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Gribben V, Kosack A, Garell C, Shaikh U, Huang M, Chang AY, Rasmussen J, Tebb K, Marbin J. Impacts of a Multicenter Medical Education Curriculum for Training Pediatric Residents on Tobacco Cessation for Adult Caregivers of Pediatric Patients. Clin Pediatr (Phila) 2023; 62:115-120. [PMID: 35891607 DOI: 10.1177/00099228221113783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is an evidence-based framework that increases pediatric providers' ability to address secondhand smoke exposure of minors. Physician champions at 4 University of California sites conducted regular 1-hour didactic trainings on CEASE principles to pediatric residents as part of a longitudinal curriculum. At the conclusion of the academic year, 111 of 284 residents (39%) completed an anonymous survey. CEASE-trained residents reported significantly higher rates than untrained residents of counseling on smoking cessation (adjusted odds ratio [OR] = 4.50, P = .009), and referring to the smokers' quitline (adjusted OR 3.6, P = .007) to 50% or more of their patients' caregivers who smoked. In addition, among CEASE-trained residents, there were significant increases in multiple post-training knowledge and self-efficacy items. Our results show that a brief educational curriculum can be helpful in changing pediatric residents' attitudes and behavior toward assisting adult caregivers to pediatric patients in smoking cessation.
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Affiliation(s)
- Valerie Gribben
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Amanda Kosack
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Cambria Garell
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Ulfat Shaikh
- Department of Pediatrics, University of California, Davis, Sacramento, CA, USA
| | - Maria Huang
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | - Andrew Y Chang
- Department of Epidemiology and Population Health, Stanford University, Stanford, CA, USA
| | - Jennifer Rasmussen
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Kathleen Tebb
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Jyothi Marbin
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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Wilson KM, Moss A, Lowary M, Gambino J, Klein JD, Kerby GS, Hovell M, Winickoff JP. Smoking Behaviors Among Tobacco-Using Parents of Hospitalized Children and Association With Child Cotinine Level. Hosp Pediatr 2021; 11:17-24. [PMID: 33272923 PMCID: PMC7769203 DOI: 10.1542/hpeds.2020-0122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Understanding patterns of parental tobacco use and their association with child exposure can help us target interventions more appropriately. We aimed to examine the association between parental smoking practices and cotinine levels of hospitalized children. METHODS This is a secondary analysis of data collected from parents of hospitalized children, recruited for a cessation intervention randomized controlled trial. Smoking parents were identified by using a medical record screening question. Parent-reported demographics and smoking habits were compared to child urine cotinine by using geometric means and log-transformed cotinine levels in multivariable linear regression analyses. RESULTS A total of 213 patients had complete baseline parent-interview and urine cotinine data. The median age was 4 (interquartile range: 1-9); 57% were boys; 56% were white, 12% were Black, and 23% were multiracial; 36% identified as Hispanic. Most families (54%) had 1 smoker in the home; 36% had 2, and 9% had ≥3. Many (77%) reported having a ban on smoking in the home, and 86% reported smoking only outside. The geometric mean cotinine level of the cohort was 0.98 ng/mL. Higher cotinine levels were associated with more smokers in the home (ratio of 2.99) and smoking inside the house (ratio of 4.11). CONCLUSIONS Having more smokers in the home and parents who smoke inside are associated with increased smoke exposure; however, even children whose families who smoke only outside the home have significant levels of cotinine, a marker for toxin exposure.
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Affiliation(s)
- Karen M Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York City, New York;
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
| | - Angela Moss
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | | | | | - Jonathan D Klein
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Gwendolyn S Kerby
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Melbourne Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, College of Health and Human Sciences, San Diego State University, San Diego, California
| | - Jonathan P Winickoff
- Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, Illinois
- Department of Pediatrics, Massachusetts General Hospital for Children, Harvard Medical School, Harvard Universty, Boston, Massachusetts
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Nardone N, Giberson J, Prochaska JJ, Jain S, Benowitz NL. A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study. JMIR Form Res 2020; 4:e18583. [PMID: 32812888 PMCID: PMC7468632 DOI: 10.2196/18583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/22/2020] [Accepted: 07/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful.
