Kids Safe and Smokefree (KiSS): a randomized controlled trial of a multilevel intervention to reduce secondhand tobacco smoke exposure in children

BMC Public Health

Bradley N Collins¹  Melissa Godfrey³  Uma S Nair³  Adam Davey³  David Fleece¹  Daniel R Taylor²  Tyra C Bryant-Stephens⁴  Beth Moughan¹  Jonathan P Winickoff⁵  Stephen J Lepore³ 

[1] Department of Pediatrics, Temple University School of Medicine, Philadelphia, USA;Department of Pediatrics, St. Christopher’s Hospital for Children, Philadelphia, USA;Department of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA;Department of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, USA;Department of Pediatrics, Massachusetts General Hospital for Children, Boston, USA

关键词: Electronic health records;    Health services;    Smoking cessation;    Tobacco control;    Prevention;    Randomized controlled trial;    Pediatrics;    Secondhand smoke;   

Others  :  1161868
DOI  :  10.1186/1471-2458-13-792

 received in 2013-07-19, accepted in 2013-08-28,  发布年份 2013

【 摘 要 】

Background

Secondhand smoke exposure (SHSe) harms children’s health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers’ advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations.

Methods/design

This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status.

Discussion

This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to “ask, advise, and refer” guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.

Trial registration

NCT01745393 (clinicaltrials.gov).

