Children's Secondhand Research Articles

Secondhand savvy: examining the influence of prior experience on motivators and barriers in parents' choice of children's secondhand products

PurposeThe main objective of this paper is to examine the motivators and barriers parents face when acquiring secondhand products for their children while specifically investigating the potential influence of prior experience on the relationship between these motivators, barriers and parents' purchase intention toward secondhand clothing for their children.Design/methodology/approachTo address these objectives, a survey was conducted, yielding 265 valid responses. The sample comprised parents, with 96 having previous experience buying secondhand products and 169 without such experience. Multiple and binomial linear regression analyses were employed to examine the collected data.FindingsTwo motivators (economic motivation and environmental sustainability) and three barriers (social embarrassment, hygiene and risk) were tested, and our findings indicate that environmental sustainability and the perception of risk significantly influenced the intention to buy secondhand products for childrenswear. The results showed that for consumers with previous experience, the perception of risk is nonsignificant, suggesting that experience influences consumers' barriers to buying secondhand products.Originality/valueThis article is focused on the consumer behavior of parents who buy clothes for their children, and it is one of the few articles that proposes and tests a theoretical framework aiming to find empirical evidence about the motivators and barriers to consuming secondhand products in this market.Research limitations/implicationsThis study was specific to the childrenswear market, with characteristics that incentivize secondhand consumption, which might limit the findings.Practical implicationsThe results suggest that marketers should focus their efforts on highlighting sustainability claims when advertising their secondhand products to consumers and investing in incentivizing consumers to buy secondhand products for the first time, as it might reduce barriers to their consumption in the future.

Eavesdropping Books as Testimony: Witnessing Secondhand Crimes Against Humanity with Young Children

AbstractHow do educators talk about trauma with young children? Specifically, how do they address children's secondhand experiences of crimes against humanity? In this article, Cara E. Furman argues that classrooms for young children must witness these experiences. A genre of picture books that Furman terms “eavesdropping texts” offer testimony that both witnesses and invites children's secondhand experiences of crimes against humanity. Here, Furman couples a close reading of the books with literary criticism and trauma theory in order to showcase the nuances of the genre and the pedagogical potential of eavesdropping books for young readers.

Identification and Characterization of Influential Factors in Susceptibility to Attention Deficit Hyperactivity Disorder Among Preschool-Aged Children.

Attention deficit hyperactivity disorder (ADHD) is the most common childhood-onset neurodevelopmental disorder. Currently, increasing amounts of attention have been focused on the epidemiologic profiling of ADHD in children, viewed as a continuously distributed risk dimension throughout the whole lifespan. This study aimed to identify and characterize potential influential factors susceptible to ADHD-related symptoms among preschool-aged children. A comprehensive questionnaire was self-designed for both children and their parents or guardians and was distributed to 30 kindergartens from Beijing and Hebei, collecting potential influential factors in susceptibility to ADHD. ADHD was assessed by the Conner’s Abbreviated Symptom Questionnaire (C-ASQ), and 7,938 children were analyzed. Least absolute shrinkage and selection operator (LASSO) regression and hierarchical degree of adjustment were used to control possible covariates. Five factors, namely, children’s secondhand smoking exposure, breastfeeding duration, sleep mode, maternal pregnancy smoking exposure, and parental self-rating for patience, were identified to be independently and significantly associated with ADHD susceptibility. Meanwhile, dose–response relationships were observed between breastfeeding duration, parental self-rating for patience, and ADHD-related symptoms. Finally, a nomogram model was created for predicting ADHD susceptibility based on significant and conventional attributes under each criterion.