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Affiliation(s)
- Natalie Nardone
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, United States
| | - Jeremy Giberson
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, United States
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, United States
| | - Shonul Jain
- Department of Pediatrics, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, United States
| | - Neal L Benowitz
- Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, United States.,Departments of Medicine, University of California, San Francisco, CA, United States.,Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA, United States
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Stakeholder Engagement in Developing an Electronic Clinical Support Tool for Tobacco Prevention in Adolescent Primary Care. CHILDREN-BASEL 2018; 5:children5120170. [PMID: 30563001 PMCID: PMC6306818 DOI: 10.3390/children5120170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/10/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022]
Abstract
Following guideline recommendations to promote tobacco prevention in adolescent primary care, we developed a patient-facing clinical support tool. The electronic tool screens patients for use and susceptibility to conventional and alternative tobacco products, and promotes patient–provider communication. The purpose of this paper is to describe the iterative stakeholder engagement process used in the development of the tool. During the pre-testing phase, we consulted with scientists, methodologists, clinicians, and Citizen Scientists. Throughout the development phase, we engaged providers from three clinics in focus groups. Usability testing was conducted via in-depth, cognitive interviewing of adolescent patients. Citizen Scientists (n = 7) played a critical role in the final selection of educational content and interviewer training by participating in mock-up patient interviews. Cognitive interviews with patients (n = 16) ensured that systems were in place for the feasibility trial and assessed ease of navigation. Focus group participants (n = 24) offered recommendations for integrating the tool into clinical workflow and input on acceptability and appropriateness, and anticipated barriers and facilitators for adoption and feasibility. Engaging key stakeholders to discuss implementation outcomes throughout the implementation process can improve the quality, applicability, and relevance of the research, and enhance implementation success.
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Butz AM. Implementing tobacco control policies for minority youth with second-hand smoke exposure and respiratory disease. Thorax 2018; 73:1004-1005. [PMID: 30049840 PMCID: PMC6464386 DOI: 10.1136/thoraxjnl-2018-212071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/03/2022]
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Benowitz NL, Jain S, Dempsey DA, Nardone N, Helen GS, Jacob P. Urine Cotinine Screening Detects Nearly Ubiquitous Tobacco Smoke Exposure in Urban Adolescents. Nicotine Tob Res 2017; 19:1048-1054. [PMID: 28031377 PMCID: PMC5896471 DOI: 10.1093/ntr/ntw390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/20/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Routine biochemical assessment of tobacco smoke exposure could lead to more effective interventions to reduce or prevent secondhand smoke (SHS)-related disease in adolescents. Our aim was to determine using urine cotinine (major nicotine metabolite) measurement the prevalence of tobacco smoke exposure among adolescents receiving outpatient care at an urban public hospital. METHODS Surplus urine was collected in 466 adolescents attending pediatric or urgent care clinics at Zuckerberg San Francisco General Hospital, serving families with lower levels of income and education, in 2013-2014. The majority were Hispanic or African American. Urine cotinine cut points of 0.05 to 0.25 ng/ml, 0.25 to 30 ng/ml, and 30 ng/ml were used to classify subjects as light SHS or thirdhand smoke exposed, SHS or light/intermittent active users, and active tobacco users, respectively. RESULTS Among subjects 87% were exposed, including 12% active smoking, 46% SHS and 30% lightly exposed. The SHS exposed group adjusted geometric mean cotinine values were significantly higher in African Americans (1.48 ng/ml) compared to other groups (0.56-1.13 ng/ml). CONCLUSIONS In a city with a low smoking prevalence (12%), a large majority (87%) of adolescents seen in a public hospital clinic are exposed to tobacco. This is much higher than reported in national epidemiological studies of adolescents, which used a plasma biomarker. Since SHS is associated with significant respiratory diseases and parents and adolescents underreport exposure to SHS, routine biochemical screening should be considered as a tool to reduce SHS exposure. The clinical significance of light exposure needs to be investigated. IMPLICATIONS Urine biomarker screening found that a large majority (87%) of adolescents treated in an urban public hospital are exposed to tobacco. Since SHS is associated with significant respiratory diseases and parents and adolescents underreport exposure to SHS, routine biochemical screening should be considered as a tool to reduce SHS exposure.
