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1.
Nicotine Tob Res ; 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34021353

RESUMO

INTRODUCTION: Young children are vulnerable to harm from tobacco smoke exposure (TSE). This study assessed the effect of Project Zero Exposure - an intervention program designed to help parents protect children from TSE - on children's exposure. METHODS: Randomized controlled trial of a home-based, theory-driven intervention. Parents of young children (< 8 years) in families with a smoking parent were eligible. The intervention included feedback on child TSE (hair nicotine), and home air quality (PM2.5), with motivational interviewing. Families were randomized to: intervention group (IG,N=69), regular control group (RCG, N=70), or to a secondary enhanced control group, (ECG, N=20). Child hair samples were taken at baseline and follow-up. We report on child TSE in the IG versus RCG at six months. RESULTS: Most enrolled families completed the trial (IG:98.6%(68/69), RCG:97.1%(68/70). LHN (ng/mg) decreased in both the IG (Baseline:-1.78±1.91,Follow-up:-2.82±1.87,p=.003) and RCG (Baseline:-1.79±1.54,Follow-up:-2.85±1.73,p=.002), but did not differ between groups at study end (p=.635). Three of five parentally-reported outcomes showed improvement over time in the IG, and one in the RCG. Among IG participants, 90% found hair nicotine feedback useful. CONCLUSIONS: No difference between the intervention and control groups was found on the objective biomarker, LHN. Child tobacco smoke exposure decreased during the trial in intervention and control groups. Trial participation, which included hair nicotine monitoring, may have contributed to decreasing exposure in both groups. Concurrent control group improvements may partially explain lack of proven intervention benefit. Biomarker monitoring warrants further investigation for reduction of child tobacco smoke exposure.

2.
J Addict Nurs ; 31(4): 243-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33264196

RESUMO

OBJECTIVE: The aim of this study was to evaluate the relationships between prenatal smoking exposure and telomere lengths (TLs) in fetuses, infants, and children. METHODS: This is a systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Databases searched were Biomedical Reference Collection, MEDLINE via PubMed, CINAHL, PsycINFO, and Google Scholar. The latest search was on October 18, 2019. RESULTS: Seven studies met the inclusion criteria and thus were reviewed. Five of the studies showed significant inverse relationships between prenatal tobacco exposure and TLs in fetuses, infants, and children. One study showed a modification effect of the postconceptual age, indicating that older fetuses with prenatal smoking exposure had shorter TLs than their counterparts. This effect was more prominent after 93 days of postconception. Another study reported a finding that was contrary to the above results, showing that the telomeres of newborns with prenatal smoking exposure were longer than those of their counterparts. CONCLUSION/RECOMMENDATIONS: This review shows that the impact of prenatal smoking on the health of unborn fetuses, infants, and children is an understudied area. Because of the inconsistent findings and cross-sectional study designs, more research is required, especially longitudinally studies. Nonetheless, the findings of the review provide partial evidence that prenatal smoking can potentially impact the genetic biomarker, TLs, and, thus, health of fetuses, infants, and children. The evidence confirms the current practice that pregnant women should be encouraged to stop smoking as soon as they become pregnant.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33212796

