The Pap smear screening as an occasion for smoking cessation and physical activity counselling: effectiveness of the SPRINT randomized controlled trial.

BACKGROUND: The organized Cervical Cancer Screening Programme (CCSP) in Italy might represent an occasion to deliver smoking cessation (SC) counselling to women attending the Pap test examination. Evidence of effectiveness of physical activity (PA) promotion and intervention in adjunct to SC counselling is not strong.Objective of the SPRINT trial was to evaluate the effectiveness of a standard SC counselling intervention delivered by trained midwives in the CCSP, and whether the adjunct of a PA counselling to the SC counselling might increase quit rates. METHODS/DESIGN: We undertook a randomized controlled trial of 1,100 women undergoing the Pap examination in the three study centres Florence, Turin, and Mantua: 363 were randomly assigned to the SC counselling arm, 366 to the SC + PA counselling arm, and 371 to the control group. The intervention was a standard brief SC counselling combined with a brief counselling on increasing PA, and was tailored according to the Di Clemente-Prochaska motivational stages of change for SC and/or PA. Primary outcomes were quit rates, improvement in the motivational stages of change for SC, and reduced daily cigarette consumption. Analysis was by intention to treat. RESULTS: Participants randomized in both intervention arms and in the preparation stage of change for SC doubled their likelihood of quitting at 6-month follow-up in comparison to controls (odds ratio [OR]=2.1, 95% confidence interval [95% CI]:1.0-4.6). Moreover, participants in the intervention arms and in the contemplation stage were more likely to reduce their daily cigarette consumption after the intervention (OR=1.8, 95% CI:1.1-3.0). Our study did not show any effect of PA counselling on various outcomes. CONCLUSIONS: Smoking cessation counselling delivered by midwives to smokers in preparation and contemplation stages of change during the Pap-smear screening was effective and should be recommended, given the high number of women attending the cervical cancer screening programme in Italy. Moreover, the daily number of women invited for the Pap-smear examination should be slightly lowered, in order to let midwives deliver SC counselling to smokers. TRIAL REGISTRATION: Current Controlled Trials ISRCTN52660565.

The Pap smear screening as an occasion for smoking cessation and physical activity counselling: baseline characteristics of women involved in the SPRINT randomized controlled trial.

BACKGROUND: Gender-specific smoking cessation strategies have rarely been developed. Evidence of effectiveness of physical activity (PA) promotion and intervention in adjunct to smoking cessation programs is not strong. SPRINT study is a randomized controlled trial (RCT) designed to evaluate a counselling intervention on smoking cessation and PA delivered to women attending the Italian National Health System Cervical Cancer Screening Program. This paper presents study design and baseline characteristics of the study population. METHODS/DESIGN: Among women undergoing the Pap examination in three study centres (Florence, Turin, Mantua), participants were randomized to the smoking cessation counselling [S], the smoking cessation + PA counselling [S + PA], or the control [C] groups. The program under evaluation is a standard brief counselling on smoking cessation combined with a brief counselling on increasing PA, and was delivered in 2010. A questionnaire, administered before, after 6 months and 1 year from the intervention, was used to track behavioural changes in tobacco use and PA, and to record cessation rates in participants. DISCUSSION: Out of the 5,657 women undergoing the Pap examination, 1,100 participants (55% of smokers) were randomized in 1 of the 3 study groups (363 in the S, 366 in the S + PA and 371 in the C groups). The three arms did not differ on any demographic, PA, or tobacco-use characteristics. Recruited smokers were older, less educated than non-participant women, more motivated to quit (33% vs.9% in the Preparation stage, p < 0.001), smoked more cigarettes per day (12 vs.9, p < 0.001), and were more likely to have already done 1 or more quit attempts (64% vs.50%, p < 0.001). The approach of SPRINT study appeared suitable to enrol less educated women who usually smoke more and have more difficulties to quit. TRIAL REGISTRATION NUMBER: ISRCTN: ISRCTN52660565.

