Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

Background: Exposure to other people’s cigarette smoke (environmental tobacco smoke, or ETS) is an important child health issue.
Objectives: To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.
Search strategy: The Tobacco Addiction Group register of studies was searched.MEDLINE, EMBASE and four other health and psychology databases were searched electronically, bibliographies of retrieved primary studies were checked and specialists in the area consulted.
Selection criteria: Controlled trials with or without random allocation were included in this review if they addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children’s environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes targeting these participants are included. These include smoke free policies and legislation, health promotion, social behavioural therapies, technology, education and clinical interventions.
Data collection and analysis: Two reviewers independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries.
Main results: Nineteen studies met the inclusion criteria, one of which was subsequently excluded. Three interventions were targeted at populations or community settings, seven studies were conducted in the well child health care setting and eight in the ill child health care setting. Twelve of these studies are from North America. In 12 of the 18 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only four of the 18 studies was there a statistically significant intervention effect. Three of these successful studies employed intensive counselling interventions targeted to smoking parents. There is little difference between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. The fourth successful intervention was in the school setting targeting the ETS exposure of children from smoking fathers.
Authors’ conclusions: Brief counselling interventions, successful in the adult health setting when coming from physicians, cannot be extrapolated to adults in the setting of child health. There is limited support for more intensive counselling interventions. There is no clear evidence for differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children’s ETS exposure.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

BackgroundChildren's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children are also at risk of exposure to ETS in child care or educational settings. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide.ObjectivesTo determine the effectiveness of interventions aiming to reduce exposure of children to ETS.Search methodsWe searched the Cochrane Tobacco Addiction Group Specialized Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, CINAHL, ERIC, and The Social Science Citation Index & Science Citation Index (Web of Knowledge). Date of the most recent search: September 2013.Selection criteriaControlled trials with or without random allocation. Interventions must have addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0 to 12 years). All mechanisms for reduction of children's ETS exposure, and smoking prevention, cessation, and control programmes were included. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions.Data collection and analysisTwo authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcome measures, no summary measures were possible and results were synthesised narratively.Main resultsFifty-seven studies met the inclusion criteria. Seven studies were judged to be at low risk of bias, 27 studies were judged to have unclear overall risk of bias and 23 studies were judged to have high risk of bias. Seven interventions were targeted at populations or community settings, 23 studies were conducted in the 'well child' healthcare setting and 24 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether the visits were to well or ill children, and another included both well and ill child visits. Thirty-six studies were from North America, 14 were in other high income countries and seven studies were from low- or middle-income countries. In only 14 of the 57 studies was there a statistically significant intervention effect for child ETS exposure reduction. Of these 14 studies, six used objective measures of children's ETS exposure. Eight of the studies had a high risk of bias, four had unclear risk of bias and two had a low risk of bias. The studies showing a significant effect used a range of interventions: seven used intensive counselling or motivational interviewing; a further study used telephone counselling; one used a school-based strategy; one used picture books; two used educational home visits; one used brief intervention and one study did not describe the intervention. Of the 42 studies that did not show a significant reduction in child ETS exposure, 14 used more intensive counselling or motivational interviewing, nine used brief advice or counselling, six used feedback of a biological measure of children's ETS exposure, one used feedback of maternal cotinine, two used telephone smoking cessation advice or support, eight used educational home visits, one used group sessions, one used an information kit and letter, one used a booklet and no smoking sign, and one used a school-based policy and health promotion. In 32 of the 57 studies, there was reduction of ETS exposure for children in the study irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure, but rather aimed to reduce symptoms of asthma, and found a significant reduction in symptoms in the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions.Authors' conclusionsWhile brief counselling interventions have been identified as successful for adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. Although several interventions, including parental education and counselling programmes, have been used to try to reduce children's tobacco smoke exposure, their effectiveness has not been clearly demonstrated. The review was unable to determine if any one intervention reduced parental smoking and child exposure more effectively than others, although seven studies were identified that reported motivational interviewing or intensive counselling provided in clinical settings was effective.