RESUMO

(1) Background: Monthly variability in smoking behaviors in caregivers of pediatric asthmatics yields questions of how much and when does smoking reduction result in improved environmental and clinical outcomes. (2) Methods: Post hoc analysis of data from a 6 month pilot randomized-control trial occurring from May 2017 to May 2018 in Baltimore City (MD, USA). The initial trial's primary intervention explored the utility of financial incentives in modifying caregiver smoking behaviors. Post hoc analyses examined all dyads independent of the initial trial's randomization status. All caregivers received pediatric tobacco smoke harm reduction education, in addition to monthly encouragement to access the state tobacco quitline for individual phone-based counseling and nicotine replacement therapy. Maternal caregivers who were active cigarette smokers and their linked asthmatic child (aged 2-12 years) were grouped into two classifications ("high" versus "low") based on the child and caregiver's cotinine levels. A "low" cotinine level was designated by at least a 25% reduction in cotinine levels during 3 months of the trial period; achieving ≤2 months of low cotinine levels defaulted to the "high" category. Twenty-seven dyads (caregivers and children) (total n = 54) were assigned to the "high" category, and eighteen dyads (caregivers and children) (total n = 36) were allocated to the "low" category. The primary outcome measure was the correlation of caregiver cotinine levels with pediatric cotinine values. Secondary outcomes included asthma control, in addition to caregiver anxiety and depression. (3) Results: Caregivers with 3 months of ≥25% decrease in cotinine levels had a significantly greater mean change in child cotinine levels (p = 0.018). "Low" caregiver cotinine levels did not significantly improve pediatric asthma control (OR 2.12 (95% CI: 0.62-7.25)). Caregiver anxiety and depression outcomes, measured by Patient Health Questionnaire (PHQ)-4 scores, was not significantly different based on cotinine categorization (p = 0.079); (4) Conclusion: Reduced pediatric cotinine levels were seen in caregivers who reduced their smoking for at least 3 months, but clinical outcome measures remained unchanged.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33105823

RESUMO

Children are particularly vulnerable to environmental tobacco smoke (ETS). There is no routine support to reduce ETS in the home. We systematically reviewed trials to reduce ETS in children in order to identify intervention characteristics and behaviour change techniques (BCTs) to inform future interventions. We searched Medline, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, and Cochrane Tobacco Addiction Group Specialised Register from January 2017 to June 2020 to update an existing systematic review. We included controlled trials to reduce parent/caregiver smoking or ETS in children <12 years that demonstrated a statistically significant benefit, in comparison to less intensive interventions or usual care. We extracted trial characteristics; and BCTs using Behaviour Change Technique Taxonomy v1. We defined "promising" BCTs as those present in at least 25% of effective interventions. Data synthesis was narrative. We included 16 trials, of which eight were at low risk of bias. All trials used counselling in combination with self-help or other supporting materials. We identified 13 "promising" BCTs centred on education, setting goals and planning, or support to reach goals. Interventions to reduce ETS in children should incorporate effective BCTs and consider counselling and self-help as mechanisms of delivery.

5.
Artigo em Inglês | MEDLINE | ID: mdl-32751695

RESUMO

Smoking prevalence stays high among adults in China, which also makes children exposed to secondhand smoke (SHS) in their households. This study aimed to investigate the status of SHS exposure among Chinese children, identify the influencing factors, and determine "co-exposure" to tobacco and other smokes in households. A total of 41,439 children aged 6-17 years were recruited from 30 provinces in Mainland China through the first Chinese Environmental Exposure-Related Human Activity Model Survey for Children (CEERHAPS-C). Information regarding children's demographics, socioeconomic status, and exposures to SHS and solid fuel smoke (SFS) in households was collected using a comprehensive questionnaire. Factors that affected exposures to household smokes were identified using multivariable logistic regressions. The overall prevalence of household SHS exposure was 41.7%, and the average duration was 14.7 ± 14.6 min/day among the exposed participants. Prevalence of household SHS exposure increased among children in older age groups and with parents in lower education levels. Among SHS-exposed children, 34% had co-exposure to SFS, and they had a significantly higher risk of co-exposure than non-SHS exposed children (odds ratio = 1.12, 95% confidence interval: 1.061, 1.162). The prevalence of household SHS exposure remains high among school-age children, suggesting the need to develop and implement smoking-free home programs.


Assuntos
Exposição Ambiental , Poluição por Fumaça de Tabaco , Adolescente , Adulto , Idoso , Criança , China/epidemiologia , Estudos Transversais , Exposição Ambiental/análise , Características da Família , Feminino , Humanos , Masculino , Prevalência , Fumar , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/análise
6.
Am J Perinatol ; 2020 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-32862421

RESUMO

OBJECTIVE: Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm. STUDY DESIGN: Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals. RESULTS: Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28-4.07). CONCLUSION: Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision. KEY POINTS: · Tobacco exposure is not associated with impaired neurodevelopment in this preterm population.. · Prenatal tobacco exposure is associated with increased need for corrective lenses.. · Tobacco use in pregnancy may be a risk factor for poorer visual acuity in children..

