Smoking at home: the impact of smoking cessation on nonsmokers' exposure to environmental tobacco smoke

Cigarette Use among Parents with Children in the Home: A Comparison of Civilian Parents and Parents with a Military Connection

We tested the null hypothesis of equal likelihood of cigarette use among parents with a military connection and parents without a military connection, and independently compared risk factors for cigarette use. We obtained National Health Interview Survey (NHIS) data from 2015 to 2019 survey waves. We delimited analysis to 2-parent households who reported children aged <18 years living with them. After a 2:1 nonparametric age matching procedure, our sample included 1106 civilian parents and 553 parents with a military connection. Using the NHIS survey-design weights, we estimated a design-based F statistic for differences in cigarette use by military connection status. We also estimated population-stratified, survey-weighted multivariable logistic regression models to determine risk factors for parent cigarette use. Whereas 6.87% parents with a military connection used cigarettes, 16.64% of age-matched civilian parents reported cigarette use. This difference was significant even after adjustment for covariates (aOR = 0.49, 95% CI = 0.32, 0.74). Recommendations for programing and policy are provided.

Parental smoking and children undergoing anesthesia: Is there a role for pediatric hospitals in smoking cessation?

PURPOSE

Pediatric hospitals within the Children's Hospital Association were surveyed to determine their tobacco cessation efforts for parents/patients.

DESIGN AND METHODS

Electronic surveys were sent to 75 anesthesia providers and/or preoperative surgery specialists at 41 facilities.

RESULTS

A total of 52 completed surveys were returned. The majority (97%) of facilities were smoke-free, and 68% included preoperative questions about parental smoking and secondhand smoke (SHS) exposure. Few offered cessation assistance.

PRACTICE IMPLICATIONS

Pediatric hospitals have a role in parental smoking cessation. This article provides recommendations for pediatric hospitals to assist parents to overcome their addiction to tobacco as they strive to provide the best possible healthcare services for children.

Parental psychosocial predictors of secondhand smoke exposure (SHSe) for children with cancer

Children with cancer are at greater risk for the negative consequences of secondhand smoke exposure, making the identification of predictors of exposure critical. The current study investigated the impact of parents' psychosocial variables (perceived stress and vulnerability, self-efficacy), as well as health-related and demographic variables, on children's current exposure levels. Data were from 135 families whose children (M = 8.6 years old) lived with a smoker and were being treated for cancer. Self-efficacy was the consistent significant psychosocial predictor of exposure and the time since a child's diagnosis was indicative of lower exposure when limiting the sample to only smoking parents (n = 95). Both predictors of exposure have implications on motivation for behavioral change and may be suggestive of a teachable moment. Interventions may profit from tailoring programs to families based on these predictors of exposure, in particular for tobacco-based interventions for parents of medically compromised children, such as children with cancer.

Targeting African American nonsmokers to motivate smokers to quit: a qualitative inquiry

African Americans bear a disproportionate health burden from smoking but are less likely than other populations to engage in cessation treatment. Intervening on adult nonsmokers residing with a smoker might represent an innovative approach to motivate smokers to engage in smoking behavior change. Twelve focus groups were conducted with African American smokers (four groups, n = 27), nonsmokers (four groups, n = 26) and pairs of cohabitating smokers and nonsmokers (four groups, n = 22) to assess attitudes and/or beliefs regarding engaging a nonsmoker in the home in smoking behavior change efforts. Participants ( N = 75) were middle-aged (45.1 ±3.7 years) females (68.0%) with 11.8 ±1.5 years of education. Smokers smoked 14.9 ±11.3 cigarettes per day, made 3.0 ±4.4 quit attempts in the past year, and are interested in receiving cessation assistance from a nonsmoker in their home. African American nonsmokers living with a smoker may be an appropriate target group to motivate smoking behavior change in the smoker. Suggestions for future research considerations are provided.

Can parents of children with cancer accurately report their child's passive smoking exposure?

