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      Secondhand smoke exposure assessment and counseling in the Chinese pediatric setting: a qualitative study

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          Abstract

          Background

          Assisting smoking parents to quit smoking and eliminating the secondhand smoke (SHS) exposure of their children is a global health priority. Engaging healthcare workers in developing countries to address this priority has been a challenge. This study intends to explore issues around current practice related to SHS exposure assessment and counseling and identify barriers to SHS exposure reduction counseling in the Chinese pediatric setting.

          Methods

          We conducted qualitative interviews (11 focus groups discussions (FGDs) with pediatricians, 6 FGDs with pediatric nurses and 11 in-depth interviews (IDIs) with hospital administrators) among 101 health-care professionals (HCP) from 5 hospitals in four major cities of Guangxi Province, China. All FGDs/ IDIs were audio recorded and analysed thematically.

          Results

          The findings suggest that few Chinese pediatricians routinely address the SHS exposure of children in their usual practice. All HCPs felt the need for clinical interventions to promote SHS exposure reduction for children. Primary barriers to SHS exposure reduction counseling in the Chinese pediatric setting included: lack of skills and training in tobacco use reduction and cessation counseling; time constraints and heavy workloads, uncertainty about the usefulness of smoking cessation interventions and lack of hospital-wide systems requiring pediatricians to record tobacco use or SHS exposure information. Ideas for overcoming these barriers were building capacity of pediatricians, collaboration with international organization to initiate training, engaging top level leaders in the effort and ensuring financial resources to support the program.

          Conclusions

          This study among hospital administrators and service providers in China demonstrated a high level of interest in delivering SHS exposure reduction interventions in the pediatric setting. The findings can inform the creation and delivery of clinical interventions in China to promote SHS exposure reduction to children in the pediatric setting.

          Electronic supplementary material

          The online version of this article (doi:10.1186/1471-2431-14-266) contains supplementary material, which is available to authorized users.

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          Most cited references27

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          Exposure to Environmental Tobacco Smoke and Cognitive Abilities among U.S. Children and Adolescents

          We used the Third National Health and Nutrition Examination Survey (NHANES III), conducted from 1988 to 1994, to investigate the relationship between environmental tobacco smoke (ETS) exposure and cognitive abilities among U.S. children and adolescents 6–16 years of age. Serum cotinine was used as a biomarker of ETS exposure. Children were included in the sample if their serum cotinine levels were ≤15 ng/mL, a level consistent with ETS exposure, and if they denied using any tobacco products in the previous 5 days. Cognitive and academic abilities were assessed using the reading and math subtests of the Wide Range Achievement Test–Revised and the block design and digit span subtests of the Wechsler Intelligence Scale for Children–III. Analyses were conducted using SUDAAN software. Of the 5,365 6- to 16-year-olds included in NHANES III, 4,399 (82%) were included in this analysis. The geometric mean serum cotinine level was 0.23 ng/mL (range, 0.035–15 ng/mL); 80% of subjects had levels < 1 ng/mL. After adjustment for sex, race, region, poverty, parent education and marital status, ferritin, and blood lead concentration, there was a significant inverse relationship between serum cotinine and scores on reading (β= −2.69, p = 0.001), math (β= −1.93, p = 0.01), and block design (β= −0.55, p < 0.001) but not digit span (β= −0.08, p = 0.52). The estimated ETS-associated decrement in cognitive test scores was greater at lower cotinine levels. A log-linear analysis was selected as the best fit to characterize the increased slope in cognitive deficits at lower levels of exposure. These data, which indicate an inverse association between ETS exposure and cognitive deficits among children even at extremely low levels of exposure, support policy to further restrict children’s exposure.
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            [Smoking and passive smoking in Chinese, 2002].

