Mel Hovell

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 ⩽ 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.

The power of nonspecific effects in healing: Implications for psychosocial and biological treatments

Abstract We evaluate the hypothesis that the power of nonspecific effects may account for as much as two thirds of successful treatment outcomes when both the healer and the patient believe in the efficacy of a treatment. Five medical and surgical treatments, once considered to be efficacious by their proponents but no longer considered effective based upon later controlled trials, were selected according to strict inclusion criteria. A search of the English literature was conducted for all studies published for each treatment area. The results of these studies were categorized, where possible, into excellent, good, and poor outcomes. For these five treatments combined, 40 % excellent, 30 % good, and 30 % poor results were reported by proponents. We conclude that, under conditions of heightened expectations, the power of nonspecific effects far exceeds that commonly reported in the literature. The implications of these results in evaluating the relative efficacy of biological and psychosocial treatments is discussed.

Parental Smoking Cessation to Protect Young Children:A Systematic Review and Meta-analysis

BACKGROUND: Young children can be protected from much of the harm from tobacco smoke exposure if their parents quit smoking. Some researchers encourage parents to quit for their childrens benefit, but the evidence for effectiveness of such approaches is mixed. OBJECTIVE: To perform a systematic review and meta-analysis to quantify the effects of interventions that encourage parental cessation. METHODS: We searched PubMed, the Cochrane Library, Web of Science, and PsycINFO. Controlled trials published before April 2011 that targeted smoking parents of infants or young children, encouraged parents to quit smoking for their childrens benefit, and measured parental quit rates were included. Study quality was assessed. Relative risks and risk differences were calculated by using the DerSimonian and Laird random-effects model. RESULTS: Eighteen trials were included. Interventions took place in hospitals, pediatric clinical settings, well-baby clinics, and family homes. Quit rates averaged 23.1% in the intervention group and 18.4% in the control group. The interventions successfully increased the parental quit rate. Subgroups with significant intervention benefits were children aged 4 to 17 years, interventions whose primary goal was cessation, interventions that offered medications, and interventions with high follow-up rates (>80%). CONCLUSIONS: Interventions to achieve cessation among parents, for the sake of the children, provide a worthwhile addition to the arsenal of cessation approaches, and can help protect vulnerable children from harm due to tobacco smoke exposure. However, most parents do not quit, and additional strategies to protect children are needed.

Social learning correlates of exercise self-efficacy: Early experiences with physical activity

Self-efficacy, the degree of confidence an individual has for performing a given behavior, is a central concept in social learning theory. Self-efficacy is a strong correlate of current exercise and a consistent predictor of future exercise behavior. This study was designed to explore the correlates of exercise self-efficacy in order to determine whether early experiences with exercise and sports fosters exercise self-efficacy in adulthood. This study explored historical and contemporaneous correlates of exercise self-efficacy using a path analytic approach and a randomly selected sample of adults. Historical experiences with exercise and sports were classified as more or less organized and as proximal or distal in time. The activities studied included those reported during elementary (ages 6-14), high school (15-18), and the period after high school. The historical activities, scaled using factor analysis, were found to have no significant direct association with self-efficacy and only marginal indirect associations with self-efficacy mediated by contemporaneous social learning variables. Contemporaneous variables drawn from social learning theory were found to have the largest direct and indirect associations with self-efficacy specifically related to vigorous exercise. Directions for experimental analysis and health promotion policy implications are discussed.

Effectiveness of Motivational Interviewing to Reduce Head Start Children’s Secondhand Smoke Exposure. A Randomized Clinical Trial

RATIONALE Secondhand smoke exposure (SHSe) is a significant modifiable risk for respiratory health in children. Although SHSe is declining overall, it has increased for low-income and minority populations. Implementation of effective SHSe interventions within community organizations has the potential for significant public health impact. OBJECTIVES To evaluate the effectiveness of motivational interviewing (MI) delivered in the context of a SHS education reduction initiative within Head Start to reduce preschool childrens SHSe. METHODS A total of 350 children enrolled in Baltimore City Head Start whose caregivers reported a smoker living in the home were recruited. Caregivers were randomized to MI + education or education alone. Assessments were conducted at baseline, 3, 6, and 12 months. MEASUREMENTS AND MAIN RESULTS The primary outcome measure was household air nicotine levels measured by passive dosimeters. Secondary outcomes included child salivary cotinine, self-report of home smoking ban (HSB), and smoking status. Participants in the MI + education group had significantly lower air nicotine levels (0.29 vs. 0.40 mg), 17% increase in prevalence of caregiver-reported HSBs, and a 13% decrease in caregiver smokers compared with education-alone group (all P values < 0.05). Although group differences in salivary cotinine were not significant, among all families who reported having an HSB, salivary cotinine and air nicotine levels declined in both groups (P < 0.05). CONCLUSIONS MI may be effective in community settings to reduce child SHSe. More research is needed to identify ways to tailor interventions to directly impact child SHSe and to engage more families to make behavioral change. Clinical trial registered with www.clinicaltrials.gov (NCT 00927264).

A Minimal Intervention to Promote Smoke-Free Homes Among 2-1-1 Callers: A Randomized Controlled Trial

OBJECTIVES We tested the efficacy of a minimal intervention to create smoke-free homes in low-income households recruited through the United Way of Greater Atlanta 2-1-1, an information and referral system that connects callers to local social services. METHODS We conducted a randomized controlled trial (n=498) from June 2012 through June 2013, with follow-up at 3 and 6 months. The intervention consisted of 3 mailings and 1 coaching call. RESULTS Participants were mostly smokers (79.7%), women (82.7%), African American (83.3%), and not employed (76.5%), with an annual household income of

Efficacy of Acupuncture for Treating Cocaine Addiction: A Review Paper

10,000 or less (55.6%). At 6-months postbaseline, significantly more intervention participants reported a full ban on smoking in the home than did control participants (40.0% vs 25.4%; P=.002). The intervention worked for smokers and nonsmokers, as well as those with or without children. CONCLUSIONS Minimal intervention was effective in promoting smoke-free homes in low income households and offers a potentially scalable model for protecting children and adult nonsmokers from secondhand smoke exposure in their homes.

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

Abstract Acupuncture is being used in more than three hundred treatment facilities for treating substance abuse including cocaine addiction. Previous review papers could not evaluate the role of acupuncture for treating cocaine addiction because of lack of clinical trials at the time. Since then, several important studies were conducted in the field. This paper reviews existing clinical trials using acupuncture to treat cocaine addiction. The existing evidence fails to document the benefit of acupuncture in treating cocaine addiction as the sole treatment. Further efforts to document the efficacy of the NADA protocol to treat cocaine addiction as the sole treatment should be re-evaluated. There is a limited amount of evidence showing possible benefits of acupuncture when used as an adjunctive therapy to complement existing substance abuse treatment program. Future efforts should concentrate on systematic studies investigating the role of acupuncture as an adjunctive treatment for cocaine addiction. In addition, more formative research exploring the efficacy of different types and protocols of acupuncture treatments for cocaine addiction should be thoroughly investigated.

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

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 Physicians 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.

Home smoking policy and environmental tobacco smoke exposure among Koreans in Seoul

Abstract 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.