women of algiers in their room, by eugene delacroix, 1834. hookahs in art
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Women of Algiers in their Room, by Eugene Delacroix, 1834.
Hookahs in Art. http://www.discoverhookah.com/store/pages.php?pageid=9
Second & Third-Hand Smoke Exposure in Private Homes: Current & Future Clinical
Interventions & Ecological Contexts
The Johns Hopkins University3/28/11
The Behavioral Ecological Model
Based on Biology/Ecology– Selection of Species– Selection of Behavior– Principles of Learning Across All Animal Species– Emphasizes Environment Determinants
Based on Principles of Learning– Contingencies of Reinforcement—incentives or rewards– Hierarchical & interacting contingencies– Meta-and Macro-contjngencies– Motivating operations or Moderating Factors
The Problem with Behavior
• It is a stream• It’s a stream interacting with the environment • The entire environment is also a stream• Neither will hold still• It’s very hard to measure a stream• It’s almost impossible to measure multiple streams • Measuring Streams is prerequisite to Modifying behavior • Measuring Multiple behaviors from multiple people
residing in multiple social networks are the streams to be targeted by behavioral science
Social Networks Defined by Contingencies
Cascading & Interlocking Contingencies
Mom asks Dad to Smoke outside
A B C
Counselor prompts
C
A
B
B
Dad smokesoutside A
C
Avoids Criticism; protects child
Cascading & Interlocking Contingencies
Asks Visitors Not to smoke
A B C
Legislative Bans
C
A
B
B
Boss smokesoutside A
C
Thanks/avoids Criticism
BEHAVIORAL COUNSELING PROGRAM
•Parents contract to reduce their child’s ETS Exposure
•Short-term goals
•Self-monitoring
•Positive feedback
•Problem-solving brainstorming
•Recruitment of social contingencies
•4-14 sessions in the home and by phone
~ The Role of Clinicians ~
•Nonsmoker Models
•Deliver Tobacco Control Services
•Contract with parents and other family members
•Address ETS as Lead contamination
•Promote Policies for reimbursement of tobacco control services
•Promote Laws restricting ETS exposure community-wide
•Most providers do few of these
Cross Validity of Measures
Contamination: Exposure:
Child Urine Cotinine ------.65------- Indoor Air Nicotine | | | | | | __________ | | .63 _________\___ | .62 | / \ | | .71 .41 | | / \ | Reported Indoor ------.78--------- Reported Smoking in Smoking presence of the child
Results of Overall Trial*Results of Overall Trial*L
og
cig
aret
tes
pe
r w
ork
/wee
kday
0
0.5
1
1.5
2
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Month in Study
Usual TreatmentMonitoringCounseling
CounselingEnds
MaterialsDistributed
*Published in Chest, 1997;111:81-88
Results: Cotinine (geometric means)
Intervention Phase• Group by time (linear) interaction
significant (p<.05)
Follow-up Phase• Group by time interaction nonsignificant
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
2.0
Urine Cotinine(ng/ml)
0 1 2 3 4 5 6 7 8 9 10 11 12 13
Months
Coaching
Control
Intervention Phase Follow-up Phase
AsthmaEduc.
Base-line
Pre-test
Post-test F.U. F.U. F.U.
ETS Coaching
Healthy Tots: SHSe and Cessation Counseling
Project Sirocco: Counseling and Cotinine Feedback
for preteens
General schematic of Thirdhand smoke (THS) formation and reactions on indoor
surfaces
THS Exposure in Homes of Smokers and Nonsmokers
No Exposure: Nonsmoking Parents, no known exposure of child
Indirect: Smoking parents, no indoor smoking at home
Direct: Smoking parents, indoor smoking at home
Matt, G.E., et al. (2004). Households contaminated by environmental tobacco smoke: sources of infant exposures. Tobacco Control, 13, 29–37.Chudler, E.H. (2004). Nicotine, Secondhand Smoke and Infants. Smoking outside the home still exposes infants to nicotine. http://faculty.washington.edu/chudler/shs.html.
KBB Value in $
Adjusted Asking Price in $
Nonsmoker Car & Seller
Smoker Seller Smoker
CarSmoker
Car & Seller
2003 Av 8,629 9,273 8,903 8,788 8,437
% Loss vs. Referent Referent 4% 5.2% 9.0%
Cascading Contingencies can Change cultures
G. Matt et al
Cascading & Interacting Contingencies
Parents DecontaminatesHome
A B C
C
A
B
B
DecontaminatesHome A
C
Sells for > $
Dr Explains Cotinine
Real Time Telemetry and Feedback: SHS exposure
Figure 3
Legislative and other Policies: Macro-contingencies that may alter clinical
metacontingencies
Tobacco Module #1 Prescription
Dose Effect – Tobacco-Use Incidence and Anti-Tobacco Prescriptions
0-1 RX 2-3 RX 3-6 RX 7-8 RX 0
2
4
6
8
10
12
14
1614.3
12.7
10.810
% Smoking Incidence
% Smoking Incidence
* *
* Significant differences between group that received 0-1 prescription.
Proportion of participants who initiated tobacco use stratified by experimental group
and “friends who think smoking is cool”
Study Sites
DAILY SHS EXPOSURE
0
10
20
30
40
50
60
70
80
Home Workplace Car Otherplaces
Anywhere
San Diego Tijuana GDL
Social Criticism in Public Places
73.7
54.3
47.2
70.6
47.7
33.2
85.7
69.665.8
88.7
72.464.2
9387.8
93.4
0
10
20
30
40
50
60
70
80
90
100
Workplaces Restaurants Transportation Schools Health Ctrs.
San Diego Tijuana Guadalajara
Percentage of respondents who considered it VERY LIKELY TO BE CRITICIZED for smoking inside public places
Secondhand smoke avoidance by preteens:To leave or stay?
Tobacco Contingencies for Avoidance Behavior
Adjusted Odds Ratio
Home Smoking Ban
None or partial 1.00
Complete 1. 56
Family Discouraged SHSe
No 1.00
Yes 1.44
Friends Discouraged SHSe
No 1.00
Yes 1.73
Friends Decline Smoking
No 1.00
Yes 1.52
Conclusions: Anti-tobacco cultures are contagious
• Differences in social criticism of tobacco varying by proximity,
• Differences in Home bans differ by proximity to California
• Workplace bans moderate city effects on home bans
• Suggests that the exposure to the California anti-tobacco culture is changing the culture of Tijuana.
What do we think?
• Counseling can decrease SHSe • Context Enhances or weakens counseling• Measurement reactivity weakens g x t sign• SHSe & THSe requires changes in Social
Networks, including Providers• Real time Feedback may enhance SHSe and
THSe control• Cascading Contingencies Change Cultures
Waterpipe Use among the Youth
Soweid, RA. (2005). Lebanon: waterpipe line to youth. Tobacco Control, 14(6):363-4.
A young female is smoking the waterpipe in a public pool area in Lebanon.