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1.
JAMA Netw Open ; 4(4): e213927, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33792730

RESUMO

Importance: Parental smoking adversely affects parents' and children's health. There are effective interventions delivered in pediatric settings to help parents quit smoking. The cost-effectiveness of this type of intervention is not known. Objective: To evaluate the cost-effectiveness of a parental smoking cessation intervention, the Clinical Effort Against Secondhand Smoke Exposure (CEASE) program, delivered in pediatric primary care, compared with usual care from a health care organization's perspective. Design, Setting, and Participants: This economic evaluation used data on intervention costs and parental smoking cessation collected prospectively as part of the CEASE randomized clinical trial. Data were collected at pediatric offices in 5 US states from April 2015 to October 2017. Participants included parents of children attending 10 pediatric primary care practices (5 control, 5 intervention). Data analysis was performed from October 2019 to August 2020. Exposures: The trial compared CEASE (practice training and support to address family tobacco use) vs usual care. Main Outcomes and Measures: The overall cost and incremental cost per quit of the CEASE intervention were calculated using microcosting methods. CEASE effectiveness was estimated using 2 trial outcomes measures assessed in repeated cross-sections: (1) change in smoking prevalence assessed by parental report for intervention vs usual care practices at 2 weeks after program initiation (baseline) and at 2-year follow-up and (2) changes in the proportion of smokers who achieved cotinine-confirmed smoking cessation in the previous 2 years at baseline vs follow-up. Monte Carlo analyses were used to provide 95% CIs. Results: The study included a total of 3054 participants (1523 at baseline and 1531 at follow-up); 2163 (70.8%) were aged 25 to 44 years old, and 2481 (81.2%) were women. Over 2 years, the total cost of implementing and sustaining CEASE across 5 intervention practices was $115 778. The incremental cost per quit for CEASE compared with usual care was $1132 (95% CI, $653-$3603), according to the change in parent-reported smoking prevalence, and $762 (95% CI, $418-$2883), according to cotinine-confirmed cessation. CEASE was cost-effective at a willingness-to-pay threshold of $2000 per quit in 88.0% of simulations based on the parent-reported smoking prevalence and 94.6% of simulations based on cotinine-confirmed smoking cessation measures. Conclusions and Relevance: These findings suggest that the CEASE intervention was associated with an incremental cost per quit that compared favorably with those of other clinical smoking cessation interventions. CEASE is inexpensive to initiate and maintain in the clinical pediatric setting, suggesting that it has the potential for a high impact on population health.


Assuntos
Terapia Comportamental/economia , Relações Pais-Filho , Atenção Primária à Saúde/economia , Abandono do Hábito de Fumar/economia , Adulto , Terapia Comportamental/métodos , Criança , Análise Custo-Benefício , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Pais , Pediatria/economia , Atenção Primária à Saúde/métodos , Abandono do Hábito de Fumar/métodos
2.
Acad Pediatr ; 21(4): 646-653, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33035731

RESUMO

BACKGROUND: The percentage of US smokers who smoke <10 cigarettes per day has increased, yet it is not known how often light parental smokers are offered and accept cessation assistance in pediatric offices. METHODS: A secondary analysis of parent interview data collected April to October 2017 at 10 pediatric practices participating in a cluster-randomized controlled trial of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention. RESULTS: Forty percent of 725 usual care control (UCC) group smokers smoked lightly (<10 cigarettes per day); of these 58% smoked very lightly (<5 per day). Compared to heavier smokers in UCC practices, light and very light smokers in UCC practices were more likely to have made a recent quit attempt (P < .001), yet less likely to have used cessation medication (P = .001). In intervention practices, compared to heavier smokers, light (P = .04) and very light (P < .01) smokers were less likely to be asked if they smoke and very light smokers were less likely to be advised to quit (P = .02) and to receive a nicotine replacement therapy (NRT) prescription (P < .01). However, light smokers (P < .001), very light smokers (P < .001), and light smokers who use e-cigarettes (P = .01) were more likely to receive assistance (NRT or quitline enrollment) in intervention versus UCC practices. CONCLUSIONS: The CEASE intervention increased assistance to light and very light smokers, yet heavier smokers received more assistance than light smokers. Improving cessation interventions for light and very light smokers is warranted.

