor infertility, there were increased odds of having a spontaneous abortion among non-smoking women who reported that both parents smoked while they were children growing up compared with women reporting that neither parent smoked [adjusted odds ratio (OR) = 4.35; 95% confidence interval (CI) = 1.04-18.1]. CONCLUSIONS Female exposure to second-hand smoke as a child or in utero may be associated with an increased risk of spontaneous abortion in adulthood. However, this may be a chance finding due to multiple comparisons. Similar associations should be explored in additional studies with more refined estimates of childhood and in utero exposure to tobacco smoke.
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Affiliation(s)
- J D Meeker
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
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Miller T, Rauh VA, Glied SA, Hattis D, Rundle A, Andrews H, Perera F. The economic impact of early life environmental tobacco smoke exposure: early intervention for developmental delay. ENVIRONMENTAL HEALTH PERSPECTIVES 2006; 114:1585-8. [PMID: 17035147 PMCID: PMC1626431 DOI: 10.1289/ehp.9165] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 07/11/2006] [Indexed: 05/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Early-life exposure to environmental tobacco smoke (ETS) can result in developmental delay as well as childhood asthma and increased risk of cancer. The high cost of childhood asthma related to ETS exposure has been widely recognized; however, the economic impact of ETS-related developmental delay has been less well understood. METHODS AND RESULTS The Columbia Center for Children's Environmental Health (CCCEH) has reported adverse effects of prenatal ETS exposure on child development in a cohort of minority women and children in New York City (odds ratio of developmental delay = 2.36; 95% confidence interval 1.22-4.58). Using the environmentally attributable fraction (EAF) approach, we estimated the annual cost of one aspect of ETS-related developmental delay: Early Intervention Services. The estimated cost of these services per year due to ETS exposure is > Dollars 50 million per year for New York City Medicaid births and Dollars 99 million per year for all New York City births. CONCLUSION The high annual cost of just one aspect of developmental delay due to prenatal exposure to ETS provides further impetus for increased prevention efforts such as educational programs to promote smoke-free homes, additional cigarette taxes, and subsidizing of smoking cessation programs.
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Affiliation(s)
- Thaddeus Miller
- Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Virginia A. Rauh
- Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Sherry A.M. Glied
- Health Policy & Management, Columbia University, New York, New York, USA
| | - Dale Hattis
- George Perkins Marsh Institute, Clark University, Worcester, Massachusetts, USA
| | - Andrew Rundle
- Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Howard Andrews
- Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Frederica Perera
- Columbia Center for Children’s Environmental Health, Mailman School of Public Health, Columbia University, New York, New York, USA
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Nollen NL, Mayo MS, Sanderson Cox L, Okuyemi KS, Choi WS, Kaur H, Ahluwalia JS. Predictors of quitting among African American light smokers enrolled in a randomized, placebo-controlled trial. J Gen Intern Med 2006; 21:590-5. [PMID: 16808741 PMCID: PMC1924642 DOI: 10.1111/j.1525-1497.2006.00404.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the predictors of quitting among African American (AA) light smokers (<10 cigarettes per day) enrolled in a smoking cessation trial. METHODS Baseline variables were analyzed as potential predictors from a 2 x 2 cessation trial in which participants were randomly assigned to 1 of 4 treatment groups: nicotine gum plus health education (HE) counseling, nicotine gum plus motivational interviewing (MI) counseling, placebo gum plus HE counseling, or placebo gum plus MI counseling. Chi-square tests, 2 sample t-tests, and multiple logistic regression analyses were used to identify predictors of cotinine (COT) verified abstinence at month 6. RESULTS In the final regression model, HE rather than MI counseling (odds ratio [OR]=2.26%, 95% confidence interval [CI]=1.36 to 3.74), older age (OR=1.03%, 95% CI=1.01 to 1.06), and higher body mass index (OR=1.04%, 95% CI=1.01 to 1.07) significantly increased the likelihood of quitting, while female gender (OR=0.46%, 95% CI=0.28 to 0.76),</=$1,800/month income (OR=0.60%, 95% CI=0.37 to 0.97), higher baseline COT (OR=0.948%, 95% CI=0.946 to 0.950), and not completing all counseling sessions (OR=0.48%, 95% CI=0.27 to 0.84) reduced the odds of quitting. CONCLUSIONS Individual characteristics may decrease the likelihood of quitting; however, the provision of directive, advice-oriented counseling focused on the addictive nature of nicotine, health consequences of smoking, benefits of quitting, and development of a concrete quit plan may be an important and effective facilitator of quitting among AA light smokers.
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Affiliation(s)
- Nicole L Nollen
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, USA.
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Abstract
OBJECTIVES This paper investigates the association between implementing a personal space smoking restriction for the home or automobile, and various sociodemographic, social, behavioral, and attitudinal variables. METHODS Approximately 1000 African-American adults (aged >18 years) residing in non-institutionalized settings were randomly selected using a cross-sectional stratified cluster sample of ten U.S. congressional districts represented by African Americans. RESULTS A 62.0% and 70.4% ban was found, respectively, on smoking in homes and cars. Multivariate analysis revealed that region, marital status, number of friends who smoked, beliefs about environmental tobacco smoke (ETS), and smoking status predicted home smoking bans, while age, number of children in household, number of friends who smoked, and beliefs about ETS and smoking status predicted car smoking bans. CONCLUSIONS Results suggest that a substantial segment of African Americans have accepted and translated public policy concerns about ETS into practice and reveal other variables that could be targeted in future interventions to increase implementation of personal space smoking restrictions.
