563755
research-article2015
JPOXXX10.1177/1043454214563755Journal of Pediatric Oncology NursingPeck et al.
Original Manuscript
Reduction of Secondhand Smoke Exposure in the Cars of Children With Cancer
Journal of Pediatric Oncology Nursing 2015, Vol. 32(6) 401–409 © 2015 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454214563755 jpo.sagepub.com
Kelly R. Peck, MA1, Vida L. Tyc, PhD2, Qinlei Huang, MS3, and Hui Zhang, PhD3
Abstract This study examined whether an intervention designed to reduce secondhand smoke exposure (SHSe) among children being treated for cancer had effects in the specific setting of a motor vehicle. The parents or guardians (n = 71) of children being treated for cancer were randomized to either a behavioral secondhand smoke (SHS) reduction program or a standard care control group. Parental reports of SHSe were collected over the course of 12 months. Younger children were exposed at baseline more than their older counterparts. The greatest initial declines in car exposure were observed among children ≤5 years old in the intervention group compared with same-aged peers in the control group. After the 3-month time point, the control group showed greater reductions in car exposure in comparison with the intervention group. Interventions that teach parents strategies to manage their smoking while driving in their personal vehicles may produce even greater reductions in child exposure and should be developed. Based on the age-specific results reported here, future studies should account for effects of child age and use settingspecific measures of SHS. Keywords pediatric oncology, secondhand smoke, parents, motor vehicle, psychology
Introduction The immediate and long-term health risks associated with secondhand smoke (SHS) are well documented. A wide range of deleterious physical (DiFranza & Lew, 1996; Etzel, 1997; Goodwin & Cowles, 2008; Hawkins & Berkman, 2011; Moon, Horne, & Hauck, 2007), behavioral (Glover et al., 2011; Levy, Winickoff, & Rigotti, 2011), and cognitive outcomes are recognized to be associated with exposure to SHS (Clifford, Lang, & Chen, 2012; Hermann, King, & Weitzman, 2008). Despite these well-established dangers, 40% of children worldwide are still exposed to SHS annually (Oberg, Jaakkola, Woodward, Peruga, & Pruss-Ustun, 2011). Children being treated for cancer are particularly vulnerable to SHS-related health risks secondary to diseaseand treatment-related toxicities (Lipshultz et al., 2005; Tyc et al., 2004; Weiner, Maity, Carlson, & Ginsberg, 2006; Ylanen et al., 2013). Newly diagnosed children with cancer who reside in smoking households are more likely to present with a history of respiratory and pulmonary symptoms than those who are not exposed to smoke in their homes (Tyc et al., 2004). Common, persistent, and progressive respiratory abnormalities have been
observed among children who received whole lung irradiation for treatment of metastatic disease (Weiner et al., 2006). Moreover, long-term survivors of pediatric cancer who report a history of anthracycline (Ylanen et al., 2013) or doxorubicin therapy (Lipshultz et al., 2005) commonly report cardiac dysfunction, which is both persistent and progressive and may increase their susceptibility to tobacco-related health problems. Secondhand smoke exposure (SHSe) in motor vehicles is a particular concern due to the confined space within a vehicle (Offermann, Colfer, Radzinski, & Robertson, 2002). Toxins emitted in cigarette smoke accumulate in a vehicle and are then trapped and recirculated over the course of weeks or months, even after smoking has ceased (Matt et al., 2008; Singer, Hodgson, Guevarra, Hawley, & Nazaroff, 2002; Sleiman et al., 1
University of Mississippi, University, MS, USA University of South Florida, Tampa, FL, USA 3 St Jude Children’s Research Hospital, Memphis, TN, USA 2
Corresponding Author: Kelly R. Peck, Department of Psychology, University of Mississippi, 205 Peabody, University, MS 38677, USA. Email: [email protected]
Downloaded from jpo.sagepub.com at UNIV OF VIRGINIA on June 4, 2016
402
Journal of Pediatric Oncology Nursing 32(6)
2010). Children exposed to in-car SHS are at a greater risk for adverse respiratory health effects (Sly, Deverell, Kusel, & Holt, 2007) due to less-developed immune systems, smaller airways, and greater oxygen demands, which result in higher respiratory rates (Elliot, Vullermin, & Robinson, 1998; Rees & Connolly, 2006). Many states have implemented laws making it illegal to smoke in the car when a child is present. Despite legislative changes, only 29% of smoking parents report having a smoke-free car rule, and only 24% of these parents report strictly enforcing this policy (Nabi-Burza et al., 2012). It has been reported that between 40% and 46% of newly diagnosed children with cancer live in smoking households (Tyc et al., 2004); however, little is known about the in-car smoking behaviors of parents of children being treated for cancer. We used a longitudinal study to examine whether a behaviorally based intervention designed to reduce parent-reported SHSe among children being treated for cancer (Tyc et al., 2013) had significant effects in the specific setting of motor vehicles. Child and parent sociodemographic characteristics as well as clinical variables were examined as predictors of parent-reported vehicular SHSe.
Method Sample Participants were 71 smoking parents or guardians of nonsmoking children (
research-article2015
JPOXXX10.1177/1043454214563755Journal of Pediatric Oncology NursingPeck et al.