3.
Prev Med ; 139: 106215, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32693178

RESUMO

We examined the prevalence of home smoking and vaping restrictions among US adults, and compared home policy differences for smoking and vaping among vapers, smokers, and dual users. Secondary data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (2015-2016) with 28,148 adults were analyzed using weighted multivariable logistic regression models that account for complex sampling design to compare differences in home policies among non-users, vapers only, smokers only, and dual users. Compared to never-users, current vapers who were ex-smokers and dual users were more likely to allow home vaping (aOR = 11.06, 95% CI: 8.04-15.21; aOR = 6.44, 95% CI: 5.01-8.28) and smoking (aOR = 1.62, 95% CI: 1.19-2.22; aOR = 3.58, 95% CI: 2.88-4.45). Current smokers were more likely to allow vaping (aOR = 3.53, 95% CI: 3.06-4.06) and smoking (aOR = 4.27, 95% CI: 3.73-4.89) inside the home than never-users. Current vapers who never smoked were more likely to allow vaping inside the home than never-users (aOR = 2.45, 95% CI: 1.53-3.93). Vapers reported much lower rates of vape-free home policies relative to both their smoke-free home policies and to vape-free home policies among smokers. Vapers may be using e-cigarettes in hopes of harm reduction, but interpreting "harm reduction" as safe, thus exposing non-users in their homes to second- and thirdhand aerosols. This underscores the need to healthcare providers to extend intervention with vapers to include implementing vape-free home policies.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Política Antifumo , Vaping , Adulto , Humanos , Fumantes , Tabaco
5.
Transl Behav Med ; 10(4): 1039-1052, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-31157864

RESUMO

Addressing parental smoking in the child healthcare setting improves the health of all family members. Innovative approaches, such as mobilizing technology-based platforms, may streamline screening and motivate acceptance of behavioral health services to treat tobacco use and dependence. The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use. Child healthcare practices in five states (IN, NC, OH, TN, and VA) used an electronic tablet screener to identify tobacco use within families and deliver tobacco cessation assistance to smokers. Motivational/educational videos on cessation were displayed via the screener to enhance its utility. Five CEASE intervention practices screened 50,111 family members for tobacco use and identified 6,885 families with children exposed to tobacco smoke. The mean number of screeners per practice per month was 417; the mean number of households with smokers identified per month was 57. Of 2,764 smokers who were at visits and consented, 57% indicated that they wanted a prescription to reduce or quit smoking; 94% of these were given preprinted prescriptions. Of 41% who requested connection to the quitline, 93% were given enrollment forms. Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke. Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice. CLINICAL TRIALS REGISTRATION: Trial Number NCT01882348.

6.
Nicotine Tob Res ; 22(3): 346-353, 2020 03 16.
Artigo em Inglês | MEDLINE | ID: mdl-30521040

RESUMO

INTRODUCTION: National and international organizations have done an excellent job of advocating and promoting breast feeding for all mothers. This study assessed to what extent an intervention increased delivery of cessation assistance to breast-feeding mothers who smoke. METHODS: Data were collected between April and October 2015 in five US states as part of a cluster randomized controlled trial in 10 pediatric practices. Practices were randomized to the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention or usual care control arms. Mothers were asked about their smoking status and breast-feeding history during a screening interview upon exiting the practice and eligible mothers who agreed to participate in an enrollment interview were asked if they received smoking cessation assistance during their child's visit. Mothers with a child 1 year old and younger were included in the analyses. RESULTS: Current breast feeding was associated with a reduced likelihood of current smoking (adjusted odds ratio [aOR] = 0.38, 95% confidence interval [95% CI] = 0.25 to 0.57) and a greater likelihood of quitting smoking (aOR = 2.33, 95% CI = 1.29 to 4.21) after controlling for known confounders. Mothers who concurrently smoked and breast-fed were more likely to be asked about smoking (66.7% vs. 28.6%, p = .01), advised to quit (61.1% vs. 21.4%, p < .01), prescribed nicotine replacement therapy (50.0% vs. 0%, p < .001), and enrolled into the quitline (27.8% vs. 0%, p < .01) at CEASE practices compared to control practices. CONCLUSION: Breast-feeding mothers were less likely to be current smokers and more likely to have recently quit smoking. Among mothers who continue to smoke and breast feed, the CEASE intervention enhances delivery of smoking cessation assistance. IMPLICATIONS: Breast feeding and eliminating infants' exposure to tobacco smoke are important protective factors for serious pediatric health risks including sudden infant death. This study shows that breast feeding was positively associated with desirable tobacco control outcomes, specifically that breast feeding was associated with a lower likelihood of smoking among ever smokers and a greater likelihood of recently quitting smoking. This is also the first study to look specifically at delivery of smoking cessation assistance to breast-feeding mothers seen at pediatric offices and demonstrates the effectiveness of delivering evidence-based smoking cessation assistance to them in this context. TRIAL REGISTRATION: www.ClinicalTrials.gov (identifier NCT01882348).