7.
J Environ Public Health ; 2020: 7591263, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32508936

RESUMO

Background: A few studies related to pediatric behavior have measured secondhand smoke exposure in children using valid objective biochemical markers. We aimed at investigating the associations between current and cumulative exposure to tobacco smoke, measured both subjectively and objectively, and behavioral problems in children. Methods: Subjects were 437 Japanese children, aged 3-6 years in 2006. Exposure to tobacco smoke was evaluated from a parent-administered questionnaire and urinary cotinine concentrations. The cotinine concentrations were measured using first-void morning urine by liquid chromatography-tandem mass spectrometry. Children's behaviors were assessed by the parent-completed Strengths and Difficulties Questionnaire. Results: After multiple adjustments for covariates, higher total difficulty scores of children were significantly associated with the larger number of cigarettes parents smoke, more smokers among cohabiters, and more pack-years of exposure to tobacco smoke from parents and cohabiters. The total difficulty scores were 8.72, 9.09, and 10.52, respectively, for children in the low, middle, and high tertiles of creatinine-corrected cotinine concentrations in urine (p=0.002, trend p=0.005). There was no substantial sex difference in the positive associations between passive smoking and the SDQ scores. Conclusions: Exposure to tobacco smoke in early childhood may be involved in the development of pediatric behavioral problems. The importance of reducing the exposure of children to tobacco smoke, particularly in the home, was further emphasized for the prevention of psychological and behavioral problems in childhood.


Assuntos
Exposição por Inalação/efeitos adversos , Comportamento Problema , Poluição por Fumaça de Tabaco/efeitos adversos , Biomarcadores/urina , Criança , Desenvolvimento Infantil , Pré-Escolar , Cotinina/urina , Feminino , Humanos , Exposição por Inalação/análise , Japão/epidemiologia , Masculino , Fatores de Risco , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/análise
8.
Artigo em Inglês | MEDLINE | ID: mdl-32585811

RESUMO

Children exposed to secondhand smoke (SHS) are at increased risk for disease. We sought to estimate the medical costs among Korean children who were exposed to SHS at home. A Markov model was developed, including five diseases (asthma, acute otitis media, acute bronchitis, pneumonia and sudden infant death syndrome) that were significantly associated with SHS in children based on a systematic review. The time horizon of the analysis was 20 years (from birth to adulthood), and the cycle length was 1 week. The direct healthcare costs were discounted annually at 5%. Univariate and probabilistic sensitivity analyses were conducted. The Markov model estimated the healthcare costs for 20 years as 659.61 USD per exposed child, an increase of approximately 30% compared to the cost per unexposed child (507.32 USD). Sensitivity analysis suggested that the younger the age of the exposure, the greater the incremental healthcare costs incurred, implying that infants and young children were especially vulnerable to the SHS exposure. Findings of this study could provide key baseline data for future economic evaluations on SHS control policies in South Korea.


Assuntos
Custos de Cuidados de Saúde , Poluição por Fumaça de Tabaco , Adulto , Criança , Pré-Escolar , Exposição Ambiental/efeitos adversos , Exposição Ambiental/análise , Humanos , Lactente , Modelos Econométricos , República da Coreia/epidemiologia , Fumar , Poluição por Fumaça de Tabaco/efeitos adversos , Poluição por Fumaça de Tabaco/análise
9.
JAMA Netw Open ; 3(5): e204714, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32396193

