Systematic Review of Mentoring to Prevent or Reduce Tobacco Use by Adolescents

BackgroundSurveys conducted 1998 to 2008 (530,849 13- to 15-year-olds, 100 countries) by the World Health Organization and the Centers for Disease Control and Prevention found increased tobacco use.ObjectivesTo conduct a systematic review of mentoring to prevent/reduce youth smoking.Data SourcesEight electronic peer-reviewed databases and gray literature searched through January 2013.Study Eligibility Criteria, Participants, and InterventionsStudies were included if they were randomized controlled trials, included children or adolescents, employed mentoring (consistent companionship, support, guidance to develop youth competence and character), and reported tobacco use.Study Appraisal/Synthesis MethodsTwo reviewers independently assessed abstracts and full-text studies. Disagreements were resolved through consensus.ResultsFour randomized controlled trials were identified. Two studies focused exclusively on tobacco outcomes; the other 2 reported on both drug and tobacco use reductions. Only 1 study reported that mentoring (by peers) reduced adolescent smoking. Heterogeneity of both participants and outcome measures did not permit meta-analysis.Conclusions and Implications of Key FindingsThere is limited literature on this topic. Further research achieving sample sizes required by power computations, minimizing attrition, and ascertaining mentoring content and achievements from mentor and mentee perspectives is needed.     

Adolescent smoking cessation

PURPOSE OF REVIEW: Approximately 25% of high school students report current cigarette use, 85% of adolescents think about quitting, and around 80% of current smokers made a quit attempt in the past year. This review analyzes recent additions to the adolescent smoking cessation literature from June 1, 2003 to May 1, 2003. RECENT FINDINGS: Adolescent attitudes toward smoking cessation are largely affected by their smoking history. Youth cessation interventions largely focus on behavioral interventions, and research concerning these interventions has yielded mixed results. Little data exist about the effectiveness of nicotine replacement therapy in adolescents, but there is growing evidence that youth use this pharmacotherapy. Recent research has explored the use of nicotine replacement therapy as an adjunct for enhanced smoking reduction in adults, and future research may focus on this tactic for youth as well. Internet cessation adjuncts and telephone quit lines also serve as future frontiers for adolescent smoking cessation research. SUMMARY: Information concerning adolescent smoking behaviors, effective interventions, and smoking cessation therapy continue to grow and provide data that improve our understanding of adolescent smoking cessation. Although we cannot directly extrapolate the adult findings to this population, adult cessation research continues to inform future adolescent cessation efforts.     

Smoking cessation in adolescents: the role of nicotine dependence, stress, and coping methods

OBJECTIVES: To compare perceived reasons for continued smoking and withdrawal symptoms between current smokers and quitters in an inner-city adolescent population. To examine the relationship of nicotine dependence, stress, and coping methods between smokers and quitters and, using the Transtheoretical Model of Change, among adjacent smoking cessation stages. DESIGN: A cross-sectional study using a self-administered questionnaire. PARTICIPANTS: The study comprised 354 clinic patients between the ages of 12 and 21 years who reported past or present smoking. MAIN OUTCOME MEASURES: Demographic characteristics, smoking status, perceived reasons for continued smoking, attempts to quit, and withdrawal symptoms, as well as standardized scales assessing nicotine dependence, stress, and coping methods. RESULTS: The overall prevalence of smoking in this population was 26%. Smokers were significantly more likely to report smoking more cigarettes per day as well as higher levels of physical addiction (P<.01), greater levels of perceived stress (P<.02), and less use of cognitive coping methods (P<.02) than quitters (P<.005). However, comparison of consecutive stages revealed a significant difference only between precontemplation and contemplation in cognitive coping methods (P<.01). Three of 20 withdrawal symptoms (cravings, difficulty dealing with stress, and anger) were reported more frequently among current smokers who had attempted to quit in the last 6 months than among former smokers (P<.01). CONCLUSION: Interventions for inner-city adolescents who smoke should be designed to target those with the highest levels of nicotine dependence, stress, and decreased use of cognitive coping methods because they are the least likely to quit on their own, rather than developing stage-specific models.     

Intervening With Smoking Parents of Inpatients to Reduce Exposure: The INSPIRE Randomized Controlled Trial

BackgroundHospitalized children have high rates of tobacco smoke exposure; parents who smoke may be receptive to interventions during their child's hospitalization.ObjectiveWe tested the efficacy of a smoking cessation intervention for parents of hospitalized children.MethodsWe 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.ResultsOf 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).ConclusionsA 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.     

