Formal tobacco-control training and thirdhand smoke counseling practices among pediatric nurses in China: a cross-sectional study of cognitive and implementation factors.

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.