Home Smoking Research Articles

A Cross-Sectional Study on Benzene Exposure in Pediatric Age and Parental Smoking Habits at Home.

After the introduction of the smoke-free legislation, household smoking has become the major source of environmental tobacco smoke (ETS) exposure for children. In our previous research, we found a strong association between urinary unmodified benzene (u-UB) levels and passive smoking exposure related to the home smoking policies (HSP). The aim of the study is to further investigate the impacts of several factors on ETS-exposure in childhood by using u-UB as tobacco-related carcinogen biomarker of exposure. Two cross-sectional studies were performed on the same target population of our previous research, in summer and winter season of the years 2017 and 2018, respectively. A questionnaire and a head space–solid phase micro-extraction/gas chromatography-mass spectrometry (HS-SPME/GC-MS) analytical method were used as investigative procedures. The improvement found in smoking habits, when compared to our previous surveys, reduced the levels of u-UB in children. However, significant differences related to the high number of smokers and smoked cigarettes, in total and at home, still persist. These differences are more relevant in the winter season. Finally, the only effective way for making homes completely smokefree is to develop public health policies for encouraging people to quit or drastically reduce smoking.

Home smoking and vaping policies among US adults: results from the Population Assessment of Tobacco and Health (PATH) study, wave 3

We examined the prevalence of home smoking and vaping restrictions among US adults, and compared home policy differences for smoking and vaping among vapers, smokers, and dual users.Secondary data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (2015–2016) with 28,148 adults were analyzed using weighted multivariable logistic regression models that account for complex sampling design to compare differences in home policies among non-users, vapers only, smokers only, and dual users.Compared to never-users, current vapers who were ex-smokers and dual users were more likely to allow home vaping (aOR = 11.06, 95% CI: 8.04–15.21; aOR = 6.44, 95% CI: 5.01–8.28) and smoking (aOR = 1.62, 95% CI: 1.19–2.22; aOR = 3.58, 95% CI: 2.88–4.45). Current smokers were more likely to allow vaping (aOR = 3.53, 95% CI: 3.06–4.06) and smoking (aOR = 4.27, 95% CI: 3.73–4.89) inside the home than never-users. Current vapers who never smoked were more likely to allow vaping inside the home than never-users (aOR = 2.45, 95% CI: 1.53–3.93). Vapers reported much lower rates of vape-free home policies relative to both their smoke-free home policies and to vape-free home policies among smokers.Vapers may be using e-cigarettes in hopes of harm reduction, but interpreting “harm reduction” as safe, thus exposing non-users in their homes to second- and thirdhand aerosols. This underscores the need to healthcare providers to extend intervention with vapers to include implementing vape-free home policies.

The Effects of Oral Health Instruction, and the Use of a Battery-Operated Toothbrush on Oral Health of Persons with Serious Mental Illness: A Quasi-Experimental Study.

People with a diagnosis of serious mental illness (SMI) have a greater incidence of poorer oral health as compared to the general population. The aim of this quasi-experimental study was to determine the effect that a combination of the use of a battery-operated toothbrush and a related educational intervention may have on the oral health of individuals with serious mental illness. Key findings include that the battery-operated toothbrush resulted in a significant improvement in the mean change in gingival index, a common indicator of oral health. The study also found that oral home care instructions, smoking and level of negative symptoms did not have an effect on the mean change in plaque or gingival indices. This project suggests that the implementation of a relatively simple, cost effective measures such as a battery-operated toothbrush may have a positive impact on the oral health in this population.