Smoking rates and the state of smoking interventions for children and adolescents with chronic illness

Engaging in smoking is particularly risky for children and adolescents with chronic illness whose health status is already compromised because of disease- and treatment-related complications. Yet, some of these youngsters smoke at rates at least comparable to those of their healthy peers. To date, few randomized smoking-prevention and cessation trials have been conducted in children with chronic medical problems. In this review we report on the smoking rates among youngsters with chronic illness, identify specific disease- and treatment-related complications that can be exacerbated by smoking, examine risk factors associated with tobacco use among medically compromised youngsters, and review smoking interventions that have been conducted to date with pediatric populations in the health care setting. The following chronic illnesses are included in this review: asthma, cystic fibrosis, cancer, sickle cell disease, juvenile-onset diabetes, and juvenile rheumatoid arthritis. Objectives for a tobacco-control agenda and recommendations for future tobacco studies in chronically ill pediatric populations are provided. Finally, tobacco counseling strategies are suggested for clinicians who treat these youngsters in their practices.     

Rehabilitation after head injury

Children and adolescents commonly sustain injuries including traumatic brain injuries. Those with moderate-to-severe injuries are routinely referred to the rehabilitation services for further assessment and management during the course of the hospital admission. Many studies have reported on the role of rehabilitation in effecting the outcome of children and adults sustaining a TBI. The purpose of this paper is to review the present literature to establish the recommendations for the role of rehabilitation in supporting children and their families in recovering from traumatic brain injury.ConclusionsDespite a lack of randomized controlled trials in rehabilitation following traumatic brain injury in children the consensus of world opinion is that rehabilitation is a critical part of care. Rehabilitation should involve the whole family and should be actively continued in to the community setting.     

Parental Dual Use of e-Cigarettes and Traditional Cigarettes

BackgroundE-cigarettes are growing in popularity. Dual use of e-cigarettes and cigarettes is an increasingly common practice, but little is known about patterns of dual use in parents. We sought to describe smoking-related behaviors among dual-users.MethodsParent exit surveys were conducted following their child's visit in 5 control pediatric practices in 5 states participating in the Clinical Effort Against Secondhand Smoke Exposure trial. We examined factors associated with dual use of e-cigarettes and cigarettes versus cigarette-only smokers, assessed by self-report.ResultsOf 1382 smokers or recent quitters screened after their child's visit between April and October 2017, 943 (68%) completed the survey. Of these, 727 parents reported current use of cigarettes; of those, 81 (11.1%) also reported e-cigarette use, meeting the definition of dual use. Compared with cigarette-only smokers, dual users were more likely to have a child younger than 1 year old, planned to quit in the next 6 months, and had tried to quit in the past (had a quit attempt in the past 3 months, called the quitline, or used medicine to quit in the past 2 years; P < .05 for each).ConclusionsParents who use both e-cigarettes and cigarettes may have greater rates of contemplating smoking cessation than parents who only smoke cigarettes. These parents may be using e-cigarettes for harm reduction or as a step toward cessation. Identification of these parents may provide an opportunity to deliver effective treatment, including nicotine-replacement therapies that do not expose infants and children to e-cigarette aerosol.     

Delivery of smoking prevention and cessation services to adolescents

OBJECTIVES: To describe the delivery of smoking prevention and cessation screening and counseling practices to adolescents and to examine the effect of physician specialty, sex, practice characteristics, and familiarity with preventive care guidelines on the delivery of smoking cessation counseling services. METHODS: Cross-sectional self-reported survey of pediatricians and family physicians in 3 New York metropolitan statistical areas who had seen 1 or more adolescents for well care within the past 6 months. RESULTS: Of 564 eligible physicians, 371 (66%) responded. Physicians reported asking most adolescents about smoking (91%) but were less likely to ask about peer smoking use (41%) or smokeless tobacco use (32%). Similarly, they reported assessing motivation to quit for 81% of smokers, but less often helped set quit dates (34%) or scheduled follow-up visits (28%). Family physicians were more likely to provide more effective smoking cessation interactions than pediatricians (mean smoking counseling performance score, 61 vs. 53; P<.001). Family physicians were also more likely to be familiar with National Cancer Institute guidelines than pediatricians (48% vs. 27%; P<.001). Female physicians reported having spent more time with their last adolescent patient (mean, 26 vs 21 minutes; P<.001) and more often spent time alone with adolescent patients (85% vs. 76% of visits; P<.001) than did male physicians. In multivariate modeling, specialty, familiarity with National Cancer Institute guidelines, time spent, and confidentiality factors were associated with better smoking counseling performance. CONCLUSION: Familiarity with smoking cessation guidelines and physician's specialty and practice style with adolescents are associated with better delivery of tobacco cessation counseling to adolescents.     

