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Anuntaseree W, Kongkanin U, Ruangnapa K, Saelim K, Prasertsan P. Effectiveness of a Telephone Counseling Intervention in Reducing Passive Smoking Among Children. HEALTH EDUCATION & BEHAVIOR 2024; 51:583-591. [PMID: 38606976 DOI: 10.1177/10901981241242798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Legislative smoking bans that prohibit smoking in public places have successfully reduced passive smoking in public areas. However, smokers only partially adhere to smoking restrictions in their homes. Young children are particularly vulnerable to exposure to tobacco smoke because they spend more time at home. In this study, we designed an intervention program based on an empowerment theory to reduce passive smoking among children. The priority participants were nonsmoking mothers living with smokers who smoke in the presence of children. The aim of this randomized control trial study was to examine the effectiveness of this intervention in reducing children's exposure to tobacco smoke at home. The intervention group received tailored educational brochures and two follow-up counseling telephone calls at 2 and 8 weeks, which provided resources to support the mothers to increase their knowledge, skill, and self-confidence in promoting behavior shaping of smokers. The control group received only tailored educational brochures. We found the intervention group demonstrated a higher rate of maternal actions to reduce their children's exposure to smoke and a higher rate than the control group of attempts to avoid smoking in the presence of children at the 16-week follow-up. These results suggest that the intervention helped reduce passive smoking among children. These findings highlight the need to empower and train mothers to help them develop rules for smoking at home. These interventions could be applied in the home of children who live with smokers who are unable or unwilling to quit smoking.
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Wheaton J, Ford B, Nairn A, Collard S. Towards a conceptual framework for the prevention of gambling-related harms: Findings from a scoping review. PLoS One 2024; 19:e0298005. [PMID: 38517885 PMCID: PMC10959398 DOI: 10.1371/journal.pone.0298005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 01/16/2024] [Indexed: 03/24/2024] Open
Abstract
The global gambling sector has grown significantly over recent years due to liberal deregulation and digital transformation. Likewise, concerns around gambling-related harms-experienced by individuals, their families, their local communities or societies-have also developed, with growing calls that they should be addressed by a public health approach. A public health approach towards gambling-related harms requires a multifaceted strategy, comprising initiatives promoting health protection, harm minimization and health surveillance across different strata of society. However, there is little research exploring how a public health approach to gambling-related harms can learn from similar approaches to other potentially harmful but legal sectors such as the alcohol sector, the tobacco sector, and the high in fat, salt and sugar product sector. Therefore, this paper presents a conceptual framework that was developed following a scoping review of public health approaches towards the above sectors. Specifically, we synthesize strategies from each sector to develop an overarching set of public health goals and strategies which-when interlinked and incorporated with a socio-ecological model-can be deployed by a range of stakeholders, including academics and treatment providers, to minimise gambling-related harms. We demonstrate the significance of the conceptual framework by highlighting its use in mapping initiatives as well as unifying stakeholders towards the minimization of gambling-related harms, and the protection of communities and societies alike.
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Affiliation(s)
- Jamie Wheaton
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
| | - Ben Ford
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
- Psychological Sciences, School of Natural and Social Sciences, University of Gloucestershire, Cheltenham, United Kingdom
- The Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Agnes Nairn
- University of Bristol Business School, University of Bristol, Bristol, United Kingdom
| | - Sharon Collard
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
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Slattery B, Dimond R, Went G, Ugalde A, Wong Shee A. Cigarette smoke exposure of hospitalised children: Prevalence of smoking in parents or carers and admission practices of health services. J Paediatr Child Health 2023; 59:1135-1139. [PMID: 37522319 DOI: 10.1111/jpc.16469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/02/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023]
Abstract
AIM The aim of this study is to understand the exposure to second-hand tobacco smoke in the homes of hospitalised children through: (i) understanding the prevalence of smoking in adults or carers and (ii) examining the health services' approach to identifying parental smoking status. METHODS This prospective observational study consisted of two surveys: one administered to parents/carers of hospitalised children and one to health services. The first cross-sectional survey aimed to elicit the proportion of children requiring admission to a regional Victorian general paediatric unit who live with adults who smoke cigarettes. The survey was delivered to participating parents/carers during the standard nursing admission process. The second survey was administered across 15 public health services to determine if identification of parent/carer's smoking status is a routine part of their standard paediatric admission practice. RESULTS For the parental survey, 453 responses were obtained from 782 consecutive new admissions. Nearly a third (n = 136, 30%) requiring hospital admission were found to be living with at least one parent/carer who identified as a current cigarette smoker. Of the 15 health services surveyed, only four (27%) nursing units reported routinely asking parents/carers about their smoking status as part of their standard admission process. CONCLUSION Admission to hospital provides an opportunity to enhance care for children by addressing nicotine dependence within their families. Findings suggest routine recording of smoking status can be improved, to drive smoking cessation and brief intervention conversations with parents and carers of children admitted to hospital.
