Article

Children and Secondhand Smoke: Clear Evidence for Action

aAAP Tobacco Consortium and AAP Julius B. Richmond Center of Excellence, Elk Grove Village, Illinois
PEDIATRICS (Impact Factor: 5.3). 12/2011; 129(1):170-1. DOI: 10.1542/peds.2011-3190
Source: PubMed
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    • "Of all deaths attributable to second-hand tobacco smoke, 31% occur among children(WHO 2009).Second hand smoking significantly contributes to morbidity including bronchitis, middle ear disease, impaired endothelial function and acute respiratory illness and asthma illness. Children as a group have shown the strongest evidence of harm attributable to SHS(Singh and Lal 2011, White et al 2012, Sims et al 2012, Lin et al 2010, Moritsugu 2007, Tanski and Wilson2012).Second-hand tobacco smoke is present in virtually all public places where smoking is permitted, and there is no safe level of exposure. With the widespread establishment of smoke-free workplaces and public venues, the home is becoming the predominant source of exposure to second-hand smoke (SHS) among children in the household. "
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    ABSTRACT: Objective To assess the impact of an electronic health record (EHR) modification and brief clinician training on tobacco smoke exposure (TSE) management in pediatric primary care. Methods Within a teaching hospital-based, urban primary care setting, we modified the EHR to include TSE screening prompts, decision support, educational literature, and simplified referral to the state quit line (QuitWorks). A brief training was conducted for the 48 clinic physicians (34 residents and 14 attendings). We collected cross-sectional, independent, random samples of EHR data from well-child visits for children ≤12 years old seen 3 months before (2024 visits) and 3 months after (1895 visits) the intervention and pooled client data from QuitWorks to evaluate TSE screening, counseling, and quit-line referrals. A needs assessment questionnaire examined preintervention attitudes and practice around TSE management; follow-up questionnaires explored satisfaction and subjective changes in skills. Results The baseline needs assessment revealed that although most clinicians agreed that it is appropriate for pediatricians to conduct TSE screening, counseling, and referral during well-child visits, only about half screened, 42% counseled, and 28% routinely offered to refer smoking parents. In pre–post analyses of 117 and 112 EHR-documented positive screens, the intervention was associated with a 16-fold greater likelihood of counseling among positive screens (adjusted odds ratio 16.12; 95% confidence interval 7.28, 35.68). Referrals to QuitWorks increased from 1 before to 31 after the intervention. Conclusions Implementation of EHR modifications and a brief training to support TSE management was associated with higher rates of counseling and quit-line referrals for parents who smoke.
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    ABSTRACT: To assess the impact of different smoking behaviors of caregivers on environmental tobacco smoke (ETS) exposure in children aged 5-6 years in Changsha, China. We conducted a cross-sectional, random digit-dial telephone survey of caregivers (n = 543) between August and October 2013. Caregivers' smoking behaviors were collected by a questionnaire. Exposure assessment was based upon determination of urinary cotinine levels in children employing gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS). In children not living with a smoker, children living with one smoker, and children living with more than one smoker at home, median urinary cotinine concentrations (ng/mL) were 0.72, 2.97, and 4.46, respectively. For children living with one smoker, median urinary cotinine levels of children exposed to ETS were associated with caregiver smoking behaviors, i.e., if a caregiver consumed more cigarettes (>20 compared with ≤10; 7.73 versus 2.29 ng/mL, respectively). The magnitude of ETS exposure in children is correlated with the smoking behaviors of the caregiver. Counseling for smoking cessation and educational interventions are needed urgently for smoking caregivers to increase their awareness about ETS exposure and to encourage smoking cessation at home or to take precautions to protect children's health.
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