Microbiological and Nutritional Quality of Market and Home Smoke Dried Shrimp

Bacteriological and nutritional quality of market and home smoke dried shrimp was carried out. Fresh and dried shrimps were bought from market. One set of the fresh shrimp was not rinsed before they were home smoke dried and used for analysis, another set was rinsed with clean water before they were home smoke dried and used for analysis and the market dried sample was used for analysis without any treatment. After the home smoke drying, the microbial load and types of microorganisms were determined using standard microbiological technique. The proximate compositions of the fresh shrimp, home smoke dried and market smoke dried shrimp were also determined. The population of the aerobic bacteria, Vibrio, Pseudomonas, fungi, Salmonella-Shigella, staphylococcal and coliform of the market smoke dried were 4.23±3.30, 1.98±3.15, 0.97±2.58, 2.95±2.96, 1.22±2.67, 3.89±3.22 and 1.88±2.86 CFU/10 g, respectively. The population of the aerobic bacteria, Vibrio, Pseudomonas, fungi, Salmonella-Shigella, staphylococcal and coliform of the home smoke dried not rinsed were 4.18±2.75, 2.69±3.43, 0.4±1.44, 1.96±2.8, 1.47±2.72, 2.33±3.08 and 2.85±3.06 CFU/10 g, respectively. The population of the aerobic bacteria, Vibrio, Pseudomonas, fungi, Salmonella-Shigella, staphylococcal and coliform of the home smoke dried rinsed shrimps were 4.11±2.48, 1.09±2.50, 0.00±0.00, 0.00±0.0, 1.56±2.62, 3.35±3.03 and 1.25±2.17 CFU/10 g, respectively. Eight bacteria genera which include Bacillus, Klebsiella, Proteus spp, Providencia, Pseudomonas, Shigella, Staphylococcus and Vibrio were identified. Aspergillus niger, Penicillium sp, Rhizopus oligosporus and Saccharomyces cerevisae were the fungi isolates identified. Although the bacterial types could contain pathogenic strains, proper cooking could inhibit their presence in food. Smoke drying of the seafood could preserve the shellfish longer since the water activity of the seafood is reduced. The Moisture, Ash, fat, crude fibre, crude protein and Carbohydrate content of the fresh shrimps was 69.42±1.33, 2.58±0.23, 1.66±0.00, 3.86±0.18, 17.81±0.78 and 4.18±0.08%, respectively. Also, the Moisture, Ash, fat, crude fibre, crude protein and Carbohydrate content of the Market smoked dried was 15.92±0.23, 10.34±0.72, 0.96±0.05, 11.13±1.22, 51.07±0.00 and 10.59±0.6%, while the Moisture, Ash, fat, crude fibre, crude protein and Carbohydrate content of the Home smoked dried was 9.50±0.00, 8.95±0.07, 0.73±0.11, 9.48±0.60, 67.34±0.00 and 4.02±0.79%, respectively. The home smoked dried shrimps had less moisture content compared to the market dried shrimps. Smoke drying would be recommended for preservation since it does not reduce the nutritional quality of the shrimp and preservation of food has been a great challenge especially in developing countries where there is poor power supply. More so fresh seafood easily perishes especially when they are not well preserved.

Continuous in-home PM2.5 concentrations of smokers with and without a history of respiratory exacerbations in Iowa, during and after an air purifier intervention

BackgroundAmericans spend most of their time indoors. Indoor particulate matter 2.5 microns and smaller (PM2.5) concentrations often exceed ambient concentrations. Therefore, we tested whether the use of an air purifying device (electrostatic precipitator, ESP) could reduce PM2.5 in homes of smokers with and without respiratory exacerbations, compared to baseline.MethodsWe assessed PM2.5 concentrations in homes of subjects with and without a recent (≤3 years) history of respiratory exacerbation. We compared PM2.5 concentrations during one month of ESP use to those during one month without ESP use.ResultsOur study included 19 subjects (53–80 years old), nine with a history of respiratory exacerbation. Geometric mean (GM) PM2.5 and median GM daily peak PM2.5 were significantly lower during ESP deployment compared to the equivalent time-period without the ESP (GSD=0.50 and 0.37 μg/m3, respectively, p<0.001). PM2.5 in homes of respiratory exacerbators tended (p<0.14) to be higher than PM2.5 in homes of those without a history of respiratory exacerbation.ConclusionSubjects with a history of respiratory exacerbation tended to have higher: mean, median and mean peak PM2.5 concentrations compared to homes of subjects without a history of exacerbations. The ESP intervention reduced in-home PM2.5 concentrations, demonstrating its utility in reducing indoor exposures.