INTRODUCTION

This study examined whether children with cancer are exposed to measurable levels of passive smoke as assessed by parent report and laboratory measures of urine cotinine, an established biomarker of passive smoke exposure (PSE). It also determined whether parents/caretakers of young cancer patients can provide valid reports of their child's PSE during the child's treatment, by examining their association with urine cotinine measures.

METHODS

Participants included 124 parents of a child with cancer who lived with at least one adult smoker in the home and was exposed to tobacco smoke in the home and/or car. Eligible patients were younger than 18 years of age, were receiving active treatment for cancer at a large pediatric oncology institution, were at least 30 days postdiagnosis, and did not smoke. Parents provided information about smoking and their child's PSE by responding to a series of questionnaires. Patients provided urine samples for cotinine analyses.

RESULTS

Findings showed that parents provided valid short-term accounts of their child's PSE in the context of their child's cancer treatment. Parent reports of PSE showed moderately strong positive relationships with urine cotinine levels which were stronger for reports provided by parents who smoked compared with nonsmoking parents.

DISCUSSION

Parent reports of PSE were validated by positive and significant associations with urine cotinine. Reports provided in the context of possible verification by biomarker assays can provide sufficiently accurate estimates of PSE to serve as outcome measures for clinical research and clinical care in a pediatric cancer setting.

Clinical effort against secondhand smoke exposure: development of framework and intervention

OBJECTIVE

The purpose of this work was to describe a novel process and present results of formative research to develop a pediatric office intervention that uses available systems of care for addressing parental smoking.

METHODS

The scientific development of the intervention occurred in 3 stages. In stage 1, we designed an office system for parental tobacco control in the pediatric outpatient setting on the basis of complementary conceptual frameworks of preventive services delivery, conceptualized for the child health care setting through a process of key interviews with leaders in the field of implementing practice change; existing Public Health Service guidelines that had been shown effective in adult practices; and adaptation of an evidence-based adult office system for tobacco control. This was an iterative process that yielded a theoretically framed intervention prototype. In stage 2, we performed focus-group testing in pediatric practices with pediatricians, nurses, clinical assistants, and key office staff. Using qualitative methods, we adapted the intervention prototype on the basis of this feedback to include 5 key implementation steps for the child health care setting. In stage 3, we presented the intervention to breakout groups at 2 national meetings of pediatric practitioners for additional refinements.

RESULTS

The main result was a theoretically grounded intervention that was responsive to the barriers and suggestions raised in the focus groups and at the national meetings. The Clinical Effort Against Secondhand Smoke Exposure intervention was designed to be flexible and adaptable to the particular practices' staffing, resources, and physical configuration. Practice staff can choose materials relevant to their own particular systems of care (www.ceasetobacco.org).

CONCLUSIONS

Conceptually grounded and focus-group-tested strategies for parental tobacco control are now available for implementation in the pediatric outpatient setting. The tobacco-control intervention-development process might have particular relevance for other chronic pediatric conditions that have a strong evidence base and have available treatments or resources that are underused.

Measuring air quality to protect children from secondhand smoke in cars

BACKGROUND

Secondhand tobacco smoke (SHS) is a major, preventable contributor to acute and chronic adverse health outcomes that affect children disproportionately. The predominant source of SHS among children is domestic exposure, and while up to two thirds of U.S. households have car smoking bans, an unacceptable number of children remain vulnerable. To help promote more effective protection through legislation, health communication strategies, or behavioral interventions, data demonstrating the adverse effect of SHS on air quality in cars are needed.

METHODS

Secondhand tobacco smoke in a motor vehicle under actual driving conditions was monitored by measuring respirable suspended particles (RSPs) of less than 2.5 microns in diameter, and carbon monoxide. Forty-five driving trials were conducted, using teams of volunteer drivers and smokers recruited from the general community. Three smoking conditions (nonsmoking baseline, active smoking, and immediate post-smoking period, each 5 minutes) were crossed with two ventilation conditions (windows open, closed) in a 3 x 2 within-sessions factorial design.

