RCT of a client-centred, caseworker-delivered smoking cessation intervention for a socially disadvantaged population

Background: Disadvantaged groups are an important target for smoking cessation intervention. Smoking rates are markedly higher among severely socially disadvantaged groups such as indigenous people, the homeless, people with a mental illness or drug and alcohol addiction, and the unemployed than in the general population. This proposal aims to evaluate the efficacy of a client-centred, caseworker delivered cessation support intervention at increasing validated self reported smoking cessation rates in a socially disadvantaged population.
Methods/Design: A block randomised controlled trial will be conducted. The setting will be a non-government organisation, Community Care Centre located in New South Wales, Australia which provides emergency relief and counselling services to predominantly government income assistance recipients. Eligible clients identified as smokers during a baseline touch screen computer survey will be recruited and randomised by a trained research assistant located in the waiting area. Allocation to intervention or control groups will be determined by time periods with clients randomised in one-week blocks. Intervention group clients will receive an intensive client centred smoking cessation intervention offered by the caseworker over two face-to-face and two telephone contacts. There will be two primary outcome measures obtained at one, six, and 12 month follow-up: 1) 24-hour expired air CO validated self-reported smoking cessation and 2) 7-day self-reported smoking cessation. Continuous abstinence will also be measured at six and 12 months follow up.
Discussion: This study will generate new knowledge in an area where the current information regarding the most effective smoking cessation approaches with disadvantaged groups is limited.

Tobacco smoking as a risk factor for major depressive disorder : a population-based study

Background : Smoking is disproportionately prevalent among people with psychiatric illness.

Aims : To investigate smoking as a risk factor for major depressive disorder.

Method : A population-based sample of women was studied using case–control and retrospective cohort study designs. Exposure to smoking was self-reported, and major depressive disorder diagnosed using the Structured Clinical Interview for DSM–IV–TR (SCID–I/NP).

Results : Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder (age-adjusted odds ratio (OR)=1.46, 95% CI 1.03–2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers (>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developed de novo major depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI 1.02–3.69); this was not explained by physical activity or alcohol consumption.

Conclusions : Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.

Parental nurturing and adverse effects of redistribution

This paper suggests that if parental nurturing is a dominating force in human capital formation then income redistribution may not promote economic growth. In particular, if, consistently with empirical evidence, parental human capital complements investment in a child’s education and yields increasing returns in the intergenerational production of human capital, income redistribution may have an adverse impact on the growth rate of average human capital. Redistribution shifts resources towards the less educationally-productive families and thus in the presence of credit markets imperfections and increasing returns, it reduces the aggregate level of investment in human capital. Moreover, if the degree of increasing returns is sufficiently large to produce sustained growth, this adverse effect on human capital formation may outweigh the conventional beneficial effects of redistribution that arises from the interaction between a production technology exhibiting diminishing returns and credit market imperfections.

Associations between parental concern for adolescent weight and the home food environment and dietary intake

Objective: Examine associations between parental concern about adolescent weight and adolescent perceptions of their dietary intake, home food availability, family mealtime environment, and parents' feeding practices.

Design: Cross-sectional study.

Setting: Adolescents, aged 12-15 years from 37 secondary schools in Victoria, Australia, and their parents completed surveys in 2004-2005.

Participants: 1,448 adolescent–parent pairs.

Main Outcome Measures: Parental concern about adolescent weight; adolescent perceptions of their food intake and home food environment.

Analysis: Chi-square tests, exploratory factor analysis, independent t tests (P < .01).

Results: Although 12% of parents perceived their adolescent as overweight, 27% were concerned about their adolescent's weight (under- or overweight). Adolescents of concerned parents reported lower intakes of energy-dense snacks and less home availability of these food items, and they perceived that their parents less often listened to and considered their food preferences when shopping and cooking, than did adolescents of unconcerned parents. Concerned parents were no more likely to provide fruits and vegetables in the home or a positive family mealtime environment than unconcerned parents, at least as reported by their adolescents.

Conclusions and Implications: Parental concern about adolescent weight was associated with lower intakes of energy-dense snacks among adolescents, less home availability of these food items, and less supportive parental feeding practices. Parents should be encouraged to listen to and consider their adolescents' food preferences, and provide supportive family mealtime environments and healthful food in the home.

Looking after well siblings of adolescent girls with anorexia : an important parental role

Background Research has suggested that well siblings of children with chronic and life-threatening illnesses are at risk for negative outcomes and that parents’ responses to the illnesses can influence the adaptation of well siblings. Yet, parents’ efforts to look after well siblings in the context of illness are rarely considered in literature about sibling adaptation. The importance of attending to the needs of well siblings was a major theme to emerge from a qualitative analysis of the experiences of parents of adolescent girls with anorexia nervosa.

Methods In-depth interviews were conducted with 24 parents of adolescent girls with anorexia and analysed using grounded theory method.