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Affiliation(s)
- Breanna Slattery
- Department of Pharmacy, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Renee Dimond
- Department of Pharmacy, Grampians Health Ballarat, Ballarat, Victoria, Australia
| | - Grace Went
- Deakin Rural Health, Deakin University, Melbourne, Victoria, Australia
| | - Anna Ugalde
- Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
| | - Anna Wong Shee
- Deakin Rural Health, Deakin University, Melbourne, Victoria, Australia
- Community and Aged Care, Grampians Health Ballarat, Ballarat, Victoria, Australia
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Rao A, Rungta N, Nandini M, Unnikrishnan B, Shenoy R, Rao A, Shetty MK. Effect of educational intervention in reducing exposure to second hand tobacco smoke among 12-year-old children as determined by their salivary cotinine levels and knowledge, attitude and behavior - a randomized controlled trial. FRONTIERS IN ORAL HEALTH 2023; 4:1277307. [PMID: 37842016 PMCID: PMC10569313 DOI: 10.3389/froh.2023.1277307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Background Tobacco use is one of the most important public health concerns, with approximately 8.7 million tobacco-related deaths each year, primarily in low- and middle-income countries. Even more concerning is the fact that 1.3 million of these deaths are seen in nonsmokers, including babies and children. This study was performed to determine whether a school-based "tobacco-free" educational intervention program among 12-year-old children would be effective in reducing their exposure to second-hand tobacco smoke (SHS) by improving their knowledge, attitude and behavior post intervention and estimating salivary cotinine levels as markers of SHS exposure. Materials and method A randomized controlled trial was performed by a cluster random sampling technique, with 30 participants each in the experimental and control arms. A knowledge, attitude, avoidance behavior and self-efficacy of avoidance questionnaire was administered, followed by estimation of salivary cotinine levels. The experimental arm received the "tobacco-free" intervention, which comprised a 40-min health education session, with the first follow-up at 15 days and the second at 30 days after the intervention. After the intervention, the questionnaire was readministered, followed by re-estimation of salivary cotinine levels. Results One month after the intervention, the number of participants who had a smoker who lived with them and the number of people who smoked inside the house were reduced in the experimental group compared to the control group. In the knowledge domain and the attitude domain, 80% and 60% of the items showed a statistically significant improvement in the experimental group compared to the control group. In the avoidance behavior domain and the Self-Efficacy of Avoidance Domain, all the items showed improvement in the experimental group compared to the control group. When the mean salivary cotinine levels were compared pre- and postintervention, it was found that although the mean postintervention salivary cotinine levels increased in both the experimental and control groups, the increase was less in the experimental group than in the control group. Conclusion The present study has been shown to be effective in improving the knowledge, attitude and avoidance behavior of adolescents toward exposure to secondhand smoke.
