Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income, urban African Americans

Trait Persistence Moderates the Association between Gender and Change in Smoking Urge Across Repeated Cue Exposure Trials

Previous research suggests that persistence, an individual difference characteristic representing the ability and willingness to maintain engagement in challenging or aversive contexts, may relate to smoking relapse. Improving understanding of the persistence-relapse risk association could guide improvements in behavioural interventions. We explored whether persistence and gender related to change in smoking urges across multiple cue exposure trials (an analogue of extinction learning and relapse risk). Participants included abstinent smokers who completed 12 massed, 5-minute smoking cue exposure trials using guided imagery as well as olfactory, tactile, visual and motor cues associated with smoking. We used multilevel logistic growth curve modelling to explore predictor associations with change in urge. Results suggested that gender related to urge whereby males showed greater initial and sustained reactivity than females. Persistence was not associated with female urge trajectories. However, compared to males with high persistence, males with low persistence evidenced sustained urge reactivity over time. Results suggest that greater persistence relates to reduction of conditioned responding (e.g., urges) among abstinent male smokers when exposure trials include complex cues most closely related to nicotine self-administration. Because persistence is modifiable, males with low persistence may benefit from interventions that include elements designed to increase persistence in urge eliciting situations.

Reducing Underserved Children's Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers

INTRODUCTION

Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure.

DESIGN

A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded.

SETTING/PARTICIPANTS

Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline.

INTERVENTION

Philadelphia Family Rules for Establishing Smoke-free Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smoke-free home.

MAIN OUTCOME MEASURES

Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status.

RESULTS

Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ(2)=10.56, p<0.01). There was no moderating effect of other smokers living at home.

CONCLUSIONS

FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02117947.

Environmental tobacco smoke exposure among smokers and non-smokers receiving outpatient substance abuse treatment

INTRODUCTION

Environmental Tobacco Smoke (ETS) has been linked to numerous health problems. While research has demonstrated high prevalence of tobacco use among individuals receiving treatment for substance use disorders (SUDs), no studies have examined ETS among individuals receiving treatment for SUDs, paying specific attention to non-smokers who may be at risk for high exposure to ETS.

METHODS

Participants (N=261) enrolled in outpatient substance abuse treatment completed a survey, in which 14 items were used to quantify ETS exposure and smoking policies across several environments.

RESULTS

Among smokers, 85% reported that their significant others also smoked as compared to 15% among non-smokers (χ(2)=6.624, p<.05). A logistic regression examined the characteristics that predicted smoking in the home. The overall model was significant, (χ(2)=36.046, p<.0005) with variables that independently predicted smoking in the home included having less than a high school diploma, being female, and living with a smoker. Income, age, and living with children were not found to be significant. Overall, 42% white collar workers 26% of service workers and 30% of blue collar workers reported no exposure to ETS. Sixty-seven percent of smokers strongly agreed or agreed that the hazards of secondhand smoke have been clearly demonstrated versus 58% of non-smokers.

CONCLUSIONS

Smokers and non-smokers enrolled in outpatient substance abuse treatment are frequently exposed to ETS at home, work, and in social settings. The dangers of ETS should be addressed among this population through education, smoke-free policies, and cessation resources, with help from their treatment facility.

The parent-child dyad and risk perceptions among parents who quit smoking

BACKGROUND

Most parental smokers are deeply invested in their child's health, but it is unknown what factors influence parent risk perceptions of the effects of smoking on their child's health and benefits to the child of cessation.

PURPOSE

To explore differences in former versus current smokers' beliefs about harm of continuing to smoke, benefits of quitting, and how much smoking interferes with their parenting.

METHODS

As part of a cluster RCT to increase tobacco control in the pediatric setting, we analyzed data collected at the ten control arm practices for 24 months starting in May 2010; a cross-sectional secondary data analysis was conducted in 2013. Parents were asked about smoking status and perceived harm, benefit, and well-being related to smoking behaviors.

RESULTS

Of the 981 enrolled smoking parents, 710 (72.4%) were contacted at 12 months. The odds of having successfully quit at 12 months was 4.12 times more likely (95% CI=1.57, 10.8) for parents who believed that quitting will benefit their children; 1.68 times more likely (95% CI=1.13, 2.51) for parents with more than a high school education; and 1.74 times greater (95% CI=1.13, 2.68) for parents with children under age 3 years. Another factor associated with having successfully quit was a prior quit attempt.

CONCLUSIONS

Providers' smoking-cessation advice and support should begin early and underscore how cessation will benefit the health and well-being of patients' children. Additionally, parents who have recently attempted to quit may be particularly primed for another attempt.

Kids Safe and Smokefree (KiSS): a randomized controlled trial of a multilevel intervention to reduce secondhand tobacco smoke exposure in children

BACKGROUND

Secondhand smoke exposure (SHSe) harms children's health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers' advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations.

