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Delcroix MH, Delcroix-Gomez C, Marquet P, Gauthier T, Thomas D, Aubard Y. Active or passive maternal smoking increases the risk of low birth weight or preterm delivery: Benefits of cessation and tobacco control policies. Tob Induc Dis 2023; 21:72. [PMID: 37256119 PMCID: PMC10226447 DOI: 10.18332/tid/156854] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 11/07/2022] [Accepted: 11/23/2022] [Indexed: 06/01/2023] Open
Abstract
In France, maternal smoking, active or passive, remains one of the highest in Europe. At the same time, there is an increase in the number of low birth weight (<2500 g) and premature (<37 weeks of amenorrhea) newborns. The objective of this narrative review is to examine the impact of active or passive maternal smoking on birth weight or prematurity rates, and to consider the benefits of policies to stop or control smoking. This is a narrative review that analyzes and discusses the major articles published over the past 20 years regarding the role of active or passive maternal smoking on the risk of low birth weight or preterm delivery. Articles were selected using the following keywords: maternal smoking, low birth weight, preterm birth, smoking cessation, passive smoking, exhaled carbon monoxide, tobacco control policies. Active smoking is associated, in a dose-response relationship, with increased risks of low birth weight and preterm delivery. Passive smoking, mainly related to the presence of a smoking spouse, increases the risk of low birth weight and preterm birth. Our review confirmed also the benefits of smoking cessation, even in the third trimester, in reducing the risk of small for gestation age or fetal growth restriction and preterm birth. Several studies of tobacco control policies have been shown to be effective in significantly reducing maternal smoking. There is sufficient evidence to infer a causal link between active or passive maternal smoking and low birth weight or preterm delivery. This causal link is compelling and sufficient to justify intensifying efforts to promote rapid progress in tobacco control policies, with the vision of a tobacco-free generation, and smoking cessation with best practices during preconception or pregnancy.
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Affiliation(s)
- Michel-Henri Delcroix
- Établissement Public de Santé Mentale, Association Périnatalité Recherche Information - Maternité Sans Tabac, Bailleul, France
| | - Conchita Delcroix-Gomez
- Service de Gynécologie-Obstétrique, Pôle Femme-Enfant, Centre Hospitalier d’Arras, Arras, France
| | - Pierre Marquet
- Service de Pharmacologie, Toxicologie et de Pharmacovigilance, Centre Hospitalier Universitaire, Limoges, France
| | - Tristan Gauthier
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, Centre Hospitalier Universitaire, Limoges, France
| | - Daniel Thomas
- Institut de Cardiologie, Groupe Hospitalier Pitié Salpêtrière, Paris, France
| | - Yves Aubard
- Service de Gynécologie-Obstétrique, Hôpital Mère-Enfant, Centre Hospitalier Universitaire, Limoges, France
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Johnson MG, Suchting R, Scheid LM, Holzapfel L, Chalise A, Stotts AL, Chapman JC, Khan AM, Northrup TF. Evaluating the relationship of in utero nicotine exposure with hypoglycemia after delivery: An observational study. J Neonatal Perinatal Med 2023; 16:445-452. [PMID: 37742665 PMCID: PMC10865725 DOI: 10.3233/npm-230124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
BACKGROUND Hypoglycemia in neonates is common and contributes to 4.0-5.8% of neonatal intensive care unit (NICU) admissions. In utero nicotine exposure is underexplored as a potential contributor to neonatal hypoglycemia. Rat models have shown that in utero nicotine exposure can be associated with a reduction in pancreatic beta cell mass, leading to glucose dysregulation. The primary aim of this work is to study the risk of developing hypoglycemia after birth in a population of in utero nicotine-exposed neonates. METHODS We conducted a retrospective matched cohort study that augmented an existing dataset of neonates admitted to a level IV NICU with household-based in utero nicotine exposure (N = 335). Neonates in the control group parents denied household smoking (N = 325), were born within a 6-month timeframe, and were within a birthweight of 50 grams of a nicotine-exposed neonate. Data reviewed included gestational age, growth parameters, maternal history of diabetes, and glucose levels within the first three hours of life per unit protocol. RESULTS 660 neonates were included in the analysis. In utero nicotine exposure demonstrated a 94.3% posterior probability (PP) for greater hypoglycemia risk (RR = 1.185, 95% CrI = [0.953, 1.445]). A 94.6% PP was demonstrated when neonates who were small for gestational age, intrauterine growth-restricted, and born to diabetic mothers were excluded (n = 482; RR = 1.271, 95% CrI = [0.946, 1.669]). CONCLUSION Nicotine exposure in utero was found to be a potential risk factor for developing hypoglycemia after birth. Mechanisms of action should be explored, and additional research on in utero nicotine exposure risks should follow.
