Secondhand Smoke Exposure Reduction After NICU Discharge: Results of a Randomized Trial

doi:10.1016/j.acap.2015.05.001

Academic Pediatrics

Volume 15, Issue 6, November–December 2015, Pages 605-612

https://doi.org/10.1016/j.acap.2015.05.001 Get rights and content

Abstract

Objective

Premature infants are at high risk for respiratory disease, and secondhand smoke (SHS) exposure further increases their risk for developing respiratory illness and asthma. Yet, SHS exposure remains problematic in this vulnerable population. Our objective was to evaluate the effects of brief asthma education plus motivational interviewing counseling on reducing SHS exposure and improving respiratory outcomes in premature infants compared to asthma education alone.

Methods

Caregivers and their infants ≤32 weeks' gestational age were enrolled after discharge from a neonatal intensive care unit in Rochester, New York, from 2007 to 2011. Participants (N = 165, 61% Medicaid insurance, 35% Black, 19% Hispanic, 59% male) were stratified by infant SHS exposure and randomly assigned to treatment or comparison groups.

Results

Caregivers in the treatment group reported significantly more home smoking bans (96% vs 84%, P = .03) and reduced infant contact with smokers after the intervention (40% vs 58%, P = .03), but these differences did not persist long term. At study end (8 months after neonatal intensive care unit discharge), treatment group infants showed significantly greater reduction in salivary cotinine versus comparison (−1.32 ng/mL vs −1.08 ng/mL, P = .04), but no significant differences in other clinical outcomes.

Conclusions

A community-based intervention incorporating motivational interviewing and asthma education may be helpful in reducing SHS exposure of premature infants in the short term. Further efforts are needed to support sustained protections for this high-risk group and ultimately, prevent acute and chronic respiratory morbidity. Strategies for successfully engaging families during this stressful period warrant attention.

Section snippets

Participants

We enrolled infants born at ≤32 weeks' gestational age, along with their caregivers, into a randomized controlled trial within 6 weeks of their discharge from the neonatal intensive care unit (NICU) at Golisano Children's Hospital in Rochester, New York. Families were recruited in-person in the NICU or over the phone after discharge from March 2007 to May 2011; 165 infants were enrolled. Exclusion criteria included caregiver age <16 years, infants with serious medical comorbidities that could

Results

We collected postintervention survey information for 144 caregivers (87%) and saliva samples from 132 infants (80%). Participating premature infants were 59% male, 35% Black, 19% Hispanic, and 61% used Medicaid as their primary insurer at enrollment; 45% of infants were born <28 weeks' gestational age, and 58% were delivered via cesarean section. Caregivers were mostly mothers of enrolled infants (98%), single (59%) and <30 years (53%); 27% did not finish high school. At enrollment, 26% of

Discussion

Our intervention had a positive impact on short-term infant SHS exposure when compared to brief asthma education alone. MI counseling along with asthma education close to the time of NICU discharge was associated with reduced caregiver-reported SHS exposure. At the follow-up survey 5 months after NICU discharge, significantly fewer infants in the intervention group had routine contact with smokers. We also found a higher prevalence of home smoking bans and total smoking bans reported by

Acknowledgments

This work was funded by a grant from the Halcyon Hill Foundation (Halterman, PI), which had no involvement in the submission of this manuscript for publication.