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Affiliation(s)
- Ashwini Rao
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Nikita Rungta
- University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - M. Nandini
- Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - B. Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Arathi Rao
- Department of Pedodontics and Preventive Dentistry, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Mranali K. Shetty
- Department of Periodontics, Manipal College of Dental Sciences, Mangalore, Manipal Academy of Higher Education (MAHE), Manipal, India
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Brown N, Luckett T, Davidson PM, DiGiacomo M. 'Stretched thin with little children' - smoking perceptions and experiences of families seeking help with parenting. J Child Health Care 2021; 25:549-561. [PMID: 33054352 DOI: 10.1177/1367493520967834] [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: 11/15/2022]
Abstract
Cigarette smoking is the leading preventable cause of poor pregnancy outcomes. Pregnancy is a trigger for smoking cessation yet, up to 50% of parents will relapse in the early years of their child's life. This study explored the smoking-related perceptions and experiences of 11 parents seeking professional help with the care and parenting of babies and toddlers using semi-structured interviews. Inductive thematic analysis identified three themes: parenting as a change catalyst, smoking as a parenting challenge and smoking as a coping strategy. Becoming a parent is a catalyst to reduce the associated risks and stigma associated with smoking, but maintaining rules and boundaries can be perceived as a further burden for parents who are struggling to care for their infant. When faced with difficulties with parenting, parents may revert to smoking as a coping strategy. Based on these study findings, interventions targeting gender norms may be useful in addressing smoking cessation.
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Affiliation(s)
- Nicola Brown
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia
| | - Patricia M Davidson
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia.,School of Nursing, 1466Johns Hopkins University, MD, USA
| | - Michelle DiGiacomo
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, 110561University of Technology Sydney, Sydney, Australia
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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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Jassal MS, Lewis-Land C, Thompson RE, Butz A. Linkage of Maternal Caregiver Smoking Behaviors on Environmental and Clinical Outcomes of Children with Asthma: A Post-Hoc Analysis of a Financial Incentive Trial Targeting Reduction in Pediatric Tobacco Smoke Exposures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8502. [PMID: 33212796 PMCID: PMC7696714 DOI: 10.3390/ijerph17228502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022]
Abstract
(1) Background: Monthly variability in smoking behaviors in caregivers of pediatric asthmatics yields questions of how much and when does smoking reduction result in improved environmental and clinical outcomes. (2) Methods: Post hoc analysis of data from a 6 month pilot randomized-control trial occurring from May 2017 to May 2018 in Baltimore City (MD, USA). The initial trial's primary intervention explored the utility of financial incentives in modifying caregiver smoking behaviors. Post hoc analyses examined all dyads independent of the initial trial's randomization status. All caregivers received pediatric tobacco smoke harm reduction education, in addition to monthly encouragement to access the state tobacco quitline for individual phone-based counseling and nicotine replacement therapy. Maternal caregivers who were active cigarette smokers and their linked asthmatic child (aged 2-12 years) were grouped into two classifications ("high" versus "low") based on the child and caregiver's cotinine levels. A "low" cotinine level was designated by at least a 25% reduction in cotinine levels during 3 months of the trial period; achieving ≤2 months of low cotinine levels defaulted to the "high" category. Twenty-seven dyads (caregivers and children) (total n = 54) were assigned to the "high" category, and eighteen dyads (caregivers and children) (total n = 36) were allocated to the "low" category. The primary outcome measure was the correlation of caregiver cotinine levels with pediatric cotinine values. Secondary outcomes included asthma control, in addition to caregiver anxiety and depression. (3) Results: Caregivers with 3 months of ≥25% decrease in cotinine levels had a significantly greater mean change in child cotinine levels (p = 0.018). "Low" caregiver cotinine levels did not significantly improve pediatric asthma control (OR 2.12 (95% CI: 0.62-7.25)). Caregiver anxiety and depression outcomes, measured by Patient Health Questionnaire (PHQ)-4 scores, was not significantly different based on cotinine categorization (p = 0.079); (4) Conclusion: Reduced pediatric cotinine levels were seen in caregivers who reduced their smoking for at least 3 months, but clinical outcome measures remained unchanged.
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Affiliation(s)
- Mandeep S. Jassal
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (C.L.-L.); (A.B.)
| | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (C.L.-L.); (A.B.)
| | - Richard E. Thompson
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA;
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; (C.L.-L.); (A.B.)
