Cessation and reduction in smoking behavior: impact of creating a smoke-free home on smokers.

The aim of this study was to assess the effect of a creating a smoke-free home (SFH) on cessation and reduction of cigarette smoking on low-income smokers. This secondary data analysis uses data from study participants who were originally recruited through 2-1-1 information and referral call centers in Atlanta (Georgia, 2013), North Carolina (2014) and the Texas Gulf Coast (2015) across three randomized controlled trials testing an intervention aimed at creating SFHs, pooling data from 941 smokers. Participants who reported adopting a SFH were more likely to report quitting smoking than those who did not adopt a SFH. This was true at 3-month follow-up and even more pronounced at 6-month follow-up and persisted when considering only those who consistently reported no smoking at 3 and 6 months. Among those who did not stop smoking, the number of cigarettes per day declined significantly more and quit attempts were more frequent for those who created a SFH compared with those who did not. Findings suggest that creating a SFH facilitates cessation, reduces cigarette consumption and increases quit attempts. Future studies should assess the long-term impact of SFHs on sustaining cessation.

Proper Orthogonal Decomposition Methods for the Analysis of Real-Time Data: Exploring Peak Clustering in a Secondhand Smoke Exposure Intervention.

This work explores a method for classifying peaks appearing within a data-intensive time-series. We summarize a case study from a clinical trial aimed at reducing secondhand smoke exposure via the installation of air particle monitors in households. Proper orthogonal decomposition (POD) in conjunction with a k-means clustering algorithm assigns each data peak to one of two clusters. Aversive feedback from the monitors increased the proportion of short-duration, attenuated peaks from 38.8% to 96.6%. For each cluster, a distribution of parameters from a physics-based model of airborne particles is estimated. Peaks generated from these distributions are correctly identified by POD/clustering with >60% accuracy.

Feasibility and efficacy of an intervention to reduce secondhand smoke exposure among infants discharged from a neonatal intensive care unit.

OBJECTIVE: To examine the feasibility and efficacy of a hospital-based, motivational intervention to reduce secondhand smoke exposure (SHSe) with mothers of infants in a neonatal intensive care unit (NICU). STUDY DESIGN: One-hundred and forty-four mothers with infants ( ≤ 1500 g at birth or ≥ 12 h ventilation) in a NICU who reported a smoker in the household were randomized to two sessions of motivational interviewing (MI) conducted in the hospital, usual care (UC) or usual care-reduced measurement (UC-RM); follow-up occurred at 1- and 6-months post discharge. RESULT: For households that did not have a total smoking ban at baseline, 63.6% of those in the MI group instituted a ban by 1-month post discharge compared with 20% of the UC group, P<0.02. Six months post discharge, fewer smoking bans were noted in the UC-RM group relative to MI and UC, P<0.01. CONCLUSION: A need for SHSe interventions among NICU parents exists and initial evidence suggests MI can impact SHSe after discharge.

Perception of body size among Mexican teachers and parents.

Obesity in Mexico has reached epidemic proportions; and body image and body satisfaction might be culturally related. Body dissatisfaction has been related to low self-esteem. The aim of this study was to assess the range of perception among Mexican teachers and parents of the ideal body size of adults, boys and girls. Two-hundred and five teachers and eighty parents from Tijuana and Tecate schools participated in the study. Participants were asked to indicate the ideal body size for each group, as well as their own ideal body size. Average perception of ideal body weight for adults 35 to 45 years of age was 4.0 +/- 0.84. Average perception for boys and girls was 4.6. Positive correlations were shown between self-perception of body size and body mass index (0.62, P < 001), waist circumference (0.55, P < 0.001). Self-perception of body size was associated with perception of ideal body size for boys (0.23, P 0.001) and girls (0.22, P < 0.001), but BMI was not associated to perception of ideal body size for boys and girls. These results suggest that teachers and parents should be taught to more accurately assess excess weight status and to initiate action to prevent or correct excessive weight among children and adults.