RESULTS

The highest mean observed RSP level was 271 mug/m(3), which is unsafe, particularly for children. Peak RSP levels were considerably higher. RSPs and carbon monoxide increased significantly from baseline after smoking, and these increases were greatest during the closed ventilation condition, compared with open ventilation.

CONCLUSIONS

Private passenger cars are a domestic environment with the potential to yield unsafe levels of SHS contaminants. These data may assist policymakers and health advocates to promote protective strategies to ensure smoke-free domestic environments for children.

Household smoking bans and adolescents' perceived prevalence of smoking and social acceptability of smoking

OBJECTIVES

Household smoking bans might decrease the visibility of cigarette smoking and communicate nonsmoking social norms and parental attitudes to youths, which may serve as mediators to reduce smoking initiation. Whether they have these effects even if parents smoke or do not otherwise communicate strong disapproval of smoking to their children is not clear. We tested these hypotheses in multi-level analyses.

METHODS

A telephone survey of a random sample of 3831 Massachusetts adolescents (12-17 years) assessed respondents' perceptions of smoking prevalence and attitudes about the social acceptability of smoking in their community. The association of these outcomes with the presence of a smoking ban in the youths' home was tested in multivariate analyses that adjusted for town-level clustering and individual and environmental characteristics.

RESULTS

A household smoking ban was reported by 71% of all youths and 49% of youths who lived with smokers. In multivariate models, youths who had a household smoking ban were more likely to perceive a lower adult smoking prevalence (OR 2.1; 95% CI 1.7-2.5; P < 0.001), greater adult disapproval of adult smoking (OR 2.0; 1.5-2.6; P < 0.001) and of teen smoking (OR 1.5; 95% CI 1.2-1.9; P = 0.001).

CONCLUSIONS

Among adolescents, a household smoking ban was associated with a lower perceived prevalence of adult smoking in their communities and more negative attitudes about the social acceptability of smoking, two factors that affect the likelihood of smoking initiation. Household smoking bans had these effects even in the presence of two parental factors known to encourage adolescent smoking initiation (parental smoking and lack of perceived parental disapproval of youth tobacco use). This provides an additional rationale for promoting household smoking bans to parents.

Inmate exposure to secondhand smoke in correctional facilities and the impact of smoking restrictions

This study was undertaken to measure the passive smoking exposure of prisoners at three correctional facilities in the US and to evaluate the effectiveness of a ban on smoking in reducing these exposures at two of these facilities. The average weekly concentration of nicotine was measured in fixed locations within the correctional facilities using passive samplers. Samples were collected before and after a smoking ban was instituted, and after the policy was modified to allow smoking outdoors. Samples were collected in the living areas, near where inmates slept and watched TV, and in selected central facilities, including dining halls, visiting rooms, booking areas, and learning centers. Average weekly concentrations of nicotine were measured in 84 locations while smoking was allowed; changes in these concentrations were measured with 112 weekly samples 4 and 9 months after the policy restricting smoking was implemented The average concentrations of nicotine were high while smoking was allowed: most living and sleeping areas averaged 3-11 microg/m(3), but the gym that was used as a bunkroom averaged 25 microg/m(3); these values compare to an average of 2 microg/m(3) in the homes of smokers. The smoking ban significantly reduced nicotine concentrations in the living areas (P<0.01 at facility A and P<0.05 at facility B) to averages of 1.5-2.2 microg/m(3); all postban samples were less than 5 microg/m(3). In conclusion, secondhand smoke concentrations in correctional facilities can be quite high; however, policies banning smoking are effective in reducing, but not eliminating, these exposures.

State-of-the-art interventions for office-based parental tobacco control

Parental tobacco use is a serious health issue for all family members. Child health care clinicians are in a unique and important position to address parental smoking because of the regular, multiple contacts with parents and the harmful health consequences to their patients. This article synthesizes the current evidence-based interventions for treatment of adults and applies them to the problem of addressing parental smoking in the context of the child health care setting. Brief interventions are effective, and complementary strategies such as quitlines will improve the chances of parental smoking cessation. Adopting the 5 A's framework strategy (ask, advise, assess, assist, and arrange) gives each parent the maximum chance of quitting. Within this framework, specific recommendations are made for child health care settings and clinicians. Ongoing research will help determine how best to implement parental smoking-cessation strategies more widely in a variety of child health care settings.