Assuntos
Aleitamento Materno/métodos , Mães/educação , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Poluição por Fumaça de Tabaco/prevenção & controle , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Adulto , Terapia Comportamental , Feminino , Humanos , Lactente , Recém-Nascido , Pediatria , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Adulto Jovem
7.
JAMA Pediatr ; 173(10): 931-939, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31403675

RESUMO

Importance: Despite the availability of free and effective treatment, few pediatric practices identify and treat parental tobacco use. Objective: To determine if the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention can be implemented and sustained in pediatric practices and test whether implementing CEASE led to changes in practice-level prevalence of smoking among parents over 2 years. Design, Setting, and Participants: This cluster randomized clinical trial was conducted from April 2015 to October 2017. Ten pediatric practices in 5 states were randomized to either implement the CEASE protocol or maintain usual care (as a control group). All parents who screened positive for tobacco use by exit survey after their child's clinical visit 2 weeks (from April to October 2015) and 2 years after intervention implementation (April to October 2017) were eligible to participate. Data analysis occurred from January 2018 to March 2019. Interventions: The CEASE intervention is a practice-change intervention designed to facilitate both routine screening in pediatric settings of families for tobacco use and delivery of tobacco cessation treatment to individuals in screened households who use tobacco. Main Outcomes and Measures: The primary outcome was delivery of meaningful tobacco treatment, defined as the prescription of nicotine replacement therapy or quit line enrollment. Furthermore, changes in practice-level smoking prevalence and cotinine-confirmed quit rates over the 2 years of intervention implementation were assessed. Results: Of the 8184 parents screened after their child's visit 2 weeks after intervention implementation, 961 (27.1%) were identified as currently smoking in intervention practices; 1103 parents (23.9%) were currently smoking in control practices. Among the 822 and 701 eligible parents who completed the survey in intervention and control practices, respectively 364 in the intervention practices (44.3%) vs 1 in a control practice (0.1%) received meaningful treatment at that visit (risk difference, 44.0% [95% CI, 9.8%-84.8%]). Two years later, of the 9794 parents screened, 1261 (24.4%) in intervention practices and 1149 (25.0%) in control practices were identified as currently smoking. Among the 804 and 727 eligible parents completing the survey in intervention and control practices, respectively, 113 in the intervention practices (14.1%) vs 2 in the control practices (0.3%) received meaningful treatment at that visit (risk difference, 12.8% [95% CI, 3.3%-37.8%]). Change in smoking prevalence over the 2 years of intervention implementation favored the intervention (-2.7% vs 1.1%; difference -3.7% [95% CI, -6.3% to -1.2%]), as did the cotinine-confirmed quit rate (2.4% vs -3.2%; difference, 5.5% [95% CI, 1.4%-9.6%]). Conclusions and Relevance: In this trial, integrating screening and treatment for parental tobacco use in pediatric practices showed both immediate and long-term increases in treatment delivery, a decline in practice-level parental smoking prevalence, and an increase in cotinine-confirmed cessation, compared with usual care. Trial Registration: ClinicalTrials.gov identifier: NCT01882348.