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Brown TJ, Gentry S, Bauld L, Boyle EM, Clarke P, Hardeman W, Holland R, Naughton F, Orton S, Ussher M, Notley C. Systematic Review of Behaviour Change Techniques within Interventions to Reduce Environmental Tobacco Smoke Exposure for Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7731. [PMID: 33105823 PMCID: PMC7660048 DOI: 10.3390/ijerph17217731] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/16/2022]
Abstract
Children are particularly vulnerable to environmental tobacco smoke (ETS). There is no routine support to reduce ETS in the home. We systematically reviewed trials to reduce ETS in children in order to identify intervention characteristics and behaviour change techniques (BCTs) to inform future interventions. We searched Medline, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, and Cochrane Tobacco Addiction Group Specialised Register from January 2017 to June 2020 to update an existing systematic review. We included controlled trials to reduce parent/caregiver smoking or ETS in children <12 years that demonstrated a statistically significant benefit, in comparison to less intensive interventions or usual care. We extracted trial characteristics; and BCTs using Behaviour Change Technique Taxonomy v1. We defined "promising" BCTs as those present in at least 25% of effective interventions. Data synthesis was narrative. We included 16 trials, of which eight were at low risk of bias. All trials used counselling in combination with self-help or other supporting materials. We identified 13 "promising" BCTs centred on education, setting goals and planning, or support to reach goals. Interventions to reduce ETS in children should incorporate effective BCTs and consider counselling and self-help as mechanisms of delivery.
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Affiliation(s)
- Tracey J. Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
| | - Sarah Gentry
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
| | - Linda Bauld
- Usher Institute and SPECTRUM Consortium, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK;
| | - Elaine M. Boyle
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Paul Clarke
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK
| | - Wendy Hardeman
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Richard Holland
- Leicester Medical School, University of Leicester, Leicester LE1 7HA, UK;
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Sophie Orton
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK;
| | - Michael Ussher
- Population Health Research Institute, St George’s, University of London, London SW17 0RE, UK;
- Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK
| | - Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (S.G.); (P.C.); (C.N.)
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Chittamuru D, Daniels R, Sarkar U, Schillinger D. Evaluating values-based message frames for type 2 diabetes prevention among Facebook audiences: Divergent values or common ground? PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30473-0. [PMID: 32938563 PMCID: PMC8213394 DOI: 10.1016/j.pec.2020.08.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 08/07/2020] [Accepted: 08/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To effectively confront the type 2 diabetes (T2D) epidemic, policymakers and the public need to problematize T2D less as a medical and more as a social problem. An award-winning T2D prevention campaign was harnessed to determine the most successful ways of framing ads on Facebook. HYPOTHESIS We will observe variation in the effectiveness of ad message-frames within audience-segments. METHODS Six parallel quasi-experiments (participants N = 203,156) were conducted with 6 disparate audience-segments defined through the Facebook ads-manager tool. Across all audiences, we exposed Facebook users to values-based ad-frames (10-15-word appeals), assigning 7 of 11 possible frames to participants within each audience in a quasi-experimental fashion (using Facebook users' birth-month). Engagement was measured by rates of ad video-views, unique-link-clicks and donations to the campaign. RESULTS Contrary to our hypothesis, we observed remarkable consistency across target audiences. Ad-frames that ranked highly with most audience-segments included Entertainment and Emotional Appeal; Defiance Against Authority Appeal; Second-Hand Smoke/Environmental Appeal; and to a lesser extent, Common-Enemy/War-Metaphor Appeal. Conclusion and Practice-Implications: Across disparate segments of society, there appears to be a set of common values that public health communication initiatives can tap into to catalyze a more inclusive movement to confront the T2D epidemic through policy, systems and environmental approaches.
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Affiliation(s)
- Deepti Chittamuru
- Public Health Department, School of Social Sciences, Humanities and Art, University of California Merced, 5200 N. Lake Rd, Merced, CA 95343 USA.
| | - Ryane Daniels
- Division of General Internal Medicine and Health Communications Research Program, Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Ave, SFGH 10, 1320A, San Francisco, CA 94110 USA.
| | - Urmimala Sarkar
- Division of General Internal Medicine and Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Ave, 1319, San Francisco, CA, 94110 USA.
| | - Dean Schillinger
- Division of General Internal Medicine and Health Communications Research Program, Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Ave, SFGH 10, 1320A, San Francisco, CA 94110 USA.