Factors related to caregivers’ risk perception of secondhand smoke exposure on children’s health

INTRODUCTIONHome is one of the main places for children’s secondhand smoke (SHS) exposure. The implementation of smoke-free rules at home might be influenced by caregivers’ risk perception of SHS exposure. This study aimed to analyze factors related to caregivers’ risk perception of SHS exposure in children.METHODSWe conducted a cross-sectional telephone survey among a representative sample of 2411 parents or legal guardians of children aged <12 years in Spain in 2016. The main study variable was caregivers’ healthrisk perception of SHS exposure on children. We investigated correlates of risk perception using multivariate Poisson regression models with robust variance.RESULTSOverall, 59.6% reported SHS exposure negatively affects children’s health a lot, while 34.1% that it affects quite a bit, and 5.5% and 0.8% a little bit or not at all, respectively. The factors associated with a higher caregivers’ risk perception were high education level (adjusted prevalence ratio, APR=1.11; 95% CI: 1.01–1.24), living in a non-smoking family unit (APR=1.17; 95% CI: 1.07–1.27), in a home with smoke-free rules (APR=1.34; 95% CI: 1.19–1.51), and with girls only (APR=1.14; 95% CI: 1.06–1.22).CONCLUSIONSCaregivers’ risk perception of SHS exposure is influenced by social determinants and smoking habits in family units. These findings support the need for interventions with a social equity perspective to reduce children’s SHS exposure.

Impact of Public Smoking Bans on Social Inequalities in Children's Exposure to Tobacco Smoke at Home: An Equity-Focused Systematic Review.

A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home. Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.

Smokers who are unmotivated to quit and have a child with asthma are more likely to quit with intensive motivational interviewing and repeated biomarker feedback.

Smokers who are not motivated to quit are an important group for intervention, particularly if they have children with asthma. Research indicates that unmotivated smokers are less responsive to intensive interventions, although motivation-by-treatment interactions have not been tested. This study examines whether motivation to quit moderates the effect of a cessation induction intervention. Parents had an asthmatic child requiring urgent care, and did not have to want to quit smoking to be eligible for the study. Two home visits included asthma education, motivational interviewing (MI) for cessation, and feedback on child's secondhand smoke exposure (SHSe). Participants were then randomized (n = 339, 79.6% female) to receive Enhanced-PAM (Precaution Adoption Model; 6 MI calls including SHSe feedback) or PAM (6 contact control calls). Motivation to quit was assessed at baseline and point-prevalence abstinence (ppa) and SHSe outcomes were objectively measured. At baseline, 38.9% were not motivated to quit. Those who were not motivated to quit were 3 to 4 times more likely to be abstinent at 6 months in Enhanced-PAM versus PAM (7-day ppa: OR = 3.71, 95% CI = [1.06, 12.99]; 30-day: OR = 4.15, 95% CI [1.20, 14.35]); those receiving Enhanced-PAM achieved quit rates comparable to motivated smokers. Those who were not motivated to quit were more than 4 times as likely to have very low/undetectable SHSe at follow-up in Enhanced-PAM versus PAM (OR = 4.46, 95% CI [1.31, 15.15]). Among motivated smokers, neither outcome significantly differed by treatment arm. It cannot be assumed that smokers who are unmotivated to quit will not be responsive to intensive interventions. (PsycINFO Database Record

Using e-cigarettes in the home to reduce smoking and secondhand smoke: disadvantaged parents' accounts.

Electronic cigarettes (e-cigarettes) are subject to considerable public health debate. Most public health experts agree that for smokers who find it particularly challenging to quit, e-cigarettes may reduce harm. E-cigarette use in the home may also reduce children's secondhand smoke (SHS) exposure, although e-cigarette vapour may pose risks. This is the first qualitative study to explore disadvantaged parents' views and experiences of e-cigarettes in relation to reducing SHS exposure in the home. Interviews with 25 disadvantaged parents from Edinburgh who smoked and had children aged 1-3 were conducted in 2013, with 17 re-interviewed in 2014. Accounts of e-cigarette perceptions and use were analysed thematically. E-cigarettes were seen by some as potentially valuable in helping quitting or reducing smoking in difficult circumstances, and protecting children from SHS when smoking outside is constrained. However, parents raised concerns about safety issues and continuing their nicotine addiction. In relation to children, concerns included possible health effects of the vapour, children playing with them and role-modelling e-cigarette use. While significant concerns remain about e-cigarettes, for some parents who find it challenging to quit or safely leave their children to smoke outside, e-cigarettes may offer potential for reducing the harm to them and their children.