8.
Acad Pediatr ; 19(7): 842-848, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30981026

RESUMO

BACKGROUND: E-cigarettes are growing in popularity. Dual use of e-cigarettes and cigarettes is an increasingly common practice, but little is known about patterns of dual use in parents. We sought to describe smoking-related behaviors among dual-users. METHODS: Parent exit surveys were conducted following their child's visit in 5 control pediatric practices in 5 states participating in the Clinical Effort Against Secondhand Smoke Exposure trial. We examined factors associated with dual use of e-cigarettes and cigarettes versus cigarette-only smokers, assessed by self-report. RESULTS: Of 1382 smokers or recent quitters screened after their child's visit between April and October 2017, 943 (68%) completed the survey. Of these, 727 parents reported current use of cigarettes; of those, 81 (11.1%) also reported e-cigarette use, meeting the definition of dual use. Compared with cigarette-only smokers, dual users were more likely to have a child younger than 1 year old, planned to quit in the next 6 months, and had tried to quit in the past (had a quit attempt in the past 3 months, called the quitline, or used medicine to quit in the past 2 years; P < .05 for each). CONCLUSIONS: Parents who use both e-cigarettes and cigarettes may have greater rates of contemplating smoking cessation than parents who only smoke cigarettes. These parents may be using e-cigarettes for harm reduction or as a step toward cessation. Identification of these parents may provide an opportunity to deliver effective treatment, including nicotine-replacement therapies that do not expose infants and children to e-cigarette aerosol.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Pais/psicologia , Fumar , Produtos do Tabaco , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto Jovem
9.
Pediatrics ; 143(4)2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30858346

RESUMO

OBJECTIVES: To determine how smoke-free and vape-free home and car policies differ for parents who are dual users of cigarettes and electronic cigarettes (e-cigarettes), who only smoke cigarettes, or who only use e-cigarettes. To identify factors associated with not having smoke-free or vape-free policies and how often smoke-free advice is offered at pediatric offices. METHODS: Secondary analysis of 2017 parental interview data collected after their children's visit in 5 control practices participating in the Clinical Effort Against Secondhand Smoke Exposure trial. RESULTS: Most dual users had smoke-free home policies, yet fewer had a vape-free home policies (63.8% vs 26.3%; P < .01). Dual users were less likely than cigarette users to have smoke-free car (P < .01), vape-free home (P < .001), or vape-free car (P < .001) policies. Inside cars, dual users were more likely than cigarette users to report smoking (P < .001), e-cigarette use (P < .001), and e-cigarette use with children present (P < .001). Parental characteristics associated with not having smoke-free or vape-free home and car policies include smoking ≥10 cigarettes per day, using e-cigarettes, and having a youngest child >10 years old. Smoke-free home and car advice was infrequently delivered. CONCLUSIONS: Parents may perceive e-cigarette aerosol as safe for children. Dual users more often had smoke-free policies than vape-free policies for the home. Dual users were less likely than cigarette-only smokers to report various child-protective measures inside homes and cars. These findings reveal important opportunities for intervention with parents about smoking and vaping in homes and cars.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Pais , Política Antifumo , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Automóveis , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Entrevistas como Assunto , Modelos Logísticos , Masculino , Análise Multivariada , Medição de Risco , Prevenção do Hábito de Fumar , Estados Unidos
10.
J Clin Outcomes Manag ; 24(12): 551-559, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29217965

RESUMO

Objective: To explain the concept of thirdhand smoke and how it can be used to protect the health of children and improve delivery of tobacco control interventions for parents in the child health care setting. Methods: Review of the literature and descriptive report. Results: The thirdhand smoke concept has been used in the CEASE intervention to improve the delivery of tobacco control counseling and services to parents. Materials and techniques have been developed for the child health care setting that use the concept of thirdhand smoke. Scientific findings demonstrate that thirdhand smoke exposure is harmful and establishes the need for clinicians to communicate the cessation imperative: the only way to protect non-smoking household members from thirdhand smoke is for all household smokers to quit smoking completely. As the scientific knowledge of thirdhand smoke increases, advocates will likely rely on it to encourage completely smoke-free places. Conclusion: Recent scientific studies on thirdhand smoke are impelling further research on the topic, spurring the creation of tobacco control policies to protect people from thirdhand smoke and stimulating improvements to the delivery of tobacco control counseling and services to parents in child health care settings.

11.
J Smok Cessat ; 12(1): 6-14, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28163788

RESUMO

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.