Perception of body size among Mexican teachers and parents / Percepción del tamaño corporal en profesores y padres mexicanos

Obesity in Mexico has reached epidemic proportions; and body image and body satisfaction might be culturally related. Body dissatisfaction has been related to low self-esteem. The aim of this study was to assess the range of perception among Mexican teachers and parents of the ideal body size of adults, boys and girls. Two-hundred and five teachers and eighty parents from Tijuana and Tecate schools participated in the study. Participants were asked to indicate the ideal body size for each group, as well as their own ideal body size. Average perception of ideal body weight for adults 35 to 45 years of age was 4.0 ± 0.84. Average perception for boys and girls was 4.6. Positive correlations were shown between self-perception of body size and body mass index (0.62, P < 001), waist circumference (0.55, P < 0.001). Self-perception of body size was associated with perception of ideal body size for boys (0.23, P 0.001) and girls (0.22, P < 0.001), but BMI was not associated to perception of ideal body size for boys and girls. These results suggest that teachers and parents should be taught to more accurately assess excess weight status and to initiate action to prevent or correct excessive weight among children and adults

La obesidad en México ha alcanzado proporciones epidérmicas: la imagen corporal y la satisfacción con el cuerpo de uno mismo podrían tener un componente cultural. La insatisfacción con el cuerpo de uno mismo se ha relacionado con auto-estima baja. El propósito de este estudio fue evaluar, entre los profesores y padres mexicanos, el rango de percepción del tamaño corporal ideal de adultos, niños y niñas. Doscientos cinco profesores y ochenta padres de colegios de Tijuana y Tecate participaron en el estudio. Se pidió a los participantes que indicasen el tamaño corporal ideal para cada grupo, así como su propio tamaño corporal ideal. La percepción promedio del peso corporal ideal para adultos de entre 35 y 45 años de edad fue 4,0 ± 0,84. La percepción ideal para niños y niñas fue 4,6. Se observaron correlaciones positivas entre la auto-percepción del tamaño corporal y el índice de masa corporal (0,62, P < 0,001), y la circunferencia de la cintura (0,55, P < 0,001). La auto-percepción del tamaño corporal se asoció con la percepción del tamaño corporal ideal para los niños (0,23, P < 0,001) y las niñas (0,22, P < 0,001), pero el IMC no se asoció con la percepción del tamaño corporal ideal en niños y niñas. Esto sugiere que se debería enseñar a los profesores y padres a evaluar de una forma más precisa el estado de peso e iniciar una acción preventiva o corregir el exceso de peso en niños y adultos

Evaluation of urinary trans-3'-hydroxycotinine as a biomarker of children's environmental tobacco smoke exposure.

The utility of urinary trans-3'-hydroxy cotinine (3HC) as a biomarker of environmental tobacco smoke (ETS) exposure was investigated in comparison with urinary cotinine (COT), the sum (3HC + COT), and ratio of the two nicotine metabolites (3HC/COT). Participants were 150 ETS exposed children (aged 1-44 months) and their parents. Child urine samples were collected during 3weekly baseline assessments and at interviews administered 3, 6, 12, and 18 months after baseline. Findings indicate that 3HC and COT can be measured reliably (rho = 0.96, 0.88) and show equivalent levels of repeated measures stability (rho = 0.71, 0.75). COT, 3HC, and 3HC + COT showed equally strong associations with air nicotine levels, reported ETS contamination, and reported ETS exposure (r=0.60-0.70). The intraclass correlations of 3HC/COT were lower than those for COT or 3HC. Older children had a higher 3HC/COT ratio than younger children (3.5 versus 2.2), and non-Hispanic White children had a higher ratio than African-American children (3.2 versus 1.9). These findings suggest that COT, 3HC, and 3HC + COT are approximately equivalent and equally strong biomarkers of ETS exposure in children. Moreover, 3HC/COT may provide a useful indicator to investigate age- and race-related differences in the metabolism of COT and 3HC.

Households contaminated by environmental tobacco smoke: sources of infant exposures.