Original Manuscript
Reduction of Secondhand Smoke Exposure in the Cars of Children With Cancer
Journal of Pediatric Oncology Nursing 2015, Vol. 32(6) 401–409 © 2015 by Association of Pediatric Hematology/Oncology Nurses Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1043454214563755 jpo.sagepub.com
Kelly R. Peck, MA1, Vida L. Tyc, PhD2, Qinlei Huang, MS3, and Hui Zhang, PhD3
Abstract This study examined whether an intervention designed to reduce secondhand smoke exposure (SHSe) among children being treated for cancer had effects in the specific setting of a motor vehicle. The parents or guardians (n = 71) of children being treated for cancer were randomized to either a behavioral secondhand smoke (SHS) reduction program or a standard care control group. Parental reports of SHSe were collected over the course of 12 months. Younger children were exposed at baseline more than their older counterparts. The greatest initial declines in car exposure were observed among children ≤5 years old in the intervention group compared with same-aged peers in the control group. After the 3-month time point, the control group showed greater reductions in car exposure in comparison with the intervention group. Interventions that teach parents strategies to manage their smoking while driving in their personal vehicles may produce even greater reductions in child exposure and should be developed. Based on the age-specific results reported here, future studies should account for effects of child age and use settingspecific measures of SHS. Keywords pediatric oncology, secondhand smoke, parents, motor vehicle, psychology
Introduction The immediate and long-term health risks associated with secondhand smoke (SHS) are well documented. A wide range of deleterious physical (DiFranza & Lew, 1996; Etzel, 1997; Goodwin & Cowles, 2008; Hawkins & Berkman, 2011; Moon, Horne, & Hauck, 2007), behavioral (Glover et al., 2011; Levy, Winickoff, & Rigotti, 2011), and cognitive outcomes are recognized to be associated with exposure to SHS (Clifford, Lang, & Chen, 2012; Hermann, King, & Weitzman, 2008). Despite these well-established dangers, 40% of children worldwide are still exposed to SHS annually (Oberg, Jaakkola, Woodward, Peruga, & Pruss-Ustun, 2011). Children being treated for cancer are particularly vulnerable to SHS-related health risks secondary to diseaseand treatment-related toxicities (Lipshultz et al., 2005; Tyc et al., 2004; Weiner, Maity, Carlson, & Ginsberg, 2006; Ylanen et al., 2013). Newly diagnosed children with cancer who reside in smoking households are more likely to present with a history of respiratory and pulmonary symptoms than those who are not exposed to smoke in their homes (Tyc et al., 2004). Common, persistent, and progressive respiratory abnormalities have been
observed among children who received whole lung irradiation for treatment of metastatic disease (Weiner et al., 2006). Moreover, long-term survivors of pediatric cancer who report a history of anthracycline (Ylanen et al., 2013) or doxorubicin therapy (Lipshultz et al., 2005) commonly report cardiac dysfunction, which is both persistent and progressive and may increase their susceptibility to tobacco-related health problems. Secondhand smoke exposure (SHSe) in motor vehicles is a particular concern due to the confined space within a vehicle (Offermann, Colfer, Radzinski, & Robertson, 2002). Toxins emitted in cigarette smoke accumulate in a vehicle and are then trapped and recirculated over the course of weeks or months, even after smoking has ceased (Matt et al., 2008; Singer, Hodgson, Guevarra, Hawley, & Nazaroff, 2002; Sleiman et al., 1
University of Mississippi, University, MS, USA University of South Florida, Tampa, FL, USA 3 St Jude Children’s Research Hospital, Memphis, TN, USA 2
Corresponding Author: Kelly R. Peck, Department of Psychology, University of Mississippi, 205 Peabody, University, MS 38677, USA. Email: [email protected]
Downloaded from jpo.sagepub.com at UNIV OF VIRGINIA on June 4, 2016
402
Journal of Pediatric Oncology Nursing 32(6)
2010). Children exposed to in-car SHS are at a greater risk for adverse respiratory health effects (Sly, Deverell, Kusel, & Holt, 2007) due to less-developed immune systems, smaller airways, and greater oxygen demands, which result in higher respiratory rates (Elliot, Vullermin, & Robinson, 1998; Rees & Connolly, 2006). Many states have implemented laws making it illegal to smoke in the car when a child is present. Despite legislative changes, only 29% of smoking parents report having a smoke-free car rule, and only 24% of these parents report strictly enforcing this policy (Nabi-Burza et al., 2012). It has been reported that between 40% and 46% of newly diagnosed children with cancer live in smoking households (Tyc et al., 2004); however, little is known about the in-car smoking behaviors of parents of children being treated for cancer. We used a longitudinal study to examine whether a behaviorally based intervention designed to reduce parent-reported SHSe among children being treated for cancer (Tyc et al., 2013) had significant effects in the specific setting of motor vehicles. Child and parent sociodemographic characteristics as well as clinical variables were examined as predictors of parent-reported vehicular SHSe.
Method Sample Participants were 71 smoking parents or guardians of nonsmoking children (