12.
BMC Public Health ; 16: 520, 2016 06 24.
Artigo em Inglês | MEDLINE | ID: mdl-27342141

RESUMO

BACKGROUND: Every U.S. state has a free telephone quitline that tobacco users can access to receive cessation assistance, yet referral rates for parents in the pediatric setting remain low. This study evaluates, within pediatric offices, the impact of proactive enrollment of parents to quitlines compared to provider suggestion to use the quitline and identifies other factors associated with parental quitline use. METHODS: As part of a cluster randomized controlled trial (Clinical Effort Against Secondhand Smoke Exposure), research assistants completed post-visit exit interviews with parents in 20 practices in 16 states. Parents' quitline use was assessed at a 12-month follow-up interview. A multivariable analysis was conducted for quitline use at 12 months using a logistic regression model with generalized estimating equations to account for provider clustering. Self-reported cessation rates were also compared among quitline users based on the type of referral they received at their child's doctor's office. RESULTS: Of the 1980 parents enrolled in the study, 1355 (68 %) completed a 12-month telephone interview and of those 139 (10 %) reported talking with a quitline (15 % intervention versus 6 % control; p < .0001). Parents who were Hispanic (aOR 2.12 (1.22, 3.70)), black (aOR 1.57 (1.14, 2.16)), planned to quit smoking in the next 30 days (aOR 2.32 (1.47, 3.64)), and had attended an intervention practice (aOR 2.37 (1.31, 4.29)) were more likely to have talked with a quitline. Parents who only received a suggestion from a healthcare provider to use the quitline (aOR 0.45 (0.23, 0.90)) and those who were not enrolled and did not receive a suggestion (aOR 0.33 (0.17, 0.64)) were less likely to talk with a quitline than those who were enrolled in the quitline during the baseline visit. Self-reported cessation rates among quitline users were similar regardless of being proactively enrolled (19 %), receiving only a suggestion (25 %), or receiving neither a suggestion nor an enrollment (17 %) during a visit (p = 0.47). CONCLUSIONS: These results highlight the enhanced clinical effectiveness of not just recommending the quitline to parents but also offering them enrollment in the quitline at the time of their child's visit to the pediatric office. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier: NCT00664261.


Assuntos
Linhas Diretas/estatística & dados numéricos , Pais , Padrões de Prática Médica , Abandono do Hábito de Fumar/métodos , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Pediatria , Encaminhamento e Consulta/estatística & dados numéricos , Estados Unidos
13.
J Clin Outcomes Manag ; 23(2): 79-86, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29497272

RESUMO

Background: Family tobacco use and exposure are significant threats to the health of children and their families. However, few pediatric clinicians address family tobacco use and exposure in a routine and effective manner. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention was developed to tackle this gap between clinical need and clinical practice. Objective: To review the main considerations and questions that clinicians and office staff expressed during telephone training to participate in CEASE. Methods: This study was conducted in pediatric practices in 5 US states. Practices were recruited by the American Academy of Pediatrics (10 intervention, 10 control). Ten training calls were recorded and transcribed. The data was then coded inductively based on themes found in the transcripts. Results: The data revealed that clinicians and staff were concerned about prescribing, dosing, and insurance coverage of nicotine replacement therapy; motivation for and methods to help families become tobacco-free; and the impact of the intervention on practice operations. Conclusion: While the majority of clinicians and office staff were interested and enthusiastic about helping families become tobacco-free, they expressed concerns that could threaten implementation of family tobacco control strategies.

14.
Acad Pediatr ; 15(1): 47-53, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25528125

RESUMO

OBJECTIVE: To examine racial differences in rates of screening parents for cigarette smoking during pediatric outpatient visits and to determine if a parental tobacco control intervention mitigates racial variation in whether cigarette smoking is addressed. METHODS: As part of the Clinical Effort Against Secondhand Smoke Exposure (CEASE) randomized controlled trial, exit interviews were conducted with parents at 10 control and 10 intervention pediatric practices nationally. Parents were asked to report if during the visit did anyone ask if they smoke cigarettes. A generalized linear mixed model was used to estimate the effect of black vs white race on asking parents about cigarette smoking. RESULTS: Among 17,692 parents screened at the exit interview, the proportion of black parents who were current smokers (16%) was lower than the proportion of white parents who smoked (20%) (P < .001). In control group practices, black parents were more likely to be asked (adjusted risk ratio 1.23; 95% confidence interval 1.08, 1.40) about cigarette smoking by pediatricians than whites. In intervention group practices both black and white parents were more likely to be asked about smoking than those in control practices and there was no significant difference between black and white parents in the likelihood of being asked (adjusted risk ratio 1.01; 95% confidence interval 0.93, 1.09). CONCLUSIONS: Although a smaller proportion of black parents in control practices smoked than white, black parents were more likely to be asked by pediatricians about smoking. The CEASE intervention was associated with higher levels of screening for smoking for both black and white parents.