Food Insecure Children's Exposure to Secondhand Smoke Is More Likely to Be Misclassified

Although food insecurity is more prevalent in households with smokers, no studies have examined the misclassification of children's secondhand smoke (SHS) exposure by household food security status. Our population‐based sample included 8453 participants (3‐12y) in the National Health and Nutrition Examination Survey 1999‐2010. Food security status was assessed by the USDA 18‐item Food Security Survey Module. Self‐reported SHS exposure by household reference participants were compared to children's serum cotinine levels. Serum cotinine levels of 蠅0.05 ng/ml were indicative of SHS exposure. Logistic regression models were used to estimate the association between household food security status and misclassification of SHS exposure. Controlling for age, gender, and race/ethnicity, children who were food insecure (Odds Ratio 1.3; 95% CI, 1.1‐1.6) were more likely to have their SHS exposure misclassified, compared to their fully food secure counterparts. The association was attenuated when family income was included in the model. In conclusion, regardless of food security status, household reference participants' reports of SHS exposure among children, especially food insecure children, may be biased.

Family Beliefs and Behaviors About Smoking and Young Children's Secondhand Smoke Exposure.

Home smoking bans (HSBs) reduce children's secondhand smoke exposure (SHSe), a contributor to health disparities. General psychosocial characteristics and SHSe beliefs and behaviors within the family may relate to HSB existence. This study's aim was to identify general psychosocial characteristics and SHSe beliefs associated with HSB presence and lower SHSe among children living with a smoker. Caregivers (n = 269) of Head Start preschool students (age 1-6 years) living with a smoker reported on HSBs, caregiver depressive symptoms and stress, family routines, SHSe beliefs, and household smoking characteristics. SHSe biomarkers included air nicotine in 2 areas of the home and child salivary cotinine. One-quarter of families reported complete HSBs, and HSBs were more common among nonsmoking (37%) versus smoking caregivers (21%; p < .01). Perceived importance of HSBs differed between nonsmoking (9.7±1.0) versus smoking caregivers (9.1±2.0; p < .01). Smoking caregivers, more smokers in the home, and lower self-efficacy and intent to implement an HSB were consistently associated with lower likelihood of HSB existence and children's higher SHSe. Caregiver SHSe beliefs were more consistently associated with HSBs and SHSe than were general psychosocial factors. Despite greater HSB likelihood and higher perceived importance of HSBs among nonsmoking versus smoking primary caregivers, SHSe reduction self-efficacy and intent are protective for Head Start students at high-risk for exposure. Pediatric healthcare providers and early education professionals may be able to support SHSe reduction efforts (e.g., smoking cessation, HSB implementation) and reduce children's SHSe with counseling strategies to address caregivers' HSB self-efficacy, intent, and related behaviors.

Predictors of children's secondhand smoke exposure at home: a systematic review and narrative synthesis of the evidence.

BackgroundChildren's exposure to secondhand smoke (SHS) has been causally linked to a number of childhood morbidities and mortalities. Over 50% of UK children whose parents are smokers are regularly exposed to SHS at home. No previous review has identified the factors associated with children's SHS exposure in the home.AimTo identify by systematic review, the factors which are associated with children's SHS exposure in the home, determined by parent or child reports and/or biochemically validated measures including cotinine, carbon monoxide or home air particulate matter.MethodsElectronic searches of MEDLINE, EMBASE, PsychINFO, CINAHL and Web of Knowledge to July 2014, and hand searches of reference lists from publications included in the review were conducted.FindingsForty one studies were included in the review. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently found to be independently associated with children's SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. Associations were strongest for parental cigarette smoking status; compared to children of non-smokers, those whose mothers or both parents smoked were between two and 13 times more likely to be exposed to SHS.ConclusionMultiple factors are associated with child SHS exposure in the home; the best way to reduce child SHS exposure in the home is for smoking parents to quit. If parents are unable or unwilling to stop smoking, they should instigate smoke-free homes. Interventions targeted towards the socially disadvantaged parents aiming to change attitudes to smoking in the presence of children and providing practical support to help parents smoke outside the home may be beneficial.

