Parent smoker role conflict and planning to quit smoking: a cross-sectional study

The effects of planned education given to parents on smoking in the home environment and passive exposure of children aged 0-5: A quasi-experimental pre-post intervention study from Turkey

PURPOSE

This study was carried out to determine the effects of planned education given to parents on smoking status at home and on children's passive smoking exposure.

DESIGN AND METHODS

This quasi-experimental study was conducted with the inclusion of 40 parents with at least one child between the ages of 0 and 5 and smoking in their homes, who were registered at a Family Health Center in a city center in the Central Anatolia Region of Turkey, from 1 September 2019 to 30 June 2020. The data of the study were collected using Participant Screening Form, a Personal Information Form, the Fagerstrom Test for Nicotine Dependence, a Smoking Behaviors and Precautions at Home Form, and a Measurement and Follow-up Form. The collected data were analyzed using the SPSS 23.0 package software.

RESULTS

In the follow-ups after the planned smoking cessation training given to the parents, the carbon monoxide measurements at their homes decreased significantly throughout the four follow-ups, the number of parents who presented to the smoking cessation outpatient clinic increased, and the number of smoking parents decreased (p < 0.05).

CONCLUSIONS

It was concluded that the planned education that was given to smoker parents reduced the smoking rates of the parents, lowered the carbon monoxide values measured in their home environments, and thus, it was effective in reducing the passive exposure of their children at the ages of 0 to 5 years to cigarette smoke.

PRACTICE IMPLICATIONS

Parents who are addicted to cigarettes should be encouraged not to smoke at home, and homes should be included in closed environments where smoking is prohibited.

Phenomenological insight into the motivation to quit smoking

INTRODUCTION

Quitting tobacco is often viewed as a difficult experience as the dependence includes sets of behavioral, cognitive, social, and physiologic phenomena that prevent most smokers from having a successful first attempt of quitting. The aim of this qualitative study was to gain insight into and understand the motivation for attempts to quit smoking in relation to the stages of the behavior change model.

METHOD

The study team based this qualitative study on Alfred Schütz's social phenomenology framework. The study team planned for fourteen in-depth interviews with patients registered at a Quit Smoking Clinic. Each in-depth session lasted 45-60 min and we audio recorded them with consent. Following full verbatim transcription, the study team carried out detailed thematic analysis using Nvivo software.

RESULTS

Out of a total of 14 patients, 10 agreed to participate (response rate 71.4%). Seven participants (70%) had successfully quit smoking, while the remaining 30% relapsed after the first quit attempt. The study team extracted from the data three key themes with eight child nodes: barriers to quitting smoking, reasons for quit attempt, and how to quit. Unsuccessful attempts were related to tobacco addiction and successful attempts were based on the need to improve one's health and family. The study explored two intrinsic (self-realization and healthy lifestyle) and two extrinsic motivations (family's health and role model for children) for attempting to quit.

CONCLUSION

The study highlights the importance of psychological support in successful quit attempts. Treatment providers should encourage behavior change through intrinsic goals, as such goals, compared to extrinsic goals, have a long-term and positive impact because they can activate autonomous motivation.

Program uptake of a parent-tailored telephone smoking cessation counselling: An examination of recruitment approaches

INTRODUCTION

Recently, a Dutch proactive parent-tailored telephone smoking cessation counselling program, Smoke-free Parents (SFP), was demonstrated to be effective in helping parents to quit smoking. This study aimed to examine the program’s uptake and the costs of two recruitment approaches (i.e. healthcare vs mass media) for SFP. In addition, parent’s barriers to participating in SFP and the characteristics of participating parents were assessed.

METHODS

As part of an effectiveness-implementation hybrid trial, 402 smoking parents were recruited via healthcare settings and mass media for an informal, proactive, and free phone call with a smoking cessation counsellor about SFP (the Netherlands, September 2016 – September 2018). Parents were asked whether they wanted to participate in SFP. If parents refused, reasons for decline and additional information (e.g. educational level) were collected.

RESULTS

Results revealed that 26.4% of the recruited parents participated in SFP. Although the program uptake of parents recruited via mass media was slightly, but not significantly, higher than via healthcare (27.3% vs 26.8%, p=0.92), the healthcare approach resulted in lower costs per participant (€99.62 vs €205.72). Smoking cessation counsellors were unable to reach almost one-third (32.7%) of the parents after they had agreed to be called about SFP.