            To describe the prevalence of smoking, quitting smoke, and passive smoking in different populations by education status, occupation and geographic distribution. Surveillance on risk behaviors in 145 disease surveillance points (DSP) was carried out in 2002 by multi-steps random sampling through questionnaires. 16,407 records had been completed with 16 056 used for analysis. Indicators as smoking, current smoking, average cigarettes smoked and the cost per day, etc., were calculated by weight on age proportions from the 2000 census. Ever-smoking rates in males and females aged 15 and over were 66.0% and 3.1%, respectively with ever-smoking rate dropped 1.8% in whole population, but increased in people aged 15-24. The number of total smokers was about 350 million, 30 million more than that in 1996. There were no obvious geographic differences seen among male, but big difference was seen in female smokers. Higher smoking rates were seen in the northeast and northern parts of the country. Rate of quitting smoking was increasing, from 9.42% in 1996 to 11.5% in 2002, referring to an increase of 10 million quitters. However, the rate of no intention to quit among smokers was still very high--74%. The average cigarettes consumption per person-day was the same as that in 1996--14.8 cigarettes/day, which cost 2.73 RBM/day. The cost was various in different groups of population with a 15 times difference. The level of exposure for passive smokers was not improved. The prevalence of passive smoking in nonsmokers were 53% in 1996 and 52% in 2002. Knowledge on smoking and health condition in population had been greatly improved, but still poor in the western areas. 60% of the people claimed in supporting banning of smoking in public places, 45% supporting the banning of all cigarettes ads, but big difference was seen in different geographic areas. The prevalence of smoking in Chinese males had reached its peak, leveling but had not yet obvious dropped. Communication on the knowledge of harm in smoking remained weak since people did not understand or support the strategies on tobacco control, especially in the western areas. Data indicated that the prevalence of tobacco use would not decrease over in short period and the disease burden caused by tobacco use would still be heavy in the next 30-50 years. The government and public health authorities should develop effective tobacco control in no time to decrease disease burden caused by smoking and passive smoking.
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              Tobacco cessation quitlines in North America: a descriptive study.

              Quitlines have become an integral part of tobacco control efforts in the United States and Canada. The demonstrated efficacy and the convenience of telephone based counselling have led to the fast adoption of quitlines, to the point of near universal access in North America. However, information on how these quitlines operate in actual practice is not often readily available. This study describes quitline practice in North America and examines commonalities and differences across quitlines. It will serve as a source of reference for practitioners and researchers, with the aim of furthering service quality and promoting continued innovation. A self administered questionnaire survey of large, publicly funded quitlines in the United States and Canada. A total of 52 US quitlines and 10 Canadian quitlines participated. Descriptive statistics are provided regarding quitline operational structures, clinical services, quality assurance procedures, funding sources and utilisation rates. Clinical services for the 62 state/provincial quitlines are supplied by a total of 26 service providers. Nine providers operate multiple quitlines, creating greater consistency in operation than would otherwise be expected. Most quitlines offer services over extended hours (mean 96 hours/week) and have multiple language capabilities. Most (98%) use proactive multisession counselling-a key feature of protocols tested in previous experimental trials. Almost all quitlines have extensive training programmes (>60 hours) for counselling staff, and over 70% conduct regular evaluation of outcomes. About half of quitlines use the internet to provide cessation information. A little over a third of US quitlines distribute free cessation medications to eligible callers. The average utilisation rate of the US state quitlines in the 2004-5 fiscal year was about 1.0% across states, with a strong correlation between the funding level of the quitlines and the smokers' utilisation of them (r = 0.74, p<0.001). Quitlines in North America display core commonalities: they have adopted the principles of multisession proactive counselling and they conduct regular outcome evaluation. Yet variations, tested and untested, exist. Standardised reporting procedures would be of benefit to the field. Shared discussion of the rationale behind variations can inform future decision making for all North American quitlines.
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                Author and article information

                Contributors
                gxlmd@126.com
                asm.abdullah@graduate.hku.hk
                ngm8525@hotmail.com
                huangka0319@sina.com
                gxlmd@126.com
                zhenyu.m@gmail.com
                yangli8290@hotmail.com
                rpazz@163.com
                jwinickoff@partners.org
                Journal
                BMC Pediatr
                BMC Pediatr
                BMC Pediatrics
                BioMed Central (London )
                1471-2431
                15 October 2014
                2014
                : 14
                : 1
                : 266
                Affiliations
                [ ]Department of Pediatrics, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi 530021 China
                [ ]Global Health Initiative, Duke Kunshan University, Kunshan, Jiangsu Province 215347 China
                [ ]Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
                [ ]School of Public Health, Guangxi Medical University, 22 Shuangyong Road, Nanning, Guangxi 530021 China
                [ ]Boston University School of Medicine, Boston Medical Center, Boston, MA USA
                [ ]MGH Center for Child and Adolescent Health Research and Policy, Harvard Medical School, Boston, USA
                Article
                1188
                10.1186/1471-2431-14-266
                4287587
                25316512
                6709fdd3-7cd5-46fb-a05d-c2a9d24a8ca7
                © Liao et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 21 April 2014
                : 9 October 2014
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2014

                Pediatrics
                secondhand smoke,pediatric setting,healthcare workers,counseling,chinese,tobacco control,qualitative study

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