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Halas G, Schultz ASH, Rothney J, Wener P, Holmqvist M, Cohen B, Kosowan L, Enns JE, Katz A. A Scoping Review of Foci, Trends, and Gaps in Reviews of Tobacco Control Research. Nicotine Tob Res 2020; 22:599-612. [PMID: 30715468 DOI: 10.1093/ntr/nty269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The burden of disease associated with tobacco use has prompted a substantial increase in tobacco-related research, but the breadth of this literature has not been comprehensively examined. This review examines the nature of the research addressing the action areas in World Health Organization's Framework Convention on Tobacco Control (FCTC), the populations targeted and how equity-related concepts are integrated. METHOD A scoping review of published reviews addressing tobacco control within the primary prevention domain. We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Educational Resources Information Centre, and PsycInfo from 2004 to 2018. RESULTS The scoping review of reviews offered a "birds-eye-view" of the tobacco control literature. Within the 681 reviews meeting inclusion criteria, there was a strong focus on smoking cessation targeting individuals; less attention has been given to product regulation, packaging, and labeling or sales to minors. Equity-related concepts were addressed in 167/681 (24.5%); few were focused on addressing inequity through structural and systemic root causes. CONCLUSION This analysis of foci, trends, and gaps in the research pursuant to the FCTC illustrated the particular action areas and populations most frequently addressed in tobacco control research. Further research is needed to address: (1) underlying social influences, (2) particular action areas and with specific populations, and (3) sustained tobacco use through the influence of novel marketing and product innovations by tobacco industry. IMPLICATIONS This scoping review of the breadth of tobacco control research reviews enables a better understanding of which action areas and target populations have been addressed in the research. Our findings alongside recommendations from other reviews suggest prioritizing further research to support policymaking and considering the role of the tobacco industry in circumventing tobacco control efforts. The large amount of research targeting individual cessation would suggest there is a need to move beyond a focus on individual choice and decontextualized behaviors. Also, given the majority of reviews that simply recognize or describe disparity, further research that integrates equity and targets various forms of social exclusion and discrimination is needed and may benefit from working in collaboration with communities where programs can be tailored to need and context.
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Affiliation(s)
- Gayle Halas
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janet Rothney
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Wener
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maxine Holmqvist
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Benita Cohen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer E Enns
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Nwosu C, Angus K, Cheeseman H, Semple S. Reducing Secondhand Smoke Exposure Among Nonsmoking Pregnant Women: A Systematic Review. Nicotine Tob Res 2020; 22:2127-2133. [DOI: 10.1093/ntr/ntaa089] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Abstract
Introduction
Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS.
Methods
MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity.
Results
Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias.
Conclusion
There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored.
Implications
• Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for “avoidance” on the woman.
• There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS.
• Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.
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Affiliation(s)
| | - Kathryn Angus
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | | | - Sean Semple
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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12
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O’Donnell R, Dobson R, de Bruin M, Turner S, Booth L, Semple S. Development of a Smoke-Free Homes Intervention for Parents: An Intervention Mapping Approach. HEALTH PSYCHOLOGY BULLETIN 2019; 3:67-86. [PMID: 32337370 PMCID: PMC7182446 DOI: 10.5334/hpb.20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Exposure to second-hand smoke (SHS) is associated with various ill-health outcomes for children and adults. Barriers to creating a smoke-free home (SFH) are well-documented. Feasible and effective interventions to create smoke-free homes for disadvantaged households are lacking. Interventions that include providing parents with objective information about the impact of smoking on air quality in their home may be particularly effective. This study describes the development of a novel, theory- and evidence-based smoke-free homes intervention using objectively-assessed air quality feedback. The intervention was developed using the six-step Intervention Mapping (IM) protocol. Findings from literature reviews, focus groups with parents, interviews with health/care professionals, and expert panel discussions shaped intervention content and materials. Findings highlighted the importance of parents receiving personalised information on second-hand smoke levels in their home. Professionals considered the use of non-judgemental language essential in developed materials. Previous literature highlighted the need to address home smoking behaviour at a household rather than individual level. The AFRESH intervention is modular and designed to be delivered face-to-face by healthcare professionals. It includes up to five meetings with parents, two sets of five days' air quality monitoring and personalised feedback, and the option to involve other household members in creating a smoke-free home using educational, motivational, and goal setting techniques. Further research is needed to evaluate the acceptability and effectiveness of the AFRESH intervention and which specific groups of parents this intervention will most likely benefit. IM was a useful framework for developing this complex intervention. This paper does not present evaluation findings.
