Purpose To test the efficacy of the Survivor Health and Resilience Education (SHARE) Program intervention—a manualized, behavioral intervention focusing on bone health behaviors among adolescent survivors of childhood cancer. Methods Participants were 75 teens age 11 – 21 years, 1 or more years post-treatment, currently cancer-free. Teens were randomized to a group-based intervention focusing on bone health, or a wait-list control. Bone health behaviors were assessed at baseline and 1-month post-intervention. Results Controlling for baseline outcome measures and theoretical predictors, milk consumption frequency (p = 0.03), past month calcium supplementation (p < 0.001), days in the past month with calcium supplementation (p < 0.001), and dietary calcium intake (p = 0.04) were significantly greater at 1-month follow-up among intervention participants compared with control participants. Conclusions The intervention had a significant short-term impact on self-reported bone health behaviors among adolescent survivors of childhood cancer. Research examining long-term intervention effectiveness is warranted.
Objective To assess current practice patterns and identify knowledge gaps among pediatric endocrinologists in the United States regarding screening and counseling for combustible tobacco and e‐cigarette use in youth with diabetes. Introduction Electronic cigarettes (e‐cigarettes) are the most used tobacco product among adolescents and may be associated with an increased risk of progression to combustible cigarette smoking, cardiovascular disease, and stroke. Diabetes mellitus is a known risk factor for cardiovascular disease, and nicotine products can increase this risk. We sought to assess current practice patterns and identify knowledge gaps among pediatric endocrinologists in the United States regarding screening and counseling for combustible tobacco and e‐cigarette use in youth with diabetes. Research Design and Methods We conducted an anonymous, online‐based survey of Pediatric Endocrine Society members who provide care to youth with Type 1 or Type 2 diabetes. The survey collected information about provider demographics and smoking habits, knowledge and attitudes regarding screening and counseling for combustible tobacco and e‐cigarette use, and current practice patterns. Results The survey was completed by 106 individuals of whom 64 reported providing care to youth with diabetes mellitus and ever asking about combustible tobacco or e‐cigarette use. The majority of respondents were female, attending providers, and working in academic medical centers. None reported a history of formal training in e‐cigarette counseling but recognized the harms of e‐cigarette use. Nearly all (98%) who ever screen for nicotine use reported routinely screening for combustible tobacco use, while 18% never screen for e‐cigarette use (p < 0.01). Over 80% of respondents reported feeling confident or very confident about discussing the harms of combustible tobacco, compared to 58% reporting the same confidence in discussing harms of e‐cigarette use (p < 0.0001). Over 90% of respondents agreed that pediatric endocrinology providers should ask about nicotine use with over half agreeing that counseling reduces the risk of initiating nicotine product use, and 30% reported lack of change with counseling as a barrier to discussing nicotine use. Lack of visit time was the most reported barrier to discussing nicotine use. More providers cited lack of knowledge regarding e‐cigarettes compared to combustible tobacco as a barrier to discussing its use. Conclusions Pediatric endocrinology providers recognize the harms of e‐cigarette use, but more frequently ask about combustible tobacco use compared to e‐cigarette use. This may be related to lower reported confidence and provider knowledge in counseling about e‐cigarette use. Increased utilization of existing resources and expanding opportunities for providers to learn more about e‐cigarettes may increase provider confidence and comfort in screening and counseling.
Objective: Tobacco exposure plays an important role in children’s health. Little is known about pediatrician’s experience with parental e-cigarette use. This pilot study aimed to assess pediatrician’s knowledge, attitude, and behaviors regarding parental e-cigarette use. Methods: This cross-sectional survey at an academic clinic assessed residents’ and attendings’ knowledge, attitudes, and behaviors regarding parental combustible and e-cigarette use and counseling and cessation barriers. Results: Sixty of 69 care providers completed the survey. Participants reported asking about parental use (5% vs 58%, Δ = 53% [95% CI Δ = 40%-67%]), advising about harms (5% vs 52%, Δ = 47% [95% CI Δ = 33%-61%]), and assisting with quitting (2% vs 28%, Δ = 27% [95% CI Δ = 15%-39%]) significantly less for e-cigarettes than for combustible cigarettes. The most common barrier to discussing use was lack of time. Lack of knowledge, unsure of harm, and lack of training were reported significantly more for e-cigarettes than for combustible cigarettes. Conclusion: Parental screening and counseling rates are significantly lower for e-cigarettes than for combustible cigarettes in this pilot study. Increased training could help pediatricians better protect children from tobacco exposure.
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