CONCLUSIONS

The present study showed that more than a quarter of all recruited parents participated in SFP and that the mass media approach and healthcare approach can be used to recruit parents for SFP. To increase the number of parents participating in SFP, it is important to overcome the identified barriers that prevent parents from participating.

"I can't stand it…but I do it sometimes" parental smoking around children: practices, beliefs, and conflicts - a qualitative study

BACKGROUND

Many parents continue to smoke around their children despite the widely known risks of children's exposure to tobacco smoke. We sought to learn about parental smoking behavior around children from parents' perspective.

METHODS

Semi-structured interviews were conducted with 65 smoking parents or partners of smoking parents of children up to age 7, to learn about home smoking rules, behaviours performed to try to protect children, and smoking-related conflicts, from parents' perspective. Interviews were recorded and transcribed and thematic analysis performed. Recruitment was challenging due to the sensitive nature of the topic.

RESULTS

Many parents described smoking around their children in certain areas of the home, outdoors, and in what they consider to be open or ventilated areas. Participants emphasized efforts to protect their children and described various mitigating practices but held mixed views as to their effectiveness. Parents had different conceptions of which areas or distances were considered 'safe'. Many smoking parents described conflicts both internal and with other family members regarding the protection of children. Some parents who continue to smoke around their children despite understanding the health risks felt powerless to effect change, as well as being uncertain as to the effectiveness of their protective strategies; others were aware but reluctant to change.

CONCLUSION

Findings shed light on some of the difficulties faced by smoking parents and obstacles to maintaining a smoke-free environment for their children, providing insight for the type of information and support required to help parents better protect their children from exposure to tobacco smoke. Awareness of health risks associated with secondhand smoke was demonstrated, yet parents in smoking families were confused regarding which rules and behaviours best protect children from exposure to tobacco smoke. Parents were sometimes aware that their smoking 'rules' and mitigating practices were limited in their effectiveness. Guidelines should be provided explaining how and when exposure occurs and how to keep children safe.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

BACKGROUND

Children's exposure to other people's tobacco smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children in child care or educational settings are also at risk of exposure to ETS. Preventing exposure to ETS during infancy and childhood has significant potential to improve children's health worldwide.

OBJECTIVES

To determine the effectiveness of interventions designed to reduce exposure of children to environmental tobacco smoke, or ETS.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), and the Social Science Citation Index & Science Citation Index (Web of Knowledge). We conducted the most recent search in February 2017.

SELECTION CRITERIA

We included controlled trials, with or without random allocation, that enrolled participants (parents and other family members, child care workers, and teachers) involved in the care and education of infants and young children (from birth to 12 years of age). All mechanisms for reducing children's ETS exposure were eligible, including smoking prevention, cessation, and control programmes. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions.

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed studies and extracted data. Due to heterogeneity of methods and outcome measures, we did not pool results but instead synthesised study findings narratively.

MAIN RESULTS

Seventy-eight studies met the inclusion criteria, and we assessed all evidence to be of low or very low quality based on GRADE assessment. We judged nine studies to be at low risk of bias, 35 to have unclear overall risk of bias, and 34 to have high risk of bias. Twenty-one interventions targeted populations or community settings, 27 studies were conducted in the well-child healthcare setting and 26 in the ill-child healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether visits were made to well- or ill-children, and another included visits to both well- and ill-children. Forty-five studies were reported from North America, 22 from other high-income countries, and 11 from low- or middle-income countries. Only 26 of the 78 studies reported a beneficial intervention effect for reduction of child ETS exposure, 24 of which were statistically significant. Of these 24 studies, 13 used objective measures of children's ETS exposure. We were unable to pinpoint what made these programmes effective. Studies showing a significant effect used a range of interventions: nine used in-person counselling or motivational interviewing; another study used telephone counselling, and one used a combination of in-person and telephone counselling; three used multi-component counselling-based interventions; two used multi-component education-based interventions; one used a school-based strategy; four used educational interventions, including one that used picture books; one used a smoking cessation intervention; one used a brief intervention; and another did not describe the intervention. Of the 52 studies that did not show a significant reduction in child ETS exposure, 19 used more intensive counselling approaches, including motivational interviewing, education, coaching, and smoking cessation brief advice. Other interventions consisted of brief advice or counselling (10 studies), feedback of a biological measure of children's ETS exposure (six studies), nicotine replacement therapy (two studies), feedback of maternal cotinine (one study), computerised risk assessment (one study), telephone smoking cessation support (two studies), educational home visits (eight studies), group sessions (one study), educational materials (three studies), and school-based policy and health promotion (one study). Some studies employed more than one intervention. 35 of the 78 studies reported a reduction in ETS exposure for children, irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure but rather sought to reduce symptoms of asthma, and found a significant reduction in symptoms among the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions.