RESUMO

Importance: Research to date has not determined a safe level of alcohol or tobacco use during pregnancy. Electroencephalography (EEG) is a noninvasive measure of cortical function that has previously been used to examine effects of in utero exposures and associations with neurodevelopment. Objective: To examine the association of prenatal exposure to alcohol (PAE) and tobacco smoking (PTE) with brain activity in newborns. Design, Setting, and Participants: This prospective cohort study enrolled mother-newborn dyads from December 2011 through August 2015, with data analyzed from June 2018 through June 2019. Pregnant women were recruited from clinical sites in Cape Town, South Africa, and the Northern Plains region of the US. Participants were a subset of newborns enrolled in the Safe Passage Study. Exclusions included birth at less than 37 or more than 41 weeks' gestation, multiple birth, or maternal use of psychiatric medication during pregnancy. Exposures: PAE and PTE groups were determined by cluster analysis. Main Outcomes and Measures: Analyses of covariance were run on EEG spectral power at 12 scalp locations across the frequency spectrum from 1 to 45 Hz in 3-Hz bins by sleep state. Results: The final sample consisted of 1739 newborns (median [interquartile range] gestational age at birth, 39.29 [1.57] weeks; 886 [50.9%] were female; median [interquartile range] newborn age at assessment, 48.53 [44.96] hours). Newborns whose mothers were in the low continuous (95% CI, -0.379 to -0.031; P < .05; 95% CI, -0.379 to -0.045; P < .05), quit (95% CI, -0.419 to -0.127; P < .001; 95% CI, -0.398 to -0.106; P < .005), and moderate or high continuous (95% CI, -0.430 to -0.124; P < .001; 95% CI, -0.420 to -0.119; P < .005) PAE clusters had increased 4- to 6-Hz and 7- to 9-Hz left-temporal EEG power. Newborns with moderate or high continuous PTE had decreased 19- to 21-Hz (95% CI, 0.034 to 0.327; P < .05) and 22- to 24-Hz (95% CI, 0.022 to 0.316; P < .05) right-central EEG compared with newborns with no PTE. Newborns with moderate or high continuous PTE had significantly decreased 22- to 36-Hz right-central EEG power compared with the quit smoking group (22-24 Hz, 95% CI, 0.001 to 0.579; P < .05; 25-27 Hz, 95% CI, 0.008 to 0.586; P < .05; 28-30 Hz, 95% CI, 0.028 to 0.607; P < .05; 31-33 Hz, 95% CI, 0.038 to 0.617; P < .05; 34-36 Hz, 95% CI, 0.057 to 0.636; P < .05). Conclusions and Relevance: These findings suggest that even low levels of PAE or PTE are associated with changes in offspring brain development.


Assuntos
Consumo de Bebidas Alcoólicas , Encéfalo/fisiopatologia , Exposição Materna , Sono/fisiologia , Fumar , Eletroencefalografia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Estudos Prospectivos , África do Sul , Estados Unidos
10.
Artigo em Inglês | MEDLINE | ID: mdl-32408551

RESUMO

Children who live with smokers are at risk of poor health, and of becoming smokers themselves. Misperceptions of the nature of tobacco smoke exposure have been demonstrated among parents, resulting in continued smoking in their children's environment. This study aimed to change parents' perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children's exposure [NIH registry (NCT02867241)]. One hundred and fifty-nine families with a child < 8 years and at least one smoking parent were randomized into intervention (69), control (70), and enhanced control (20) groups. Reported exposure, parental smoking details, and a child hair sample were obtained at the start of the study and 6-8 months later. Parental perceptions of exposure (PPE) were assessed via a questionnaire. The intervention consisted of motivational interviews, feedback of home air quality and child's hair nicotine level, and information brochures. PPE were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = -3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered. By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children.