Association between exposure to pesticides and allergic diseases in children and adolescents: a systematic review with meta-analysis

ObjectiveThe study aimed to conduct a systematic review of the literature to verify the association between exposure to pesticides and allergic diseases (asthma, allergic rhinitis, and atopic dermatitis) in children and adolescents.MethodA systematic review and meta-analysis were performed using the PRISMA method with the question “What is the association between exposure to pesticides and allergic diseases in children (asthma, allergic rhinitis, and atopic dermatitis)?” MEDLINE, EMBASE, SciELO, and Cochrane electronic databases were searched throughout the period in the literature up to September 2020. A total of 1296 studies were found, and 24 were selected.ResultsExposure to pesticides showed a two-fold greater risk of developing or exacerbating asthma in children and adolescents (odds ratio [OR] = 2.14 95% confidence interval [CI] 1.26-3.64, p < 0.01). There was no association between exposure to pesticides and the development of allergic rhinitis (OR = 2.73, 95% CI 0.13-57.8, p = 0.52) and atopic dermatitis (OR = 2.19, 95% CI 0.51-9.36, p = 0.29).ConclusionsExposure to pesticides increases the risk of developing or exacerbating asthma in children and adolescents. There was no evidence of an association between exposure to pesticides and the development of allergic rhinitis and atopic dermatitis in children and adolescents, possibly due to the low number of studies found in this review.     

Systematic Review of Mentoring to Prevent or Reduce Alcohol and Drug Use by Adolescents

BackgroundUse of alcohol and illicit drugs by adolescents is an important problem worldwide.ObjectiveTo undertake a systematic review of mentoring in preventing/reducing adolescents' alcohol and drug use.Data SourcesWe searched 8 multidisciplinary electronic databases, the gray literature, and reference lists of included studies.Study Eligibility Criteria, Participants, and InterventionsRandomized controlled trials (RCTs) of mentoring in adolescents to prevent/reduce alcohol or drug use.ResultsSix RCTs were included in this review. Four RCTs provided evidence on mentoring and alcohol use. The 2 that could be pooled showed less alcohol use by mentored youth. Six RCTs on mentoring and drug use were identified, 2 of which provided some evidence of the effect of mentoring in reducing drug use.LimitationsOnly 1 RCT was at low risk of bias for randomization. None of the studies stated they concealed allocation. Of the 6 included studies, 1 was at high risk and 5 at unclear risk for attrition.Conclusions and Implications of Key FindingsFour RCTs provided evidence on mentoring and alcohol use, and the 2 that could be pooled showed less use by mentored youth. The 6 RCTs that provided evidence on drug use could not be pooled. Two did provide some evidence that mentoring is associated with less drug use. Very few well-designed studies evaluate the effects of mentoring on adolescent drug and alcohol use.     

Do antipyretics prevent the recurrence of febrile seizures in children? A systematic review of randomized controlled trials and meta-analysis

ObjectivesTo determine the effectiveness of antipyretics use in prevention of subsequent febrile seizures in children.Data sourcesA search for all available electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, ACP Journal Club, Database of Abstracts of Reviews of Effects (DARE), Cochrane Central Register of Controlled Trials, Cochrane Methodology Register) from 1950 to July 2011 was done. No language restrictions were applied, but English abstract required.Study selectionWe included randomized controlled trials comparing the efficacy of antipyretic drugs to placebo in reducing the recurrence rate of febrile seizures in children (6–72 months) with previous febrile seizures. We excluded reviews, letters, and uncontrolled or non-randomized studies.Data extraction and synthesisThe literature search was performed by a professional medical librarian. Based of the preliminary search, two reviewers independently pooled studies for detailed manual review per the inclusion criteria. We used the Cochrane Review Manager software (Revman 5) to calculate the odds ratio and 95% confidence intervals (CI) for seizure recurrence, assuming a random-effects model.ResultsInitial search identified 479 citations, five articles underwent further rigorous evaluation by two reviewers and three papers met the inclusion criteria. In these three studies, 540 children were included, of whom 348 received antipyretics (acetaminophen (15 mg/kg), ibuprofen (5–10 mg/kg) or diclofenac (1.5 mg/kg)) and 192 received placebo for prevention of subsequent febrile seizures during a 1–2 year follow-up period. Seventy-nine patients (22.7%) in the antipyretics group and forty-seven patients (24.4%) in the placebo group had febrile seizure recurrence during follow up. No statistically significant difference was found between the antipyretics and the placebo groups in the recurrence rate of febrile seizures (OR 0.9, 95% CI: 0.57–1.43).ConclusionAntipyretics were ineffective in reducing the recurrence of febrile seizures.     

