The efficacy of online parenting interventions in addressing emotional problems in children and adolescents: A meta-analysis of randomized controlled trials.

BACKGROUND: Parenting interventions offer opportunities for reducing emotional problems in children and adolescents, based on addressing parental risk and protective factors. Online parenting interventions were developed more recently to increase access to interventions for parents, and the aim of this systematic review and meta-analysis is to investigate their efficacy. METHODS: We conducted a meta-analysis pooling studies that tested online parenting interventions having as outcome emotional problems in children/adolescents. We considered as secondary outcome parent mental health and moderation effects for the type of population, intervention characteristics, and risk of bias. RESULTS: Thirty-one studies met the inclusion criteria and were included in the meta-analysis. For child/adolescent emotional problems, at post-intervention, 13 studies were pooled, yielding an ES of g = -0.26 (95% CI [-0.41, -0.11]; p < .001) favoring the online parental interventions over wait-list, while at follow-up five RCTs were pooled, yielding an ES of g = -0.14 (95% CI [-0.25, -0.02]; p = .015) favoring the parental online interventions over wait-list. Moderation analyses suggest that longer online parenting programs are more effective in improving child emotional problems. CONCLUSIONS: Online parent programs have positive effects on reducing emotional symptoms in children and adolescents. Future research will need to develop and investigate the efficacy of the programs that can personalize their contents and delivery methods.

Perceived safety of smoking a few cigarettes during pregnancy and provider advice in a sample of pregnant smokers from Romania.

AIMS: To assess the prevalence of the perceived safety of smoking a few (generally fewer than five per day) cigarettes during pregnancy and identify associated factors in a sample of pregnant smokers in Romania, a middle-income country. DESIGN AND SETTING: Cross-sectional design with a convenience sample using a polled data set collected between 2016 and 2019 in the formative and baseline phases of the Quit Together randomized control trial (RCT) in Romania. Data were collected using a structured questionnaire administered by research assistants in clinics in the formative phase and self-administered through the study website at the RCT baseline. PARTICIPANTS: A total of 217 pregnant smokers (mean age = 28.5 ± 5.8) enrolled in the formative and RCT phases of the research project. MEASUREMENTS: The main outcome was the perceived safety of smoking a few cigarettes during pregnancy (generally fewer than five per day). Covariates included the health-care providers' advice towards smoking tobacco cigarettes during pregnancy, socio-demographics, the presence of depression and anxiety symptoms and level of nicotine dependence. FINDINGS: More than 35% of participants agreed that smoking a few cigarettes during pregnancy was safe for them and their baby. The perceived safety of smoking a few cigarettes during pregnancy was significantly associated with being told by health-care providers that it is acceptable to continue to smoke cigarettes in small amounts [odds ratio (OR) = 3.08; 95% CI = 1.35-6.99; P < 0.01], perceived harm reduction of smoking light cigarettes (OR = 2.67; 95% CI = 1.19-5.97; P = 0.02) and moderate to severe depression and anxiety score (OR = 0.34; 95% CI = 0.13-0.84; P = 0.02). CONCLUSIONS: More than one-third of pregnant Romanian women appear to believe that smoking 'a few' cigarettes during pregnancy is safe for them and their fetuses. Those who are told by their health-care providers that it is acceptable to smoke in small amounts during pregnancy have higher odds of perceiving smoking 'a few' cigarettes during pregnancy as safe compared with other pregnant Romanian women.

A couples-focused intervention for smoking cessation during pregnancy: The study protocol of the Quit Together pilot randomized controlled trial.

Tobacco smoking remains the leading global cause of preventable disease and death. Preconception and pregnancy smoking are high in Central and Eastern Europe. Quit Together is a partnership between a US university and a Romanian university, obstetrics and gynecology clinics in Romania, and other community partners in Romania. The objective of the Quit Together pilot study is to adapt, enhance and test the implementation feasibility and initial efficacy of an evidence-based pregnancy and postnatal couple intervention for smoking cessation in Romania. Quit Together builds on the Motivation and Problem Solving (MAPS) approach, enhanced by targeting the couples' smoking behavior and focusing on dyadic efficacy for smoking cessation. The study is an ongoing randomized controlled trial of 120 Romanian pregnant smokers and their partners. Participants are randomized to: 1) an intervention arm consisting, typically, of up to 8 prenatal and postnatal telephone counseling calls for the women and 4 for their partners, combining motivational strategies and problem-solving/coping skills to encourage the woman to quit smoking and the partner to support her decision; and 2) a control arm (usual care). The primary outcome is maternal biochemically verified smoking abstinence at 3 months postpartum. Quit Together has the potential to identify effective strategies to increase maternal smoking cessation during pregnancy and smoking abstinence after birth. If effective, Quit Together is expected to have a sustainable positive impact on the health of the child, mother and partner, and potentially reduced health system costs.