METHODS/DESIGN

This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status.

DISCUSSION

This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to "ask, advise, and refer" guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.

TRIAL REGISTRATION

NCT01745393 (clinicaltrials.gov).

Factors associated with maternal depressive symptoms among low-income, African American smokers enrolled in a secondhand smoke reduction programme

Introduction Maternal depressive symptoms increase the risk of poor maternal and child health outcomes, and are a primary barrier to health behaviour change. Social cognitive theory can guide our understanding of risk factors that may have an impact on maternal depressive symptoms. The aim of this paper was to understand the correlates of maternal depressive symptoms among low-income African American smokers completing a 16-week intervention trial to reduce young children's second-hand smoke exposure (SHSe). Methods This study presents a secondary analysis of depression symptoms among 227 maternal smokers completing the SHSe-reduction trial. The end-of-treatment Center of Epidemiologic Studies Depression Scale (CES-D) score was used to assess depressive symptoms (dichotomised as 0 = score of < 16 and 1 = score of ≥ 16). Multivariate logistic regression analysis was used to test the one-way hypothesis that odds of significant depressive symptoms would be associated with greater total number of household smokers, greater number of paediatric sick visits, greater daily exposure of child to cigarette smoke by their mother, greater life-event stress, and lower social support, marital status, employment status and level of educational attainment. Results Number of household smokers (OR = 1.57, P = 0.049), social support (OR = 0.88, P < 0.001) and life-event stress (OR = 1.04, P = 0.001) predicted significant maternal depressive symptoms; all other variables were not significant predictors in the model. Conclusion Number of household smokers is a novel risk factor for understanding significant maternal depressive symptoms in the context of a childhood SHSe-reduction trial. Improving our understanding of the household-level social milieu in the context of SHSe-reduction interventions will assist in reducing the risk of maternal depressive symptoms.

Home smoking bans among U.S. households with children and smokers. Opportunities for intervention

BACKGROUND

Public health campaigns have reduced the exposure of U.S. children to secondhand smoke at home; however, these may not have been equally effective across subgroups.

PURPOSE

To examine prevalence of home smoking bans among U.S. households with both children and smokers, over time and by demographic subgroups.

METHODS

The Tobacco Use Supplement to the Current Population Survey (TUS-CPS) is a nationally representative household survey of tobacco use. The 1992/1993 and 2006/2007 TUS-CPS interviewed 22,746 households from a major racial/ethnic group with both children and adult smokers. Predictors of complete home smoking bans among demographic subgroups were identified using multivariate logistic regression. Analyses were conducted in 2010-2011.

RESULTS

Complete home smoking bans among U.S. households with children and smokers (smoking families) more than tripled, from 14.1% in 1992/1993 to 50.0% in 2006/2007. However, non-Hispanic white and African-American smoking families lagged behind Asian/Pacific Islanders and Hispanics. In 2006/2007, 67.2% of African-American smoking families allowed smoking in the home, as did 59.2% of smoking families with all children aged ≥14 years. Bans were more likely among more-educated households and in states with lower adult smoking prevalence; however, these differences were attenuated in some racial/ethnic groups.

CONCLUSIONS

As of 2006/2007, only half of U.S. households with both children and smokers had complete home smoking bans. Home bans were less common among smoking families with older children, in African-American households, and in Hispanic or non-Hispanic white households in states with high smoking prevalence. Interventions are needed to promote smoke-free homes among these groups.

Unexpected benefits: pathways from smoking restrictions in the home to psychological well-being and distress among urban Black and Puerto Rican Americans

INTRODUCTION

This study examined the pathways from smoking policies in the home (no ban, partial ban, and total ban on smoking) to psychological well-being (e.g., self-esteem) and psychological symptoms (e.g., depressive symptoms) as mediated by a healthy lifestyle (engaging in exercise, eating healthful foods, and sleeping enough) and cigarette smoking among a sample of urban Black and Puerto Rican Americans.

METHODS

Questionnaire data were collected from 816 participants (mean age = 32 years). Structural equation modeling (SEM) was employed to examine the pathways of restrictions on smoking in the home to a healthy lifestyle, cigarette smoking, psychological well-being, and psychological distress.

RESULTS

The SEM showed mediational pathways linking higher levels of restrictions on smoking in the home with a healthy lifestyle, which in turn was related negatively to psychological distress and positively to psychological well-being. Higher levels of restrictions on smoking in the home were also related inversely to cigarette smoking, which was related positively to psychological distress and negatively to psychological well-being.

CONCLUSIONS

Findings show that higher levels of restrictions on smoking in the home are associated with a healthier lifestyle and less cigarette smoking, which in turn are associated with better psychological functioning. Greater restrictions on smoking in the home may thus support positive lifestyle choices, including exercise and nutrition, as well as psychological functioning.