\u201cI can\u2019t stand it\u2026but I do it sometimes\u201d parental smoking around children: practices, beliefs, and conflicts \u2013 a qualitative study

BackgroundMany parents continue to smoke around their children despite the widely known risks of children’s exposure to tobacco smoke. We sought to learn about parental smoking behavior around children from parents’ perspective.MethodsSemi-structured interviews were conducted with 65 smoking parents or partners of smoking parents of children up to age 7, to learn about home smoking rules, behaviours performed to try to protect children, and smoking-related conflicts, from parents’ perspective. Interviews were recorded and transcribed and thematic analysis performed. Recruitment was challenging due to the sensitive nature of the topic.ResultsMany parents described smoking around their children in certain areas of the home, outdoors, and in what they consider to be open or ventilated areas. Participants emphasized efforts to protect their children and described various mitigating practices but held mixed views as to their effectiveness. Parents had different conceptions of which areas or distances were considered ‘safe’. Many smoking parents described conflicts both internal and with other family members regarding the protection of children. Some parents who continue to smoke around their children despite understanding the health risks felt powerless to effect change, as well as being uncertain as to the effectiveness of their protective strategies; others were aware but reluctant to change.ConclusionFindings shed light on some of the difficulties faced by smoking parents and obstacles to maintaining a smoke-free environment for their children, providing insight for the type of information and support required to help parents better protect their children from exposure to tobacco smoke. Awareness of health risks associated with secondhand smoke was demonstrated, yet parents in smoking families were confused regarding which rules and behaviours best protect children from exposure to tobacco smoke. Parents were sometimes aware that their smoking ‘rules’ and mitigating practices were limited in their effectiveness. Guidelines should be provided explaining how and when exposure occurs and how to keep children safe.

Parental Perceptions of Children's Exposure to Tobacco Smoke and Parental Smoking Behaviour.

Around 40% of children are exposed to tobacco smoke, increasing their risk of poor health. Previous research has demonstrated misunderstanding among smoking parents regarding children’s exposure. The parental perceptions of exposure (PPE) measure uses visual and textual vignettes to assess awareness of exposure to smoke. The study aimed to determine whether PPE is related to biochemical and reported measures of exposure in children with smoking parents. Families with at least one smoking parent and a child ≤ age 8 were recruited. In total, 82 parents completed the PPE questionnaire, which was assessed on a scale of 1–7 with higher scores denoting a broader perception of exposure. Parents provided a sample of their child’s hair and a self-report of parental smoking habits. Parents who reported smoking away from home had higher PPE ratings than parents who smoke in and around the home (p = 0.026), constituting a medium effect size. PPE corresponded with home smoking frequency, with rare or no home exposure associated with higher PPE scores compared to daily or weekly exposure (p < 0.001). PPE was not significantly related to hair nicotine but was a significant explanatory factor for home smoking location. PPE was significantly associated with parental smoking behaviour, including location and frequency. High PPE was associated with lower exposure according to parental report. This implies that parental understanding of exposure affects protective behaviour and constitutes a potential target for intervention to help protect children.

Culturally tailored tobacco control: Aboriginal community perspectives in Sydney, Australia.

A community-based project was developed to support quit attempts and denormalise smoking in Aboriginal communities. This qualitative study evaluates the effectiveness of project strategies, messages and the partnership process, and explores impacts observed by Aboriginal community members, complementing findings from a quantitative evaluation. The study comprised five focus groups (40 participants) and 14 in-depth interviews (with 15 community members). Data were analysed thematically by manual and NVivo software methods. Results demonstrate that the project attracted community attention, was well recalled and messages were considered convincing and persuasive. Participants reported being more likely to quit and to discuss smoking with family and friends, and noticed that many people were quitting. Participants observed an increase in asking people not to smoke in the home and fewer people smoking at events, but noted that many smokers struggled to stay quit. The partnership and participation of Aboriginal Health Workers were viewed as crucial. The qualitative findings reinforce quantitative evaluation findings suggesting that the project contributed to denormalising smoking and motivating quit attempts. The evaluation provided insight into how the project changed attitudes and motivated community members to make quit attempts and provided ideas to meet the ongoing challenge.

