Tobacco smoke exposure and chronic conditions of childhood

Associations Between Caregiver Health Literacy and Preschool Children's Secondhand Smoke Exposure

OBJECTIVE

Examine the associations between caregiver health literacy (HL) and smoking-related outcome expectancies, implementation of home/car smoking bans (H/CSBs), and child secondhand smoke exposure (SHSe).

METHODS

Caregivers of Head Start children residing with a smoker(s) completed measures assessing HL, outcome expectancies, and H/CSB implementation. Biomarkers of child SHSe included home air nicotine monitors and child salivary cotinine.

RESULTS

Caregivers with lower HL had higher levels of home air nicotine and child salivary cotinine in the full sample and among smokers. After controlling for child age and number of smokers in the home, lower HL was associated with higher endorsement of negative smoking expectancies in the full sample and in smokers. HL was not associated with H/CSB implementation across groups.

CONCLUSIONS

Caregiver HL is associated with child SHSe and is important in shaping smoking-related beliefs. HL is not directly related to adoption of SHSe-reduction behaviors such as H/CSBs.

The effects of passive smoking on the six-minute walk test in obese pediatric cases

OBJECTIVE

The aim of this study was to evaluate whether exposure to second-hand smoke affected the six-minute walk test (6 MWT) of obese non-asthmatic pediatric cases.

METHODS

Obese pediatric patients (body mass index >95th p) with no existing co-morbidities were included in the study. Smoke exposure was assessed with a self-reported questionnaire completed by the parents. The subjects were divided into two groups: Group 1 consisting of obese children exposed to passive smoking and Group 2 of obese children not exposed to passive smoking. In addition to 6 MWT, spirometric flow and volume, including forced expiratory volume in 1 s and peak expiratory flow rate, were also measured in all subjects. The results of the 6 MWT were assessed to determine any association with passive smoking.

RESULTS

The study included 75 obese pediatric cases (40 male, 35 female) with a mean age of 9.06 ± 0.97 years. The 6 MWT results in Group 1 was 501.88 ± 62.12 meters and in Group 2 559.63 ± 72.93 meters. The difference was statistically significant (p=0.001).

CONCLUSIONS

Passive smoking may negatively affect the respiratory and cardiovascular capacity in obese children, who are already at risk of lower cardiopulmonary function. The evaluation of 6 MWT in these pediatric patients may be useful for monitoring and families should be warned about potential problems due to smoking.

Secondhand smoke exposure across the life course and the risk of adult-onset depression and anxiety disorder

INTRODUCTION

The aim of this paper was to investigate the association between childhood and adulthood exposure to secondhand smoke (SHS) and depression, panic attack, and generalized anxiety disorder among adults in the United States over a 10-year period.

METHODS

Data were drawn from the Midlife Development in the United States (MIDUS) Waves 1 and 2 (N=2053). Self-reported childhood and adulthood SHS exposure at Wave 1 (1994) was examined in relation to incident depression, panic attack, and generalized anxiety disorder 10 years later at Wave 2 (2005).

RESULTS

Childhood SHS alone was not associated with mood and anxiety disorders in adulthood. Exposure to SHS in both childhood and adulthood was associated with increased depression and panic attack in adulthood. These associations did not appear to be due to confounding.

LIMITATIONS

SHS exposure was measured via self-report; biological data confirming exposure were not collected. More objective measures of SHS exposure are needed in future studies.

CONCLUSIONS

In summary, persistent exposure to SHS across the life course may be associated with increased risk of depression and panic attacks. Our results are consistent with prior findings and extend earlier results by showing a relationship between SHS exposure and mental health problems over time. Replication with biological measures of SHS over time is a necessary next step toward better understanding the pathways explaining these relationships.

The acceptability of incorporating a youth smoking prevention intervention in the pediatric emergency department

The pediatric emergency department (PED) is under-utilized as a setting in which to provide tobacco prevention interventions for at-risk children. We sought to determine the acceptability and feasibility of incorporating a brief, parental tobacco prevention intervention to 520 parents during the PED visit. Mean age (SD) of parents and children was 38.6 (7.1) and 11.5 (1.1), respectively; 47% of children were female; 45% were African American; 36% of parents had an annual income less than $25,000; 28.8% of parents were current smokers. Over 90% of parents said the intervention provided "useful" and "easy to understand" information and 97% of practitioners said it did not "interfere with clinical care." Given the high prevalence of parental smoking in the PED, there is a high likelihood that their children will initiate smoking in the future. Thus, the use of the PED as a venue to providing tobacco prevention interventions warrants further evaluation.

Parental tobacco screening and counseling in the pediatric emergency department: practitioners' attitudes, perceived barriers, and suggestions for implementation and maintenance

INTRODUCTION

The pediatric emergency department (PED) is a venue that underuses parental tobacco screening and brief cessation counseling. We sought to explore PED practitioners' attitudes and perceived barriers regarding the implementation and adoption of tobacco screening/cessation counseling of parental smokers in the PED setting, as well as to solicit suggestions for improving the sustainability and maintenance of such practices.

METHODS

We conducted an exploratory, qualitative study of a convenience sample of PED practitioners using the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Individual, focused interviews were conducted to determine factors that would maximize the implementation and maintenance of parental tobacco screening and intervention counseling as standard PED practice.

RESULTS

Thirty interviews were conducted from which relevant data, patterns, and themes were identified. Reach factors included targeting parental smokers with children with respiratory diseases, having adequate training of practitioners, and providing "prearranged" counseling packages. Effectiveness factors included practitioner desire for outcome data about intervention effectiveness (eg, changes in children's secondhand smoke exposure and parental quit rates). Solutions to increase intervention adoption included quick electronic health record prompts and the provision of onsite tobacco cessation experts. Implementation suggestions emphasized the importance of financial support and the alignment of tobacco screening/counseling with strategic plans. Maintenance factors included institutional and technical support, as well as the importance of intervention "champions" in the PED.