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Affiliation(s)
- Gary King
- Department of Biobehavioral Health, Pennsylvania State University, University Park, Pennsylvania, USA.
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Bono R, Vincenti M, Schilirò T, Traversi D, Pignata C, Scursatone E, Dotti G, Gilli G. Cotinine and N-(2-hydroxyethyl)valine as markers of passive exposure to tobacco smoke in children. JOURNAL OF EXPOSURE ANALYSIS AND ENVIRONMENTAL EPIDEMIOLOGY 2005; 15:66-73. [PMID: 15026775 DOI: 10.1038/sj.jea.7500344] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Large segments of populations, including children, are exposed to environmental tobacco smoke (ETS), a risk factor for lung cancer and heart, circulatory and respiratory diseases. Recently, ETS was classified as a class A carcinogen by USEPA, as carcinogenic to humans by IARC (group 1) and by the National Toxicology Program of the US National Institutes of Health. Cotinine, a product of the metabolism of nicotine, is measurable in urine and, correlates strictly and directly to ETS exposure, therefore representing a well-known internal dose marker. Another marker of active tobacco smoking is the N-(2-hydroxyethyl) valine (HOEtVal) which results from the reaction between ethylene oxide (EtO) and the N-terminal valine of hemoglobin. The aim of this study was the evaluations of ETS markers, namely urinary cotinine and HOEtVal measured in blood in 100 children with ages ranging between 3 and 13 years. Experimental findings show that cotinine, as a specific internal dose marker, and HOEtVal, as a nonspecific biological effective dose marker, both depend on the passive exposure to ETS as well as on the active habit of smoking.
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Affiliation(s)
- Roberto Bono
- Department of Public Health and Microbiology, University of Torino, Torino, Italy.
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Pulvers KM, Catley D, Okuyemi K, Scheibmeir M, McCarter K, Jeffries SK, Ahluwalia JS. Gender, smoking expectancies, and readiness to quit among urban African American smokers. Addict Behav 2004; 29:1259-63. [PMID: 15236832 DOI: 10.1016/j.addbeh.2004.03.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The relationship between smoking expectancies and readiness to quit as well as gender differences in expectancies and readiness to quit was examined among 484 urban African American smokers. Univariate analyses revealed that higher positive expectancies were generally associated with less readiness to quit and higher negative expectancies were associated with greater readiness to quit. A multivariable model indicated that stimulation/state enhancement, taste/sensorimotor manipulation, and weight control were most strongly related to intention to quit. Although men and women did not differ on readiness to quit, women reported higher scores on the negative affect reduction subscale than did men.
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Affiliation(s)
- Kim M Pulvers
- Department of Preventive Medicine and Public Health/Mailstop 1008, School of Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City 66160-7370, USA.
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Winickoff JP, McMillen RC, Carroll BC, Klein JD, Rigotti NA, Tanski SE, Weitzman M. Addressing parental smoking in pediatrics and family practice: a national survey of parents. Pediatrics 2003; 112:1146-51. [PMID: 14595060 DOI: 10.1542/peds.112.5.1146] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Parental smoking has been associated with increased rates of sudden infant death syndrome, low birth weight, otitis media, asthma, and decreased lung growth. No prior parent surveys have assessed national rates of screening and counseling for parental tobacco use in the context of their child's visit to primary care. OBJECTIVE To assess and compare rates of pediatrician and family practitioner screening and counseling for parental smoking. Design/Methods. Data were collected by telephone survey of households from July to September 2001. The sample is weighted by race and gender based on 1999 US Census estimates to be representative of the US population. RESULTS Of 3566 eligible respondents contacted, 3002 (84%) completed surveys; 902 of those were parents who had a child seen by a pediatrician (62%) or family practitioner (38%) in the past year. About half of all parents who visited a pediatrician or family practitioner reported that they had been asked about household member smoking status (52% vs 48%). More parents who visited pediatricians had been asked if they had rules prohibiting smoking in the home than those who visited family practitioners (38% vs 29%). Of 190 (21%) parents who were smokers, fewer than half reported being counseled by either specialty about dangers of second-hand smoke (41% vs 33%) or risks of modeling smoking behavior (31% vs 28%). Similarly, fewer than half of parental smokers received advice to quit (36% vs 45%). CONCLUSION Overall rates of screening and counseling for parental smoking in pediatric and family practice are low. Despite some differences between specialties, significant opportunities exist to improve tobacco control activities in primary care settings that serve children.
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Affiliation(s)
- Jonathan P Winickoff
- MGH Center for Child and Adolescent Health Policy, Harvard Pediatric Health Services Research Program, Boston, Massachusetts 02114, USA.
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