Reported willingness among adolescent nonsmokers to help parents, peers, and others to stop smoking

BACKGROUND

This study of 1025 adolescent nonsmokers aged 11-19 years examined level of interest and factors associated with reported willingness to help someone stop smoking.

METHODS

Data were collected from a survey distributed primarily in the schools at four geographic and ethnically diverse study sites.

RESULTS

A total of 692 adolescents identified someone close to them who smokes whom they thought should quit. Of these, 90% reported that they would be willing to help this person stop smoking. Multivariate predictors of willingness to help were female gender, less difficulty reading English, and greater level of comfort with talking to the smoker about their smoking. The smoker that the adolescents were willing to help was most often a parent or same age friend.

CONCLUSIONS

If this strong interest among adolescents could be tapped, engaging teens as support persons could be a novel public health approach to reaching parents, adolescents, and other smokers in the population.

Effect of children on home smoking restriction by inner-city smokers

OBJECTIVE

The home is the site of the most significant environmental tobacco smoke (ETS) exposure for children. Surveys show that adults, including smokers, agree that smoking should be restricted in homes of smokers with children. However, in a national survey, only 12.5% of such homes are actually smoke-free. This study examined factors associated with home smoking restriction among inner-city smokers.

METHODS

A cross-sectional survey of 598 adult smokers who attended an inner-city community health center was conducted.

RESULTS

Home smoking restriction was reported by 38.2% of all smokers (95% confidence interval [CI]: 33.6%-42.8%). Univariate analysis showed smoking restriction was positively associated with presence of children and of a nonsmoking adult partner in the home, intentional limiting of smoking, stages of change, and fewer number of cigarettes smoked daily. On multivariate analysis, home smoking restriction was more likely with the presence of a child (odds ratio: 2.63; 95% CI: 1.70-4.08) and a nonsmoking adult partner (odds ratio: 2.30; 95% CI: 1.32-4.02) in the home.

CONCLUSIONS

The presence of children and of nonsmoking adults is associated with the practice of smoking restriction in the homes of inner-city smokers. These findings suggest that inner-city smokers are concerned about health effects of ETS on children. Health professionals should target nonsmoking adult members of households with children and smokers but no home smoking restriction and emphasize the health effects of ETS on children as a motivation for smoking parents to limit exposure and to quit smoking.

Social environment effects on health and aging: integrating epidemiologic and demographic approaches and perspectives

This paper provides an overview of epidemiological and demographic research linking social characteristics of both individuals and communities to differences in both morbidity and mortality risks. Evidence is presented linking three broad aspects of the social environment to health--the network of personal social relationships within which most of us live our lives, individual socioeconomic status (SES), and community-level social characteristics. Large and consistent bodies of literature from both epidemiology and demography provide clear evidence for the generally health-promoting effects of personal social relationships and SES. The bulk of the evidence relates to mortality although both fields have begun to examine other health outcomes, including aspects of physical and cognitive functioning as well as disease outcomes. A smaller but growing body of community-level data, reflecting both the socioeconomic/resource characteristics of these broader communities and, more specifically, social features of these environments, also point to health impacts from these more macro level social environment characteristics. Much remains to be elucidated, however, concerning the actual mechanisms through which something as complex and multifaceted as SES "gets under the skin." This necessarily includes consideration of external characteristics of the environments (both physical and sociocultural) where people live and work, and individual characteristics, as well as possible interactions between these in producing the observed SES gradients in health and mortality. These questions concerning links between social environment conditions and health may be a particularly fruitful area of future collaboration, drawing on the shared interest of demographers and epidemiologists in understanding how different social conditions promote variation in distributions of better versus worse health outcomes within a population.

Smoking in correctional facilities: a survey of employees

OBJECTIVE

To assess level of endorsement and expected consequences of worksite smoking restriction policies among correctional employees.

DESIGN

Mailed survey to Vermont state correctional employees.