Persistent tobacco smoke residue in multiunit housing: Legacy of permissive indoor smoking policies and challenges in the implementation of smoking bans.

Secondhand smoke (SHS) is a common indoor pollutant in multiunit housing (MUH). It is also the precursor of thirdhand smoke (THS), the toxic mixture of tobacco smoke residue that accumulates in indoor environments where tobacco has been used. This study examined the levels, distribution, and factors associated with THS pollution in low-income MUH. Interviews were conducted 2016-2018 in a cross-sectional study of N=220 MUH homes in San Diego, California. Two surface wipe samples were collected per home and analyzed for nicotine, a THS marker, using liquid chromatography-triple quadrupole mass spectrometry. Nicotine was detected in all homes of nonsmokers with indoor smoking bans (Geo Mean=1.67µg/m2; 95% CI=[1.23;2.30]) and smokers regardless of an indoor ban (Geo Mean=4.80µg/m2; 95% CI=[1.89;12.19]). Approximately 10% of nonsmokers' homes with smoking bans showed nicotine levels higher than the average level in homes of smokers without smoking bans from previous studies (≥30µg/m2). Housing for seniors, smoking bans on balconies, indoor tobacco use, difficult to reach surfaces, and self-reported African-American race/ethnicity were independently associated with higher THS levels. Individual cases demonstrated that high levels of surface nicotine may persist in nonsmoker homes for years after tobacco use even in the presence of indoor smoking bans. To achieve MUH free of tobacco smoke pollutants, attention must be given to identifying and remediating highly polluted units and to implementing smoking policies that prevent new accumulation of THS. As THS is a form of toxic tobacco product waste, responsibility for preventing and mitigating harmful impacts should include manufacturers, suppliers, and retailers.

Genetic predisposition and environmental factors associated with the development of atopic dermatitis in infancy: a prospective birth cohort study.

The influence of environmental factors on atopic dermatitis (AD) has been investigated in many cross-sectional studies. It remains however unclear if they could influence AD development early in life. This prospective birth cohort study aimed to monitor aspects of family lifestyle and child's nutrition within a Caucasian population and to assess its association with AD development over the first 2years of life. Genetic predisposition was evaluated based on family history and profilaggrin genotyping. Of 149 included children, 36 developed AD. Infants with a family history of atopy developed AD 2.6 times more frequently (30 of 97) than infants without atopic predisposition (6 of 52). Genotyping was carried out on 50% of the children included. Profilaggrin mutations (R501X, 2282del4, R2447X, and S3247X) were infrequent in our population. Lower incidence of AD was observed in infants exposed to a damp housing environment, lower household income, and smoking mothers with a higher but not with a lower education level.Conclusion: Family history of atopy was a significant risk factor for AD regardless of the most common, currently defined, FLG mutations. Humidity at home and passive smoking seem associated with AD development in infancy. What is Known: • Atopic dermatitis (AD) is associated with mutations in various genes of the immune system and the epidermal barrier complex in particular filaggrin (FLG) mutation. • Inherited factors alone cannot explain the rising AD; environmental factors are therefore likely to play a decisive role in this rise but the exact role that these factors may play in increasing AD risk in infancy remains unclear. Moreover, the relationship between environmental factors and AD has been the focus of mostly cross-sectional studies and not prospective studies. What is New: • This prospective birth cohort study demonstrates that family history of atopy is a significant risk factor for AD regardless of the most common, currently defined, FLG mutations. • A lower incidence of AD was observed in infants exposed to a moist housing environment, lower household income, and smoking of mothers with a higher but not with a lower education level.

Smoke-Free Home Intervention in Permanent Supportive Housing: A Multifaceted Intervention Pilot.