Assuntos
Afro-Americanos/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Pais , Pediatria/métodos , Fumar , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Modelos Lineares , Masculino , Uso de Tabaco , Estados Unidos , Adulto Jovem
15.
Pediatrics ; 133(4): e850-6, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24590745

RESUMO

OBJECTIVE: To determine if the belief that thirdhand smoke is harmful to children is associated with smoking parents' attitudes, home or car smoking policies, and quitting behaviors. METHODS: Data from a national randomized controlled trial, Clinical Effort Against Secondhand Smoke Exposure, assessed thirdhand smoke beliefs of 1947 smoking parents in an exit survey after a pediatric office visit in 10 intervention and 10 control practices. Twelve-month follow-up data were collected from 1355 parents. Multivariable logistic regression determined whether belief that thirdhand smoke harms the health of children is independently associated with parental behaviors and attitudes 12 months later. A χ(2) test assessed whether parents who disagreed that thirdhand smoke is harmful were more likely to make a quit attempt if they later believed that thirdhand smoke is harmful. RESULTS: Belief at the exit survey that thirdhand smoke is harmful was independently associated with having a strictly enforced smoke-free home policy (adjusted odds ratio: 2.05; 95% CI: 1.37-3.05) and car policy (adjusted odds ratio: 1.69; 95% CI: 1.04-2.74) at the 12-month follow-up. A significantly higher percentage (71% vs 50%) of parents who did not hold the thirdhand smoke harm belief at baseline made at least 1 quit attempt if they agreed that thirdhand smoke is harmful at the 12-month follow-up (P = .02). CONCLUSIONS: Thirdhand smoke harm belief was associated with a strictly enforced smoke-free home and car and attempts to quit smoking. Sensitizing parents to thirdhand smoke risk could facilitate beneficial tobacco control outcomes.


Assuntos
Cultura , Pais/psicologia , Poluição por Fumaça de Tabaco , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
16.
Am J Prev Med ; 43(5): 533-6, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23079177

RESUMO

BACKGROUND: Thirdhand smoke is residual tobacco smoke contamination that remains after a cigarette is extinguished. A national study indicates that adults' belief that thirdhand smoke (THS) harms children is associated with strict household no-smoking policies. The question of whether pediatricians can influence THS beliefs has not been assessed. PURPOSE: To identify prevalence of THS beliefs and associated factors among smoking parents, and the association of pediatrician intervention on parent belief that THS is harmful to their children. METHODS: Exit interview data were collected from 1980 parents following a pediatric office visit. Parents' level of agreement or disagreement that THS can harm the health of babies and children was assessed. A multivariate logistic regression model was constructed to identify whether pediatricians' actions were independently associated with parental belief that THS can harm the health of babies and children. Data were collected from 2009 to 2011, and analyses were conducted in 2012. RESULTS: Ninety-one percent of parents believed that THS can harm the health of babies and children. Fathers (AOR=0.59, 95% CI=0.42, 0.84) and parents who smoked more than ten cigarettes per day (AOR=0.63, 95% CI=0.45, 0.88) were less likely to agree with this statement. In contrast, parents who received advice (AOR=1.60, 95% CI=1.04, 2.45) to have a smokefree home or car or to quit smoking and parents who were referred (AOR=3.42, 95% CI=1.18, 9.94) to a "quitline" or other cessation program were more likely to agree that THS can be harmful. CONCLUSIONS: Fathers and heavier smokers were less likely to believe that THS is harmful. However, pediatricians' actions to encourage smoking parents to quit or adopt smokefree home or car policies were associated with parental beliefs that THS harms children. TRIAL REGISTRATION: This study is registered at NCT00664261.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Estudos Transversais , Pai/psicologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Mães/psicologia , Análise Multivariada , Pediatria/métodos , Prevalência , Encaminhamento e Consulta/estatística & dados numéricos , Fumar/epidemiologia , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto Jovem
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