Assuntos
Abandono do Hábito de Fumar , Poluição por Fumaça de Tabaco , Fumar Tabaco , Tabagismo , Adulto , Criança , Exposição Ambiental , Humanos , Relações Pais-Filho , Pais , Fumar , Tabagismo/terapia
11.
Gynecol Obstet Fertil Senol ; 48(7-8): 567-577, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32247092

RESUMO

INTRODUCTION: Smoking during pregnancy leads to fetal passive smoking. It is associated with several obstetrical complications and is a major modifiable factor of maternal and fetal morbidity. Long-term consequences also exist but are less well known to health professionals and in the general population. METHODS: Consultation of the Medline® database. RESULTS: Maternal smoking during pregnancy is associated in the offspring with sudden infant death syndrome (NP2), impaired lung function (NP2), lower respiratory infections and asthma (NP2), overweight and obesity (NP2), cancers (NP3), risk of tobacco use, nicotine dependence and early smoking initiation (NP2). Unadjusted analyses show associations between in utero tobacco exposure and cognitive deficits (NP3), impaired school performance (NP3) and behavioral disorders in children (NP2), which are in a large part explained by environmental factors. There is a cross-generational effect of smoking during pregnancy. For example, an increased risk of asthma is observed in the grandchildren of smoking women (NP4). The respective roles of ante- and post-natal smoking remain difficult to assess. CONCLUSION: These results highlight the importance of prevention measures against tobacco use in the general population, as well as screening measures and support for smoking cessation before or at the beginning of the pregnancy.

12.
JAMA Netw Open ; 3(3): e201195, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32186745

RESUMO

Importance: The number of children with prenatal opioid exposure to medication for addiction treatment (MAT) with methadone and buprenorphine for maternal opioid use disorder is increasing, but the associations of this exposure with cognitive outcomes are not well understood. Objective: To examine the strength and consistency of findings in the medical literature regarding the association of prenatal exposure to MAT with early childhood cognitive development, particularly when accounting for variables outside MAT exposure. Data Sources: A search strategy obtained publications from PubMed, CINAHL, PsycINFO, Web of Science, and Embase from January 1972 to June 2019. Reference lists from identified articles were searched. Study Selection: Inclusion criteria were cohort studies, studies including children aged 1 to 60 months with at least 2 months of prenatal MAT exposure, studies using standardized direct-observation testing scales, and studies reporting means and SDs. Case reports, case series, historical controls, and reviews were excluded. Data Extraction and Synthesis: Two authors independently selected studies for inclusion, extracted data, and assessed study quality. Data extracted included demographic characteristics, covariates, sources of bias, and effect estimates. Meta-analysis was performed using random-effects models. This study was conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Data extraction and synthesis were conducted between January 2018 and August 2019. Main Outcomes and Measures: Cognitive test scores and demographic variability between exposed and unexposed groups. Results: A total of 16 unique cohorts, described in 27 articles and including 1086 children (485 [44.7%] with MAT exposure), were included in a quantitative synthesis. On meta-analysis, MAT exposure was associated with lower cognitive development scores (pooled standardized mean difference, -0.57; 95% CI, -0.93 to -0.21; I2 = 81%). Multiple subanalyses on demographic characteristics (ie, maternal education, race/ethnicity, socioeconomic status, prenatal tobacco exposure, infant sex) were conducted. In the subanalysis of studies with comparable prenatal exposure to tobacco smoke, the association of MAT exposure with cognitive scores was no longer statistically significant and became homogeneous (standardized mean difference, -0.11; 95% CI, -0.42 to 0.20; I2 = 0%). Conclusions and Relevance: In this study, predefined subanalyses demonstrated how poor recruitment, particularly imbalances in maternal tobacco use, could contribute to a negative overall association of cognitive development test scores with prenatal MAT exposure. Promoting tobacco cessation for pregnant women with opioid use disorder should be prioritized in this high-risk population.


Assuntos
Analgésicos Opioides/efeitos adversos , Disfunção Cognitiva/induzido quimicamente , Exposição Materna/efeitos adversos , Tratamento de Substituição de Opiáceos/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/psicologia , Buprenorfina/efeitos adversos , Desenvolvimento Infantil/efeitos dos fármacos , Pré-Escolar , Cognição/efeitos dos fármacos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Fatores de Risco
13.
Artigo em Inglês | MEDLINE | ID: mdl-32204415