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Affiliation(s)
- Mary G. Johnson
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
- Department of Pediatrics, Division of Neonatology, Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Lisa M. Scheid
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - L.N. Holzapfel
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Aditi Chalise
- McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Angela L. Stotts
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - John C. Chapman
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Amir M. Khan
- Department of Pediatrics, Division of Neonatology, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
| | - Thomas F. Northrup
- Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston [UTHealth], Houston, TX, USA
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Gregory EF, Maddox AI, Levine LD, Fiks AG, Lorch SA, Resnicow K. Motivational interviewing to promote interconception health: A scoping review of evidence from clinical trials. PATIENT EDUCATION AND COUNSELING 2022; 105:3204-3212. [PMID: 35870992 PMCID: PMC9529865 DOI: 10.1016/j.pec.2022.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 07/07/2022] [Accepted: 07/15/2022] [Indexed: 06/12/2023]
Abstract
BACKGROUND Promoting interconception health can improve birth outcomes and long-term women's health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement. OBJECTIVE This scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions. METHODS We searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features. RESULTS There were 37 included studies. Interventions addressed breastfeeding, teen contraception, tobacco, alcohol, or substance use, vaccine acceptance, nutrition, physical activity, and depression. No trials addressed more than one topic. Nineteen studies demonstrated improved outcomes. Interventions during the perinatal or postnatal periods were more likely to demonstrate improved interconception outcomes than interventions in the prenatal period. No other trial characteristics were consistently associated with demonstrating improved outcomes. DISCUSSION MI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion. PRACTICAL VALUE MI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.
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Affiliation(s)
- Emily F Gregory
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA.
| | - Adya I Maddox
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA
| | - Lisa D Levine
- Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, USA
| | - Alexander G Fiks
- Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA
| | - Scott A Lorch
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, USA; Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia. Philadelphia, USA
| | - Kenneth Resnicow
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, USA
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Stotts AL, Villarreal YR, Green C, Berens P, Blackwell S, Khan A, Suchting R, Velasquez M, Markham C, Klawans MR, Northrup TF. Facilitating treatment initiation and reproductive care postpartum to prevent substance-exposed pregnancies: A randomized bayesian pilot trial. Drug Alcohol Depend 2022; 239:109602. [PMID: 35987083 DOI: 10.1016/j.drugalcdep.2022.109602] [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] [Received: 05/13/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND For non-treatment-seeking women who use substances during pregnancy, immediately postpartum may be an optimum time for intervention. Our study tested a novel, brief, hospital-initiated, adaptive motivational interviewing plus acceptance and commitment therapy (MIACT) intervention to facilitate treatment initiation and reproductive planning postpartum among mothers who used substances during pregnancy. METHODS Mothers (N = 64) with an infant admitted to a neonatal intensive care unit were enrolled if they or their infant tested positive for an illicit substance at delivery or had a documented positive drug screen during pregnancy. A parallel group, randomized controlled design assigned participants to MIACT or conventional care (CC), with assessments at week 2 and 4 during treatment and follow-up at 2 and 6 months post treatment. Bayesian generalized linear modeling was used to evaluate outcomes as a function of treatment. RESULTS Results indicated that during treatment the MIACT group demonstrated an 84% probability of benefit relative to CC with regard to initiating treatment (RR=1.5), however the effect was not seen at follow-up. MIACT was also associated with an increased probability of attending a postpartum obstetrics visit (RR=1.4), and receiving contraception during treatment and at both follow-ups, with posterior probabilities of 96% or higher and relative risks ranging from 1.5 to 5.1 at varying timepoints. Substance use rates for the MIACT versus CC were higher at follow-up. CONCLUSIONS Brief, hospital-initiated interventions can assist postpartum mothers who use substances to enter treatment and obtain contraception in order to reduce future substance-exposed pregnancies.