Maternal folic acid supplementation and infant birthweight in low‐ and middle‐income countries: A systematic review

The relationship between maternal folic acid supplementation in pregnancy and infant birthweight has not been well described in low‐ and middle‐income countries. We conducted a systematic review and meta‐analysis of the current evidence of the association between folic acid supplementation in pregnancy on three primary outcomes: the incidence of low birthweight, small for gestational age, and mean birthweight. Seventeen studies were identified, which satisfied the inclusion criteria, covering a total of 275,421 women from 13 cohort studies and four randomized controlled trials. For the primary outcome of mean birthweight (n = 9), the pooled mean difference between folic acid and control groups was 0.37 kg (95% confidence interval [CI]: 0.24 to 0.50), and this effect was larger in the randomized controlled trials (0.56, 95% CI: 0.15 to 0.97, n = 3). The pooled odds ratio was 0.59 for low birthweight (95% CI: 0.47 to 0.74, n = 10) among folic acid supplementation versus control. The pooled odds ratio for the association with small for gestational age was 0.63 (95% CI: 0.39 to 1.01, n = 5). Maternal folic acid supplementation in low‐ and middle‐income countries was associated with an increased mean birthweight of infants and decreases in the incidence of low birthweight and small for gestational age.     

The role of smoking-cessation-specific parenting in adolescent smoking-specific cognitions and readiness to quit

BACKGROUND: An instrument assessing smoking-cessation-specific parenting was developed and tested in relation to a) the pros of smoking and quitting and self-efficacy to resist smoking, and b) adolescent readiness to quit. METHODS: Cross-sectional survey data from 998 Dutch adolescents who smoked regularly were used to perform structural equation analyses. RESULTS: Adolescents who perceived relatively few advantages of smoking and many benefits of quitting reported a high readiness to quit. Self-efficacy was not related to readiness to quit. Smoking-cessation-specific parenting was both directly related to a high readiness to quit, and indirectly through the perceived pros of quitting. Also, if one or both parents were smokers, adolescents reported experiencing less smoking-cessation-specific parenting and a lower readiness to quit. However, in general, differences in paths were not found between adolescents with two parents who did not smoke and adolescents with one or two parents who smoked. CONCLUSIONS: Given that anti-smoking socialisation has not yet been operationalised in terms of smoking-cessation-specific parenting, the present results will warrant further research into smoking-cessation-specific parenting in relation to adolescent smoking cessation. Further, parental smoking should not discourage parents from engaging in smoking-cessation-specific parenting as its relations with smoking cognitions and readiness to quit were highly similar in both the group with two parents who did not smoke and the group with one or two parents who smoked.     

Relevance of intraglandular injections of Botulinum toxin for the treatment of sialorrhea in children with cerebral palsy: A review

BackgroundAfter the age of 4 years, drooling becomes pathological and impacts the quality of life of children with cerebral palsy. Intraglandular injection of Botulinum toxin is one of the treatments available to limit this phenomenon.AimsThe objectives of this review were to validate the efficacy of Botulinum toxin injections for drooling in children with cerebral palsy, determine recommendations and identify potential side effects.MethodsWe conducted a literature review from 2001 in the following databases: Embase, Pubmed and Cochrane using the keywords: sialorrhea, drooling, hypersalivation, Botulinum toxin, cerebral palsy and children. Only the articles evaluating the efficacy of Botulinum toxin in children with cerebral palsy over the age of 4 were researched.ResultsEight studies were found: 2 case studies, 3 open and non-controlled studies and 3 randomized controlled trials. Efficacy results in this indication are quite encouraging and the use of BTX injections is safe but the overall level of evidence of these studies was quite low.ConclusionHowever, intraglandular injection of Botulinum toxin has a place among the therapeutic array available for the management of sialorrhea in this population even if no standardized protocol is available yet.     