MAIN OUTCOME MEASURES

Support for various policy alternatives for both staff and inmate smoking; expected consequences of restrictive smoking policies and smoking behaviour.

PARTICIPANTS

321 of 640 (50%) state correctional employees responded.

RESULTS

Employees were somewhat receptive to smoking restrictions for inmates, but less supportive of staff smoking restrictions. A complete ban on inmate smoking both indoors and outdoors was supported by 56% and 49% of never and ex-smokers, respectively, but only 15% of current smokers (p < 0.01). A similar ban on employee smoking was supported by 38% of never and ex-smokers, but only 3% of current smokers (p < 0.01). Overall, employees were most supportive (52%) of a policy for themselves that banned indoor smoking and restricted it to certain areas outdoors. Current smokers were more likely to expect negative consequences as a result of further restrictions than were never or ex-smokers.

CONCLUSIONS

Although our findings are limited by a low response rate, most employees support an indoor ban, but not a total ban on smoking. Employees generally favoured a policy that was slightly more restrictive than the current policy, but were less supportive of tighter smoking restrictions for themselves. However, a more restrictive smoking policy is likely to result in some degree of resistance among current smoking employees, who may require specific attention to address their opposition.

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors

PURPOSE

To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior.

DESIGN

Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program.

SETTING

Random telephone interviews within 18 California counties.

SUBJECTS

A representative sample of 1315 adult smokers, aged 25 years and older.

MEASURES

The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS).

RESULTS

Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05).

CONCLUSIONS

These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.

Health promoting effects of friends and family on health outcomes in older adults

OBJECTIVE

To highlight the significant impact of social relationships on health and illness and suggest implications of these effects for health promotion efforts among older adults.

DATA SOURCES

Published studies on social relationships and health (or health behaviors) for the period 1970-1998 were identified through MEDLINE by using the key words social relationships, social support, and health, as well as review of health-related journals such as the American Journal of Epidemiology, Annals of Epidemiology, American Journal of Public Health, Journal of Health and Social Behavior, Social Science and Medicine, and the Journals of Gerontology.

STUDY SELECTION

Major published original research was considered. Where published research was too extensive for full discussion of all studies, preference was given to studies focusing on older adults and those using stronger methodology (i.e., representative samples, longitudinal data, or multivariate analyses controlling for potential confounders).

DATA EXTRACTION

Reported findings were organized in terms of three major categories: (1) results related to major health outcomes such as mortality, CHD, and depression; (2) findings related to health behaviors; and (3) findings related to potential biological pathways for observed health effects of social relationships.

DATA SYNTHESIS

Protective effects of social integration with respect to mortality risk among older adults are the most thoroughly documented, although protective effects have also been documented with respect to risks for mental and physical health outcomes and for better recovery after disease onset. There is also now a growing awareness of the potential for negative health effects from social relationships that are characterized by more negative patterns of critical and/or demanding interactions, including increased risks for depression and angina. Biological pathways are suggested by evidence that more negative social interactions are associated with physiological profiles characterized by elevated stress hormones, increased cardiovascular activity, and depressed immune function, whereas more positive, supportive social interactions are associated with the opposite profile.

CONCLUSIONS

Available data clearly indicate that social relationships have the potential for both health promoting and health damaging effects in older adults, and that there are biologically plausible pathways for these effects. Such evidence suggests that aspects of the social environment could play an important role in future health promotion efforts for older adults, although careful consideration of both potentially positive as well as negative social influences is needed.

Measuring secondhand smoke exposure in babies: the reliability and validity of mother reports in a sample of low-income families

The reliability and validity of mother's reports of their infants' exposure to secondhand smoke (SHS) were examined in an ethnically diverse sample of low-income, low-education families (N = 141 mothers). At baseline and posttest, smoking mothers reported about their infants' SHS exposure at different locations and by different sources during the previous week. Findings show that mothers can give reliable accounts of the degree to which they contribute to their babies' SHS exposure. Mothers are able to differentiate between their own smoking behavior and the extent to which they expose their infants. Consistent with the overall exposure pattern, exposure caused by the mother and exposure occurring at home showed the strongest associations with biological and environmental measures. These findings suggest that smoking mothers can provide reliable and valid reports of the degree to which their infants are exposed to SHS.

