Effectiveness of Behavior Change interventions for smoking cessation among expectant and new fathers

Background

The perinatal period is an optimal time to intervene for achieving smoking cessation in expectant parents and offers multiple health benefits for women and the newborn. While Behavior Change Technique (BCT) interventions are a promising approach to support pregnant smokers to quit smoking, effectiveness of these interventions among expectant and new fathers is not equally well documented. Better understanding of the potential utility of these BCT interventions for this group is important for the development of effective gender-sensitive programmes.

Methods

This systematic review examines the existing evidence on effectiveness of BCTs on smoking cessation outcomes when offered to expectant and new fathers (child < 1 year) both through individual and/or couple-based interventions. Eight databases were searched for peer-reviewed articles. Studies were subjected to systematic retrieval and quality-assessment by two independent reviewers.

Results

We identified 9 randomised control trial studies (including 4,681 men) that fulfilled the inclusion criteria. In terms of quit outcome data, 8 studies reported biochemically verified quit rates for men. While 5 BCT interventions targeted expectant/new fathers, 3 were directed to couples and 1 primarily focused on women with a component directed at men. Though most of the interventions were found to be effective, they showed small significant positive effects on cessation outcomes. Findings are suggestive of gender specific interventions being more likely to have positive outcomes. High heterogeneity across the studies made it difficult to determine the most effective BCT approach.

Conclusions

This review suggests that use of BCT interventions for smoking cessation among expectant and new fathers is effective in achieving positive quit rates; however, these studies are limited. Further research is needed to determine the most effective BCT approach associated with smoking cessation among this group.

Key messages

• BCT interventions for smoking cessation among expectant and new fathers are a promising approach to increase quit rates.

• Future research needs to develop evidence based BCT interventions for smoking cessation specifically targeting expectant and new fathers to inform policy and practice.

Organizing the institutional Public Health response to heat under climate change: A scoping review

Background

Extreme heat events are a major health risk, and their intensity and frequency are expected to increase under climate change. Heat health action plans (HHAP) aim to prevent adverse health effects through measures such as warning systems or communication campaigns. This scoping review asked whether the peer-reviewed Public Health literature suggests evidence for good practice governance of HHAP.

Methods

Databases PubMed and Web of Science were searched using search string combinations of heat, policy, warning system, and related terms. Data was extracted into a pre-defined extraction table based on theory-driven variables related to responsibilities, processes of stakeholder involvement, evaluation and whether good practice advice was provided. Findings were narratively synthesized and gaps in the current knowledge evaluated from a normative standpoint.

Results

Searches resulted in 6681 hits. After title, abstract and full text screening, 20 articles were assessed, 11 from Europe and 9 from other regions. Findings on structure of governance revealed that the Ministry of Health or Ministry for the Environment leads the development of an adaptation plan or HHAP guidance, while locally Departments of Health most often lead coordination of actions. Interagency cooperation was reported as essential, while in the majority of included studies the public are perceived as recipients of advice and warnings rather than as active stakeholders. Tailoring national guidance to local contexts as well as raising awareness of the plan not only among the public but also among all levels of management was one suggested good practice.

Conclusions

Few articles explicitly examine the organization of HHAP and no conclusions about whether a specific approach is superior can be drawn from these studies. To adequately protect human health from extreme heat events, an assessment of whether current governance structures are able to provide effective heat health action could be useful.

Key messages

The peer-reviewed literature does not provide information on which type of HHAP governance is superior. In the absence of a gold standard, it should be assessed what stakeholders and discourses are absent from HHAP governance to ensure vulnerable groups are adequately addressed by HHAP.

Lessons from the field: Gender roles and researcher reflexivity in smoking cessation in South Asia

Background

In South Asia, dual epidemics of smoking and tuberculosis (TB) have contributed to a high burden of lung disease. To address these health risks, the TB & Tobacco study uses the TB diagnosis as a teachable moment and implements a behaviour support counselling intervention, conducted by TB health workers, for patients in Bangladesh, Nepal and Pakistan. In this region, smoking tobacco is perceived as problematic for women, and being confronted with questions on smoking from a health professional may be uncomfortable for men and women. Anticipating these challenges, we incorporated gender sensitivity into training of health workers.

Methods

During implementation of the cessation support in routine TB care, a process evaluation assessed interactions between participants and the intervention through interviews with health workers and patients with TB participating in the cessation program. This presentation focusses on a retrospective self-reflection on how we conceptualized gender roles based on prior research, and how research findings partially challenged these assumptions.

Findings

While parts of our interview findings point towards smoking as a stigmatized practice for women and some men in South Asia as expected, several male and female respondents across socio-economic and geographical spheres contradicted this assumption. We discovered that health workers’ self-efficacy and perceived smoking stigma among health workers influenced whether they discussed smoking with women or minors. Many patients, on the other hand, told us that they were interested in receiving help to cure their TB and were willing to talk to about smoking with their health workers and their family members.

Conclusions

Patients in this study were more open to talking about smoking than anticipated. When including gender sensitivity into the standard training for health workers, we should be careful not to increase doubts in health workers about addressing smoking with women.

Evaluation of a simple method for minimizing iatrogenic blood loss from discard volumes in critically ill newborns and children

OBJECTIVE

To validate a simple method avoiding discard volumes in pediatric patients with indwelling arterial and venous lines.

DESIGN

Zero-discarding was achieved by passive extracorporeal arteriovenous backflow via standard single pressure transducer equipment. We tested backflow distances (10, 20 and 30 cm beyond the sampling port), corresponding to withdrawal volumes of 0.6 ml, 0.8 ml and 1.0 ml, respectively, in comparison to conventional sampling with discard of 0.6 ml. With the backflow technique, the "withdrawal volume" was flushed back to the patient after sampling. We enrolled 120 patients who were allocated to either of the following paired sampling procedures: 10 cm versus conventional, 20 cm versus conventional, 30 cm versus conventional and two paired conventional samples. The order of the sampling was randomly allocated. Bias and precision were determined using Bland-Altman diagrams and algorithms.

RESULTS

No appreciable difference was found for blood gases, hemoglobin, potassium and calcium between the backflow technique and conventional sampling. Sodium results and blood glucose showed a bias towards higher values with the backflow technique (mean difference, sodium, 0.9 mmol/l; glucose, mean difference 0.5 mmol/l, standard deviation 0.44 mmol/l).

CONCLUSIONS

The backflow technique provides reliable results for blood gases and electrolytes. However, in patients at risk of hypoglycemia, the backflow method should not be used to monitor blood glucose levels.