Implementation of a systematic tobacco treatment protocol in a surgical outpatient setting: a feasibility study.

Background: Smoking cessation programs started as late as 4 weeks before surgery reduce perioperative morbidity and death, yet outpatient clinic interventions are rarely provided. Our aim was to evaluate the feasibility of implementing a tobacco treatment protocol designed for an outpatient surgical setting. Methods: We completed a pre-post feasibility study of the implementation of a systematic, evidence-based tobacco treatment protocol in an outpatient colorectal surgery clinic. Outcomes included smoking prevalence, pre- and postimplementation smoker identification and intervention rates, recruitment, retention, smoking cessation and provider satisfaction. Results: Preimplementation, 15.5% of 116 surveyed patients were smokers. Fewer than 10% of surveyed patients reported being asked about smoking, and none were offered any cessation intervention. Over a 16-month postimplementation period, 1198 patients were seen on 2103 visits. Of these, 950 (79.3%) patients were asked smoking status on first visit and 1030 (86.0%) were asked on at least 1 visit. Of 169 identified smokers, 99 (58.6%) were referred to follow-up support using an opt-out approach. At 1-, 3- and 6-month follow-up, intention-to-quit rates among 78 enrolled patients were 24.4%, 22.9% and 19.2%, respectively. Postimplementation staff surveys reported that the protocol was easy to use, that staff would use it again and that it had positive patient responses. Conclusion: Implementation of our smoking cessation protocol in an outpatient surgical clinic was found to be feasible and used minimal clinic resources. This protocol could lead to increases in identification and documentation of smoking status, delivery of smoking cessation interventions and rates of smoking reduction and cessation.

Contexte: Les programmes d'abandon du tabagisme entamés jusqu'à 4 semaines avant une opération réduisent la morbidité et la mortalité périopératoires, mais les cliniques externes n'en proposent que rarement. L'étude visait à évaluer s'il est faisable d'appliquer un protocole de traitement du tabagisme pensé pour les milieux de soins chirurgicaux extrahospitaliers. Méthodes: Nous avons réalisé une étude de faisabilité pré- et postexpérimentale sur l'application d'un protocole de traitement systématique fondé sur des données probantes à une clinique externe de chirurgie colorectale. Les résultats à l'étude étaient les suivants : prévalence du tabagisme, identification des fumeurs et taux d'intervention avant et après la mise en place du protocole, recrutement, rétention, abandon du tabagisme et satisfaction des fournisseurs. Résultats: Au départ, 15,5 % des 116 patients sondés fumaient. Moins de 10 % des répondants avaient été questionnés sur leur statut tabagique, et aucun ne s'était vu proposer un programme d'abandon. Au cours des 16 mois suivant la mise en place du protocole, 1198 patients ont été rencontrés dans le cadre de 2103 consultations. Parmi eux, 950 (79,3 %) ont été interrogés sur leur statut tabagique à la première rencontre, et 1030 (86 %) l'ont été au moins 1 fois. Des 169 fumeurs identifiés, 99 (58,6 %) ont été orientés vers un programme de soutien selon une approche de consentement présumé. Après 1 mois, 24,4 % des 78 patients participants étaient déterminés à arrêter de fumer; 22,9 % l'étaient toujours après 3 mois, et 19,2 % après 6 mois. Les sondages menés a posteriori auprès du personnel indiquent que le protocole est facile à utiliser, que les employés s'en serviraient de nouveau, et que les patients l'ont accueilli favorablement. Conclusion: Il a été possible de mettre en place notre protocole d'abandon du tabagisme à une clinique externe de chirurgie, et ce en employant un minimum de ressources cliniques. Le protocole pourrait permettre de connaître et de consigner davantage de statuts tabagiques, d'orienter un plus grand nombre de fumeurs vers les programmes d'abandon et d'accroître les taux de réduction et d'abandon du tabagisme.

Developing patient resources to enable the exchange of healthy lifestyle information between clinicians and families of children with complex heart problems.

