Effect of Feedback Regarding Urinary Cotinine and Brief Tailored Advice on Home Smoking Restrictions among Low-Income Parents of Children with Asthma: A Controlled Trial

doi:10.1006/pmed.2001.0953

Preventive Medicine

Volume 34, Issue 1, January 2002, Pages 58-65

https://doi.org/10.1006/pmed.2001.0953 Get rights and content

Abstract

Background. Since most smoker parents of children with asthma are unable to quit, an alternative measure that would reduce their children's exposure to environmental tobacco smoke (ETS) is to ban smoking in the home.

Methods. Compared with 136 usual-care controls, 128 intervention-group parents recruited from South Australian pediatric hospital outpatient waiting rooms were given written and verbal feedback about their 1- to 11-year-old child's urinary cotinine-to-creatinine level, information booklets, and two telephone calls encouraging a ban on smoking at home.

Results. At 6 months, 49.2% of the intervention group reported having banned smoking in the home compared with 41.9% of controls, but the differential rate of change from baseline was not significant (P = 0.40). At follow-up, there were no significant differences between groups in the percentage reporting bans on smoking in the car, the mean reduction from baseline in total daily consumption or consumption in front of the child, children's urinary cotinine level, or parental smoking cessation.

Conclusions. The intervention did not change parents' propensity to create or maintain bans on smoking in their homes or otherwise change smoking habits to reduce their children's exposure to ETS. More intensive interventions may be required to achieve change among low-income smoker parents of children with asthma.

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Research has shown that beliefs about thirdhand smoke are related to increased protective behaviors such as enforcing a ‘smoke-free home’ [20]. Several interventions aimed at reducing TSE of children in the home used feedback of biomarkers with varying degrees of success [21–25]. Despite the potential utility of biomarkers for both behavior-change interventions and monitoring, the topic of parental receptivity to child biomarker testing to assess TSE has received little attention in the research literature.
Widespread tobacco smoke exposure (TSE) of children suggests that parents may be unaware of their children's exposure. Biomarkers demonstrate exposure and may motivate behavior change, but their acceptability is not well understood.
Sixty-five in-depth interviews were conducted with parents of young children, in smoking families in central Israel. Data were analyzed using thematic analysis.
Consent to testing was associated with desire for information, for reassurance or to motivate change, and with concerns for long-term health, taking responsibility for one's child, and trust in research. Opposition to testing was associated with preference to avoid knowledge, reluctance to cause short-term discomfort, perceived powerlessness, and mistrust of research.
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Parents were receptive to non-invasive child biomarker testing. Biomarker information could help persuade parents who smoke that their children need protection.
Biomarker testing of children in smoking families is an acceptable and promising tool for education, counseling, and motivation of parents to protect their children from TSE. Additionally, biomarker testing allows objective assessment of population-level child TSE.
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Similar to our previous studies, only 28% of caregivers in our study whose child had a TSE-related illness believed that their smoking was putting their child’s health at risk, and 44% of caregivers believed that quitting would benefit their child [17]. Our findings support previous primary care or hospital-based research that found no clear evidence of cessation success with caregivers whose children have a TSE-related or even a general “ill child” visit [29-32]. However, a recent meta-analysis indicates that interventions designed to achieve cessation among caregivers for the sake of their children appear to increase quit rates, especially when interventions include the use of medications [15].
There is a high prevalence of smoking among caregivers who bring their children to the pediatric emergency department (PED) and even higher rates of tobacco smoke exposure (TSE) and related morbidity among their children. The PED visit presents an opportunity to intervene with caregivers, but it is unknown whether they are more likely to quit if their child has a TSE-related illness. We sought to examine a PED-based smoking cessation intervention and compare outcomes based on children’s TSE-related illness.
A single-arm, prospective trial, with baseline, 3, and 6 month assessments was used in this study. Caregivers whose child had either a TSE-related (n = 100) or non–TSE-related illness (n = 100) were given a brief intervention consisting of counseling, referral to the Quitline, and free nicotine replacement therapy.
Participants were 91.5% female, 50.5% African American, 100% Medicaid recipients, 30.8 years old, child age mean of 5.5 years, 90% highly nicotine dependent, and 60.3% and 75.8% allowed smoking in the home and car, respectively. At follow-up (65% retention), 80% reported quit attempts at 3 months and 89% between 3 and 6 months. There were significant decreases in number of cigarettes smoked, time to first cigarette, and smoking in the home and car. Quit rates were 12.2% at 3 months, 14.6% at 6 months, and 7.3% at both time points (50% biochemically confirmed). There were no significant differences in outcomes based on children’s illness.
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Evidence has not shown which interventions are most effective in reducing ETS exposure in childhood (Baxi et al., 2014). One promising aspect of behavioral change strategies to reduce children's ETS exposure is the provision of feedback based on child's urine cotinine level (CUCL) (Chilmonczyk et al., 1992; McIntosh et al., 1994; Wakefield et al., 2002; Wilson et al., 2001). The two aims of this paper are 1) to explore the reach of households with children below the age of 4 years using proactive recruitment at their homes and to 2) describe the efficacy of a brief intervention to reduce ETS exposure using CUCL feedback on ETS absorption in child and behavioral change counseling.
To explore the reach of a German population-based household sample using proactive recruitment and to test the efficacy of a behavioral change counseling intervention including feedback about children's urine cotinine level (CUCL).
A randomized controlled trial (2008–2010) was conducted in households with at least one child aged below 4 years and at least one current smoker. The study area comprised of 3570 households. A screening assessment was provided in 2641 households; 1282 included one current smoker and 852 completed the study protocol. The intervention group (IG; n = 428) received feedback about CUCL and up to two counseling sessions. The control group (CG; n = 424) received a leaflet. Assessments were provided at baseline and 12-month follow-up. Heckman's selection model analysis was used to consider the detection limit of cotinine in urine (10 ng/ml).
CUCL below the detection limit in the IG was found in 43.2% at baseline and 44.6% at follow-up and in 44.8% of the CG at baseline and 47.2% at follow-up. The CUCL difference between follow-up and baseline was smaller in the CG than in the IG. The effect was not significant.
Data revealed a high reach of the target population but failed to identify an intervention effect.
Clinical Trial Registration www.clinicaltrials.gov (NCT00647413).
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^☆: This study was funded by the Australian National Health and Medical Research Council (Grant 980608).