DISCUSSION

By highlighting important viewpoints of practitioners regarding tobacco screening and counseling, the findings can help guide and direct the development and evaluation of sustainable interventions to facilitate tobacco use treatment in the PED.

The ONE step initiative: quality improvement in a pediatric clinic for secondhand smoke reduction

BACKGROUND AND OBJECTIVE

Although comprehensive smoking counseling to limit secondhand smoke (SHS) is widely endorsed, it is often not done. Published evaluations of brief and practical systems that improve screening and counseling to reduce SHS are limited. Our objective was to determine if a quality improvement activity around smoking counseling leads to changes in (1) medical assistant and pediatric provider assessment of smoking history and (2) smoking or other behaviors affecting children's SHS exposure.

METHODS

In a large urban teaching clinic we assessed the ONE Step intervention, which included the following: (1) "Ask" (medical assistant asking whether caregivers smoke); (2) "Advise" (providers advising smoking outside and quitting if ready); (3) "Refer" (providers referring to the Colorado telephone QuitLine); and (4) electronic medical record prompts and required documentation regarding smoking. Medical assistant and provider assessments of smoking were evaluated with a chart review by using a pre-/posttest design. Caregiver behavior change was evaluated with a time-series survey that included assessment at baseline and follow-up via telephone at 6 and 12 months from study entry.

RESULTS

ONE Step was associated with a statistically significant increase in Ask, Advise, and Refer documentation. Caregiver surveys showed that 97% found discussions of SHS with providers acceptable. Six- and 12-month follow-ups, respectively, showed that 14% and 13% of smokers reported quitting and that 63% and 70% of current smokers reported reduced SHS exposure.

CONCLUSIONS

ONE Step was feasible to deliver in a busy outpatient setting, acceptable to families, and appears to have resulted in decreased exposure to SHS in our pediatric population.

A qualitative evaluation of 40 voluntary, smoke-free, multiunit, housing policy campaigns in California

Background

Although it is legal for multiunit housing (MUH) property owners in all 50 states to prohibit smoking on their premises, including in individual units, MUH constitutes a relatively new setting to reduce exposure to secondhand smoke via voluntary smoke-free policy. This paper examines California state-funded smoke-free MUH policy campaigns between 2004 and 2010.

Methods

A cross-case analysis of 40 state-funded smoke-free MUH policy campaigns was conducted via an examination of final evaluation reports submitted to the California Tobacco Control Program.

Results

The most effective voluntary smoke-free MUH policy campaigns typically included: (1) learning the local [MUH] context, (2) finding and using a champion, (3) partnering with like-minded organisations, (4) building relationships with stakeholders, (5) collecting and using local data and (6) making a compelling case to decision makers.

Discussions

The aforementioned steps tended to be intertwined, and successfully securing voluntary smoke-free MUH policy required a strategic but flexible plan of implementation prior to entrance into the field. Campaigns designed to enhance voluntary smoke-free MUH policy adoption should underscore the economic viability of such policies during each strategic step.

Comparing child health, access to care, and utilization of health services between Ohio Appalachia's River and non-river bordering counties

Appalachia's River and non-River Bordering Counties. Children living in Ohio's Appalachian counties that border the Ohio River are disproportionally exposed to adverse environmental conditions prevalent along the river that may contribute to disparities in health, access to care and care utilization. This study examined if there were differences in health, access to care and care utilization between Ohio's Appalachian children living in counties that border the Ohio River and those living in counties that do not border the river. A secondary analysis of the 28 Appalachian counties from Ohio's 88 counties included in the 2008 Ohio Family Health Survey was conducted using a Bayesian Hierarchical Modeling strategy. Descriptive analyses comparing geographic groups across demographic, health, access, utilization, and health insurance also were conducted. Childhood asthma was more prevalent in the river-bordering counties (16.4%) compared to the non-river counties (9.4%). Children with asthma had more sere symptoms in the river bordering counties (8.2%) compared to the non-river bordering counties (4.4%). Children residing in river bordering counties had higher rates of obesity (24.4%) and overweight (17%). After controlling for child health and insurance status, children living in the river bordering counties had less access to care (est. -7.14, CI = -17.3,0.74) and more difficulty accessing specialty care. Children residing in the non-river counties had more sickness care utilization (est. 0.25, CI = 0.01, 0.49). Regardless of region, children with a regular health care provider and place for care were healthier. Differences in child health, access to care and utilization of services exist within Ohio's Appalachian region.

Effects of cigarette smoke residues from textiles on fibroblasts, neurocytes and zebrafish embryos and nicotine permeation through human skin

Toxic substances from cigarette smoke can attach to carpets, curtains, clothes or other surfaces and thus may pose risks to affected persons. The phenomenon itself and the potential hazards are discussed controversially, but scientific data are rare. The objective of this study was to examine the potential of textile-bound nicotine for permeation through human skin and to assess the effects of cigarette smoke extracts from clothes on fibroblasts, neurocytes and zebrafish embryos. Tritiated nicotine from contaminated cotton textiles penetrated through adult human full-thickness skin as well as through a 3D in vitro skin model in diffusion chambers. We also observed a significant concentration-dependent cytotoxicity of textile smoke extracts on fibroblast viability and structure as well as on neurocytes. Early larval tests with zebrafish embryos were used as a valid assay for testing acute vertebrate toxicity. Zebrafish development was delayed and most of the embryos died when exposed to smoke extracts from textiles. Our data show that textiles contaminated with cigarette smoke represent a potential source of nicotine uptake and can provoke adverse health effects.