Frontiers in public health · 2026
Formal tobacco-control training and thirdhand smoke counseling practices among pediatric nurses in China: a cross-sectional study of cognitive and implementation factors.
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Zhang Li, Tang Yingji, Yang Yang, Chen Mingyue
Аннотация
BACKGROUND: Thirdhand smoke (THS) exposure poses significant health risks to children, yet pediatric healthcare providers' capacity to deliver evidence-based counseling remains poorly characterized, particularly in high-burden settings. This study examined THS counseling practices among pediatric nurses in China, with particular emphasis on the relative contributions of formal tobacco-control training, cognitive factors, and implementation context.
METHODS: We conducted a cross-sectional survey of pediatric nurses at The Third Xiangya Hospital of Central South University, Changsha, China. Data were collected between February 2022 and October 2025 (response rate: 83.7%). Participants completed validated instruments assessing THS knowledge, attitudes, self-efficacy, counseling practices, implementation factors, and clinical performance using standardized vignettes. Sequential multivariable linear regression was used to identify independent predictors of counseling practices.
RESULTS: Among 633 pediatric nurses (mean age 32.1 ± 5.7 years; 91.6% female), 248 (39.2%) had received formal tobacco-control training in the preceding 24 months. Training was the strongest correlate of counseling practices (β = 2.23; 95% CI, 1.56-2.89; p < 0.001; ΔR2 = 0.068), while knowledge, attitudes, and self-efficacy added negligible explanatory power (ΔR2 = 0.004). Yet absolute practice rates remained suboptimal even among trained nurses: only 51.6% consistently explained THS concepts and 44.4% offered cessation referrals. Only 34.4% correctly rejected the misconception that absence of odor indicates no THS exposure. Vignette scores declined from 20.16 ± 1.56 for healthy infant scenarios to 18.43 ± 1.76 for disadvantaged families (p < 0.001), despite their higher household smoking burden. High facilitator availability (74-80%) did not predict practice scores, pointing to workflow integration deficits rather than resource shortfalls.
CONCLUSION: Training is associated with more frequent THS counseling, yet misconceptions persist and disadvantaged families receive lower-quality care. Prospective trials are needed to test whether skills-based training redesign and workflow-embedded decision supports can translate this association into equitable improvements in child health protection.
METHODS: We conducted a cross-sectional survey of pediatric nurses at The Third Xiangya Hospital of Central South University, Changsha, China. Data were collected between February 2022 and October 2025 (response rate: 83.7%). Participants completed validated instruments assessing THS knowledge, attitudes, self-efficacy, counseling practices, implementation factors, and clinical performance using standardized vignettes. Sequential multivariable linear regression was used to identify independent predictors of counseling practices.
RESULTS: Among 633 pediatric nurses (mean age 32.1 ± 5.7 years; 91.6% female), 248 (39.2%) had received formal tobacco-control training in the preceding 24 months. Training was the strongest correlate of counseling practices (β = 2.23; 95% CI, 1.56-2.89; p < 0.001; ΔR2 = 0.068), while knowledge, attitudes, and self-efficacy added negligible explanatory power (ΔR2 = 0.004). Yet absolute practice rates remained suboptimal even among trained nurses: only 51.6% consistently explained THS concepts and 44.4% offered cessation referrals. Only 34.4% correctly rejected the misconception that absence of odor indicates no THS exposure. Vignette scores declined from 20.16 ± 1.56 for healthy infant scenarios to 18.43 ± 1.76 for disadvantaged families (p < 0.001), despite their higher household smoking burden. High facilitator availability (74-80%) did not predict practice scores, pointing to workflow integration deficits rather than resource shortfalls.
CONCLUSION: Training is associated with more frequent THS counseling, yet misconceptions persist and disadvantaged families receive lower-quality care. Prospective trials are needed to test whether skills-based training redesign and workflow-embedded decision supports can translate this association into equitable improvements in child health protection.