Community interventions for preventing smoking in young people.

Cochrane Database Syst Rev. 2011 Jul 6;(7):CD001291.

Carson KV, Brinn MP, Labiszewski NA, Esterman AJ, Chang AB, Smith BJ.

Source: Clinical Practice Unit, The Queen Elizabeth Hospital, 4A Main Building, 28 Woodville Road Woodville South, Adelaide, South Australia, Australia, 5011.

Abstract

BACKGROUND:

Cigarette smoking is one of the leading causes of preventable death in the world. Decisions to smoke are often made within a broad social context and therefore community interventions using coordinated, multi-component programmes may be effective in influencing the smoking behaviour of young people.

OBJECTIVES:

To determine the effectiveness of multi-component community based interventions in influencing smoking behaviour, which includes preventing the uptake of smoking in young people.

SEARCH STRATEGY:

The Tobacco Addiction group's specialised register, Medline and other health, psychology and public policy electronic databases were searched, the bibliographies of identified studies were checked and raw data was requested from study authors. Searches were updated in August 2010.

SELECTION CRITERIA:

Randomized and non randomized controlled trials that assessed the effectiveness of multi-component community interventions compared to no intervention or to single component or school-based programmes only. Reported outcomes had to include smoking behaviour in young people under the age of 25 years.

DATA COLLECTION AND ANALYSIS:

Information relating to the characteristics and the content of community interventions, participants, outcomes and methods of the study was extracted by one reviewer and checked by a second. Studies were combined in a meta-analysis where possible and reported in narrative synthesis in text and table.

MAIN RESULTS:

Twenty-five studies were included in the review and sixty-eight studies did not meet all of the inclusion criteria. All studies used a controlled trial design, with fifteen using random allocation of schools or communities. One study reported a reduction in short-term smoking prevalence (twelve months or less), while nine studies detected significant long-term effects. Two studies reported significantly lower smoking rates in the control population while the remaining thirteen studies showed no significant difference between groups. Improvements were seen in secondary outcomes for intentions to smoke in six out of eight studies, attitudes in five out of nine studies, perceptions in two out of six studies and knowledge in three out of six studies, while significant differences in favour of the control were seen in one of the nine studies assessing attitudes and one of six studies assessing perceptions.

AUTHORS' CONCLUSIONS:

There is some evidence to support the effectiveness of community interventions in reducing the uptake of smoking in young people, but the evidence is not strong and contains a number of methodological flaws.

Update of

    * Cochrane Database Syst Rev. 2003;(1):CD001291.

PMID: 21735383 [PubMed - in process]

Clinical Report−−Health Supervision for Children With Down Syndrome

Marilyn J. Bull and the COMMITTEE ON GENETICS
PEDIATRICS Volume 128, Number 2, August 2011
These guidelines are designed to assist the pediatrician in caring for
the child in whom a diagnosis of Down syndrome has been confirmed
by chromosome analysis. Although a pediatrician’s initial contact with
the child is usually during infancy, occasionally the pregnant woman
who has been given a prenatal diagnosis of Down syndrome will be
referred for review of the condition and the genetic counseling provided.
Therefore, this report offers guidance for this situation as well

Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum Reaffirmation Recommendation Statement

The U.S. Preventive Services Task Force (USPSTF) has reaffirmed its 2005 recommendation that all newborns should receive topical eye medication for the prevention of gonococcal ophthalmia neonatorum within 24 hours of birth. This is a Grade A recommendation. The USPSTF concluded that there was no evidence of harms associated with the treatment, and the evidence showed a clear benefit to offering the preventive measure to all newborns. The recommendation is available at http://www.uspreventiveservicestaskforce.org/uspstf10/gonoculproph/gonocuprs.htm.

Efficacy of a School-Based Childhood Obesity Intervention Program in a Rural Southern Community: TEAM Mississippi Project.

Greening L, Harrell KT, Low AK, et al. Obesity (Silver Spring). 2011 Jun;19(6):1213-9. Epub 2011 Jan 13
Abstract
A healthy lifestyle school-based obesity intervention was evaluated in a rural southern community where the rate of obesity ranks as the highest. School-age children (N = 450) ranging from 6 to 10 years of age (M(age) = 8.34) participated in monthly physical activity and nutritional events during a 9-month academic year. The children`s nutritional knowledge, number of different physical activities, fitness level, dietary habits, waist circumference, BMI percentile, and percentage body fat were measured pre- and postintervention. Changes on these measures were compared to students in a school employing the school system`s standard health curriculum. Regression analyses with residualized change scores revealed that the intervention school showed statistically significant improvement in percentage body fat, physical activity, performance on fitness tests, and dietary habits compared to the control school. There was no evidence of differences in outcomes based on gender or ethnicity/race. With rates of obesity and overweight reaching 50% in southern rural communities, intervening early in development may offer the best outcome because of the difficulties with changing lifestyle behaviors later in adulthood. A population-based approach is recommended over a targeted approach to cultivate a culture of healthy lifestyle behaviors when children are developing their health-care habits. Evidence suggests that both boys and girls, and African-American and white children can benefit equally from such interventions.