Re-testing the link between youth receptivity to tobacco promotion and their susceptibility to smoke

The Index of Receptivity to Tobacco Industry Promotion (IRTIP) is a model that is used by hundreds of articles. The causal claim based on findings from this model is even more pervasive, and has resulted in much of the modern post 1998 tobacco legislation that is still enforced. This thesis tested the link between adolescent receptivity to tobacco industry promotion and susceptibility to smoking. Pierce et al. (1998) reported that they had found a positive and causal association between receptivity and susceptibility by using IRTIP. They claimed that receptivity to tobacco industry promotion was the only significant causal factor affecting adolescent susceptibility to smoking. Exposure to peer and parental smoking was not found to be a significant effect. A review of the literature found that many sections of IRTIP differ from accepted marketing theory on how cigarette advertising and promotions affect adolescent adoption of cigarette smoking. The proxy measures used in IRTIP were shown to diverge from those previously used for measuring the constructs of Attention, Intention, Desire and Action (AIDA) in marketing communications. IRTIP also differs from previous theory by including measures that attempt to quantify the effect of tobacco premiums into a model that was designed to measure the effects of advertising.

Parental divorce during adolescence and adjustment in early adulthood

Presents a study which examined the relationship between parental divorce during adolescence and the psychosocial adjustment of young adults. Methods; Results; Discussion.

High-functioning autism and sexuality: a parental perspective

Few studies have compared sexual behaviours among adolescents with high-functioning autism (HFA) and typical populations, and indicated whether specialized education is required. We hypothesized that adolescents with HFA would (1) display poorer social behaviours; (2) engage in fewer behaviours related to privacy and have poorer knowledge regarding privacy issues; (3) have less sex education; and (4) display more inappropriate sexual behaviours; and that (5) parental concerns would be greater for the HFA sample. Parents of typical adolescents (n = 50) and adolescents with HFA (n = 23) were surveyed with a Sexual Behaviour Scale (SBS) developed by the authors, with domains corresponding to the hypotheses. The HFA and typical groups were found to be significantly different on all five domains. However, following covariation with age and level of social behaviour, it was found that only parental concerns about their child distinguished between typical adolescents and those with HFA. Specialized sex education programmes with a social interaction emphasis should be considered for this group.

Understanding parental motivators and barriers to uptake of child poison safety strategies: a qualitative study

Objectives: To develop an understanding of factors acting as barriers and motivators to parental uptake of child poison safety strategies.

Design: A qualitative study involving semistructured interviews and focus groups. A grounded theory approach was used for the collection and analysis of data.

Participants: Sixty five parents of children under 5 years of age, some of whom had experienced an unintentional child poisoning incident.

Results: A range of knowledge based, environmental, and behavioral barriers to comprehensive parental uptake of poison safety practices were identified. As a result there tended to be only partial implementation of safety initiatives in the home. Selection of safety practices was often guided by the interests and behaviors of the child. This made the child vulnerable to changes in the home environment, inadequate supervision, and/or shifts in their own behavior and developmental ability. Personal or vicarious exposure of a parent to a child poisoning incident was a significant motivator for parental review of safety practices.

Conclusion: Environmental measures targeting child resistant containers, warning labels, and lockable poisons cupboards will support parents’ efforts to maintain poison safety. Additional education campaigns using stories of actual poisoning incidents may help to increase awareness of risk and encourage increased uptake.

Adolescent and parental perceptions of interparental conflict

Research indicates adolescent adjustment problems are associated with high levels of interparental conflict. This study examined parents’ and adolescents’ perceptions of interparental conflict and the relationship of these perceptions to adolescent adjustment through a survey of adolescent secondary students and their parents. Sixty-two adolescents and 62 parents participated in the study. Adolescents completed three self-report measures of psychological adjustment, a demographic questionnaire and the Consensus and Cohesion subscales of the Dyadic Adjustment Scale (DAS). Parents completed the same subscales of the DAS and a demographic questionnaire. There were no significant differences between the levels of interparental conflict perceived by adolescents and parents. However, adolescent perceptions of interparental conflict were a better predictor of adolescent psychological adjustment when compared to parental perceptions of conflict. The results of this study emphasise the importance of adolescent perceptions of interparental conflict, and provide support for both parental and adolescent reports of family functioning to be taken into account in future clinical studies.

Parental concerns about childhood obesity and the strategies employed to prevent unhealthy weight gain in children.