OBJECTIVES: To examine (1) whether dust and surfaces in households of smokers are contaminated with environmental tobacco smoke (ETS); (2) whether smoking parents can protect their infants by smoking outside and away from the infant; and (3) whether contaminated dust, surfaces, and air contribute to ETS exposure in infants. DESIGN: Quasi-experiment comparing three types of households with infants: (1) non-smokers who believe they have protected their children from ETS; (2) smokers who believe they have protected their children from ETS; (3) smokers who expose their children to ETS. SETTING: Homes of smokers and non-smokers. PARTICIPANTS: Smoking and non-smoking mothers and their infants < or = 1 year. MAIN OUTCOME MEASURES: ETS contamination as measured by nicotine in household dust, indoor air, and household surfaces. ETS exposure as measured by cotinine levels in infant urine. RESULTS: ETS contamination and ETS exposure were 5-7 times higher in households of smokers trying to protect their infants by smoking outdoors than in households of non-smokers. ETS contamination and exposure were 3-8 times higher in households of smokers who exposed their infants to ETS by smoking indoors than in households of smokers trying to protect their children by smoking outdoors. CONCLUSIONS: Dust and surfaces in homes of smokers are contaminated with ETS. Infants of smokers are at risk of ETS exposure in their homes through dust, surfaces, and air. Smoking outside the home and away from the infant reduces but does not completely protect a smoker's home from ETS contamination and a smoker's infant from ETS exposure.

Intervention to reduce environmental tobacco smoke exposure in Latino children: null effects on hair biomarkers and parent reports.

OBJECTIVE: To evaluate the effectiveness of a lay delivered intervention to reduce Latino children's exposure to environmental tobacco smoke (ETS). The a priori hypothesis was that children living in households that were in the intervention group would have lower exposure over time than measurement only controls. DESIGN: A two group, randomised control trial was conducted. SETTING: Areas of San Diego county with a large Latino population. PARTICIPANTS: 143 Latino parent-child pairs. INTERVENTION: Trained bicultural and bilingual Latina lay community health advisors, or promotoras, conducted problem solving aimed at lowering the target child's exposure to ETS in the household. Six home and telephone sessions were delivered by the promotoras over a four month period. MAIN OUTCOME MEASURES: Outcome measures were collected at baseline, immediately post-intervention, three months post-intervention, and 12 months post-intervention. Four outcomes were considered: (1) parent's paper-and-pencil reports of the child's past month exposure; (2) hair samples from the child analysed for past month nicotine; (3) hair samples from the child analysed for past month cotinine; and (4) per cent confirmed reducers. RESULTS: There were no significant condition-by-time interactions, the term indicative of a differential intervention effect. Significant or near significant time main effects were seen for children's hair cotinine, per cent confirmed reducers, and, in particular, parent reports of exposure. CONCLUSIONS: Applying a lay promotora model to deliver the behavioural problem solving intervention unfortunately was not effective. A likely explanation relates to the difficulty of delivering a relatively complex intervention by lay women untrained in behaviour change theory and research methods.

Engineering clinician leadership and success in tobacco control: recommendations for policy and practice in Hungary and Central Europe.

Decades of research and advocacy to control tobacco use and related public-health harm have not counterbalanced the tobacco industry's successful stronghold, which is ever-increasing in countries with weaker anti-tobacco leadership. Current rates of tobacco use and harm in Hungary and other Central European countries mark them as some of the industry's greater successes. Following the Behavioural Ecological Model, a framework for behavioural and cultural change, this paper reviews important ways that dentists, physicians and other healthcare providers can counter the tobacco industry's influence on patients, communities, and the nation. The analysis includes policies and practices shown to be effective in controlling and undermining the tobacco industry, and outlines new policies and practices that show promise based on the behavioural change framework. The components of an all-encompassing tobacco-control programme are described through explicit recommendations for research, practice and policy that are necessary to establish a professional and societal culture that extinguishes the influence and harm of the tobacco industry in Hungary, Central Europe and developing countries worldwide.

Somatic complaints and isoniazid (INH) side effects in Latino adolescents with latent tuberculosis infection (LTBI).

This study examined the potential effects of INH side effects and non-specific somatic complaints on medication adherence in 96 Latino adolescents participating in a controlled trial designed to increase isoniazid (INH) adherence. These participants (who received usual medical care) were interviewed monthly over 9 months. Participants were questioned regarding medication taking, the frequency of 15 INH-related side effects from the Physician's Desk Reference (PDR) [1], and 21 non-specific somatic complaints. Participants were aged 12-19 years, 53.1% were male, 66.7% were born in Mexico, 73% had no health insurance, and 52.5% were classified as bicultural. Approximately 70% of participants experienced at least one side effect during the trial. Side effects that occurred while taking INH were not significantly related to total number of pills taken; somatic complaints that occurred during 9 months of INH were significantly negatively related to cumulative adherence. Females reported significantly more somatic complaints at baseline than males.