RESUMO

The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother's and child's health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Abandono do Hábito de Fumar , Poluição por Fumaça de Tabaco , Criança , Feminino , Humanos , Nicotina , Gravidez , Tabaco , Dispositivos para o Abandono do Uso de Tabaco
14.
Artigo em Inglês | MEDLINE | ID: mdl-32106496

RESUMO

Traditional risk factors and environmental exposures only explain less than half of the disease burden. The developmental origin of the health and disease (DOHaD) concept proposes that prenatal and early postnatal exposures increase disease susceptibility throughout life. The aim of this work is to demonstrate the application of the DOHaD concept in a chained risk assessment and to provide an estimate of later in life burden of disease related to maternal smoking. We conducted three systematic literature searches for meta-analysis and reviewed the literature reporting meta-analyses of long-term health outcomes associated with maternal smoking and intermediate risk factors (preterm birth, low birth weight, childhood overweight). In the chained model the three selected risk factors explained an additional 2% (34,000 DALY) of the total non-communicable disease burden (1.4 million DALY) in 2017. Being overweight in childhood was the most important risk factor (28,000 DALY). Maternal smoking was directly associated with 170 DALY and indirectly via the three intermediate risk factors 1000 DALY (1200 DALY in total). The results confirm the potential to explain a previously unattributed part of the non-communicable diseases by the DOHAD concept. It is likely that relevant outcomes are missing, resulting in an underestimation of disease burden.


Assuntos
Recém-Nascido de Baixo Peso , Sobrepeso , Nascimento Prematuro , Efeitos Tardios da Exposição Pré-Natal , Fumar/efeitos adversos , Criança , Feminino , Humanos , Recém-Nascido , Masculino , Mães , Gravidez , Medição de Risco , Fatores de Risco
15.
Arch Dis Child ; 105(6): 539-544, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31862698

RESUMO

OBJECTIVE: To evaluate whether vascular health in young children was associated with exposure to a 6-week episode of coal mine fire smoke or environmental tobacco smoke (ETS) in a retrospective cohort study. METHODS: Three years after a coal mine fire in Victoria, Australia, we investigated the vascular health of children either in utero (n=75) or aged <2 years (postnatal exposure, n=96) at the time of the fire. The outcomes were the carotid intima-media thickness (IMT) and pulse wave velocity (PWV). The mean and peak daily particulate matter <2.5 µm in diameter (PM2.5) exposures were estimated based on their daily locations throughout the fire period. Multivariable linear regression models were used to test for associations between the fire-related PM2.5 and outcomes adjusted for relevant covariates including ETS. RESULTS: In the postnatal-exposure group, each 10 µg/m³ increase in mean PM2.5 level was independently positively associated with PWV (ß=0.116, p=0.028). When these two groups were combined, there was an association between mean PM2.5 and increased PWV in those children who had ETS exposure (ß=0.148, p=0.033) or whose mothers smoked (ß=0.151, p=0.011), but not in those not exposed to ETS or maternal smoking. CONCLUSIONS: Three years after a coal mine fire, infants aged up to 2 years at the time of exposure have increases in vascular stiffness. Although no adverse effects were observed in the in uterus exposure group, further follow-up study is needed to elucidate the long-term effects of coal mine fire smoke exposure.


Assuntos
Carvão Mineral/toxicidade , Exposição Ambiental/efeitos adversos , Incêndios , Fumaça/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Rigidez Vascular , Poluentes Atmosféricos/toxicidade , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Recém-Nascido , Modelos Lineares , Masculino , Material Particulado/análise , Material Particulado/toxicidade , Gravidez , Efeitos Tardios da Exposição Pré-Natal , Estudos Retrospectivos , Vitória/epidemiologia
16.
Am J Prev Med ; 58(1): 21-30, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759804