Objectives: To describe parental concerns about their child’s weight, to determine the proportion of parents taking preventive action to avoid obesity in their children and the predictors of taking preventive action, and to describe the strategies adopted by parents.
Design: A cross-sectional survey was conducted. Children’s heights and weights were measured, and parents completed a questionnaire that included measures of their own weight status, perceptions of their child’s weight, concerns about their child’s current weight and future weight as an adolescent and adult, and the strategies used to prevent obesity.
Setting: The study was conducted in Melbourne, Australia.
Subjects: A total of 291 families of children aged 5–6 years and 919 families of children aged 10–12 years participated.
Results: Eighty-nine per cent of parents of overweight 5–6-year-olds and 63% of parents of overweight 10–12-year-olds were unaware their child was overweight. Seventy-one per cent of parents of overweight 5–6-year-olds and 43% of parents of overweight 10–12-year-olds were not concerned about their child’s current weight. Although 31% of parents of 5–6-year-olds and 43% of parents of 10–12-year-olds were taking action to prevent unhealthy weight gain in their children, less-educated parents were less likely to do so.
Conclusions: Public health programmes are required to raise parental recognition of childhood overweight and of related risk behaviours, and to provide parents with practical strategies to prevent unhealthy weight gain in their children.

The hazards of starting and quitting smoking: some Australian evidence

The empirical analysis employs individual level data from the Australian Health Survey combined with retrospective data on tobacco price matched to the age at which the individual started and quit smoking. Split-population hazard models are estimated for both starting and quitting smoking. The analysis suggests price plays a significant role in the decision to start smoking but not in the decision to quit. Further sensitivity analysis of different age groups and an alternative data source, questions the robustness of the significant role of price in the smoking initiation decision. From a policy perspective, the results indicate that increases in tobacco taxation can be an important instrument in reducing the incidence of smoking, but should be combined with other mechanisms such as mandating smoke-free environments and antismoking education. Our results strongly support the targeting of antismoking campaigns towards teenagers.

A preliminary investigation of the relationship between parental empathy and social anxiety and children's social anxiety

This study investigated the association between parents' social anxiety and empathy, and their children's social anxiety, Twenty-one mothers, 12 fathers and 24 children aged between 7 and 12 years were recruited from state primary schools in the eastern metropolitan region of Melbourne, Australia. Parents completed self-report questionnaires assessing their parental empathy and level of social anxiety. Children completed a modified version of the social anxiety questionnaire. All parent variables, except for maternal anxiety, were related to children's social anxiety. Overall, parental empathy was found to have a considerable association with child social anxiety, which is consistent with arguments that micro-level family mechanisms are important influences on child social anxiety. Future studies of parental empathy with clinical populations and data collection from multiple sources are recommended.

Parental decision-making surrounding complicated births: the impact on parent-infant and infant-marital relationships

This paper reviews current research regarding the impact of birth complications on parental decisionmaking, and the resulting effects on parent-infant and infant-marital relationships. It discusses the importance of informed decision-making on parental satisfaction of the birthing experience, and the benefits of certain strategies, such as kangaroo care, in the facilitation of greater levels of attachment and improved relationships. The paper concludes with suggestions for future research areas to focus on finding better ways to prepare and support parents in these situations, thus improving the quality of relationships between parents and with their child.

The effectiveness of callback counselling for smoking cessation: a randomized trial

Aims. The development of acceptable, widely available and effective smoking cessation methods is central to public health strategy for tobacco control. We examined the effectiveness of a telephone callback counselling intervention, compared to the provision of self-help resources alone.

Methods. Participants were 998 smokers calling a state-wide "Quitline" service randomly allocated to either callback counselling or ordinary care. The callback condition consisted of a series of brief counselling calls at strategic times in addition to ordinary care. The number of calls varied according to caller needs, and most occurred generally just before the person's quit day and in the week or two after it. The service was delivered by trained telephone counsellors.

Results. At the 3-month follow-up, significantly more participants in the callback group (24%) reported that they were quit, compared to those in the usual care comparison group (13%). The difference in point prevalence of smoking declined to 6% by the 12-month follow-up. Using sustained abstinence there was a significant benefit of callback counselling at 12-month follow-up. Treating dropouts as smokers reduced the overall magnitude of the effects somewhat. The benefit of callbacks was to marginally increase quit attempts and to significantly reduce relapse.

Conclusion. Our findings are consistent with those of other studies demonstrating benefits of callback telephone counselling to facilitate cessation. Such counselling provides a flexible, relatively inexpensive and widely available form of cessation service. It appears to encourage a greater proportion of quit attempts and to reduce the rate of relapse among those quitting. Further research is required to determine ways to enhance effectiveness, particularly studies of how to reduce relapse.