Effect of intervention programs in schools to reduce screen time: a meta‐analysis

Objectiveto evaluate the effects of intervention program strategies on the time spent on activities such as watching television, playing videogames, and using the computer among schoolchildren.Sourcesa search for randomized controlled trials available in the literature was performed in the following electronic databases: PubMed, Lilacs, Embase, Scopus, Web of Science, and Cochrane Library using the following Keywords randomized controlled trial, intervention studies, sedentary lifestyle, screen time, and school. A summary measure based on the standardized mean difference was used with a 95% confidence interval.Data synthesisa total of 1,552 studies were identified, of which 16 were included in the meta‐analysis. The interventions in the randomized controlled trials (n = 8,785) showed a significant effect in reducing screen time, with a standardized mean difference (random effect) of: −0.25 (−0.37, −0.13), p < 0.01.Conclusioninterventions have demonstrated the positive effects of the decrease of screen time among schoolchildren.     

Prospective associations of breastfeeding and smoking cessation among low‐income pregnant women

Although low‐income pregnant women have high rates of smoking and low rates of breastfeeding, few studies have examined prospective associations between these risk factors in community samples. Doing so may help improve breast‐feeding support programs in this population. We used a secondary analysis of 247 low‐income pregnant smokers in Memphis, Tennessee, who were interviewed up to 4 times (twice during pregnancy and twice through 6 months postpartum). Smoking cessation during prepartum and postpartum was defined as a self‐report of not smoking for ≥1 week and an expired carbon monoxide level of <10 ppm. Multivariable logistic regression analyses were used to determine whether intent to breastfeed was associated with smoking cessation and whether smoking cessation was associated with actual breastfeeding. Models were adjusted for sociodemographic, pregnancy‐related, and smoking‐related confounders. Thirty‐nine percent of participants intended to breastfeed, and 38% did so. Women who intended to breastfeed were 2 times more likely to quit smoking prepartum (adjusted OR = 1.99, 95% CI [1.06, 3.74]), but not postpartum (adjusted OR = 1.27, 95% CI [0.57, 2.84]). Quitting smoking at baseline and during pregnancy was associated with subsequent breastfeeding (adjusted OR 2.27, 95% CI [1.05, 4.94] and adjusted OR = 2.49, 95% CI [1.21, 5.11]). Low‐income women who intended to breastfeed were more likely to quit smoking during pregnancy and those who quit smoking at baseline and prepartum were more likely to breastfeed. Simultaneously supporting breastfeeding and smoking cessation may be very useful to change these important health behaviours among this high‐risk population.     

Mindfulness-Based Interventions Among Adolescents With Chronic Diseases in Clinical Settings: A Systematic Review

Introduction

We aimed to determine the benefits/efficacy of mindfulness-based interventions (MBIs) implemented among adolescents with chronic diseases in clinical settings.

Do paediatricians provide brief intervention for adolescents who smoke?

AIMS: This study aimed to describe the self-reported practice of paediatricians in brief interventions for adolescents who smoke. We also aimed to compare practice with confidence, skills and knowledge of brief intervention and nicotine replacement therapy after a targeted training programme. METHODS: Medical staff at The Children's Hospital at Westmead completed a questionnaire of clinical practice and confidence in brief intervention for smoking cessation. Data were analysed comparing self-reported practice with confidence, skill and knowledge of brief interventions, based on Fiore's 5A's approach (Ask about smoking at every opportunity, Assess willingness to quit, Advise patients to quit smoking, Assist quit attempts and Arrange follow up). RESULTS: Fifty-seven clinicians completed questionnaires, 55 (96%) recognised the importance of asking adolescents about smoking. Thirty-one (54%) identified adolescent smokers all or most of the time, increasing to 50 (88%) if their presenting condition was associated with smoking. Twenty-five (44%) clinicians assessed the stage of change, 33 (58%) advised the adolescent to quit smoking, nine (16%) assisted quit attempts and 10 (17.5%) arranged follow up. Clinicians more confident in brief intervention skills, motivational interviewing and relapse prevention were more likely to use the 5A's (P<0.05). Training increased clinician's confidence in brief intervention skills and knowledge of nicotine replacement therapy (P<0.01); however, there was no statistically significant change in clinical practice 1 month post training. CONCLUSION: Training paediatricians in brief intervention skills, motivational interviewing and relapse prevention can increase the use of 5A's brief intervention in clinical practice, potentially increasing quit attempts in adolescents who smoke.     

Psychopharmacology of autistic spectrum disorders in children and adolescents

This article provides an overview of the psychopharmacologic management of irritability, hyperactivity, and repetitive behaviors in children and adolescents with autism spectrum disorder. A review of the current literature on medications used to treat these conditions with emphasis on randomized controlled trials is presented.