Smoke-free homes (SFHs), the voluntary adoption of home smoking restrictions, are associated with reduced secondhand smoke exposure. However, SFHs are uncommon in permanent supportive housing (PSH) for formerly homeless adults, who have fivefold higher smoking rates than the general population. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. Rest of the methods, PSH residents (n = 100) and staff (n = 62) from 15 PSH sites participated in the intervention between October 2017 and February 2018. Research staff provided counseling to PSH residents on how to adopt an SFH and trained PSH staff on how to counsel residents on smoking cessation. The primary outcome was self-reported voluntary adoption of an SFH for ≥90 days, and the secondary outcome was carbon monoxide-verified PPA at 6-month follow-up. PSH staff completed the Smoking Knowledge, Attitudes, and Practices survey at baseline and 3-month follow-up. At 6 months, 31.3% of PSH residents had adopted an SFH (vs. 13.0% at baseline) and 16.9% reported carbon monoxide-verified PPA. A positive attitude toward an SFH policy was associated with increased odds of SFH adoption (adjusted odds ratio = 8.68, 95% confidence interval: 2.42, 31.17). Voluntary SFH adoption was associated with increased PPA (adjusted odds ratio = 26.27, 95% confidence interval: 3.43, 201.30). PSH staff reported improved attitudes toward and self-efficacy in delivering cessation care, and decreased barriers to discussing smoking cessation among PSH residents between baseline and 3-month follow-up. In this single-arm study, a brief intervention increased SFH adoption and PPA among PSH residents. To date, few interventions have addressed SFHs and their association with tobacco use among PSH residents. A "ground-up" approach that relies on buy-in from residents and that promotes voluntary SFHs is an innovative way to increase smoke-free living environments in PSH. This approach could pave a pathway for smoke-free policy implementation in these sites. PSH can play a role in reducing the burden of tobacco use by empowering its residents to adopt voluntary SFHs, which could increase smoking cessation among residents.

The influence of demographic and lifestyle factors on urinary levels of PAH metabolites-empirical analyses of Cycle 2 (2009-2011) CHMS data.

Polycyclic aromatic hydrocarbons (PAHs) are a group of compounds formed during the incomplete combustion of organic matter. Several are mutagenic carcinogens; the magnitude of exposure can be assessed by examining urinary levels of PAH metabolites. Data from biomonitoring studies that record urinary PAH metabolite levels, as well as demographic and lifestyle information, can be used to investigate relationships between PAH exposure and variables, such as smoking status, workplace smoking restrictions, age, sex, household income, home age, and occupation. This study analysed creatinine-adjusted urinary PAH metabolite concentrations and questionnaire data from ~1200 individuals aged 16 years and older surveyed in Cycle 2 of the Canadian Health Measures Survey (CHMS). Statistical analyses revealed that smoking status, age, and sex are associated with urinary concentrations of a pyrene metabolite (1-OHP), phenanthrene metabolites (ΣOH-Phen), fluorene metabolites (ΣOH-Flu) and naphthalene metabolites (ΣOH-Nap). More specifically, smoking status, age and sex can collectively account for 30, 24, 52, and 34% of the observed variations in 1-OHP, ΣOH-Phen, ΣOH-Flu and ΣOH-Nap metabolites, respectively (p < 0.001). Analyses of non-smokers revealed weak but significant effects of age, sex, home age, and occupation on urinary levels of selected PAH metabolites (i.e., <7% of observed variation, p < 0.05). The unexplained variation in PAH metabolite levels is most likely related to diet, which was not examined. Although the results revealed significant relationships between urinary PAH metabolite levels and several lifestyle and/or demographic variables, robust examinations of selected effects (e.g., sex, home age, occupation) will require datasets that are balanced with respect to the other highlighted variables. The results can be used to identify remedial measures to reduce exposure and concomitant risk, and/or design follow-up studies to test hypotheses regarding the causes of exposure differences empirically related to sex, age, home age, and occupation.

Indoor Particulate Matter From Smoker Homes Induces Bacterial Growth, Biofilm Formation, and Impairs Airway Antimicrobial Activity. A Pilot Study.