Testing a model of avoiding environmental tobacco smoke in young adults

PURPOSE

To test an explanatory model of gender, self-efficacy, situational influences, and other health-promoting behaviors on the avoidance of environmental tobacco smoke (ETS) in young adults. ETS is a cause of lung cancer, pulmonary disease, and cardiovascular disease. Although young adults are at increased risk for ETS exposure, there are few behavioral studies of ETS exposure and no reported studies of ETS exposure in young adults. Although college students are often exposed to ETS, the college environment offers a setting in which the opportunities for change are substantial.

DESIGN

Model-testing. Data are reported on a convenience sample of 136 nonsmoking 18- to 25-year old students in one mid-atlantic U.S. university. This sample of nonsmokers was drawn from a larger sample of 241 smokers and nonsmokers in 1995. Model constructs were based on Pender's health promotion model (HPM).

METHODS

The General Self-efficacy Scale, Health Promotion Lifestyle Profile, and ETS Avoidance Scale were used along with items measuring ETS-avoidance efficacy and Living with Smoke. Path analysis was used to test the model.

FINDINGS

The trimmed explanatory model showed that 26% of the variance in avoiding ETS was accounted for by gender, having self-efficacy, and ETS-avoidance efficacy, not living with people who smoke, and performing other healthy behaviors. Being female and general self-efficacy indirectly influenced ETS avoidance through their effects on related health promoting behaviors.

CONCLUSIONS

The explanatory model of ETS avoidance can provide useful information for the development of interventions to prevent exposure to passive smoke. Given the occurrence of ETS exposure in young adults, longitudinal research using this explanatory model is yielding promising results. Enhancing the self-efficacy of young adults and encouraging healthy lifestyle behaviors may be an important factor in their avoidance of ETS.

An explanatory model of variables influencing health promotion behaviors in smoking and nonsmoking college students

College students can establish healthy lifestyle practices that can have lifelong implications. Many students, however, continue to engage in risky behaviors such as active and passive smoking. The purpose of this study was to test an explanatory model of variables which can influence health promotion behaviors in smoking and nonsmoking college students. Pender's Health Promotion Model provided the framework for the study. Health promotion behaviors were found to be most effective when students: had an increased self-efficacy, avoided environmental tobacco smoke (ETS), perceived themselves as healthy, were female, and had a powerful external and internal health locus of control. College students may benefit from health promotion interventions designed to influence the avoidance of ETS and alter perceptions of self-efficacy, control of health, and health status. Such interventions may result in a decrease in both active and passive smoking.

Household smoking restrictions and adolescents' exposure to environmental tobacco smoke

BACKGROUND

Reducing adolescents' exposure to environmental tobacco smoke (ETS) is an important public health goal. This paper identifies the linkage between young people's exposure at home and household smoking restrictions, and suggests the promotion of such restrictions as a strategy to reduce health risks.

METHODS

Data are from the 1993 Massachusetts Tobacco Survey, a telephone survey of 1,606 adolescents.

RESULTS

Seventy-eight percent of adolescents reported exposure to ETS during the preceding week. Reported hours of exposure at home were associated with the number of adult smokers in the household (P < 0.001). Fifty-three percent of teens who lived with smokers reported no smoking restrictions for family members, 22% reported designated smoking areas, and 25% reported smoking bans. Among those households, smoking restrictions for family members were associated with significant reductions in mean hours of ETS exposure reported: no restrictions were associated with 33.2 hr of exposure during the prior week, designated smoking areas--12.7 hr, and household smoking bans--2.4 hr. Restrictions on visitor smoking were associated with significant reductions in home ETS exposure for teens who lived with nonsmokers, but had no independent effect among teens who lived with smokers.

CONCLUSIONS

Health risks experienced by adolescents living with adult smokers can be substantially reduced by household smoking restrictions.