AUTHORS' CONCLUSIONS

A minority of interventions have been shown to reduce children's exposure to environmental tobacco smoke and improve children's health, but the features that differentiate the effective interventions from those without clear evidence of effectiveness remain unclear. The evidence was judged to be of low or very low quality, as many of the trials are at a high risk of bias, are small and inadequately powered, with heterogeneous interventions and populations.

Healthy families: study protocol for a randomized controlled trial of a screening, brief intervention, and referral to treatment intervention for caregivers to reduce secondhand smoke exposure among pediatric emergency patients

Background

Involuntary exposure to secondhand smoke (SHSe) is an important cause of morbidity in children who present to the pediatric emergency department (PED) and urgent care (UC). SHSe interventions delivered in the PED and UC would benefit both the smoker and child, but there have been no large trials testing the efficacy of such interventions. The Healthy Families program is the first randomized controlled trial to test whether a screening, brief intervention, and referral to treatment (SBIRT) intervention delivered in the PED and UC will be effective in decreasing SHSe in children and increasing cessation in smokers.

Methods/design

This trial uses a randomized, two-group design in which caregiver-smokers of children 0–17 years old are recruited from the PED and UC. Eligible caregiver-smokers are randomized to either the: 1) SBIRT Condition with face-to-face, tailored counseling that focuses on the child’s illness, the importance of reducing child SHSe, caregiver smoking cessation, and the option to receive nicotine replacement therapy; or 2) Healthy Habits Control Condition which includes face-to-face, tailored attention control “5–2–1-0” counseling that focuses on improving the child’s health. Dyadic assessments are conducted in-person at baseline, and via email, phone, or in-person at 6-weeks and 6-months. The primary outcomes are biochemically-verified, 7-day point prevalence and prolonged smoking abstinence. Secondary outcomes are cigarettes smoked per week, 24 h quit attempts, and biochemically validated child SHSe at each time point. The costs of this intervention will also be analyzed.

Discussion

This study will test an innovative, multilevel intervention designed to reduce child SHSe and increase smoking cessation in caregivers. If effective and routinely used, this SBIRT model could reach at least one million smokers a year in the U.S., resulting in significant reductions in caregivers’ tobacco use, SHSe-related pediatric illness, and healthcare costs in this population of children.

Trial registration

ClinicalTrials.gov Identifier: NCT02531594. Date of registration: August 4, 2015.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4278-8) contains supplementary material, which is available to authorized users.

A Cross-Sectional Study of Happiness and Smoking Cessation among Parents

INTRODUCTION

Smoking cessation among adults is associated with increased happiness. This association has not been measured in parents, a subset of adults who face uniquely stressful and challenging circumstances that can affect happiness.

AIMS

To determine if parental smoking cessation is associated with increased happiness and to identify characteristics of parental quitters who experience increased happiness.

METHODS

1355 parents completed a 12-month follow-up interview from a U.S. national trial, Clinical Effort Against Secondhand Smoke Exposure (CEASE). Multivariable logistic regression examined if level of happiness was independently associated with quitting smoking and identified characteristics associated with feeling happier after quitting smoking.

RESULTS/FINDINGS

Parents' level of happiness was independently associated with quitting smoking (aOR=1.60, 95% CI=1.42-1.79). Factors associated with increased happiness among quitters include engaging in evidence-based cessation assistance (aOR=2.69, 95% CI=1.16-6.26), and adopting strictly enforced smoke-free home (aOR=2.55, 95% CI=1.19-5.48) and car (aOR=3.85, 95% CI=1.94-7.63) policies. Additionally, parents who believed that being a smoker got in the way of being a parent (aOR=5.37, 95% CI=2.61-11.07) and who believed that thirdhand smoke is harmful to children (aOR=3.28, 95% CI=1.16-9.28) were more likely to report feeling happier after quitting.