BACKGROUND: Healthy active lifestyles are critically important for children with complex heart problems (CHP) that affect heart structure, rhythm or function. They are at increased risk for morbidities such as atherosclerosis, obesity, anxiety and depression. Educating children with CHP and their families about the relevance of healthy lifestyles is an important part of clinical care. DESIGN: This study used a collaborative approach among six patients/family members and 22 health professionals to develop a series of knowledge-to-action tools suitable for counselling children with CHP and their families about their healthy lifestyle needs. METHODS: After development of the knowledge-to-action tools had been completed, one cardiologist and one research assistant implemented one or more of these new resources during each clinic visit as appropriate for each patient. Thirty-nine parents and eight children completed post-clinic interviews to explore their perceptions of the new resources. The nine resources developed included brochures and websites addressing physical activity with a heart condition, body contact restrictions, exercise test results, emotional health, finding community resources, encouragement for asking healthy lifestyle questions and a brief, in-clinic healthy lifestyle assessment. RESULTS: Families found the resources useful and helpful for clarifying their specific concerns. They also provided suggestions to improve the content and delivery of the resources so that they would be suitable for a variety of settings-schools, community and sports. CONCLUSION: Future research is required to evaluate the effectiveness of these resources for raising awareness and knowledge about healthy active lifestyles among children with CHP and the impact of these resources for changing healthy lifestyle behaviours.

Television viewing and food intake during television viewing in normal-weight, overweight and obese 9- to 11-year-old Canadian children: a cross-sectional analysis.

It is unclear if children of different weight status differ in their nutritional habits while watching television. The objective of the present paper was to determine if children who are overweight or obese differ in their frequency of consumption of six food items while watching television compared with their normal-weight counterparts. A cross-sectional study of 550 children (57·1 % female; mean age = 10 years) from Ottawa, Canada was conducted. Children's weight status was categorised using the Centers for Disease Control and Prevention cut-points. Questionnaires were used to determine the number of hours of television watching per day and the frequency of consumption of six types of foods while watching television. Overweight/obese children watched more television per day than normal-weight children (3·3 v. 2·7 h, respectively; P = 0·001). Obese children consumed fast food and fruits/vegetables more frequently while watching television than normal-weight or overweight children (P < 0·05). Children who watched more than 4 h of television per d had higher odds (OR 3·21; 95% CI 1·14, 9·03; P = 0·03) of being obese, independent of several covariates, but not independent of moderate-to-vigorous physical activity. The finding that both television watching and the frequency of consumption of some food items during television watching are higher in children who are obese is concerning. While the nature of the present study does not allow for the determination of causal pathways, future research should investigate these weight-status differences to identify potential areas of intervention.

Objectively-measured sleep and its association with adiposity and physical activity in a sample of Canadian children.

Cross-sectional associations between objectively-measured sleep duration, sleep efficiency and sleep timing with adiposity and physical activity were examined in a cohort of 567 children from Ottawa, Canada. Five-hundred and fifteen children (58.8% female; age: 10.0 ± 0.4 years) had valid sleep measurements and were included in the present analyses. Physical activity, sedentary time and sleep parameters were assessed over 7 days (actigraphy). Height, weight and waist circumference were measured according to standardized procedures. Percentage body fat was assessed using bioelectric impedance analysis. Light physical activity and sedentary time were greater in children with the shortest sleep durations (P < 0.0001), whereas children with the highest sleep efficiencies had lower light physical activity and more sedentary time across tertiles (P < 0.0001). In multivariable linear regression analyses, and after adjusting for a number of covariates, sleep efficiency was inversely related to all adiposity indices (P < 0.05). However, sleep duration and sleep timing were not associated with adiposity indices after controlling for covariates. Inverse associations were noted between sleep duration and light physical activity and sedentary time (P < 0.0001). Sleep efficiency (P < 0.0001), wake time and sleep timing midpoint (P < 0.05) were negatively associated with light physical activity, but positively associated with sedentary time. In conclusion, only sleep efficiency was independently correlated with adiposity in this sample of children. Participants with the shortest sleep durations or highest sleep efficiencies had greater sedentary time. More research is needed to develop better sleep recommendations in children that are based on objective measures of sleep duration, sleep efficiency and sleep timing alike.

Electronic screens in children's bedrooms and adiposity, physical activity and sleep: do the number and type of electronic devices matter?