RESUMO

INTRODUCTION: Standard care interventions to reduce children's tobacco smoke exposure (TSE) may not be sufficient to promote behavior change in underserved populations. A previous study demonstrated the short-term efficacy of an experimental counseling intervention, Family Rules for Establishing Smokefree Homes (FRESH) compared with standard care on boosting low-income children's TSE reduction and maternal smoking at 16-week end of treatment (EOT). This study tested long-term posttreatment efficacy of this treatment through a 12-month follow-up. STUDY DESIGN: This study was a two-arm RCT. SETTING/PARTICIPANTS: Maternal smokers (n=300) not seeking cessation treatment were recruited from low-income, urban communities. Participants exposed their <4-year-old children to tobacco smoke daily. Data collection and analyses occurred from 2006 to 2018. INTERVENTION: The FRESH behavioral intervention included 2 home visits and 7 phone sessions. FRESH used cognitive behavioral skills training, support, problem-solving, and positive social reinforcement to facilitate the adoption of increasingly challenging TSE-protection behaviors. No nicotine-replacement therapy or medication was provided. MAIN OUTCOME MEASURES: Primary outcomes were child cotinine (TSE biomarker) and reported TSE from EOT through 12 months after treatment. A secondary outcome was bioverified maternal smoking cessation. RESULTS: Compared with controls, children in FRESH had significantly lower cotinine (ß= -0.31, p<0.01) and lower maternal-reported TSE (ß= -1.48, p=0.001) through the 12-month follow-up. A significant effect of time (ß= -0.03, p=0.003) reflected a posttreatment decrease in cotinine. There was no treatment × time interaction, suggesting the treatment effect at EOT was sustained after treatment. Compared with controls, FRESH mothers maintained significantly higher odds of quitting smoking from EOT through 12-month follow-up (OR=8.87, 95% CI=2.33, 33.75). CONCLUSIONS: Study results with a sample of underserved maternal smokers demonstrated that the short-term effect of FRESH counseling at 16-week EOT was maintained through 12 months after treatment-for both bioverified child TSE reduction and maternal smoking cessation. Smokers in low-income communities demonstrate elevated challenges to success in standard smoking treatment. FRESH follow-up results suggest the high potential value of more-intensive behavioral intervention for vulnerable smokers. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02117947.


Assuntos
Terapia Comportamental , Mães/estatística & dados numéricos , Poluição por Fumaça de Tabaco , Fumar Tabaco/tendências , Populações Vulneráveis , Pré-Escolar , Cotinina/análise , Cotinina/urina , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Pobreza , Telefone , Fatores de Tempo , Poluição por Fumaça de Tabaco/prevenção & controle , Poluição por Fumaça de Tabaco/estatística & dados numéricos
17.
Br J Nutr ; 123(4): 402-409, 2020 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-31699167

RESUMO

Growth patterns are known to differ between breastfed and formula-fed infants, but little is known about the relative impact of maternal smoking in pregnancy v. feeding mode on growth trajectory in infancy. We conducted a secondary analysis of a trial, the Tolerance of Infant Goat Milk Formula and Growth Assessment trial involving 290 healthy infants, to examine whether smoking in pregnancy modified the association between feeding mode and body composition of infants. Fat mass (FM) and fat-free mass (FFM) were estimated at 1, 2, 3, 4, 6 and 12 months of age using bioimpedance spectroscopy. Formula-fed infants (n 190) had a higher mean FFM at 4 months (mean difference (MD) 160 g, 95 % CI 50·4, 269·5 g, P < 0·05)) and 6 months (MD 179 g, 95 % CI 41·5, 316·9 g, P < 0·05) compared with the breastfed infants (n 100). Sub-group analysis of breastfed v. formula-fed infants by maternal smoking status in pregnancy showed that there were no differences in the FM and FFM between the breastfed and formula-fed infants whose mothers did not smoke in pregnancy. Formula-fed infants whose mothers smoked in pregnancy were smaller at birth and had a lower FM% and higher FFM% at 1 month compared with infants of non-smoking mothers regardless of feeding mode, but the differences were not significant at other time points. Adequately powered prospective studies with an appropriate design are warranted to better understand the relative impact of maternal smoking, feeding practice and the growth trajectory of infants.