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Affiliation(s)
- Neal L Benowitz
- Division of Clinical Pharmacology and Experimental Therapeutics, Medical Service, Departments of Medicine, and Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, CA
| | - Shonul Jain
- Department of Pediatrics, University of California, San Francisco, CA
| | - Delia A Dempsey
- Department of Pediatrics, University of California, San Francisco, CA
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, CA
| | - Natalie Nardone
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, CA
| | - Gideon St. Helen
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, CA
- Division of Clinical Pharmacology, Department of Medicine, University of California, San Francisco, CA
| | - Peyton Jacob
- Center for Tobacco Control Research and Education, Department of Medicine, University of California, San Francisco, CA
- Department of Psychiatry, University of California, San Francisco, CA
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Rosen LJ, Tillinger E, Guttman N, Rosenblat S, Zucker DM, Stillman F, Myers V. Parental receptivity to child biomarker testing for tobacco smoke exposure: A qualitative study. PATIENT EDUCATION AND COUNSELING 2015; 98:1439-45. [PMID: 26160037 DOI: 10.1016/j.pec.2015.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/20/2015] [Accepted: 05/30/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Widespread tobacco smoke exposure (TSE) of children suggests that parents may be unaware of their children's exposure. Biomarkers demonstrate exposure and may motivate behavior change, but their acceptability is not well understood. METHODS Sixty-five in-depth interviews were conducted with parents of young children, in smoking families in central Israel. Data were analyzed using thematic analysis. RESULTS Consent to testing was associated with desire for information, for reassurance or to motivate change, and with concerns for long-term health, taking responsibility for one's child, and trust in research. Opposition to testing was associated with preference to avoid knowledge, reluctance to cause short-term discomfort, perceived powerlessness, and mistrust of research. Most parents expressed willingness to allow measurement by urine (83%), hair (88%), or saliva (93%), but not blood samples (43%); and believed that test results could motivate behavior change. CONCLUSIONS Parents were receptive to non-invasive child biomarker testing. Biomarker information could help persuade parents who smoke that their children need protection. PRACTICE IMPLICATIONS Biomarker testing of children in smoking families is an acceptable and promising tool for education, counseling, and motivation of parents to protect their children from TSE. Additionally, biomarker testing allows objective assessment of population-level child TSE.
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Affiliation(s)
- Laura J Rosen
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Tillinger
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dept. of Sociology, Faculty of Social Sciences, Bar Ilan University, Ramat Gan, Israel
| | - Nurit Guttman
- Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Shira Rosenblat
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Dept. of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - David M Zucker
- Dept. of Statistics, Hebrew University, Jerusalem, Israel
| | - Frances Stillman
- Dept. of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Vicki Myers
- Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Joseph A, Spector L, Wickham K, Janis G, Winickoff J, Lindgren B, Murphy S. Biomarker evidence of tobacco smoke exposure in children participating in lead screening. Am J Public Health 2013; 103:e54-9. [PMID: 24134342 DOI: 10.2105/ajph.2013.301315] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed tobacco smoke exposure (TSE), defined according to detection of cotinine, in dried blood spots collected from children for lead screening. METHODS Dried blood spots collected from a national sample of 1541 Black and White children and submitted to a commercial laboratory for lead analysis were analyzed for cotinine. We used an anonymous administrative data set including information on children's characteristics to conduct univariate and multivariate analyses. RESULTS Cotinine was detected in 61% of dried blood spots; 17% of samples had cotinine levels above 3 nanograms per gram. Median cotinine levels were significantly higher among Black than White children (0.66 ng/g vs 0.30 ng/g) and among Medicaid recipients (0.94 ng/g vs < 0.3 ng/g). In multivariate analyses, significant increases in cotinine levels were associated with Black (vs White) race, older age, Medicaid coverage, higher state smoking rate, and higher average winter temperature. Detectable cotinine levels were significantly associated with higher lead levels. CONCLUSIONS TSE is highly prevalent among children undergoing lead screening, and exposure levels are greater among Black children and children on Medicaid. TSE may contribute to lead exposure. Concurrent lead screening and biological screening for TSE may be a feasible approach to increasing childhood TSE detection.
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Affiliation(s)
- Anne Joseph
- Anne Joseph is with the Department of Medicine, Masonic Cancer Center, University of Minnesota, Minneapolis. Logan Spector is with the Department of Pediatrics, Masonic Cancer Center, University of Minnesota. Katherine Wickham is with the Masonic Cancer Center, University of Minnesota. Gregory Janis is with MEDTOX Laboratories, St. Paul, MN. Jonathan Winickoff is with the Center for Child and Adolescent Health Research and Policy and the Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston. Bruce Lindgren is with the Biostatistics and Bioinformatics Core, University of Minnesota. Sharon Murphy is with the Department of Biochemistry, Molecular Biology and BioPhysics, Masonic Cancer Center, University of Minnesota
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Carlsson N, Johansson A, Abrahamsson A, Andersson Gäre B. How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas. BMC Pediatr 2013; 13:76. [PMID: 23672646 PMCID: PMC3660282 DOI: 10.1186/1471-2431-13-76] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 05/02/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. METHOD Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. RESULTS Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. CONCLUSION The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.