CONCLUSIONS

Parents who quit smoking reported being happier than parents who did not quit. Though prospective studies can clarify what factors cause an increase in happiness, letting pediatricians know that most parents who smoke report being happier when quitting may facilitate communication with parents around cessation.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier: NCT00664261.

Tobacco Use Disorder: A Family Disease

This clinical case presentation discusses a family in which 3 generations are affected by tobacco. The discussants discuss approaches to be taken to minimize the exposure of an infant to tobacco smoke from older relatives, behavioral and pharmacological approaches to assist smoking cessation, and concerns regarding electronic cigarettes.

Do partial home smoking bans signal progress toward a smoke-free home?

Understanding who establishes partial home smoking bans, what these bans cover, and whether they are an intermediate step in going smoke-free would help to inform smoke-free home interventions. Participants were recruited from United Way of Greater Atlanta's 2-1-1 contact center. Data were collected at baseline, 3 and 6 months via telephone interview. Participants (n = 375) were mostly African American (84.2%) and female (84.3%). The majority (58.5%) had annual household incomes <$10,000. At baseline, 61.3% reported a partial smoking ban and 38.7% reported no ban. Existence of a partial ban as compared with no ban was associated with being female, having more than a high school education, being married and younger age. Partial bans most often meant smoking was allowed only in designated rooms (52.6%). Other common rules included: no smoking in the presence of children (18.4%) and smoking allowed only in combination with actions such as opening a window or running a fan (9.8%). A higher percentage of households with partial bans at baseline were smoke-free at 6 months (36.5%) compared with households with no bans at baseline (22.1%). Households with partial smoking bans may have a higher level of readiness to go smoke-free than households with no restrictions.

Overcoming challenges in the changing environment of practice-based research

PURPOSE

Conducting studies in national practice-based research networks presents logistic and methodologic challenges. Pediatric Research in Office Settings (PROS) has learned valuable lessons in implementing new strategies and adapting to challenges. We describe practical challenges and results of novel applied strategies in implementing and testing the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention as part of a national-level cluster-randomized controlled trial.

METHODS

In the trial, 20 PROS practices were randomized to either a CEASE intervention arm or a control arm. Parents of children seen in the office who indicated smoking in the past 7 days were asked to complete a postvisit enrollment interview and telephone interviews 3 and 12 months later. Identified challenges included (1) recruiting 20 practices serving a high percentage of parent smokers; (2) screening all parents bringing children for visits and enrolling eligible parents who smoked; and (3) achieving an acceptable 12-month telephone response rate.

RESULTS

A total of 47 interested practices completed the Practice Population Survey, of which 20 practices in 16 states completed parent enrollment. Thirty-two research assistants screened 18,607 parents and enrolled 1,980 of them. The initial telephone interview response rate was 56% at 12 months, with incorrect and disconnected numbers accounting for nearly 60% of nonresponses. The response rate rose to 67% after practices supplied 532 new contact numbers and 754 text messages were sent, with 389 parents completing interviews.

CONCLUSION

The strategies we used to overcome methodologic barriers in conducting a national intervention trial allowed data collection to be completed in the office setting and increased the telephone interview response rate.

Smoking, smoking cessation and tobacco control in rural China: a qualitative study in Shandong Province

Background

Smoking prevalence is high in China and even higher among rural residents. The aims of this study were: 1) to gain insights into the motivations of tobacco use and barriers to smoking cessation among rural village residents; 2) to understand the current tobacco control measures in the rural villages and barriers encountered or perceived for implementation.

Methods

Qualitative semi-structured face-to-face interviews and focus group discussions were conducted of 59 rural villagers including 37 village residents, 10 village leaders and 12 village doctors in three counties in Shandong Province, China.

Results

Smoking initiation was most often out of curiosity when seeing others smoke, but pressure from cigarette sharing and gifting custom was the major barrier to smoking cessation. The most important reason for quitting successfully was a detrimental health problem. Although many attempted to quit at the advice of other family members, relapses were common and few were able to quit completely and for long-term unless accompanied by significant health issues. Although doctor’s advice to quit is effective, many doctors do not offer advice to all patients. There is a lack of true understanding of the harm of smoking and second-hand smoking among the villagers and a lack of access to and knowledge of effective smoking cessation tools among both smokers and village doctors. Tobacco control activities at villages were rare and infrequent.