The feasibility and efficacy of tobacco use prevention in orthodontics.

SMILES PLUS was the first study to extend the clinician-delivered logic model to prevention of tobacco use among adolescents. This multi-site trial with 154 participating offices, based on social learning theory and a behavioral ecological model, was designed to test whether orthodontists can prevent preteens from initiating smoking. The study found that orthodontists do not automatically adhere to anti-tobacco prevention services. Social learning variables can enhance both adherence to counseling guidelines and content of counseling to increase prevention effects. Providing financial incentives, tracking prescriptions, prompting positive feedback from patients, and adopting anti-tobacco counseling models in the office are likely to enhance anti-tobacco preventive services. Training orthodontists to be comfortable when advising nonsmoking youth not to start and to use social consequences to justify youth avoidance of tobacco might increase adherence to protocols and make their counseling more powerful. Adolescent smokers prior to intervention were more likely to start other risky behaviors later. Preventing tobacco use may halt additional risk behaviors and thereby reduce morbidity/mortality even more than expected from tobacco control alone. New and refined clinical trials should be conducted to determine the most effective interventions for adolescent tobacco control by clinicians.

Observational assessment of family functioning at mealtime in preschool children with cystic fibrosis.

OBJECTIVE: To examine functioning during a dinner meal in families of a child with a chronic illness that requires dietary treatment recommendations, as compared to families of a child without a chronic illness. METHODS: Ratings of seven dimensions of family functioning on the McMaster Mealtime Family Interaction Coding System (MICS) were obtained on 29 families of children with CF and 29 families of children with no chronic illness, ages 2 to 6 years, during a videotaped dinner meal at home. RESULTS: Ratings of families with a child with CF were significantly lower than those for families of children without a chronic illness on Overall Family Functioning and five of the six MICS dimensions: Communication, Interpersonal Involvement, Affect Management, Behavior Control, and Role Allocation and approached significance on the Task Accomplishment dimension. The ratings of families of a child with CF were in the "clinically significant" range on all subcales, including Task ACCOMPLISHMENT. CONCLUSIONS: This study suggests that family functioning at mealtimes may be different in families of children with CF in which explicit dietary guidelines exist than in families of children with no illness or dietary guidelines. These results are discussed in terms of global family functioning and treatment approaches to dietary treatment recommendations.

Increasing asthma knowledge and changing home environments for Latino families with asthmatic children.

We tested an asthma education program in 204 underserved Latino families with an asthmatic child. The education program consisted of one or two sessions delivered in each family's home in the targeted participant's preferred language by a bilingual, bicultural educator. We encouraged, but did not require, attendance by the child. The curriculum was culturally-tailored, and all participants received education on understanding asthma, preventing asthma attacks, and managing asthma. Outcomes included change in asthma knowledge and change in home environment asthma management procedures. Asthma knowledge increased significantly (39 to 50% correct from pre- to post-test, P < 0.001) and participants made significant changes to the child's bedroom environment (mean number of triggers decreased from 2.4 to 1.8, P < 0.001; mean number of controllers increased from 0.7 to 0.9, P < 0.001). The results support the value of asthma education and its importance in the national agenda to reduce health disparities among minorities.

[Reducing children's exposure to environmental tobacco smoke: Evidence from the U.S. and implications for Hungary] / Gyermekek környezeti dohányfüstártalmának csökkenése: az Egyesült Allamok tapasztalatainak hasznosítása Magyarországon.

This review summarizes empirical evidence for clinical interventions designed to reduce children's residentia environmental tobacco smoke (ETS) exposure. Legislation prohibiting ETS exposure in public buildings, especially work settings, may decrease ETS exposure in private residences. Media, policy/legal regulations, and brief clinical advice require more study to determine their effectiveness for decreasing ETS exposure in private residences. Three published and two in progress trials found that repeated counseling reduced ETS exposure in asthmatic and healthy children from lower through middle class families. Dentists, physicans, and other clinicians may be strategic supervisors for paraprofessional counseling designed to lower children's ETS exposure in their home. Research is needed to determine the cultural tailoring needed to be effective in Hungary.

