Smoking prevalence and desire to quit among employees in Transylvanian foster care homes.

OBJECTIVES: Few studies have investigated smoking habits among foster care home children and employees, who are at high risk for smoking. Additionally, there are no published studies on the intention to quit smoking among employees of the Romanian Child Protection system, a gap we address in this manuscript. METHODS: A repeated cross-sectional survey was conducted among foster care employees in three Transylvanian counties (Mures, Sibiu, Covasna) in January 2014 to February 2015 (baseline) and September-December 2016 (follow-up). A foster home-based smoking prevention and cessation intervention targeting employees and children was conducted between the two waves. Multivariate logistic regression analysis was conducted to determine associations between socio-demographics, reasons for smoking, tobacco use patterns, reasons for quitting, and tobacco policy attitudes on intention to quit (dependent variable), controlling for participation in the smoking prevention intervention. RESULTS: 305 employees participated in the baseline (76.4% of females, 23.6% of males) and 304 employees in the follow-up surveys (68.8% of females, 31.2% of males) after the smoking prevention and cessation intervention. At baseline, 34.8% of respondents reported that no one was smoking within the foster care home, which increased to 59.1% at follow-up (p < 0.001). Being male and a high level of professional satisfaction were the only correlates of intention to quit in the bivariate models at baseline. Professional satisfaction and a belief that smoking is bad for one's health were the only correlates of intention to quit at follow-up. In multivariable models, professional satisfaction was the only consistent predictor of intention to quit at both time points (OR 5.63, 95% CI 1.71-18.56; OR 4.98, 95% CI 1.43-17.30). CONCLUSIONS: Efforts should be made to promote cessation among foster care employees that includes evidence-based support, along with compliance to policies that prohibit smoking indoors to reinforce cessation efforts.

Tobacco use among children in Romanian foster care homes.

BACKGROUND: Children living in facilities under the supervision of child protection authorities are vulnerable to early smoking experimentation. This is the first study to report the prevalence and correlates of smoking behaviour among foster care home residents in Romania. METHODS: We conducted an in-person, cross-sectional survey of 914 resident children in 148 foster care homes of four Transylvanian counties. We included children <18 and those with complete tobacco use information in the analytical sample (n = 791). Sociodemographic, peer and foster family characteristics were evaluated for their influence on tobacco experimentation and past 30-day use. RESULTS: Respondents included 50.7% girls of average age 13.6 years (range 8-17). Almost half reported ever experimenting with tobacco (44.6%) and approximately one in four reported past 30-day use (25.9%). Factors significantly associated with an increased odds of smoking experimentation and past 30-day use in the multivariable model included being 13-17 years old (vs. <12 years), having friends who are current smokers, and having a sibling who smokes. Living in a home with a foster mother or foster father who smokes was associated with increased odds of experimentation and past-30 day use, respectively. The longer time living in foster care was associated with decreased odds of experimentation and past 30-day use controlling for all covariates. CONCLUSION: Anti-tobacco programmes that incorporate the role family and peers to reduce smoking are needed to address the high rates of use among Romanian foster care children.