Conclusions

This study highlighted the need to develop tobacco control measures that reflect the unique culture in rural China. Smoking cessation measures are not likely to achieve large scale effect unless the prevailing cigarette sharing and gifting custom is drastically changed. More educations of the hazards of smoking and second-hand smoking to village residents and educations of effective smoking cessation treatment to both village residents and healthcare providers are needed.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

BACKGROUND

Children's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children are also at risk of exposure to ETS in child care or educational settings. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide.

OBJECTIVES

To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.

SEARCH METHODS

We searched the Cochrane Tobacco Addiction Group Specialized Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, CINAHL, ERIC, and The Social Science Citation Index & Science Citation Index (Web of Knowledge). Date of the most recent search: September 2013.

SELECTION CRITERIA

Controlled trials with or without random allocation. Interventions must have addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0 to 12 years). All mechanisms for reduction of children's ETS exposure, and smoking prevention, cessation, and control programmes were included. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcome measures, no summary measures were possible and results were synthesised narratively.

MAIN RESULTS

Fifty-seven studies met the inclusion criteria. Seven studies were judged to be at low risk of bias, 27 studies were judged to have unclear overall risk of bias and 23 studies were judged to have high risk of bias. Seven interventions were targeted at populations or community settings, 23 studies were conducted in the 'well child' healthcare setting and 24 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether the visits were to well or ill children, and another included both well and ill child visits. Thirty-six studies were from North America, 14 were in other high income countries and seven studies were from low- or middle-income countries. In only 14 of the 57 studies was there a statistically significant intervention effect for child ETS exposure reduction. Of these 14 studies, six used objective measures of children's ETS exposure. Eight of the studies had a high risk of bias, four had unclear risk of bias and two had a low risk of bias. The studies showing a significant effect used a range of interventions: seven used intensive counselling or motivational interviewing; a further study used telephone counselling; one used a school-based strategy; one used picture books; two used educational home visits; one used brief intervention and one study did not describe the intervention. Of the 42 studies that did not show a significant reduction in child ETS exposure, 14 used more intensive counselling or motivational interviewing, nine used brief advice or counselling, six used feedback of a biological measure of children's ETS exposure, one used feedback of maternal cotinine, two used telephone smoking cessation advice or support, eight used educational home visits, one used group sessions, one used an information kit and letter, one used a booklet and no smoking sign, and one used a school-based policy and health promotion. In 32 of the 57 studies, there was reduction of ETS exposure for children in the study irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure, but rather aimed to reduce symptoms of asthma, and found a significant reduction in symptoms in the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions.

AUTHORS' CONCLUSIONS

While brief counselling interventions have been identified as successful for adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. Although several interventions, including parental education and counselling programmes, have been used to try to reduce children's tobacco smoke exposure, their effectiveness has not been clearly demonstrated. The review was unable to determine if any one intervention reduced parental smoking and child exposure more effectively than others, although seven studies were identified that reported motivational interviewing or intensive counselling provided in clinical settings was effective.

Household smoking restrictions related to secondhand smoke exposure in Guangdong, China: a population representative survey

INTRODUCTION

China has a higher household secondhand smoke exposure rate than other countries. This study aims to estimate the prevalence rate of households implementing smoking bans in Guangdong and to identify factors correlated with household smoking bans.

METHODS

A cross-sectional, stratified random cluster sampling survey was conducted in Guangdong in 2010. A total of 2,114 adults aged 15 and older completed the face-to-face interviews with a response rate of 70%. The survey employed an adapted and validated questionnaire from the China Global Adult Tobacco Survey. Household smoking policy was divided into 3 groups: full ban, partial ban, and no ban. A multiple logistic regression model was employed to explore factors related to a full household smoking ban.

RESULTS

The survey found 14.2% of respondents reported a full ban, 23.6% reported a partial ban, and 62.2% reported no ban of smoking at home. Current smoking status was the strongest predictor for less restrictive household smoking policies (odds ratio [OR] = 4.9, 95% CI = 2.634-8.999). Our study suggested that people with a high level of education were more likely to implement a full household smoking ban (OR = 4.4, 95% CI = 2.388-8.178). Additionally, urban residents were significantly more likely to report a full household smoking ban than rural residents (OR = 1.67, 95% CI = 1.202-2.322).

CONCLUSIONS

Household smoking bans were not sufficiently established in Guangdong, China. Intensified efforts were called to promote home smoking bans, especially for those with a lower education level, with lower income, and living in rural areas.