OBJECTIVE: To examine whether the number and type of electronic screens available in children's bedrooms matter in their relationship to adiposity, physical activity and sleep. METHODS: A cross-sectional study was conducted involving 502 children aged 9-11 years from Ottawa, Ontario. The presence (yes/no) of a television (TV), computer or video game system in the child's bedroom was reported by the parents. Percentage body fat was measured using bioelectrical impedance. An accelerometer was worn over seven days to assess moderate-to-vigorous physical activity (MVPA), total sedentary time, sleep duration and sleep efficiency. Screen time was self-reported by the child. RESULTS: After adjustment for age, sex, ethnicity, annual household income and highest level of parental education, children with 2-3 screens in their bedroom had a significantly higher percentage of body fat than children with no screen in their bedroom. However, while children with 2-3 screens in their bedroom engaged in more screen time overall than those with no screen, total sedentary time and MVPA were not significantly different. Sleep duration was not related to the number of screens in the bedroom, but sleep efficiency was significantly lower in children with at least 2 screens in the bedroom. Finally, children having only a TV in their bedroom had significantly higher adiposity than those having no screen at all. In contrast, the presence of a computer in children's bedrooms was not associated with higher adiposity than that of children with no screen. CONCLUSIONS: A higher number of screens in a child's bedroom was associated with higher adiposity, more total screen time and lower sleep efficiency. Having a TV in the bedroom appears to be the type of screen presence associated with higher levels of adiposity. Given the popularity of screens among children, these findings are increasingly relevant to health promotion strategies.

Independent and combined associations of total sedentary time and television viewing time with food intake patterns of 9- to 11-year-old Canadian children.

The relationships among sedentary time, television viewing time, and dietary patterns in children are not fully understood. The aim of this paper was to determine which of self-reported television viewing time or objectively measured sedentary time is a better correlate of the frequency of consumption of healthy and unhealthy foods. A cross-sectional study was conducted of 9- to 11-year-old children (n = 523; 57.1% female) from Ottawa, Ontario, Canada. Accelerometers were used to determine total sedentary time, and questionnaires were used to determine the number of hours of television watching and the frequency of consumption of foods per week. Television viewing was negatively associated with the frequency of consumption of fruits, vegetables, and green vegetables, and positively associated with the frequency of consumption of sweets, soft drinks, diet soft drinks, pastries, potato chips, French fries, fruit juices, ice cream, fried foods, and fast food. Except for diet soft drinks and fruit juices, these associations were independent of covariates, including sedentary time. Total sedentary time was negatively associated with the frequency of consumption of sports drinks, independent of covariates, including television viewing. In combined sedentary time and television viewing analyses, children watching >2 h of television per day consumed several unhealthy food items more frequently than did children watching ≤2 h of television, regardless of sedentary time. In conclusion, this paper provides evidence to suggest that television viewing time is more strongly associated with unhealthy dietary patterns than is total sedentary time. Future research should focus on reducing television viewing time, as a means of improving dietary patterns and potentially reducing childhood obesity.

A cross-sectional examination of socio-demographic and school-level correlates of children's school travel mode in Ottawa, Canada.

BACKGROUND: Active school transport (AST) is an important source of children's daily physical activity (PA). However, decreasing rates of AST have been reported in multiple countries during the last decades. The purpose of the present study was to examine the socio-demographic and school-level correlates of AST. METHODS: A stratified sample of children (N = 567, mean age = 10.0 years; 57.8% female) was recruited in the Ottawa area. Four sources of data were used for analyses: 1) child questionnaire including questions on school travel mode and time; 2) parent questionnaire providing information on household socio-demographic characteristics; 3) school administrator survey assessing school policies and practices pertaining to PA; and 4) school site audit performed by the study team. Generalized linear mixed models were used to identify socio-demographic and school-level correlates of AST while controlling for school clustering. RESULTS: Individual factors associated with higher odds of AST were male gender (OR = 1.99; 95% CI = 1.30-3.03), journey time <5 minutes vs. >15 minutes (OR = 2.26; 95% CI = 1.17-4.37), and 5-15 minutes vs. >15 minutes (OR = 2.27; 95% CI = 1.27-4.03). Children were more likely to engage in AST if school administrators reported that crossing guards were employed (OR = 2.29; 95% CI = 1.22-4.30), or if they expressed major or moderate concerns about crime in the school neighbourhood (OR = 3.34; 95% CI = 1.34-8.32). In schools that identified safe routes to school and where traffic calming measures were observed, children were much more likely to engage in AST compared to schools without these features (OR = 7.87; 95% CI = 2.85-21.76). Moreover, if only one of these features was present, this was not associated with an increased likelihood of AST. CONCLUSION: These findings suggest that providing crossing guards may facilitate AST. Additionally, there was a synergy between the identification of safe routes to school and the presence of traffic calming measures, suggesting that these strategies should be used in combination.