Reducing Secondhand Smoke Exposure of Children Undergoing Surgery

Warner, David O.; Campbell, Erin; Hathaway, Julie; Shi, Yu; Flick, Randall P.; Harrison, Tracey E.; Hinds, Richard; Klesges, Robert C.; Vickers, Kristin S.

doi:10.5993/ajhb.38.6.14

Cited by 3 publications

(4 citation statements)

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“…Qualitative research has identified a preference among smoking parents whose children are undergoing surgery for a harm-reduction message over cessation. 16 However, we also know that parents who are able to make their home smoke free, they are subsequently more likely to go on to make a quit attempt. 17 Families who smoke are potentially reachable within the hospital setting.…”

Section: Open Accessmentioning

confidence: 99%

“… 18 There is an expectation among parents in paediatric hospital settings that the physicians will enquire about their smoking, and report that it is acceptable to do this. 16 19 Parents who access care for their child in paediatric emergency departments (EDs) are reported to be motivated to quit and receptive to smoking cessation advice. 20–23 However, less is known about whether parents, if they are not willing or able to quit smoking, are receptive to SHS harm reduction advice in this setting, although there is qualitative evidence to suggest that the health of the child is as a motivating factor among parents to change their smoking behaviours.…”

Section: Introductionmentioning

confidence: 99%

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Exploring stakeholder views on intervening in hospital around childhood secondhand smoke exposure (Precedent): a protocol for a qualitative study

et al. 2021

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IntroductionSecondhand smoke exposure (SHSe) in childhood is linked with increased morbidity and mortality. Hospital or secondary care contact may present a ‘teachable moment’ to provide parents with support to change their home smoking behaviours to reduce children’s SHSe. There is a lack of robust qualitative evidence around parents and healthcare professionals (HCPs) views on using this teachable moment to successfully initiate behavioural change. We aim to identify and understand what is important to stakeholders with a view to informing the development of a support package to help parents change their home smoking behaviours.Methods and analysisThis qualitative study will be theoretically underpinned by the Capability, Opportunity and Motivation Behaviour (COM-B) model of behavioural change. It will involve semistructured interviews and/or discussion groups with up to 20 parents who smoke and up to 25 HCPs. Stakeholders will be recruited from a single National Health Service children’s hospital in England. Interviews and/or discussion groups will be audio recorded, transcribed and anonymised. The transcripts and any field notes will be analysed using the framework method. Initially, we will apply COM-B to the data deductively and will then code inductively within each domain.Ethics and disseminationThe protocol for this study received a favourable outcome from the East Midlands Leicester Central Research Ethics Committee (19/EM/0171). Results will be written up as part of a PhD thesis, submitted for publication in peer-reviewed journals and presentation at conferences.Trial registration numberISRCTN40084089.

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Section: Open Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring stakeholder views on intervening in hospital around childhood secondhand smoke exposure (Precedent): a protocol for a qualitative study

et al. 2021

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“…The minimal time required for recovery of organ dysfunction after smoking cessation for wound healing is 3 to 4 weeks, 7 for bone healing is 4 weeks, 8 for immune competence is 2 to 6 weeks and for pulmonary function is 6 to 8 weeks. 9 For planned admissions, smoking cessation 8 weeks or more before admission is considered by National Health Service, UK as an optimum amount of time for the body to recover from the immediate effects of smoking. 10 The deleterious effects of smoking on the musculoskeletal system seem to be partially reversible and quitting smoking before operation mitigates the adverse effects of smoking on postoperative complications.…”

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confidence: 99%

“…In practice, smoking parents are more ready to accept environmental tobacco smoke exposure mitigation than smoke quitting. 20 Smoking is not allowed in hospital and throughout the perioperative period. The no smoking hospital environment creates an external force to support abstinence.…”