Background: Particulate matter (PM) air pollution causes deleterious health effects; however, less is known about health effects of indoor air particulate matter (IAP).Objective: To understand whether IAP influences distinct mechanisms in the development of respiratory tract infections, including bacterial growth, biofilm formation, and innate immunity. Additionally, we tested whether IAP from Iowa houses of subjects with and without recent respiratory exacerbations recapitulated the National Institute of Standards and Technology (NIST) IAP findings.Methods: To test the effect of NIST and Iowa IAP on bacterial growth and biofilm formation, we assessed Staphylococcus aureus growth and Pseudomonas aeruginosa biofilm formation with and without the presence of IAP. To assess the effect of IAP on innate immunity, we exposed primary human airway surface liquid (ASL) to NIST, and Iowa IAP. Lastly, we tested whether specific metals may be responsible for effects on airway innate immunity.Results: NIST and Iowa IAP significantly enhanced bacterial growth and biofilm formation. NIST IAP (whole particle and the soluble portion) impaired ASL antimicrobial activity. IAP from one Iowa home significantly impaired ASL antimicrobial activity (p < 0.05), and five other homes demonstrated a trend (p ≤ 0.18) of impaired ASL antimicrobial activity. IAP from homes of subjects with a recent history of respiratory exacerbation tended (p = 0.09) to impair ASL antimicrobial activity more than IAP from homes of those without a history respiratory exacerbation. Aluminum and Magnesium impaired ASL antimicrobial activity, while copper was bactericidal. Combining metals varied their effect on ASL antimicrobial activity.Conclusions: NIST IAP and Iowa IAP enhanced bacterial growth and biofilm formation. ASL antimicrobial activity was impaired by NIST IAP, and Iowa house IAP from subjects with recent respiratory exacerbation tended to impair ASL antimicrobial activity. Individual metals may explain impaired ASL antimicrobial activity; however, antimicrobial activity in the presence of multiple metals warrants further study.

Smokefree home rules and cigarette smoking intensity among smokers in different stages of smoking cessation from 20 low-and-middle income countries

Smokefree environment created by smokefree policies is associated with smoking reduction; however, there is paucity of literature on the relationship between smokefree home rules and smoking intensity in low-and-middle income countries (LMICs), and how smokefree policy affects smoking behavior of smokers at different stages of smoking cessation. This study examined the relationship between smokefree home rules and average number of cigarettes smoked per day (CPD) among daily smokers at different stages of the transtheoretical model (TTM) of change. Data from 18,718 current daily cigarette smokers from the Global Adult Tobacco Survey (GATS) conducted from 2011 to 2017 in 20 LMICs were analyzed. Weighted multivariable linear regression analyses were conducted using the log of CPD as the outcome variable with smokefree home rules as the exposure variable, controlling for selected covariates. Approximately 15% of the participants were in precontemplation, 5% were in preparation, 15% lived in partial smokefree homes, and 30% lived in complete smokefree homes. The average number of CPD was 12.3, 12.0, and 10.6 among participants living in homes where smoking was allowed, partial smokefree homes, and complete smokefree homes, respectively. Compared to living in homes where smoking was allowed, living in complete smokefree homes were associated with 22.5% (95%CI = 18.4%–26.5%), 17.9% (95%CI = 8.4%–27.3%), and 29.3% (95% CI = 17.1%–41.5%) fewer CPD among participants in precontemplation, contemplation, and preparation stages, respectively. These findings suggest that complete smokefree home policy will benefit smokers in LMICs irrespective of their intention to quit smoking in addition to protecting non-smokers from secondhand smoke exposure.

Support for smoke-free public places among adults in four countries in sub-Saharan Africa.

There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA). This study examines the support for smoke-free public places in SSA and delineates their correlates. Data collected through the Global Adult Tobacco Survey (2012-2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

Opportunities for Tailored Support to Implement Smoke-Free Homes: A Qualitative Study among Lower Socioeconomic Status Parents.

With the aim of preventing children from being exposed to secondhand smoke, we examined to which level lower socio-economic status (SES) households had implemented home smoking rules and the factors that hampered parents in their process of change toward a complete smoke-free home (SFH). We conducted a qualitative study including semi-structured in-depth interviews with 14 parents of young children living in a lower SES neighborhood of a provincial town in the Netherlands. Interview transcripts were subjected to a qualitative content analysis. Three distinct levels of SFH implementation emerged: complete SFH, flexible SFH, and partial SFH. Differences between parents at these three levels essentially concerned: (1) the role of child-related moral considerations in their motivation for an SFH; (2) whether they felt they had the agency to set and enforce home smoking rules; (3) the difficulties they experienced in changing their smoking habit from smoking indoors to smoking outdoors. Parents also had different opinions about the role their children could play in facilitating the parental process of change. We conclude that the current level of SFH implementation may serve as a starting point for developing tailored interventions. Such interventions should probably address other factors than the commonly used awareness–knowledge–commitment approach.

