A cluster randomised trial of a telephone-based intervention for parents to increase fruit and vegetable consumption in their 3- to 5-year-old children: study protocol

Background: Inadequate fruit and vegetable consumption in childhood increases the risk of developing chronic disease. Despite this, a substantial proportion of children in developed nations, including Australia, do not consume sufficient quantities of fruits and vegetables. Parents are influential in the development of dietary habits of young children but often lack the necessary knowledge and skills to promote healthy eating in their children. The aim of this study is to assess the efficacy of a telephone-based intervention for parents to increase the fruit and vegetable consumption of their 3- to 5-year-old children. Methods/Design: The study, conducted in the Hunter region of New South Wales, Australia, employs a cluster randomised controlled trial design. Two hundred parents from 15 randomly selected preschools will be randomised to receive the intervention, which consists of print resources and four weekly 30-minute telephone support calls delivered by trained telephone interviewers. The calls will assist parents to increase the availability and accessibility of fruit and vegetables in the home, create supportive family eating routines and role-model fruit and vegetable consumption. A further two hundred parents will be randomly allocated to the control group and will receive printed nutrition information only. The primary outcome of the trial will be the change in the child's consumption of fruit and vegetables as measured by the fruit and vegetable subscale of the Children's Dietary Questionnaire. Pre-intervention and post-intervention parent surveys will be administered over the telephone. Baseline surveys will occur one to two weeks prior to intervention delivery, with follow-up data collection calls occurring two, six, 12 and 18 months following baseline data collection. Discussion: If effective, this telephone-based intervention may represent a promising public health strategy to increase fruit and vegetable consumption in childhood and reduce the risk of subsequent chronic disease. Trial registration: Australian Clinical Trials Registry ACTRN12609000820202

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Abstract Background Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation. Specific objectives The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention. Design Pre-post study design in four VA hospitals Participants Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day. Intervention The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units. Outcomes The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period. Trial number NCT00816036http://deepblue.lib.umich.edu/bitstream/2027.42/112349/1/13012_2009_Article_190.pd

Youth tobacco control research and activities in the United States: the current national landscape

This paper highlights the increasing level of collaboration, resource sharing, and consensus building in youth tobacco control taking place in the United States. Better knowledge of current research, activities, and collaborations in this area will help in the planning of activities and the rational allocation of funds for tobacco control programs, research, advocacy, and the counter-advertising activities. We defined three general classifications for organizations that had national youth tobacco control activities: Government centers and institutes, government organizations, and bridging organizations. We asked national experts in our own organization and all other included organizations to suggest additional groups for inclusion. After gathering available public information on each organization from Web sites and printed materials, we than solicited additional information by personal communication with individuals in leadership positions for youth tobacco control within each group. We developed a uniform framework to present a clear picture of each group in the areas of institutional conception, general goals, youth tobacco control research, and youth tobacco control activities. The tables provide a helpful reference guide presenting the institutional conception, goals, funding for research, activities, and Web sites for the institutions and organizations discussed here. Many groups have current youth tobacco control priorities in the United States. This synthesis of current research, funding sources, programmatic activities, and collaborations in the United States will be a valuable resource for clinicians, tobacco control advocates, researchers, and program planners

The state of office-based interventions for youth tobacco use

Tobacco use is a serious pediatric health issue as dependence begins during childhood or adolescence in the majority of tobacco users. Primary care settings provide tremendous opportunities for delivering tobacco treatment to young tobacco users. Although evidence-based practice guidelines for treating nicotine dependence in youths are not yet available, professional organizations and the current clinical practice guideline for adults provide recommendations based on expert opinion. This article reports on the current tobacco treatment practices of pediatric and family practice clinicians, discusses similarities and differences between adolescent and adult tobacco use, summarizes research efforts to date and current cutting-edge research that may ultimately help to inform and guide clinicians, and presents existing recommendations regarding treating tobacco use in youths. Finally, recommendations are made for the primary care clinician, professional organizations, and health care systems and policies. Pediatricians and other clinicians can and should play an important role in treating tobacco dependence in youths

The Natural History and Diagnosis of Nicotine Addiction

Addicted smokers experience nicotine withdrawal anytime they go too long without smoking. Withdrawal presents as a continuum of symptoms of escalating severity described by smokers as “wanting,” then “craving,” and eventually “needing” to smoke. These may be followed by irritability, impatience, moodiness, difficulty concentrating, restlessness, and sleep disturbances. This spectrum of intensifying withdrawal symptoms creates a compulsion to smoke that makes quitting difficult. The compulsion to smoke is the core feature of nicotine addiction accounting for its clinical course, physiological characteristics, prognosis, and behavioral manifestations. A compulsion can develop quickly, having been experienced by one third of youth who have smoked only 3 or 4 cigarettes. Its physiologic basis is evident in neurophysiological measures and its recurrence after each cigarette at a characteristic interval. At first, a single cigarette can keep withdrawal at bay for weeks, but as addiction progresses, cigarettes must be smoked at progressively shorter intervals to suppress withdrawal symptoms. The physiologic need to repeatedly self-administer nicotine at shorter intervals explains a full spectrum of addictive symptoms ranging from the prodromal symptom of wanting, to chain smoking. The early process of nicotine addiction is recognized if a person experiences regular wanting for a cigarette. When symptoms include craving or needing, the now addicted patient is experiencing a compulsion to smoke. This simple diagnostic approach covers the full spectrum of addiction in smokers of all ages and levels of tobacco use, and is more valid than a clinical diagnosis based on the current Diagnostic and Statistical Manual criteria