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Trial characteristics are summarized in Table 1. All trials focused on a single health topic and 19 demonstrated improved outcomes in the intervention group. [18–30] There were no trials for which the control group demonstrated improved outcomes.
Promoting interconception health can improve birth outcomes and long-term women’s health. Motivational Interviewing (MI) is an evidence-based behavior change strategy that can address interconception health behaviors and health care engagement.
This scoping review assessed the evidence for using MI to promote interconception health and assessed features of successful MI interventions.
We searched PubMed, CHINAL, and Cochrane databases for clinical trials that involved an MI intervention and at least one comparison group published by 8/31/2021. Interventions occurred during pregnancy or within three months postpartum and outcomes were measured between birth and one year postpartum. We abstracted data on trial characteristics including outcome, population, interventionist training, MI fidelity monitoring, intervention dose, and comparison condition. We examined whether trials that demonstrated statistically significant improvement in outcomes had common features.
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MI has been applied to a variety of interconception health behaviors, with some promising results, particularly for interventions in the perinatal or postpartum period. Outcomes were not clearly attributable to any other differences in intervention or study design. Further exploring context or implementation may help maximize the potential of MI in interconception health promotion.
MI may be implemented across a range of clinical settings, patient groups, and time points around pregnancy. Interventions on health topics relevant to the interconception period should incorporate perinatal or postpartum components.
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The maximum number was 10. MI directs the provider to help clients explore and resolve ambivalence to change, and to create their own goals for success;34 MI and similar strategies have been demonstrated to decrease SHS among children.35,36 Parents received information about protecting children from smoking in the home, including other smokers, or visitors.
Hospitalized children have high rates of tobacco smoke exposure; parents who smoke may be receptive to interventions during their child's hospitalization.
We tested the efficacy of a smoking cessation intervention for parents of hospitalized children.
We conducted a randomized, single-blind clinical trial from 12/14-5/18 at the Children's Hospital Colorado. Hospitalized children who had a parent who smoked tobacco were eligible. Intervention: Intervention participants received motivational interviewing sessions, 2 weeks of nicotine replacement therapy; both groups received referral to the Quitline Consenting parents completed a questionnaire; urine was collected from the child for measurement of cotinine. Our primary outcome was: 1) increase in reporting “no one is allowed to smoke anywhere” in the home (smoke-free home rule). Additional outcomes included: 2) change in child's cotinine from baseline to 1 year, and 3) parental quitting at 1 year. Data were analyzed using Chi-square and t tests for bivariable data, and multivariable logistic and linear regression.
Of 1641 eligible families approached, 252 were randomized (15%); 149 families had follow-up data at 12 months (59%). In the adjusted analysis, there was no difference between the groups in smoke free home rules, or child cotinine level; in an intention-to-treat analysis, 15% in the intervention group versus 8% of controls reported quit (p=0.07).
A smoking cessation intervention can be delivered to parents of hospitalized children. While hospitalization provides an opportunity to help parents quit smoking, more efficient and effective engagement strategies are needed to optimize tobacco control success.
Reducing Tobacco Smoke Exposure in High-Risk Infants: A Randomized, Controlled Trial
2020, Journal of Pediatrics
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 4 months' 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 6 months 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.
The feasibility of an air purifier and secondhand smoke education intervention in homes of inner city pregnant women and infants living with a smoker
2018, Environmental Research
Secondhand smoke (SHS) and other air pollutants adversely affect the health of pregnant women and infants. A feasibility study aimed at reducing air pollution in homes of pregnant women or infants living with a smoker was completed.
In collaboration with the Baltimore City Health Department, women ≥ 18 years of age and either pregnant nonsmokers, or post-partum (any smoking status) with an infant age 0–12 months were recruited. Homes had at least one smoker. Intervention included two air purifiers and secondhand smoke education. Outcomes included feasibility, change in fine particulate matter (PM_2.5), air nicotine, and salivary cotinine pre- and post-intervention.
Fifty women were enrolled (mean age 27 years, 92% African American, 71% single, 94% Medicaid eligible, 34% reported smoking) and 86% completed the study. Of the 50 women, 32 had infants and 18 were pregnant at time of enrollment. Post- intervention, 70% of participants reported smokers were less likely to smoke indoors, and 77% had at least one air purifier turned on at the final visit. Participant satisfaction was high (91%) and 98% would recommend air purifiers. Indoor PM_2.5 was significantly decreased (P < 0.001). Salivary cotinine was significantly decreased for non-smoking women (P < 0.01) but not infants, and no significant change in air nicotine occurred (P = 0.6).
Air purifiers with SHS education is a feasible intervention in homes of women and infants. These data demonstrate reduction in indoor PM_2.5 and salivary cotinine in non-smoking adults. Air purifiers are not an alternative for smoking cessation and a home/ car smoking ban. Smoking cessation should be strongly encouraged for all pregnant women, and nonsmoking mothers with infants should be counseled to completely avoid SHS exposure. This study provides support for a future intervention evaluating clinical endpoints.
Changes and Factors Associated With Tobacco Counseling: Results From the AAP Periodic Survey
2017, Academic Pediatrics
The American Academy of Pediatrics (AAP) advises pediatricians to counsel parents and patients who use tobacco to quit. This study assesses changes in counseling between 2004 and 2010, and factors associated with counseling in 2010.
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Tobacco smoking and smoke exposure during pregnancy are associated with a range of adverse health outcomes, including preterm birth. Also, children born preterm have a higher risk of complications including bronchopulmonary dysplasia and asthma when their mothers smoked during pregnancy.
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Helping future mothers to stop smoking and protect their children from second hand smoke exposure must be a key priority for health care workers and policy makers alike.

View all citing articles on Scopus

: The authors declare that they have no conflict of interest.

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Tobacco and Substance AbuseSecondhand Smoke Exposure Reduction After NICU Discharge: Results of a Randomized Trial

Abstract

Objective

Methods

Results

Conclusions

Section snippets

Participants

Results

Discussion

Acknowledgments

J Allergy Clin Immunol

Ann Epidemiol

Am J Prev Med

Chest

Am J Prev Med

Am J Prev Med

Passive smoking, women and children

Maternal smoking during pregnancy, prematurity and recurrent wheezing in early childhood

Pediatr Pulmonol

Risk factors for hospital admission with RSV bronchiolitis in England: a population-based birth cohort study

PLoS One

Exercise-induced bronchoconstriction in school-age children born extremely preterm

Pediatr Res

Prenatal and postnatal tobacco smoke exposure and respiratory health in Russian children

Respir Res

Health effects of passive smoking—10: summary of effects of parental smoking on the respiratory health of children and implications for research

Thorax

Early life second-hand smoke exposure and serious infectious morbidity during the first 8 years: evidence from Hong Kong's “Children of 1997” birth cohort

Tob Control

Environmental exposures and respiratory morbidity among very low birth weight infants at 1 year of life

Arch Dis Child

A pilot study to enhance preventive asthma care among urban adolescents with asthma

J Asthma

Effect of counselling mothers on their children's exposure to environmental tobacco smoke: randomised controlled trial

BMJ

A randomized trial to reduce passive smoke exposure in low-income household with young children

Pediatrics

Tobacco and Substance Abuse
Secondhand Smoke Exposure Reduction After NICU Discharge: Results of a Randomized Trial