Reducing Tobacco Smoke Exposure in High-Risk Infants: A Randomized, Controlled Trial

To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit. A randomized, controlled trial compared motivational interviewing plus financial incentives with conventional care on infant urine cotinine at 1 and 4months' follow-up. Mothers of infants in the neonatal intensive care unit (N=360) who reported a smoker living in the home were enrolled. Motivational interviewing sessions were delivered in both the hospital and the home. Financial incentives followed session attendance and negative infant cotinine tests postdischarge. The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P≤.01) and mothers who completed the study within 6months postdischarge (per protocol; P≤.05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P≤.01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P≤.05). Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families. ClinicalTrials.gov: NCT01726062.

Children With Poorly Controlled Asthma: Randomized Controlled Trial of a Home-Based Environmental Control Intervention

To determine the efficacy of a home-based environmental control (EC) intervention, based on biomarkers for allergen sensitization and secondhand smoke (SHS) exposure, in reducing asthma emergency department (ED) visits among inner-city children with persistent asthma.Children (mean age: 6.3 years) with physician-diagnosed persistent asthma (n = 222) were recruited from an asthma ED visit from August 2013 to February 2016. Subjects had had ≥2 ED asthma visits or >1 hospitalization in the past 12 months and were residents in the Baltimore metropolitan area. Children in foster care and other significant nonasthma respiratory conditions were excluded.In this prospective randomized controlled trial, children in the intervention or attention control group were stratified by age. All children had serological immunoglobulin E testing to common environmental allergens and salivary cotinine measurements for SHS exposure. Caregivers completed surveys about the child’s indoor exposure to mice, cockroaches, cats, and dogs at the baseline, 6-month, and 12-month time points. The intervention group had a medical follow-up visit in the ED within 7 days of enrollment, 2 home nurse visits for asthma follow-up, a targeted EC educational and remediation program based on the child’s sensitizations, and motivational interviews with caregivers of children with a positive salivary cotinine result to encourage a ban on home smoking. The control group had 3 home nurse visits, basic EC education without remediation, and a smoking cessation referral.Most (204 out of 222) completed the study at 1 year. Subjects were 65% boys, 94% African American, and 94% Medicaid insured. Approximately 75% had moderate to severe asthma with >1 asthma ED visit in the previous 3 months. Eighty-three percenthad positive serological allergy test results, and 56% had positive salivary cotinine results. The asthma medication ratio of controller to total controller or rescue canisters used, cotinine levels, mouse or cockroach exposure, symptom-free nights, and caregiver worry about medication side effects were no different between groups. Children who resided in homes with no SHS exposure and who were in the control group, atopic children, younger children, and children with an asthma medication ratio >0.5 were more likely have a repeat ED visit. For children with positive SHS exposure, time to first repeat ED visit did not differ by group. For children with no SHS exposure and after adjusting for age, allergic sensitization, and medication fills, the control subjects (70%) were more likely than intervention subjects (45%) to have a repeat ED visit. Overall, baseline increased controller and rescue medication fills were the only factors associated with increased risk for repeat ED visits for all subjects.Home-based, targeted EC intervention was not more effective in reducing repeat asthma ED visits in children with persistent asthma and SHS exposure compared with controls.This study further illustrates that achieving good asthma control truly requires a consistent, multipronged approach. Indoor allergies and SHS are problematic factors in asthma management, and smoking and/or indoor allergen interventions in other studies have reported mixed success in improving asthma outcomes. The type or number of interventions in this study may have been inadequate and/or did not account for all other caregiver or social challenges. Not considering the baseline and asthma medical management during the study is a significant limitation. Also, this study included mostly inner-city, minority subjects with very poorly controlled asthma, so possibly, these interventions could have different outcomes in other populations.