【 授权许可】

   
2013 Lepore et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]USDHHS: Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Washington, DC: US Government Printing Office; 2006.
• [2]EPA: Respiratory health effects of passive smoking: lung cancer and other disorders. Washington, D.C: U.S. Environmental Protection Agency, Office of Research and Development, Office of Health and Environmental Assessment; 1992.
• [3]Metsios GS, Flouris AD, Angioi M, Koutedakis Y: Passive smoking and the development of cardiovascular disease in children: A systematic review. Cardiol Res Pract 2011., 2011http://dx.doi.org/10.4061/2011/587650 webcite
• [4]Twardella D, Bolte G, Fromme H, Wildner M, von Kries R: Exposure to secondhand tobacco smoke and child behaviour - results from a cross-sectional study among preschool children in Bavaria. Acta Paediatr 2010, 99(1):106-111.
• [5]American Academy of Pediatrics: Counseling parents about smoking cessation. Amerian Academy of Pediarics Resources for Clinicians. 2011. http://www.aap.org/richmondcenter/counselingParents.html webcite
• [6]Winickoff JP, Berkowitz AB, Brooks K, Tanski SE, Geller A, Thomson C, Lando HA, Curry S, Muramoto M, Prokhorov AV, et al.: State-of-the-art interventions for office-based parental tobacco control. Pediatrics 2005, 115(3):750-760.
• [7]Collins BN, Levin KP, Bryant-Stephens T: Pediatrician practices and attitudes about environmental tobacco smoke and parental smoking. J Pediatr 2007, 150(5):147-152.
• [8]Mueller D, Collins BN: Pediatric otolayngologists’ actions regarding secondhand smoke exposure: Pilot data suggest an opportunity to enhance tobacco intervention. Otolary HN Surg 2008, 139(3):348-352.
• [9]Kottke TE, Solberg LI, Brekke ML, Maxwell P: Smoking cessation strategies and evaluation. J Am Coll Cardiol 1988, 12(4):1105-1110.
• [10]Anderson NB: Levels of analysis in health science: A framework for integrating sociobehavioral and biomedical research. Ann N Y Acad Sci 1998, 840(1):563-576.
• [11]Collins BN, Nair US, Jaffe K, Hovell MF, Wileyto EP, Audrain-McGovern J: Behavioral counseling with maternal smokers in underserved communities is effective in reducing young children’s SHS exposure. Baltimore, MD: Society for Research in Nicotine and Tobacco; 2010.
• [12]Bandura A: Social Learning Theory. Englewood Cliffs, NJ: Prentice-Hall; 1990.
• [13]Hovell MF, Hughes SC: The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control. Nicotine Tob Res 2009, 11:1254-1264.
• [14]Carmichael SL, Ahluwalia IB: Correlates of postpartum smoking relapse. Results from the Pregnancy Risk Assessment Monitoring System (PRAMS). Am J Prev Med 2000, 19(3):193-196.
• [15]O’Connell K, Fears B, MR C, Gerkovich M, Zechmann A: Overcoming the urge to smoke: The strategies of long-term abstainers and late relapsers. Psychol Addict Behav 1991, 5:1-8.
• [16]Prochaska JJ, Hall SM, Humfleet G, Munoz RF, Reus V, Gorecki J, Hu D: Physical Acticvity as a stragtegy for maintining tobacco abstinence: a randomzed trial. Prev Med 2008, 47(2):215-220.
• [17]Cohen S, Lichtenstein E: Partner behaviors that support quitting smoking. J Consult Clin Psychol 1990, 58(3):304-309.
• [18]Brandon TH, Collins BN, Juliano LM, Lazev AB: Preventing relapse among former smokers: a comparison of minimal interventions through telephone and mail. J Consult Clin Psychol 2000, 68(1):103-113.
• [19]Fossum B, Arborelius E, Bremberg S: Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: an example of client-centered communication. Prev Med 2004, 38(3):295-310.
• [20]Collins BN, Lepore SJ: Association between anxiety and smoking in a sample of urban black men. J Immigr Minor Health 2009, 11(1):29-34.
• [21]Rose J, Behm FM, Drgon T, Johnson C, Uhl GR: Personalized smoking cessation: interactions between nicotine dose, dependence and quit success genotype score. Molecular Medicine 2010., 17[Epub ahead of print]
• [22]Collins BN, Ibrahim J, Hovell MH, Tolley NM, Nair US, Jaffe K, Zanis D, Audrain-McGovern J: Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income African Americans. Health Aff (Millwood) 2010, 2(11):1264-1271.
• [23]Schulz KF, Altman DG, Moher D: CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010, 8:18. BioMed Central Full Text
• [24]Winickoff JP, Nabi-Burza E, Chang Y, Finch S, Regan S, Wasserman R, Ossip D, Woo H, Klein J, Dempsey J, et al.: Implementation of a Parental Tobacco Control Intervention in Pediatric Practice. Pediatrics 2013, 132(1):109-117.
• [25]Winickoff JP, Park ER, Hipple BJ, Berkowitz A, Vieira C, Friebely J, Healey EA, Rigotti NA: Clinical effort against secondhand smoke exposure: development of framework and intervention. Pediatrics 2008, 122(2):e363-375.
• [26]Hovell MF, Wahlgren DR, Adams M: The logical and empirical basis for the behavioral ecological model. San Francisco, CA: Jossey-Bass; 2009.
• [27]Sesame Workshop: Food for thought: Eating well on a budget. 2010. http://www.sesamestreet.org/parents/topicsandactivities/toolkits/food webcite
• [28]Benowitz NL, Jacob IP, Ahijevch K, Jarvis MJ, Hall SM, LeHouezec J, Hansson A, Lichtenstein E, Henningfield J, et al.: Nicotine Tob Res. 2002, 4(2):149-159.
• [29]Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO: The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire. Br J Addict 1991, 86(9):1119-1127.
• [30]Andresen EM, Malmgren JA, Carter WB, Patrick DL: Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med 1994, 10(2):77-84.
• [31]Gilpin EA, White MM, Farkas AJ, Pierce JP: Home smoking restrictions: which smokers have them and how they are associated with smoking behavior. Nicotine Tob Res 1999, 1(2):153-162.
• [32]Roski J, Schmid LA, Lando HA: Long-term associations of helpful and harmful spousal behaviors with smoking cessation. Addict Behav 1996, 21(2):173-185.
• [33]O’Connell KA, Gerkovich MM, Cook MR, Shiffman S, Hickcox M, Kakolewski KE: Coping in real time: using Ecological Momentary Assessment techniques to assess coping with the urge to smoke. Res Nurs Health 1998, 21(6):487-497.
• [34]DiClemente CC: Self-efficacy and smoking cessation maintenance: A preliminary report. Cogn Ther Res 1981, 5(2):175-187.
• [35]Preacher KJ, Hayes AF: Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behav Res Methods 2008, 40(3):879-891.
• [36]Preacher KJ, Hayes AF: SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 2004, 36(4):717-731.
• [37]Cohen J: Statistical power analysis for the behavioral sciences. 2nd edition. Hillsdale, NJ: Lawrence Erlbaum Associates; 1988.
• [38]Collins BN, Wileyto EP, Hovell MF, Nair US, Jaffe K, Audrain-McGovern J: Proactive recruitment predicts retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers. Transl Behav Med 2011, 1(3):394-399.