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Unger JB, Soto DW, Rendon AD, Baezconde-Garbanati L, Cruz TB. Empowering Hispanic Multiunit Housing Residents to Advocate for Smokefree Policies: A Randomized Controlled Trial of a Culturally Tailored Fotonovela Intervention. Health Equity 2019; 3:198-204. [PMID: 31289780 PMCID: PMC6608690 DOI: 10.1089/heq.2018.0098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Hispanic residents of multiunit housing (MUH) are disproportionately exposed to secondhand (SHS) and thirdhand tobacco smoke (THS) from neighboring apartment units and common areas. Comprehensive legislation and voluntary policies are needed to protect residents from smoke. We developed a culturally tailored bilingual fotonovela to educate Hispanic residents about SHS and THS and encourage them to talk to their neighbors and landlords about reducing smoke exposure. This article describes a randomized controlled trial of the fotonovela. The objective of the study was to evaluate the effect of the fotonovela on knowledge, attitudes, and behavioral intentions about reducing smoke exposure. Methods: Hispanic MUH residents (N=403) completed a survey and were randomly assigned to receive the fotonovela, a text pamphlet, or no materials. They completed a follow-up survey 6 months later. Results: Among the entire sample, there were no significant differences across the three groups in knowledge or attitudes at follow-up. However, when the analyses were restricted to respondents who actually read part or all of the booklets (77% in the fotonovela group and 71% in the text pamphlet group), there were significant differences in two of the six outcome measures; those who read the fotonovela had higher scores on self-efficacy to talk to others about smoke and positive attitudes toward advocacy actions, relative to those who read the text pamphlet. Conclusion: Results indicate that a fotonovela can be an effective tool to empower Hispanic MUH residents to advocate for voluntary smokefree policies, but more efforts are needed to encourage residents to read the materials.
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Affiliation(s)
- Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Daniel W Soto
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Angelica Delgado Rendon
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
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14
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Wagner GA, Sanchez ZM, Fidalgo TM, Caetano SC, Carliner H, Martins SS. Sociodemographic factors associated with smoking risk perception in adolescents in São Paulo, Brazil. BRAZILIAN JOURNAL OF PSYCHIATRY 2019; 41:546-549. [PMID: 30758434 PMCID: PMC6899349 DOI: 10.1590/1516-4446-2018-0219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/23/2018] [Indexed: 11/25/2022]
Abstract
Objective: We examined the sociodemographic factors associated with smoking risk perceptions (SRP) in youth living in two very different neighborhoods in the city of São Paulo, Brazil: a middle-class central area (Vila Mariana) and a poor outer-city area (Capão Redondo). Methods: A cross-sectional survey was conducted with 180 public school-attending youth (all aged 12 years) and their parents. SRP was evaluated through self-reports. Weighted multinomial logistic regression was used to examine factors associated with SRP. Results: Smoking was considered a high-risk behavior by 70.9% of adolescents. There were significant differences in SRP associated with socioeconomic status (SES) and maternal smoking status. Having a non-smoking mother was positively associated with perceiving smoking as having low to moderate risk versus no risk (OR=3.91 [95%CI 1.27-12.02]). Attending school in Capão Redondo was associated with perceiving smoking as having high risk compared to no risk (OR=3.00 [95%CI 1.11-8.12]), and low SES was negatively associated with perceiving at least some risk in smoking versus perceiving no risk in this behavior. Conclusions: Youth whose mothers smoke appear to have lower SRP than those whose mothers do not smoke. Living in a poor outer-city area was associated with higher SRP.