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confidence: 99%

Quit Smoking before Orthopaedic Surgery

2017

Journal of Orthopaedics, Trauma and Rehabilitation

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Cigarettes are smoked by over 1 billion people, which is nearly 20% of the world population. There is a gradual decline in smoking prevalence in areas of developed economy. For example, the smoking prevalence of Hong Kong people aged 15 or above dropped from 23.3% in 1982 to 10.5% in 2015. 1 Smoking is the single most important preventable risk factor for premature death and chronic diseases, including cancer and cardiovascular disease. Smokers die 13 years earlier than non-smokers. Smoking is responsible for 7,000 deaths and nearly 6 million deaths a year in Hong Kong and worldwide respectively. For various reasons, the prevalence of smoking is higher among patients than the general population. 30.7% of hospital patients were current smokers compared to the 21% of average population in UK. 2 The prevalence of smoking in patients with acute limb fractures was more than twice the general population in Australia. 3 The direct medical cost and indirect cost (loss of productivity from sick leaves and premature deaths) is up to 11.3 billion Hong Kong dollars a year. The direct medical cost of smoking accounts for 5.7% of global health expenditure and the indirect cost of smoking totaled to 1.8% of the world's annual gross domestic product (GDP). 4 Over 7,000 known toxins (70 of which are carcinogenic) are released and inhaled during smoking. These include nicotine, carbon monoxide and hydrogen cyanide etc. Carbon monoxide reduces oxygen carrying capacity of red blood cells and formation of carboxymyoglobin reduces oxygen storage in muscles. Hydrogen cyanide impedes cellular oxidative metabolism. Nicotine has multiple adverse effects including inhibition of osteoblast formation and function (impaired bone healing and non-union), impairment of wound and tendon healing (wound complications), impairment of immune response (wound infection), vasoconstriction, increased platelet adhesiveness (tissue hypoxia) and addiction. All these contribute to the increased risk of surgery in patients who smoke, whether current smoker or ever-smoker. Smoking exposes patients scheduled for surgery to risk increases of 20% in-hospital mortality and 40% in major complications including deep infection, pneumonia, unscheduled intubation, pulmonary embolism, ventilation >48 hours, stroke, coma >24 hours, cardiac arrest, myocardial infarction, transfusion >5 unit, sepsis, septic shock. 5 There is ample available evidence that current smoking increases complications in almost all type of surgery. Smoking is associated with surgical site infection and postoperative wound infection after spine surgery, total joint arthroplasty and fracture fixation; fracture non-union, non-union after spinal fusion, ankle fusion, osteotomy and internal fixation and bone grafting for scaphoid non-union; worse outcomes after spine surgery for lumbar disc prolapse, spinal stenosis and cervical myelopathy; periprosthetic joint infection and lower survivorship after total hip, knee arthroplasty, shoulder arthroplasty; worse outcomes after Contents lists available at S...

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A Mixed-Methods Systematic Review and Synthesis of Secondary Care Interventions to Reduce Secondhand Smoke Exposure Among Children and Young People

Ferris

Cummins

Chiswell

et al. 2020

Nicotine &Amp; Tobacco Research

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Introduction Childhood secondhand smoke exposure (SHSe) is linked with increased morbidity and mortality. Hospital or secondary care contact presents a ‘teachable moment’ to support parents to change their home smoking behaviours to reduce children’s SHSe. This mixed-methods review explores: (1) if existing interventions in this context are effective, (2) if they are reported in sufficient detail to be replicated, (3) the experiences of HCPs delivering such interventions, and (4) the experiences of parents receiving such interventions. Methods Five electronic databases and the grey literature were searched for relevant literature published and indexed January 1980 to February 2020. Fourteen papers reporting twelve studies (nine quantitative and five qualitative) were included. Aligned with the Joanna Briggs Institute method, a segregated approach was used involving independent syntheses of the quantitative and qualitative data followed by an overall mixed-methods synthesis. Results There was some evidence of effective interventions that resulted in a short-term (< 6 months) reduction in children’s SHSe when SHSe was subjectively measured. This was not seen in longer term follow-up (> 6 months) or when SHSe was measured objectively. Inconsistencies with reporting make replication challenging. Experiential evidence suggests a mismatch between stakeholder preferences and interventions being offered. Conclusions The paediatric secondary care interventions included in this analysis failed to show statistically significant evidence of longer-term effectiveness to reduce children’s SHSe in all but one low quality study. There was also inadequate reporting of interventions limiting assessment of effectiveness. It offer further insights into areas to target to develop effective interventions. Implications This review used rigorous methods to explore the current, global literature on how children’s exposure to SHS is being tackled in secondary care. This review identified only one low quality intervention study showing a statistically significant reduction in children’s SHSe beyond six months. Synthesis with qualitative research identifies a mismatch between what parents want in an intervention and what has been delivered to date. Reporting quality needs to be improved to ensure that interventions can be replicated and studies conducted within the NHS to ensure suitability to this setting.

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Reducing Secondhand Smoke Exposure of Children Undergoing Surgery

Abstract: Both parents and clinicians are receptive to clinician-delivered interventions to reduce the SHS exposure of children scheduled for elective surgery.

Cited by 3 publications

References 21 publications

Exploring stakeholder views on intervening in hospital around childhood secondhand smoke exposure (Precedent): a protocol for a qualitative study

Exploring stakeholder views on intervening in hospital around childhood secondhand smoke exposure (Precedent): a protocol for a qualitative study

Quit Smoking before Orthopaedic Surgery

A Mixed-Methods Systematic Review and Synthesis of Secondary Care Interventions to Reduce Secondhand Smoke Exposure Among Children and Young People

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