Barriers and incentives for Italian paediatricians to become smoking cessation promoters: a GARD-Italy Demonstration Project

Cilluffo, Giovanna; Ferrante, Giuliana; Cutrera, Renato; Piacentini, Giorgio; Bignamini, Elisabetta; Landi, Massimo; Martucci, Paola; Morcaldi, Luigi; Midulla, Fabio; Viegi, Giovanni; Grutta, Stefania La

doi:10.21037/jtd-gard-20-003

Cited by 4 publications

(10 citation statements)

References 19 publications

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“…Conversely, interventions for mothers in the “good knowledge” class may be focused on improving home management of acute attacks, which may not always require visiting the ED. Reducing barriers to smoking cessation should also be a relevant topic to be investigated by ad hoc trained pediatricians [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Fasola

Malizia

Ferrante

et al. 2022

IJERPH

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Mothers’ knowledge about childhood asthma influences management practices and disease control, but validating knowledge/practice questionnaires is difficult due to the lack of a gold standard. We hypothesized that Latent Class Analysis (LCA) could help identify underlying mother profiles with similar knowledge/practices. A total of 438 mothers of asthmatic children answered a knowledge/practice questionnaire. Using answers to the knowledge/practice questionnaire as manifest variables, LCA identified two classes: Class 1, “poor knowledge” (33%); Class 2, “good knowledge” (67%). Classification accuracy was 0.96. Mothers in Class 2 were more likely to be aware of asthma-worsening factors and indicators of attacks. Mothers in Class 1 were more likely to prevent exposure to tobacco smoke (91.1% vs. 78.8%, p = 0.005). For attacks, mothers in Class 2 were more likely to go to the emergency department and follow the asthma action plan. Mothers in Class 2 more frequently had a high education level (79.5% vs. 65.2%, p = 0.004). Children in Class 2 more frequently had fully controlled asthma (36.7% vs. 25.9%, p = 0.015) and hospitalizations for attacks in the previous 12 months (24.2% vs. 10.7%, p = 0.003). LCA can help discover underlying mother profiles and plan targeted educational interventions.

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Section: Discussionmentioning

confidence: 99%

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Fasola

Malizia

Ferrante

et al. 2022

IJERPH

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“…Our search yielded 9308 studies published between January 1, 1960, and October 5, 2021, with 1280 remaining after removal of duplicates and 552 assessed for eligibility (eFigure 1 in Supplement 1). Of 283 studies…”

Section: Resultsmentioning

confidence: 99%

“…The number of studies increased over time. For example, 4 studieswere published in 2000 and 21 in 2021, with a high of 31 in 2020 (eTable 2, eTable 3, eTable 4, eTable 5, and eFigure 2 in Supplement 1). Together, the included studies describe the views of 66 732 physicians who largely practiced general practice, internal medicine, or family medicine primarily in an office setting in the US.…”

Section: Resultsmentioning

confidence: 99%

Physician Reluctance to Intervene in Addiction

Campopiano von Klimo,

Nolan,

Corbin

et al. 2024

JAMA Netw Open

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ImportanceThe overdose epidemic continues in the US, with 107 941 overdose deaths in 2022 and countless lives affected by the addiction crisis. Although widespread efforts to train and support physicians to implement medications and other evidence-based substance use disorder interventions have been ongoing, adoption of these evidence-based practices (EBPs) by physicians remains low.ObjectiveTo describe physician-reported reasons for reluctance to address substance use and addiction in their clinical practices using screening, treatment, harm reduction, or recovery support interventions.Data SourcesA literature search of PubMed, Embase, Scopus, medRxiv, and SSRN Medical Research Network was conducted and returned articles published from January 1, 1960, through October 5, 2021.Study SelectionPublications that included physicians, discussed substance use interventions, and presented data on reasons for reluctance to intervene in addiction were included.Data Extraction and SynthesisTwo reviewers (L.N., M.C., L.F., J.P., C.S., and S.W.) independently reviewed each publication; a third reviewer resolved discordant votes (M.C. and W.C.). This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and the theoretical domains framework was used to systematically extract reluctance reasons.Main Outcomes and MeasuresThe primary outcome was reasons for physician reluctance to address substance use disorder. The association of reasons for reluctance with practice setting and drug type was also measured. Reasons and other variables were determined according to predefined criteria.ResultsA total of 183 of 9308 returned studies reporting data collected from 66 732 physicians were included. Most studies reported survey data. Alcohol, nicotine, and opioids were the most often studied substances; screening and treatment were the most often studied interventions. The most common reluctance reasons were lack of institutional support (173 of 213 articles [81.2%]), knowledge (174 of 242 articles [71.9%]), skill (170 of 230 articles [73.9%]), and cognitive capacity (136 of 185 articles [73.5%]). Reimbursement concerns were also noted. Bivariate analysis revealed associations between these reasons and physician specialty, intervention type, and drug.Conclusions and RelevanceIn this systematic review of reasons for physician reluctance to intervene in addiction, the most common reasons were lack of institutional support, knowledge, skill, and cognitive capacity. Targeting these reasons with education and training, policy development, and program implementation may improve adoption by physicians of EBPs for substance use and addiction care. Future studies of physician-reported reasons for reluctance to adopt EBPs may be improved through use of a theoretical framework and improved adherence to and reporting of survey development best practices; development of a validated survey instrument may further improve study results.

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“…Health policies must focus on smoking cessation especially during pregnancy, which is a vulnerable window of exposure [ 40 ]. In this context, ad-hoc training courses for promoting smoking cessation should be implemented among primary care physicians [ 41 ]. The present study identifies preventable risk factors for which there are available and effective evidence-based interventions.…”

Section: Discussionmentioning

confidence: 99%

Investigating the Relationship between Parental Education, Asthma and Rhinitis in Children Using Path Analysis

Rocco

Cilluffo

Ferrante

et al. 2022

IJERPH

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Parental socioeconomic position (SEP) is a known determinant of a child’s health. We aimed to investigate whether a low parental education, as proxy of SEP, has a direct effect on physician-diagnosed asthma, current asthma and current allergic rhinitis in children, or whether associations are mediated by exposure to other personal or environmental risk factors. This study was a secondary data analysis of two cross-sectional studies conducted in Italy in 2006. Data from 2687 adolescents (10–14 years) were analyzed by a path analysis model using generalized structural equation modelling. Significant direct effects were found between parental education and family characteristics (number of children (coefficient = 0.6229, p < 0.001) and crowding index (1.1263, p < 0.001)) as well as with exposure to passive smoke: during pregnancy (maternal: 0.4697, p < 0.001; paternal: 0.4854, p < 0.001), during the first two years of children’s life (0.5897, p < 0.001) and currently (0.6998, p < 0.001). An indirect effect of parental education was found on physician-diagnosed asthma in children mediated by maternal smoking during pregnancy (0.2350, p < 0.05) and on current allergic rhinitis mediated by early environmental tobacco smoke (0.2002; p < 0.05). These results suggest the importance of promotion of ad-hoc health policies for promoting smoking cessation, especially during pregnancy.

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Barriers and incentives for Italian paediatricians to become smoking cessation promoters: a GARD-Italy Demonstration Project

Cited by 4 publications

References 19 publications

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Asthma-Related Knowledge and Practices among Mothers of Asthmatic Children: A Latent Class Analysis

Physician Reluctance to Intervene in Addiction

Investigating the Relationship between Parental Education, Asthma and Rhinitis in Children Using Path Analysis

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