Assuntos
Composição Corporal/fisiologia , Fórmulas Infantis , Fenômenos Fisiológicos da Nutrição do Lactente , Exposição Materna/efeitos adversos , Leite Humano , Fumar/efeitos adversos , Adulto , Aleitamento Materno , Desenvolvimento Infantil/fisiologia , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Efeitos Tardios da Exposição Pré-Natal/etiologia , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia
18.
J Pediatr ; 218: 35-41.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31870605

RESUMO

OBJECTIVE: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit. STUDY DESIGN: A randomized, controlled trial compared motivational interviewing plus financial incentives with conventional care on infant urine cotinine at 1 and 4 months' follow-up. Mothers of infants in the neonatal intensive care unit (N = 360) who reported a smoker living in the home were enrolled. Motivational interviewing sessions were delivered in both the hospital and the home. Financial incentives followed session attendance and negative infant cotinine tests postdischarge. RESULTS: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05). CONCLUSIONS: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01726062.


Assuntos
Assistência ao Convalescente/métodos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Entrevista Motivacional/métodos , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
19.
J Pediatr ; 218: 28-34.e2, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31759580

RESUMO

OBJECTIVE: To explore the associations between prenatal exposure to tobacco and neurocognitive development, in the absence of prematurity or low birth weight. STUDY DESIGN: We followed mother-child pairs within Healthy Start through 6 years of age. Children were born at ≥37 weeks of gestation with a birth weight of ≥2500 g. Parents completed the Third Edition Ages and Stages Questionnaire (n = 246) and children completed a subset of the National Institutes of Health Toolbox Cognition Battery (n = 200). The Ages and Stages Questionnaire domains were dichotomized as fail/monitor and pass. Maternal urinary cotinine was measured at approximately 27 weeks of gestation. Separate logistic regression models estimated associations between prenatal exposure to tobacco (cotinine below vs above the limit of detection) and the Ages and Stages Questionnaire domains. Separate linear regression models estimated associations between prenatal exposure to tobacco and fully corrected T-scores for inhibitory control, cognitive flexibility, and receptive language, as assessed by the National Institutes of Health Toolbox. A priori covariates included sex, maternal age, maternal education, daily caloric intake during pregnancy, race/ethnicity, household income, maternal psychiatric disorders, and, in secondary models, postnatal exposure to tobacco. RESULTS: Compared with unexposed offspring, exposed offspring were more likely to receive a fail/monitor score for fine motor skills (OR, 3.9; 95% CI, 1.5-10.3) and decreased inhibitory control (B: -3.0; 95% CI, -6.1 to -0.7). After adjusting for postnatal exposure, only the association with fine motor skills persisted. CONCLUSIONS: Prenatal and postnatal exposures to tobacco may influence neurocognitive development, in the absence of preterm delivery or low birth weight. Increased developmental screening may be warranted for exposed children.


Assuntos
Desenvolvimento Infantil , Cognição/fisiologia , Exposição Materna/efeitos adversos , Transtornos do Neurodesenvolvimento/epidemiologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Criança , Pré-Escolar , Colorado/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Transtornos do Neurodesenvolvimento/etiologia , Gravidez , Fatores de Risco
20.
Nicotine Tob Res ; 22(11): 1981-1988, 2020 10 29.
Artigo em Inglês | MEDLINE | ID: mdl-31536116

RESUMO

INTRODUCTION: Compared with the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations. METHODS: Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines ("Ask, Advise, Refer" [AAR]) plus individualized telephone counseling (AAR + counseling), or AAR + control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers. RESULTS: Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways. CONCLUSIONS: Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking. IMPLICATIONS: Pediatric harm reduction interventions to protect children of smokers from tobacco smoke have emerged to address tobacco-related health disparities in underserved populations. Low-income smokers experience greater tobacco-related disease burden and more difficulty with smoking behavior change in standard evidence-based interventions than the general population of smokers. Therefore, improving knowledge about putative behavioral mechanisms of smoking behavior change that results in lower child exposure risk could inform future intervention improvements.

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