Die Bedeutung des Migrationshintergrundes für die Tabakrauchbelastung von Kindern

Differences in children's secondhand smoke (SHS) exposure were examined by migration-specific characteristics, socioeconomic factors and living conditions, as well as with regard to the parents SHS knowledge and SHS attitudes. Data from 5,336 pre-school children (29% migrants) were collected in a cross-sectional study in 2008/2009 in Germany through parental questionnaire (response rate: 61%). Using multiple logistic regression, the association of migration background and children's SHS exposure was analysed. Children with a migration background are at an increased risk of SHS exposure in their homes. Multivariate analyses show that adjusting for socioeconomic factors and parental knowledge of how to protect their children from SHS reduces the estimates of migration background significantly. Compared to children without migration background, the chance of SHS exposure for children with migration background is still increased (OR [95% CI]: 1.57 [1.23-2.01]). Children of Turkish-speaking families, compared to children from German-speaking families, are most often burdened by SHS (3.05 [2.18-4.26]). Migrant-sensitive tobacco prevention in selected risk groups is necessary to provide support for creating smoke-free homes for children.

Smoking Restrictions in the Homes of Children With Cancer

To examine smoking restrictions in households of children with cancer and their effect on biological measures of children's secondhand smoke exposure (SHSe). A sample of 135 parents of nonsmoking children with cancer who lived with a smoker completed structured interviews. Approximately 43% of families prohibited smoking in the home. Children living in homes that prohibited smoking had median cotinine levels that were 71% and 52% lower than did those from homes with no and partial restrictions. Parents should be directed to completely ban all smoking from the home and car to best protect their children from SHSe.

Reducing secondhand smoke exposure at home

Children's secondhand smoke (SHS) exposure remains a significant public health concern. In the UK, over half of children who live with smokers are regularly exposed to SHS at home. School nurses are well placed to raise the issue of SHS exposure, explain the benefits of creating smoke-free environments, and help with practical advice. This article looks at the impact of secondhand smoke exposure and a training module available to school nurses, which aims to help them acquire the knowledge and skills required to intervene effectively with anyone who smokes and cares for children.

The Impact of Tobacco Control Policies on Disparities in Children’s Secondhand Smoke Exposure: A Comparison of Methods

To examine the impact of cigarette excise taxes and smoke-free legislation on tobacco use among households with school-age children and adolescents as well as disparities in children's secondhand smoke exposure. We compare the results from models using causal inference techniques to those from cross-sectional models. We linked families of 6-17-year-olds from the 2003 (N = 67,607) and 2007 (N = 62,768) contacts of the National Survey of Children's Health with state-level cigarette excise taxes and smoke-free legislation total score (0 [none]-32 [very strong]) in 2001 and 2005. Parents reported whether anyone in the household used tobacco products. In adjusted causal inference models every $1.00 increase in cigarette excise tax between 2001 and 2005 was associated with a 4 percentage point decrease in household tobacco use between 2003 and 2007 (p = 0.008); however, there was no effect of smoke-free legislation on household tobacco use. Significant interactions revealed that cigarette tax increases were only associated with reductions in household tobacco use for parents of white children and, separately, lower income households. In contrast, in adjusted cross-sectional models, a higher smoke-free legislation total score was associated with a lower prevalence of household tobacco use. Stronger cigarette excise taxes decrease tobacco use among households with school-age children and adolescents, but smoke-free legislation at the state level does not change parental smoking. Since cross-sectional models cannot assess the direction of causality, evaluations should employ causal inference methods to help inform policy decisions to reduce disparities in adult smoking and, ultimately, protect children from secondhand smoke.