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Affiliation(s)
- Angela L Stotts
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA.
| | | | - Charles Green
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Pamela Berens
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Sean Blackwell
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Amir Khan
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Robert Suchting
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
| | - Mary Velasquez
- The University of Texas at Austin, 1823 Red River St, Austin, TX 78712, USA
| | - Christine Markham
- UTHealth School of Public Health, 1200 Pressler, Houston, TX 77030, USA
| | | | - Thomas F Northrup
- UTHealth McGovern Medical School, 6431 Fannin, Houston, TX 770030, USA
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Pisinger C, Toxværd CG, Rasmussen M. Smoking Cessation Programs Are Less Effective in Smokers with Low Socioeconomic Status Even When Financial Incentives for Quitting Smoking Are Offered-A Community-Randomized Smoking Cessation Trial in Denmark. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10879. [PMID: 36078595 PMCID: PMC9518409 DOI: 10.3390/ijerph191710879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Financial incentives offered to those who quit smoking have been found effective, also in persons with low socioeconomic status (SES), but no previous study has investigated who benefits most: smokers with low or high SES. In this community-randomized trial ("Richer without smoking"), three Danish municipalities were randomized to reward persons who were abstinent when attending the municipal smoking cessation program (FIMs) and three municipalities were randomized to spend the same amount on smoking cessation campaigns recruiting smokers to the smoking cessation program (CAMs). The municipalities each received approximately USD 16,000. An intention-to-treat approach was used in analyses. In regression analyses adjusted for individual- and municipal-level differences, we found that smokers with high SES living in FIMs had significantly higher proportion of validated long-term successful quitters (OR (95% CI): 2.59 (1.6-4.2)) than high-SES smokers living in CAM. Smokers with low SES, however, did not experience the same benefit of financial incentives as smokers with high SES. Neither the FIMs nor the CAMs succeeded in attracting more smokers with low SES during the intervention year 2018 than the year before. Our study showed that smokers with low SES did not experience the same benefit of financial incentives as smokers with high SES.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
| | - Cecilie Goltermann Toxværd
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mette Rasmussen
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, Bispebjerg & Frederiksberg Hospital, 2000 Frederiksberg, Denmark
- Clinical Health Promotion Centre, WHO-CC, Department of Health Sciences, Lund University, 223 62 Lund, Sweden
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Notley C, Brown TJ, Bauld L, Boyle EM, Clarke P, Hardeman W, Holland R, Hubbard M, Naughton F, Nichols A, Orton S, Ussher M, Ward E. Development of a Smoke-Free Home Intervention for Families of Babies Admitted to Neonatal Intensive Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063670. [PMID: 35329355 PMCID: PMC8949360 DOI: 10.3390/ijerph19063670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/07/2022] [Accepted: 03/12/2022] [Indexed: 02/05/2023]
Abstract
Neonatal intensive care units (NICUs) have a disproportionately higher number of parents who smoke tobacco compared to the general population. A baby’s NICU admission offers a unique time to prompt behaviour change, and to emphasise the dangerous health risks of environmental tobacco smoke exposure to vulnerable infants. We sought to explore the views of mothers, fathers, wider family members, and healthcare professionals to develop an intervention to promote smoke-free homes, delivered on NICU. This article reports findings of a qualitative interview and focus group study with parents whose infants were in NICU (n = 42) and NICU healthcare professionals (n = 23). Thematic analysis was conducted to deductively explore aspects of intervention development including initiation, timing, components and delivery. Analysis of inductively occurring themes was also undertaken. Findings demonstrated that both parents and healthcare professionals supported the need for intervention. They felt it should be positioned around the promotion of smoke-free homes, but to achieve that end goal might incorporate direct cessation support during the NICU stay, support to stay smoke free (relapse prevention), and support and guidance for discussing smoking with family and household visitors. Qualitative analysis mapped well to an intervention based around the ‘3As’ approach (ask, advise, act). This informed a logic model and intervention pathway.