Tobacco use and other risk behaviors: cross-sectional and predictive relationships for adolescent orthodontic patients.

BACKGROUND: The purpose of these analyses was to examine the prevalence of selected substance abuse, general and dental health risk, and scholastic risk behaviors and their cross-sectional and predictive relationships with tobacco use among 15, 179 adolescent orthodontic patients in Southern California. METHODS: Subjects were recruited through 154 orthodontists' offices and interviewed by telephone at baseline and two-year posttest. RESULTS: Results show a pattern of increasing prevalence of risk behaviors with age. In most cases, gender differences were small. There were statistically significant positive relationships between each risk behavior and tobacco use status for both boys and girls. Prevalence rates of risk behaviors other than tobacco use were highest for current smokers, intermediate for experimenters, and lowest for respondents reporting that they had never used tobacco. Baseline tobacco use predicted each posttest risk behavior in logistic regression analyses. Principle components analysis (with varimax rotation) of posttest risk practices other than tobacco use yielded three theoretically meaningful factors, all which were predicted by baseline tobacco use in multiple regressions. CONCLUSIONS: These findings show that tobacco use among adolescents can predict subsequent risk practices other than tobacco use as long as two years, and that unhealthy behaviors among teens are interrelated. Orthodontists, who have a high frequency of adolescent patient contact, may be in a unique position to deliver health promotion interventions to their patients; possibly targeting multiple risk behaviors.

Evaluation of a real-time passive personal particle monitor in fixed site residential indoor and ambient measurements.

Recent experimental findings in animals and humans indicate adverse respiratory effects from short-term exposures to particulate air pollutants, especially in sensitive subpopulations such as asthmatics. The relationship between air pollution and asthma has mainly been determined using particulate matter (PM) measurements from central sites. Validated tools are needed to assess exposures most relevant to health effects. Recently, a personal passive particulate sampler (personal Data-RAM, pDR, MIE Inc., Bedford, MA) has become available for studying personal exposures to PM with time resolution at 1 min. The pDR measures light scatter from PM in the 0.1-10 microM range, the significant range for health effects. In order to assess the ability of the pDR in predicting gravimetric mass, pDRs were collocated with PM2.5 and PM10 Harvard Impactors (HI) inside and outside nine homes of asthmatic children and at an outdoor central Air Pollution Control District site. Results are presented of comparisons between the HI samplers and the pDR in various modes of operation: passive, active, and active with a heated inlet. When used outdoors at fixed sites the pDR readings exhibit interference from high relative humidity (RH) unless operated with a method for drying inlet air such as a heater, or if readings at times of high RH are adjusted. The pDR correlates more highly with the HI PM2.5 than with the HI PM10 (r2 = 0.66 vs. 0.13 for outdoors, r2 = 0.42 vs. 0.20 for indoors). The pDR appears to be a useful tool for an epidemiologic study that aims to examine the relationship between health outcomes and personal exposure to peaks in PM.

Reported measures of environmental tobacco smoke exposure: trials and tribulations.

OBJECTIVE: This report extends previous summaries of reported environmental tobacco smoke (ETS) exposure measures, reviews the empirical evidence of their validity for children's exposure, and discusses future research. DATA SOURCES: Studies were identified by computer search and from the authors' research. STUDY SELECTION: Studies were selected for inclusion of nicotine and/or cotinine and quantitative reported measures of ETS exposure. DATA SYNTHESIS: Five studies found significant associations between reported quantitative exposure of children to ETS and either environmental nicotine or urine cotinine assays. Correlation coefficients between parent reports and nicotine ranged from 0.22 to 0.75. Coefficients for cotinine ranged from 0.28 to 0.71. Correlations increased over time and were stronger for parents' reports of their own smoking as a source of children's exposure than for reports of exposure from others. CONCLUSIONS: Empirical studies show general concordance of reported and either environmental or biological measures of ETS exposure. Relationships were moderate, and suggest sufficient validity to be employed in research and service programs. Future studies need to identify the differences in types of reported or objective measures, population characteristics, etc, contributing to observed variability in order to understand better the conditions under which more valid reported ETS exposure and other measures can be obtained. Reported and either environmental or biological measures should be used in combination, and existing measures should be directed to interventions that may reduce ETS exposure among children.