A Second Reporter Matters: Agreement Between Parents' and Children's Reports of Smoking Bans in Families

Home and car smoking bans implemented by caregivers are important approaches to reducing children's secondhand smoke (SHS) exposure and attendant health risks. Such private smoking bans are usually informal and are subject to individuals' interpretation, observation, and recall. Relying on a single reporter may lead to misclassification of bans in families. To determine (1) proportion of families with discordant reports of bans; (2) association between parent-child report agreement and SHS exposure; and (3) whether including a second reporter of bans improves prediction of child SHS exposure. In each of 386 participating families a preteen and a parent reported separately on their home and car smoking bans, and agreement was determined. ANOVA, chi-square, and multiple linear regression were used to determine relationships between SHS exposure (measured by urine cotinine and reported exposure) and home/car smoking bans reported by preteens and parents. In 19% of families, reports disagreed for home smoking bans; 30%, for car smoking bans. Families who agreed on the presence of a ban had the lowest exposure, families who agreed on the absence of a ban had the highest exposure, and intermediate exposure for those who disagreed. Parent and child reports of bans each explained significant, unique variance in child SHS exposure. Due to relatively high prevalence of discordant reporting, a more accurate classification of home/car smoking bans may result from including multiple reporters.

Risk perception in smokers with children with asthma.

No studies have examined the relationship between caregiver beliefs about the risks of smoking to their own health and caregiver beliefs about the effect of their smoking on their child's health. In the current study, we investigated our proposed risk congruence hypothesis among caregivers who smoke. Specifically, we investigated whether caregivers' self-perceived risk of smoking is directly associated with their perception of the risks of smoking to their child. The sample consisted of 271 regular smokers (≥ 3 cigarettes per day; Mage = 32.9 years; 214 women) who were caregivers of children with asthma (Mage = 4.9 years) who had a recent visit to the emergency room for their asthma. Three constructs of perceived risk were measured via self-report questionnaires assessing both caregiver perception of smoking risk to self and to child: Precaution Effectiveness, Optimistic Bias, and Perceived Vulnerability. Child asthma-related functional morbidity and home and child secondhand smoke exposure were also assessed. Consistent with our risk congruence hypothesis, self-perceived risk of smoking was significantly associated with perceived risk to child, over and above the child's secondhand smoke exposure and caregiver report of child's asthma symptoms (i.e., asthma-related functional morbidity). These findings should be considered in the design of clinical interventions seeking to influence risk of caregiver behavior on child health.

Exploring Children's Secondhand Smoke Exposure with Early Child Care Providers

Exposure to secondhand smoke (SHS) is a contributor to the increased morbidity and mortality experienced by inner-city African-American children. Limited evidence-based programming exists regarding how to address the negative effects of SHS in this community. A collaboration with an early child care center provided an opportunity to explore factors related to young children's SHS exposure as the first step in developing strategies to reduce exposure. Survey data were obtained between 2008 and 2009 from 63 African-American parents of infants and children aged ≤ 5 years at two early child care centers located in an urban Minneapolis neighborhood. Forty-three of these children had salivary cotinine levels assessed. Parents living below the poverty level were more likely to report that their children were regularly exposed to SHS by family/friends (p = 0.01). Sixty-eight percent of participants reported complete home smoking restrictions, which was significantly correlated with advice from the child's health provider (p = 0.001). Nonsmokers and older parents were less likely to receive advice (p = 0.03). Of the 43 children in whom cotinine levels were assessed, 39.5% had levels > 0.64 ng/ml, which suggests high SHS exposure. Lower cotinine levels were significantly correlated with living in detached houses. Exposure to SHS was common for children in this study. These findings, if supported by additional research, can be used to develop and disseminate targeted health messages about childhood SHS sources/negative effects and strategies to reduce exposure.

Motivating Latino caregivers of children with asthma to quit smoking: A randomized trial.