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Affiliation(s)
- Caitlin Notley
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
- Correspondence: ; Tel.: +44-1603-591275
| | - Tracey J. Brown
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
| | - 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;
- Neonatal Unit, Leicester Royal Infirmary, Leicester LE5 4PW, UK;
| | - Paul Clarke
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
- 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;
| | - Marie Hubbard
- Neonatal Unit, Leicester Royal Infirmary, Leicester LE5 4PW, UK;
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, UK; (W.H.); (F.N.)
| | - Amy Nichols
- Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich NR4 7UY, UK;
| | - 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
| | - Emma Ward
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; (T.J.B.); (P.C.); (E.W.)
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Duration of breastmilk feeding of NICU graduates who live with individuals who smoke. Pediatr Res 2021; 89:1788-1797. [PMID: 32937651 PMCID: PMC7960563 DOI: 10.1038/s41390-020-01150-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Breast milk has many benefits for infants, but initiating breastfeeding/pumping can be difficult for mothers of preterm infants, especially those who smoke (or live with individuals who smoke). The primary aim of this study was to identify risks for breastfeeding/pumping cessation with neonatal intensive care unit (NICU) infants' mothers who smoke or live with individuals who smoke, using a novel survival-analytic approach. METHODS/DESIGN Mothers (N = 360) were recruited for a secondhand smoke prevention intervention during infants' NICU hospitalizations and followed for ~6 months after infant discharge. Data were obtained from medical records and participant self-report/interviews. RESULTS The sample was predominantly ethnic/racial minorities; mean age was 26.8 (SD = 5.9) years. One-fifth never initiated breastfeeding/pumping (n = 67; 18.9%) and mean time-to-breastfeeding cessation was 48.1 days (SD = 57.2; median = 30.4 [interquartile range: 6.0-60.9]). Education, length of stay, employment, race/ethnicity, number of household members who smoke, and readiness-to-protect infants from tobacco smoke were significantly associated with breastfeeding cessation. Further, infants fed breast milk for ≥4 months had 42.7% more well-child visits (p < 0.001) and 50.0% fewer respiratory-related clinic visits (p < 0.05). CONCLUSIONS One-quarter of infants admitted to NICUs will be discharged to households where individuals who smoke live; we demonstrated that smoking-related factors were associated with mothers' breastfeeding practices. Infants who received breast milk longer had fewer respiratory-related visits. IMPACT One-quarter of NICU infants will be discharged to households where smokers live. Initiating/sustaining breastfeeding can be difficult for mothers of preterm NICU infants, especially mothers who smoke or live with others who smoke. Education, employment, race/ethnicity, length of stay, household member smoking, and readiness-to-protect infants from tobacco smoke were significantly associated with time-to-breastfeeding cessation. Infants fed breast milk for ≥4 months had 42.7% more well-child visits and 50.0% fewer respiratory-related clinic visits, compared to infants fed breast milk <4 months. Data support intervention refinements for mothers from smoking households and making NICU-based healthcare workers aware of risk factors for early breastfeeding cessation.
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Northrup TF, Stotts AL, Suchting R, Khan AM, Green C, Klawans MR, Quintana PJE, Hoh E, Hovell MF, Matt GE. Thirdhand Smoke Contamination and Infant Nicotine Exposure in a Neonatal Intensive Care Unit: An Observational Study. Nicotine Tob Res 2021; 23:373-382. [PMID: 32866238 DOI: 10.1093/ntr/ntaa167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 08/26/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Thirdhand smoke (THS) is ultrafine particulate matter and residue resulting from tobacco combustion, with implications for health-related harm (eg, impaired wound healing), particularly among hospitalized infants. Project aims were to characterize nicotine (THS proxy) transported on neonatal intensive care unit (NICU) visitors and deposited on bedside furniture, as well as infant exposure. METHODS Cross-sectional data were collected from participants in a metropolitan NICU. Participants completed a survey and carbon monoxide breath sample, and 41.9% (n = 88) of participants (n = 210) were randomly selected for finger-nicotine wipes during a study phase when all bedside visitors were screened for nicotine use and finger-nicotine levels. During an overlapping study phase, 80 mother-infant dyads consented to bedside furniture-nicotine wipes and an infant urine sample (for cotinine analyses). RESULTS Most nonstaff visitors' fingers had nicotine above the limit of quantification (>LOQ; 61.9%). Almost all bedside furniture surfaces (93.8%) and infant cotinine measures (93.6%) had values >LOQ, regardless of household nicotine use. Participants who reported using (or lived with others who used) nicotine had greater furniture-nicotine contamination (Mdn = 0.6 [interquartile range, IQR = 0.2-1.6] µg/m2) and higher infant cotinine (Mdn = 0.09 [IQR = 0.04-0.25] ng/mL) compared to participants who reported no household-member nicotine use (Mdn = 0.5 [IQR = 0.2-0.7] µg/m2; Mdn = 0.04 [IQR = 0.03-0.07] ng/mL, respectively). Bayesian univariate regressions supported hypotheses that increased nicotine use/exposure correlated with greater nicotine contamination (on fingers/furniture) and infant THS exposure. CONCLUSIONS Potential furniture-contamination pathways and infant-exposure routes (eg, dermal) during NICU hospitalization were identified, despite hospital prohibitions on tobacco/nicotine use. This work highlights the surreptitious spread of nicotine and potential THS-related health risks to vulnerable infants during critical stages of development. IMPLICATIONS THS contamination is underexplored in medical settings. Infants who were cared for in the NICU are vulnerable to health risks from THS exposure. This study demonstrated that 62% of nonstaff NICU visitors transport nicotine on their fingers to the NICU. Over 90% of NICU (bedside) furniture was contaminated with nicotine, regardless of visitors' reported household-member nicotine use or nonuse. Over 90% of infants had detectable levels of urinary cotinine during NICU hospitalizations. Results justify further research to better protect infants from unintended THS exposure while hospitalized.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX
| | - Angela L Stotts
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX.,Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, TX
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, UTHealth, McGovern Medical School, Houston, TX
| | - Amir M Khan
- Department of Pediatrics, UTHealth, McGovern Medical School, Houston, TX
| | - Charles Green
- Department of Pediatrics, UTHealth, McGovern Medical School, Houston, TX.,Center for Clinical Research and Evidence-Based Medicine, UTHealth, McGovern Medical School, Houston, TX
| | - Michelle R Klawans
- Department of Family and Community Medicine, University of Texas Health Science Center at Houston (UTHealth), McGovern Medical School, Houston, TX
| | | | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, CA
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, CA
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA
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9
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. High Cotinine and Healthcare Utilization Disparities Among Low-Income Children. Am J Prev Med 2021; 60:267-275. [PMID: 33131989 PMCID: PMC7854767 DOI: 10.1016/j.amepre.2020.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study assesses the associations of child salivary cotinine, parent-reported smoking, and child tobacco smoke exposure with the number of child healthcare visits and hospital admissions over a 6-month period. This study also assesses the relationships between participant characteristics and child cotinine. METHODS Longitudinal data were evaluated from a sample of 313 clinically ill children aged 0-9 years who lived with a smoker and presented to a pediatric emergency department or urgent care in 2016-2018. In 2020, cotinine measurements were log transformed, and Poisson and linear regression were performed. RESULTS The majority of the children came from low-income homes (66.1%) and had public insurance/self-pay (95.5%). Child cotinine concentrations ranged from 0.1 to 332.0 ng/mL (geometric mean=4.8 ng/mL, 95% CI=4.1, 5.5). Poisson regression results indicated that each 1-unit increase of log-cotinine concentration was associated with an increase in pediatric emergency department visits over a 6-month period after the baseline visit, with an adjusted RR of 1.16 (95% CI=1.01, 1.34). Each 1-unit increase of log-cotinine concentration was associated with an increase in the frequency of hospital admissions over the 6-month period, with an adjusted RR of 1.50 (95% CI=1.08, 2.09). No differences were found between parent-reported smoking or child tobacco smoke exposure and healthcare utilization. Linear regression results indicated that children who were younger (β= -0.227, p=0.049), were White (geometric mean=5.5 ng/mL), had a medical history of prematurity (geometric mean=8.1 ng/mL), and had a winter baseline visit (geometric mean=6.5 ng/mL) had higher cotinine concentrations. Children living in apartments (geometric mean=5.5 ng/mL) and multiunit homes (geometric mean=5.5 ng/mL) had higher cotinine concentrations than those in single-family homes (geometric mean=3.6 ng/mL). CONCLUSIONS Routine biochemical screening could identify children who are in need of intensive tobacco smoke exposure reduction interventions.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio.
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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