²: To whom reprint requests should be addressed at the Center for Behavioral Research in Cancer, Cancer Control Research Institute, Anti-Cancer Council of Victoria, 100 Drummond Street, Carlton, Victoria 3053, Australia. Fax: (61) (3) 9635 5380. E-mail: [email protected].

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Regular ArticleEffect of Feedback Regarding Urinary Cotinine and Brief Tailored Advice on Home Smoking Restrictions among Low-Income Parents of Children with Asthma: A Controlled Trial☆

Abstract

Prev Med

Am J Prev Med

Arch Pediatr

Chest

Summary of effects of parental smoking on the respiratory health of children and implications for research

Thorax

The impact of passive smoking on emergency room visits of urban children with asthma

Am Rev Respir Dis

Passive smoke exposure impairs recovery after hospitalization for acute asthma

Arch Pediatr Adolesc Med

Smoking behaviours of Australian adults in 1995: trends and concerns

Med J Aust

Advising parents of asthmatic children on passive smoking: randomized controlled trial

Br Med J

Parents' perceptions of the pros and cons of banning smoking at home

Health Promot J Aust.

Factors modifying exposure to environmental tobacco smoke in children (Athens, Greece)

Cancer Causes Control

Reduction of environmental tobacco smoke exposure among asthmatic children: a controlled trial

Chest

Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies

Tobacco Control

Regular Article
Effect of Feedback Regarding Urinary Cotinine and Brief Tailored Advice on Home Smoking Restrictions among Low-Income Parents of Children with Asthma: A Controlled Trial☆