Secondhand smoke exposure is associated with asthma onset and exacerbation. Latino children have higher rates of asthma morbidity than other groups. The current study compared the effectiveness of a newly developed smoking cessation treatment with existing clinical guidelines for smoking cessation. Latino caregivers who smoked (N = 133; 72.9% female; mean age = 36.8 years) and had a child with asthma were randomly assigned to receive 1 of 2 smoking cessation counseling interventions during a home-based asthma program: (a) behavioral action model (BAM; modeled on clinical guidelines for smoking cessation) or (b) precaution adoption model (PAM; feedback on the caregiver's carbon monoxide level and child's secondhand smoke exposure using Motivational Interviewing). Counseling was delivered by a bilingual Latina health educator, and the content was tailored to Latino values and culture. It was not necessary for smokers to want to quit smoking to participate. Smoking cessation was biochemically verified and secondhand smoke exposure was objectively measured through passive nicotine monitors. Intent-to-treat analyses showed that 20.5% of participants in the PAM condition and 9.1% of those in the BAM condition were continuously abstinent at 2 months posttreatment (OR = 2.54; 95% CI = 0.91-7.10), whereas 19.1% of participants in the PAM condition and 12.3% of those in BAM condition were continuously abstinent at 3 months posttreatment (OR = 1.68; 95% CI = 0.64-4.37). Secondhand smoke exposure decreased only in the BAM condition (p < .001), an effect due to less smoking around the child among nonquitters in this condition. Asthma morbidity showed significant decreases in the posttreatment period for the PAM group only (p < .001). Results provide support for targeting specific populations with theory-based interventions.

Counseling to reduce children's secondhand smoke exposure and help parents quit smoking: a controlled trial.

We tested a combined intervention to reduce children's secondhand smoke exposure (SHSe) and help parents quit smoking. After baseline, mothers who exposed their children younger than 4 years to 10 or more cigarettes/week were randomized to the intervention (n = 76) or usual care control condition (n = 74). Outcomes were assessed at 3, 6, 12, and 18 months. Intervention families were offered 10 in-person at home and 4 telephone counseling sessions over 6 months, and additional pre- and postquit telephone sessions. Counseling procedures included behavioral contracting, self-monitoring, and problem solving. Parents' reports of their smoking and children's exposure showed moderate and significant correlations with children's urine cotinine levels and home air nicotine (r = .40-.78). Thirteen (17.1%) intervention group mothers and 4 (5.4%) controls reported that they quit smoking for 7 days prior to 1 or more study measurements, without biochemical contradiction (p = .024). Results of generalized estimating equations showed significantly greater decrease in reported SHSe and mothers' smoking in the counseled group compared with controls. Reported indoor smoking and children's urine cotinine decreased, yet group differences for changes were not significant. Nicotine contamination of the home and resulting thirdhand exposure may have contributed to the failure to obtain a differential decrease in cotinine concentration. Partial exposure to counseling due to dropouts and lack of full participation from all family members and measurement reactivity in both conditions may have constrained intervention effects. Secondhand smoke exposure counseling may have been less powerful when combined with smoking cessation.

Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships.

This study explored predictors of smoking quit attempts in a sample of low-income smoking mothers who participated in a randomized trial of a 6-month, 14-session counseling intervention to decrease their children's secondhand smoke exposure (SHSe) and eliminate smoking. Measures were taken at baseline and at 3, 6, 12, and 18 months on 150 mothers who exposed their children (aged <4 years) to > or = 10 cigarettes/week in the home. Reported 7-day quits were verified by saliva cotinine or urine anabasine and anatabine levels. There were few quits longer than 6 months. Mothers in the counseling group reported more 24-hr quits (p = .019) and more 7-day quits (p = .029) than controls. Multivariate modeling revealed that having quit for at least 24 hr in the year prior to baseline and the number of alternative cessation methods ever tried were predictive of the longest quit attempt during the 18-month study. Mothers in the counseling group who at baseline felt SHSe posed a health risk for their children or who at baseline had more permissive home smoking policies had longer quit attempts. Results confirm that attempts to quit smoking predict additional quit attempts. This suggests that practice may be necessary for many people to quit smoking permanently. Findings of interaction analyses suggest that participant factors may alter the effects of treatment procedures. Failure to account for or employ such factors in the analysis or design of community trials could confound the results of intervention trials.