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Affiliation(s)
- Gabriela A Wagner
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brazil
| | - Zila M Sanchez
- Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Departamento de Medicina Preventiva, São Paulo, SP, Brazil
| | - Thiago M Fidalgo
- Departamento de Psiquiatria, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Sheila C Caetano
- Departamento de Psiquiatria, Escola Paulista de Medicina, UNIFESP, São Paulo, SP, Brazil
| | - Hannah Carliner
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
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15
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'If I pay rent, I'm gonna smoke': Insights on the social contract of smokefree housing policy in affordable housing settings. Health Place 2019; 56:106-117. [PMID: 30716667 DOI: 10.1016/j.healthplace.2019.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Abstract
Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N = 115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these "social contracts" strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.
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Zhou YH, Mak YW, Ho GWK. Effectiveness of Interventions to Reduce Exposure to Parental Secondhand Smoke at Home among Children in China: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16010107. [PMID: 30609776 PMCID: PMC6339015 DOI: 10.3390/ijerph16010107] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 12/17/2022]
Abstract
There are health consequences to exposure to secondhand smoke (SHS). About two-thirds of children in China live with at least one person, usually a parent, who smokes at home. However, none of the reviews of interventions for reducing SHS have targeted children in China. The purpose of this study was to review the effectiveness of interventions for reducing parental SHS exposure at home among children in China. We searched various electronic databases for English and Chinese publications appearing between 1997 and 2017. Thirteen relevant studies were identified. Common strategies used in intervention groups were non-pharmacological approaches such as counseling plus self-help materials, and attempting to persuade fathers to quit smoking. Family interactions and follow-up sessions providing counseling or using text messages could be helpful to successful quitting. Several encouraging results were observed, including lower cotinine levels in children (n = 2), reduced tobacco consumption (n = 5), and increased quit rates (n = 6) among parents. However, the positive effects were not sustained 3~6 months after the interventions. Self-reported quitting without bio-chemical validation was the most common outcome measure. A study design using biochemical validations, a longer follow-up period, and targeting all people living with children in the same household is recommended.
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Affiliation(s)
- Yan Hua Zhou
- School of Nursing, Zhejiang Chinese Medical University, Hangzhou 310051, China.
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 999077, China.
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong 999077, China.
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Brown N, Luckett T, Davidson PM, DiGiacomo M. Family-focussed interventions to reduce harm from smoking in primary school-aged children: A systematic review of evaluative studies. Prev Med 2017; 101:117-125. [PMID: 28601619 DOI: 10.1016/j.ypmed.2017.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 01/15/2023]
Abstract
Children living in families where adults smoke are exposed to harmful effects of tobacco smoke and risk a predisposition to smoking initiation. Interventions to support families to reduce risk of harm from smoking have been developed and tested. The purpose of this review is to identify effective family-based interventions used to promote smoke-free home environments in families with primary school age children (aged 5-12years). A systematic search of MEDLINE, Cochrane and CINAHL electronic databases was conducted. Narrative synthesis of included articles was completed. Guidelines for reporting behaviour change interventions were used to summarise and compare intervention timing, content, intensity and delivery. Quality of included studies was critiqued using United States Preventative Services Taskforce (USPST) procedures for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Nineteen articles that evaluated 14 intervention studies focussed on child smoking prevention (n=5), parent smoking cessation (n=4) and environmental tobacco smoke reduction (n=6). Interventions and outcomes were heterogeneous, and were rarely informed by theoretical frameworks relating to family, parenting or child development. Family based interventions may be an important strategy to reduce the effects of smoking for children. There is a need for interventions to be informed by theory relevant to children, parenting and families.