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Affiliation(s)
- Noomi Carlsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Department of Public Health and Medical Care, Jönköping County Council, Box 1024, SE-551 11 Jönköping, Sweden
| | - AnnaKarin Johansson
- Department of Medicine and Health, Division of Nursing Science, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
| | - Agneta Abrahamsson
- Department of Health and Society, University College of Kristianstad, SE-291 88, Kristianstad, Sweden
| | - Boel Andersson Gäre
- Department of Clinical and Experimental Medicine, Division of Paediatrics, Faculty of Health Sciences, Linköping University, SE-581 83, Linköping, Sweden
- Futurum – the Academy for Healthcare, Jönköping County Council, SE-551 85, Jönköping, Sweden
- The Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Box 1026, SE-551 11 Jönköping,Sweden
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Dempsey DA, Meyers MJ, Oh SS, Nguyen EA, Fuentes-Afflick E, Wu AHB, Jacob P, Benowitz NL. Determination of tobacco smoke exposure by plasma cotinine levels in infants and children attending urban public hospital clinics. ACTA ACUST UNITED AC 2013; 166:851-6. [PMID: 22566513 DOI: 10.1001/archpediatrics.2012.170] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine the prevalence of secondhand smoke (SHS) exposure among infants and young children who received preventive care at pediatric preventative care clinics associated with an urban public hospital. Cotinine, a metabolite of nicotine, has been used to study SHS exposure in population-based studies of children 3 years of age or older. DESIGN Retrospective study using a convenience sample. SETTING Urban county pediatric primary care clinics in San Francisco, California. PARTICIPANTS A total of 496 infants and children (mean [SD] age, 2.4 [1.9] years). INTERVENTIONS Discarded plasma samples (which were routinely collected for lead screening) were tested, and medical records were reviewed, for SHS exposure. MAIN OUTCOME MEASURE Secondhand smoke exposure based on cotinine plasma level and history of exposure in the medical record. RESULTS Thirteen percent of parents reported that their child was exposed to SHS, yet biochemical testing detected cotinine in 55% of samples, at a geometric mean (SD) of 0.23 (3.55) ng/mL. There were no significant sex or age differences. African American children had much higher mean cotinine levels than did Latino children (multiplicative factor change in cotinine, 6.01 ng/ml [95% Cl, 4.49-8.05 ng/ml] [correction]. CONCLUSION In a city with a low smoking rate (12%) and public smoking bans, we documented 55% exposure among infants and young children, using a plasma biomarker, compared with 13% exposure reported by parents. Because SHS is associated with significant respiratory diseases and parents underreport exposure, routine biochemical screening should be considered as a tool to identify and reduce SHS exposure.
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Sun protection, probiotics and parental smoking cessation. Curr Opin Pediatr 2012; 24:746-52. [PMID: 23080131 DOI: 10.1097/mop.0b013e32835a1ae1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW This article addresses three areas where new research demonstrates the potential to impact the health of children and adolescents: sun protection, probiotic use, and parental smoking cessation. RECENT FINDINGS Skin cancer rates are rising, and sun exposure in childhood and exposure to tanning beds are important preventable risk factors. Research on the use of probiotics to treat a variety of intestinal and nonintestinal diseases is expanding. By counseling parents about smoking cessation, pediatricians can assist in decreasing childhood exposure to harmful second-hand and third-hand smoke. SUMMARY New research on probiotic use in children shows its potential in prevention and treatment of common childhood illnesses. By finding ways to educate patients and parents on the dangers of ultraviolet radiation and smoke exposure, pediatricians can improve both short-term and long-term health of their patients.
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Barnoya J, Navas-Acien A. Protecting the world from secondhand tobacco smoke exposure: where do we stand and where do we go from here? Nicotine Tob Res 2012; 15:789-804. [PMID: 23072872 DOI: 10.1093/ntr/nts200] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Article 8 of the Framework Convention on Tobacco Control mandates all signatory countries to "protect citizens from exposure to tobacco smoke in workplaces, public transport and indoor public places." Even though there has been great progress in the implementation of Article 8, still most of the world population remains exposed to secondhand smoke (SHS). In this article, we sought to summarize the research that supports Article 8, where do we stand, and current research gaps and future directions. DISCUSSION Secondhand smoke is an established cause of heart disease and several types of cancer. Additional research is needed to reach final conclusions for diseases where evidence is only suggestive of causality. The only solution to SHS exposure in public places is banning smoking indoors. Research on the gaming industry and nightclubs, particularly in developing countries, needs to be disseminated to support their inclusion in smoke-free laws. Aside from indoor bans, additional research is needed for outdoor and multiunit housing bans and in support of measures that protect children and other vulnerable populations. The impact of smoke-free laws on other health outcomes, besides heart disease and respiratory outcomes, is another area where further research is needed. Thirdhand smoke assessment and health effects are also likely to be a topic of further research. As new tobacco products emerge, evaluating SHS exposure and effects will be vital. CONCLUSIONS Furthering research in support of Article 8 can contribute to reach the final goal of protecting everyone from SHS exposure.
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Affiliation(s)
- Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, MO 63110, USA.
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