Wheeze and asthma in children: associations with body mass index, sports, television viewing, and diet.

BACKGROUND: Obesity, physical activity, and dietary habits are distinct but strongly interrelated lifestyle factors that may be relevant to the prevalence of wheeze and asthma in children. Our goal was to analyze the relationship of body mass index (BMI), regular sports participation, TV viewing, and diet with current wheezing and asthma. METHODS: We investigated 20,016 children, aged 6-7 years, who were enrolled in a population-based study. Parents completed standardized questionnaires. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), while adjusting for several confounders and simultaneously considering BMI, regular sports activity, TV viewing and selected dietary items. RESULTS: A total of 1575 children (7.9%) reported current wheezing and 1343 (6.7%) reported current asthma. In a multivariate model, an elevated BMI was associated with wheeze and current asthma: children from the highest quintile (compared with the lowest quintile) had an increased risk of wheeze (OR = 1.47; CI = 1.20-1.82) or current asthma (1.61; 1.28-2.01). Wheeze or asthma was not associated with regular sports activity. Subjects who spent 5 or more hours per day watching television were more likely to experience wheeze (1.53; 1.08-2.17) or current asthma (1.51; 1.04-2.2) compared with those who viewed TV less than 1 hour a day. Adding salt to food was strongly and independently associated with current wheeze (2.58; 1.41-4.71) and current asthma (2.68; 1.41-5.09). CONCLUSIONS: Our data support the hypothesis that high body weight, spending a lot of time watching television, and a salty diet each independently increase the risk of asthma symptoms in children.

[Prevalence of asthma and allergies among migrant children and adolescents in Italy]. / Prevalenza delle malattie respiratorie e allergiche in bambini e adolescenti immigrati in Italia.

Prevalence of asthma and allergies in children shows large variations among different populations, but there is limited evidence about these conditions in immigrants from developing countries. The aim of this study was to evaluate the prevalence of asthma symptoms and allergies in immigrant children and adolescents living in Italy and to investigate the possible role of genetic and environmental factors in the development of such diseases. There were 1340 (4.0%) immigrants in Italy, mainly from East Europe (31.7%); 532 were born in Italy to foreign parents and 808 were born abroad. Asthma and other atopic diseases were on the whole significantly less common among immigrant children than among Italians, while some infectious diseases in the first two years of life resulted more present in immigrant children than in Italians.

[Environmental, social and demographic characteristics of children and adolescents, resident in different Italian areas]. / Caratteristiche demografiche, sociali e stili di vita della popolazione infantile in varie aree geografiche italiane.

The second phase of the SIDRIA study provides important information regarding the family characteristics of Italian children (6-7 years old) and adolescents (13-14 years old), and the frequency of risk factors for asthma and allergies, allowing comparisons between study areas according to differences in latitude (North, Centre, South) and urbanization level (metropolitan areas, with at least 500,000 inhabitants, and other areas). Parental education level was higher in metropolitan and central areas. The frequency of children and adolescents born abroad, and the percentage of mothers and fathers employed were higher outside metropolitan areas and there was an increase from the South to the North of Italy. This trend was paralleled by an increase in maternal age at child's birth and in the frequency of low birth weight and day care attendance. The frequency of breastfeeding was greater in children than in adolescents; the opposite was registered for passive smoking, with a frequency of exposure higher in adolescents than in children, especially in the Northern and Central areas, even if the proportion of subjects having at least one parent who smokes was still high in both age groups. The prevalence of overweight children was striking, especially in the South where physical activity was less frequent and children had the unhealthy habit of consuming a lot of snacks and carbonated beverages. Frequency of exposure to traffic in the area of residence was particularly high, especially in the metropolitan areas.

[Changes in social characteristics and risk factors for asthma and allergies among children and adolescents in Italy]. / I cambiamenti delle caratteristiche sociali e dei fattori di rischio per l'asma e le allergie tra i bambini e gli adolescenti italiani.