Impact of Community Respiratory Viral Infections in Urban Children With Asthma

To prospectively evaluate the influence of viral infection on respiratory symptoms, lung function, and nasal cytokines in children with asthma living in an urban environment.The study included 53 children with asthma living in Detroit, Michigan.Subjects were recruited with a screening questionnaire distributed through a community-based research partnership. Subjects participated in 4 2-week surveillance assessments, corresponding with fall, winter, spring, and summer seasons over the course of 1 year. During each 2-week surveillance period, spirometry, fraction of exhaled nitric oxide, symptom reports, and nasal lavage samples were obtained on 3 separate occasions. Respiratory symptoms were measured by using a previously published respiratory symptom score. “Sick periods” were defined when symptom scores were >2, and an additional assessment with previously stated measurements was completed over the 1-week sick period. Subjects were contacted weekly via telephone to monitor for illnesses and initiate sick period assessments. Nasal lavage samples were analyzed for the following: presence of respiratory viral nucleic acid, rhinovirus typing and viral copy numbers, and messenger RNA and protein expression analysis of select biomarkers previously shown to be elevated in rhinovirus infection.The investigators enrolled 53 subjects, who were predominantly African American, elementary school–aged, and had high prevalence of home smoke exposure. Approximately 75% of subjects had mild intermittent or mild persistent asthma. Six hundred fifty-eight nasal aspirates were obtained. Of the samples, 22.9% of surveillance samples and 33.7% of respiratory illness samples were virus positive, with rhinovirus accounting for 48.9% of infections. Comparing the presence of respiratory virus with high- and low-symptom illnesses, children with severe colds (symptom scores >5) had signs of airway inflammation on spirometry with a statistically significant decrease of ∼10% of predicted forced expiratory flow at 25% to 75% of pulmonary volume as well as higher biomarker elevations in both nasal messenger RNA of CXCL-10 and protein expression of CXCL8, CXCL10, CCL-2, and CCL-4 when compared with virus-negative asymptomatic conditions. Mild virus-positive colds (symptoms scores 1–4) and asymptomatic infections showed normal airway function by spirometry and fewer biomarker elevations. Viral-negative coldlike illnesses had increased nitric oxide with otherwise normal spirometry.Urban children with asthma have reduced forced expiratory flow at 25% to 75% of pulmonary volume and higher elevations of nasal biomarkers during high-symptom respiratory infections compared with low-symptom infections or symptomatic virus-negative illnesses.Researchers in this study prospectively evaluate the effect of viral infections on respiratory symptoms and lung function in urban children with asthma. High-symptom colds were associated with decreases in small airway function compared with lower-symptom illnesses. Interestingly, the nasal biomarkers elevated during symptomatic viral infections were related to neutrophil recruitment and not eosinophil or allergic response. Also, many upper respiratory tract illnesses in the study were virus negative, suggesting other triggers for symptoms.

Smoking behavior and social contexts associated with smoking among dual-smoker couples.

To examine smoking behavior and social contexts related to smoking among dual-smoker couples. Cross-sectional online survey study. A convenience sample of 183 dual-smoker couples. Investigator-developed survey on smoking and related social contexts. Participants smoked 16.0 cigarettes daily for 14.2years; 48.4% shared more than half of their smoking time with their spouse. More than half made quit attempts in the past year individually (M=5.3) and jointly (M=2.5). Couples sharing more smoking time were more likely to be motivated to quit (p=.002), make quit attempts (p<.0001), and be interested in cessation interventions (p=.002); but less likely to implement home smoking bans (p<.001). Among those who reported quit attempts, 41% quit by themselves and 15.3% sought professional assistance. Most common reasons for relapse were chronic stress and crisis, 63.6%, however, were interested in smoking cessation services, preferably technology-based interventions. We found smoking interdependence within dual-smoker couples. Despite high levels of motivation to quit, most did not utilize professional help, leading to low successful quit rates. Technology-based smoking cessation interventions incorporating spousal support and addressing stress/crisis may best assist dual-smoker couples.