Motivational Interviewing for Parent-child Health Interventions: A Systematic Review and Meta-Analysis

Purpose: Motivational interviewing (MI) is a patient-centered approach focusing on building intrinsic motivation for change. This paper presents a meta-analysis of parent-involved MI to improve pediatric health behavior and health outcomes. Methods: Study inclusion criteria: (1) examined modifiable pediatric health behaviors (\u3c 18 years old); (2) used MI or motivational enhancement; (3) conducted a randomized controlled trial with a comparison group (non-MI control or active treatment group); (4) conducted the intervention with only a parent or both a parent and child; and (5) were written in English. Twenty-five studies (with 5,130 participants) were included and independently rated. Weighted mean effect sizes, using random-effects assumptions, were calculated. Results: Relative to comparison groups, MI was associated with significant improvements in health behaviors (e.g., oral health, diet, physical activity, reduced screen time, smoking cessation, reduced second hand smoke) and reduction in body mass index. Results suggest that MI may also outperform comparison groups in terms of dental caries, but more studies are needed. MI interventions were more successful at improving diets for Caucasians and when the intervention included more MI components. Conclusions: Our findings provide support for providing motivational interviewing to parents and children to improve pediatric health behaviors

Motivating Parents of Kids with Asthma to Quit Smoking: The Effect of the Teachable Moment and Increasing Intervention Intensity Using a Longitudinal Randomized Trial Design

Aims—We tested two aims: 1) The Teachable Moment (TM): whether second hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma vs. parents of healthy children (HC) and 2) whether greater intervention intensity (Enhanced-PAM) produces greater cessation than a previously tested intervention (Precaution Adoption Model; PAM). Design and interventions—Aim 1: Two home visits (asthma education or child wellness), and cessation induction using Motivational Interviewing and SHSe feedback. Aim 2: Post home-visits, parents with asthmatic children were randomized to PAM (n=171; 6 asthma education calls) or Enhanced-PAM (n=170; 6 asthma education/smoking cessation calls + repeat SHSe feedback). Setting—Rhode Island USA. Participants—Parents of asthmatic (n=341) or healthy (n=219) children who did not have to want to quit smoking to enroll. Measurements—were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day ppa, and SHSe (primary) and asthma morbidity (secondary). Findings—Aim 1: The TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day (OR=2.60, 95% CI = 1.22–5.54) and 7-day ppa (OR=2.26, 95% CI=1.13– 4.51) at 2 months (primary endpoint) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR=3.60; 95% CI= 1.72–7.55). Aim 2: Enhanced-PAM was more likely to achieve 30-day ppa at the primary endpoint, 4-months (OR=2.12, 95% CI 1.09–4.12) and improved asthma outcomes vs. PAM. Conclusions—Smoking cessation interventions (Motivational Interviewing + biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes

The Relationship Antecedents of Smoking (RAS) Scale: A new scale to assess couple-focused triggers to smoke.

The purpose of this pilot study is to assess the reliability and construct validity of a measure of relationship-focused antecedents for smoking (RAS). The scale includes both positively-valenced items (e.g.. “I feel like smoking when I am relaxing with my partner”) and negatively-valenced items (e.g., “I feel like smoking when my partner criticizes me”). Participants included 123 individuals who smoke cigarettes with co-habitating smoking (n=63) or non-smoking (n=60) romantic partners. Participants completed the RAS and a series of measures associated with smoking outcomes. Principal component analysis with varimax rotation resulted in a 2-component solution. The RAS showed excellent internal consistency for the total scale (α=.96) and for the positive (α=.88) and negative (α=.97) subscales. Higher positive subscale scores were associated with lower motivation to quit while higher negative scores were associated with lower relationship satisfaction and dyadic efficacy to quit. Higher scores on both subscales were related to higher social motives, dependence motives, and social outcome expectances. Participants with smoking partners reported higher positive subscale scores and lower negative subscale scores. The RAS may be helpful in the design of smoking cessation interventions for couples

History of Depression and Smoking Cessation Outcome: A Meta-Analysis

The authors conducted a meta-analysis of published studies to (a) evaluate the premise that a history of major depression is associated with failure to quit smoking and (b) identify factors that moderate the relationship between history of depression and cessation outcome. Fifteen studies met the selection requirements and were coded for various study methodology and treatment characteristics. DSTAT was used to calculate individual study effect sizes, determine the mean effect size across studies, and test for moderator effects. No differences in either short-term (≤ 3 months) or long-term abstinence rates (≥ 6 months) were observed between smokers positive versus negative for history of depression. Lifetime history of major depression does not appear to be an independent risk factor for cessation failure in smoking cessation treatment

Letter to the editor: Response to Covey

Dr. Covey asserts that our meta-analysis of the association between history of major depression and smoking treatment outcome (Hitsman, Borrelli, McChargue, Spring, & Niaura, 2003) was flawed because we did not limit our analysis to participants randomized to placebo or alternative least intensive treatment condition

The longitudinal, bidirectional relationships between parent reports of child secondhand smoke exposure and child smoking trajectories

This study examines the longitudinal relationships between child smoking and secondhand smoke exposure (SHSe). Participants were 222 parent–child dyads. The parents smoked, had a child with (48%) or without asthma, and were enrolled in a smoking/health intervention. Parent-reported child SHSe was measured at baseline and 4, 6, and 12-month follow-ups; self-reported child smoking was assessed at these points and at 2-months. A parallel process growth model was used. Baseline child SHSe and smoking were correlated (r = 0.30). Changes in child SHSe and child smoking moved in tandem as evidenced by a correlation between the linear slopes of child smoking and SHSe (r = 0.32), and a correlation between the linear slope of child smoking and the quadratic slope of child SHSe (r = − 0.44). Results may inform interventions with the potential to reduce child SHSe and smoking among children at increased risk due to their exposure to parental smoking.</p