One of the main objectives of SIDRIA-2 study was to evaluate the possible changes in the occurrence of social characteristics and risk factors for asthma and allergies in childhood, comparing the data obtained in 2002 to those collected in 1994-1995. A positive change in socio-economic characteristics of the childrens' and adolescents' families was generally observed. The levels of exposure to outdoor (traffic) and indoor (passive smoking) pollutants are still high, although a decreasing trend in parents' smoking habits is evident.

Paracetamol and antibiotics in childhood and subsequent development of wheezing/asthma: association or causation?

BACKGROUND: Several studies found an association between early administration of paracetamol and antibiotics and development of wheezing. This could be due to confounding: wheeze and asthmatic symptoms in early childhood are difficult to distinguish from respiratory tract infections that are widely treated with these drugs; in case of persistence of symptoms up to school age, this could explain the observed relationship. METHODS: We investigated the association between paracetamol and antibiotics use in the first year of life and wheezing phenotypes, i.e. wheezing starting in different time periods (early, persistent and late-onset) in the SIDRIA-2 study, a cross-sectional survey of 16,933 children aged 6-7 years. Directed acyclic graph (DAG) was used to depict the causal structure. RESULTS: Paracetamol and antibiotics administration in the first year were associated with early wheezing (first 2 years of life only) [odds ratio (OR): 2.27; 95% confidence interval (95% CI): 1.98-2.62 and OR = 3.76, 95% CI: 3.31-4.27] and with persistent wheezing (first 2 years + last 12 months) (OR = 1.77, 95% CI: 1.49-2.10 and OR = 3.06, 95% CI: 2.60-3.60), whereas the association with late-onset wheezing (in the last 12 months only) was weak (OR = 1.12, 95% CI: 0.97-1.31 and OR = 1.18, 95% CI: 1.02-1.38 for paracetamol and antibiotics, respectively). DAG shows that even in the absence of a direct (causal) arrow from early drugs use to wheezing at school age, the two are associated due to confounding (through the 'infection' node). CONCLUSIONS: It is important to take into account different phenotypes in order to disentangle the association of paracetamol and antibiotics with wheezing.

Maternal complications and procedures in pregnancy and at birth and wheezing phenotypes in children.

RATIONALE: There is increasing interest in the potential influence of fetal and early life conditions on childhood wheezing. OBJECTIVES: To investigate the associations between maternal complications and procedures in pregnancy and at birth and the risk of various wheezing phenotypes in young children. METHODS: We studied 15,609 children, aged 6-7 yr, enrolled in a population-based study. Standardized questionnaires were completed by the children's mothers. RESULTS: Of the children, 9.5% (1,478) had transient early wheezing, 5.4% (884) had persistent wheezing, and 6.1% (948) had late-onset wheezing. Maternal hypertension or preeclampsia was associated with an increased risk of all three wheezing phenotypes (for transient early wheezing: odds ratio [OR], 1.40; 95% confidence interval [95% CI], 1.08-1.82; for persistent wheezing: OR, 1.59; 95% CI, 1.15-2.19; and for late-onset wheezing: OR, 1.47; 95% CI, 1.06-2.01). Use of antibiotics for urinary tract infections was associated with transient early wheezing (OR, 1.52; 95% CI, 1.16-2.00), whereas antibiotic administration at delivery was associated with both transient early wheezing (OR, 1.21; 95% CI, 1.01-1.46) and persistent wheezing (OR, 1.39; 95% CI, 1.10-1.75). Children who had a mother with diabetes were also more likely to have persistent wheezing (OR, 1.72; 95% CI, 0.99-3.00). Neither amniocentesis/chorionic villus sampling, nor weight gain in pregnancy, nor cesarean section was associated with the subsequent development of wheezing. Maternal asthma or atopy was not an effect modifier of the associations found. CONCLUSIONS: Some maternal complications during pregnancy and at delivery may increase the risk of developing different phenotypes of wheezing in childhood.