Results The data indicated that parents viewed caring for well siblings in the context of anorexia as an important role and responsibility. Parents reported making conscious and active efforts to look after well siblings by: maintaining normality; compensating for changes to routines; protecting siblings; providing emotional support; and managing the consequences.

Conclusions This paper provides a picture of the actions parents take to help well siblings adapt to anorexia in the family. Further research is needed to develop and expand this understanding to families experiencing a wide range of chronic and life-threatening illnesses. The findings underline the importance of clinical attention and further research into the critical parental role of caring for well siblings.

The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK : an update to 2006-07 NHS costs

Background: Estimates of the economic cost of risk factors for chronic disease to the NHS provide evidence for prioritization of resources for prevention and public health. Previous comparable estimates of the economic costs of poor diet, physical inactivity, smoking, alcohol and overweight/obesity were based on economic data from 1992–93.

Methods: Diseases associated with poor diet, physical inactivity, smoking, alcohol and overweight/obesity were identified. Risk factor-specific population attributable fractions for these diseases were applied to disease-specific estimates of the economic cost to the NHS in the UK in 2006–07.

Results: In 2006–07, poor diet-related ill health cost the NHS in the UK £5.8 billion. The cost of physical inactivity was £0.9 billion. Smoking cost was £3.3 billion, alcohol cost £3.3 billion, overweight and obesity cost £5.1 billion.

Conclusion: The estimates of the economic cost of risk factors for chronic disease presented here are based on recent financial data and are directly comparable. They suggest that poor diet is a behavioural risk factor that has the highest impact on the budget of the NHS, followed by alcohol consumption, smoking and physical inactivity.

Dual audiences, double pedagogies : representing family literacy as parental work in picture books

Narrative for a dual audience of children and adults is a field of expanding interest among children’s literature scholars. A great deal of the extant research is implicitly or explicitly informed by longstanding anxieties about the status of children’s fiction, a context that shifts the parameters of the analysis to questions of literary sophistication. Whilst some attention is paid to the readersubject position of the child reader, rather less is given to the positioning of the adult reader in relation to the pedagogical agendas of such texts. This article examines picture books featuring parents reading to preschool children. In the context of family literacy, it is an instance in which the pedagogical address to the adult reader is as significant as the address to the child. Drawing on distinctions between double and dual address, the article examines the ways in which representations of parents.

Does cigarette promotion increase susceptibility to smoking? : a re-test of the link between tobacco industry promotion and adolescent susceptibility to cigarette use

In 1998, using the Index of Receptivity to Tobacco Industry Promotion (IRTIP), it was claimed that tobacco promotion increased youth susceptibility to smoking. Arguably, this claim started the belief that ?cigarette advertising causes smoking? and led to many countries severely restricting cigarette promotion. The problem is, ten years lat... more »er, youth are still lighting up. Could they have gotten it wrong? The IRTIP procedure is widely used to model the link between promotional activities and susceptibility to product use. It is now being used for other products like alcohol, fast-food and colas. This book reports the results of a verification and re-test of the IRTIP model. Using the original data, it was found that IRTIP magnifies Response-Style and Respondent Drop-Out Biases. These biases are shown to lead to the finding of a positive link between tobacco promotion and susceptibility to smoking. Because the IRTIP process is biased, it may be prudent to revisit the many research studies that have used this procedure. The faulty 1998 claim may have harmed efforts to control and limit the use of cigarettes.

Extreme response bias in measuring susceptibility to smoking.

Pierce, Choi, Gilpin, Farkas, and Berry (1998) were the first to claim that they could provide causal evidence that tobacco industry advertising and promotion caused adolescent smoking. This claim continues to significantly influence the theory and conceptualization of how youth react to tobacco marketing. The Pierce et al. (1998) methodology has been used by many researchers to establish the influence of tobacco marketing on adolescent smoking (Goldberg, 2003; NCI, 2006; Sargent, Dalton, & Beach, 2000). Pierce et al. (1998) selected respondents for only the second of their two survey longitudinal study because they chose the extreme-negative response. This choice could be the result of the tendency of some significant number of sample members exhibiting extreme-response bias. The results from an analysis of several questions from the original data used by Pierce et al. (1998) has suggested that there is a significant extreme-response style pattern in the Pierce et al. data. This unaccounted for bias in the responses of their sample was due to the procedure used by Pierce et al. (1998) in the selection of their respondents. The Pierce et al. (1998) sample selection procedure requires more research before the causal link can be claimed.

Questioning the construct of 'susceptibility' in the causal link between tobacco industry promotion and adolescent smoking

The first article to report on a causal connection between tobacco industry promotion and adolescent smoking (Pierce et al. 1998) had, and continues to have, a significant influence on the marketing of cigarettes in many parts of the world. A key construct in determining causality was the ability to identify the respondents’ “susceptibility to smoke”. Through an analysis of the questions, and reanalysis of the original data used by Pierce et al. (1998), it is shown that the construct is flawed, and needs revision before a causal link can be claimed with the original data.