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Affiliation(s)
- Nicola Brown
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia.
| | - Tim Luckett
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia.
| | - Patricia M Davidson
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia; Johns Hopkins University, School of Nursing, Baltimore, MD 20215, USA.
| | - Michelle DiGiacomo
- University of Technology Sydney, Faculty of Health, Centre for Cardiovascular and Chronic Care, P.O. Box 123, Broadway, New South Wales 2007, Australia.
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Risica PM, Gavarkovs A, Parker DR, Jennings E, Phipps M. A tailored video intervention to reduce smoking and environmental tobacco exposure during and after pregnancy: Rationale, design and methods of Baby's Breath. Contemp Clin Trials 2016; 52:1-9. [PMID: 27818283 DOI: 10.1016/j.cct.2016.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/28/2016] [Accepted: 10/29/2016] [Indexed: 11/29/2022]
Abstract
Low-cost interventions to decrease environmental tobacco smoke (ETS) exposure of pregnant women and their newborns are needed to lower health risks of exposed fetuses and infants. Baby's Breath is a tailored video intervention developed and tested in a randomized controlled trial. The study aimed to test the efficacy of tailored video versus usual care approaches to reduce the ETS exposure of fetuses of low-income women during and after pregnancy; and to assess this intervention separately among non-smoking and smoking women. Participating women, recruited early in pregnancy, who spoke English, were at least 18years old, smoke exposed (current smokers, quit smoking on their own, or were exposed to smoke of others), pregnant with only one baby, and had access to a telephone and video player, were randomized to experimental or control conditions. Intervention participants received newsletters containing content aimed at smoking cessation and avoidance (5 during and 3 after pregnancy), in addition to videos (3 during and 2 after pregnancy) individually tailored on behavioral theory-based survey questions. Comparison participants received newsletters and videos on healthy pregnancy topics. Outcomes included salivary cotinine of both mother and baby (32weeks gestation and 6months postpartum) as well as self-reported ETS exposure and avoidance behaviors. This study may demonstrate the efficacy of a low-cost intervention to decrease ETS exposure, and will fill an important gap in describing the utility of this innovative intervention technology, as well as demonstration of potential benefits to this type of intervention.
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Affiliation(s)
- Patricia Markham Risica
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI, United States; Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, RI, United States; Institute for Community Health Promotion, Brown School of Public Health, Brown University, Providence, RI, United States.
| | - Adam Gavarkovs
- Department of Behavioral and Social Sciences, Brown School of Public Health, Brown University, Providence, RI, United States.
| | - Donna R Parker
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI, United States; Memorial Hospital of RI, Center of Primary Care and Prevention, Pawtucket, RI, United States; Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Ernestine Jennings
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States.
| | - Maureen Phipps
- Department of Epidemiology, Brown School of Public Health, Brown University, Providence, RI, United States; Department of Obstetrics & Gynecology, Warren Alpert Medical School of Brown University, Providence, RI, United States; Women & Infants Hospital of Rhode Island, Providence, RI, United States.
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19
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Griffis H, Matone M, Kellom K, Concors E, Quarshie W, French B, Rubin D, Cronholm PF. Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies. BMC Public Health 2016; 16:764. [PMID: 27514836 PMCID: PMC4982407 DOI: 10.1186/s12889-016-3464-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 08/05/2016] [Indexed: 11/16/2022] Open
Abstract
Background Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied. Methods Mixed methods approach using a retrospective cohort of propensity score matched home visiting clients and local-area comparison women with first births between 2008–2014 in a large Northeast state. Multivariable logistic and linear regression estimated third trimester prenatal tobacco smoking cessation and reduction. Additionally, qualitative interviews were conducted with 76 home visiting clients. Results A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children. Conclusions While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families. Electronic supplementary material The online version of this article (doi:10.1186/s12889-016-3464-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heather Griffis
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.
| | - Meredith Matone
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA.,Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Katherine Kellom
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA
| | - Erica Concors
- PolicyLab, The Children's Hospital of Philadelphia, 3535 Market, Suite 1424, Philadelphia, PA, 19104, USA
| | - William Quarshie
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Benjamin French
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA
| | - David Rubin
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter F Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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