Pediatrician Advice, Family Counseling, & SHS Reduction for Underserved Children

儿科医生建议、家庭咨询、

• 批准号: 8237312
• 负责人: BRADLEY N COLLINS
• 金额: $ 52.79万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-03-01 至 2017-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8237312
• 关键词: Abstinence; Academy; Accounting; Address; Adopted; American; Anxiety; Asthma; Attention; Attenuated; Behavioral; Biological Markers; Child; Child health care; Childhood; Cigarette; Clinic; Clinic Visits; Clinical; Cognitive; Communities; Complex; Coping Skills; Cotinine; Counseling; Dental; Disease; Dose; Effectiveness; Environmental Tobacco Smoke; Exposure to; Failure; Family; Future; Guidelines; Health; Health Benefit; Health Care Costs; High Prevalence; Home environment; Human Resources; Intervention; Link; Low income; Malignant Neoplasms; Measures; Mediating; Mediator of activation protein; Medical; Mental Depression; Minority; Modeling; Morbidity - disease rate; Motivation; Navigation System; Nicotine Dependence; Nicotine Withdrawal; Otitis; Outcome; Parents; Participant; Patient Care; Pediatrics; Pharmaceutical Preparations; Philadelphia; Population; Positioning Attribute; Prevalence; Professional counselor; Provider; Public Health; Randomized; Relative (related person); Reporting; Risk; Risk Factors; Science; Self Efficacy; Services; Smoke; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Social support; Source; Sudden infant death syndrome; Symptoms; System; Target Populations; Testing; Tobacco; Tobacco use; Training; Training Support; Treatment Efficacy; Underserved Population; United States National Institutes of Health; Urine; Ursidae Family; Work; addiction; base; behavior change; cardiovascular disorder risk; cost; effective intervention; evidence base; follow-up; high risk; improved; innovation; interest; intervention effect; medically underserved; mortality; multi-component intervention; multilevel analysis; nicotine replacement; novel; parental influence; pediatrician; public health priorities; skills; skills training; smoking cessation; social; success; theories; treatment effect

DESCRIPTION (provided by applicant): Child secondhand smoke exposure (SHSe) is a significant, complex public health problem that is linked to cancer and cardiovascular disease risk factors, and many other health consequences including asthma, otitis, SIDS, and dental carries. With many regions adopting public smoking bans, reducing home-level smoking (homes and cars) has become the last bastion of intervention to protect children from SHSe. In addition, reducing SHSe in low-income, medically-underserved communities has become a public health priority due to the increased SHSe morbidity burden these populations bear. Given evidence that single-level approaches (e.g., home smoking bans brief provider advice) are insufficient to tackle the many facets of this multi- determined problem, this proposal will test a comprehensive, multilevel intervention in communities with the highest SHSe morbidity risks. The proposed intervention model integrates strategies across clinic, family, and community levels of service. While specific components are evidence-based, the proposed model is novel and consistent with the NIH roadmap to advance the science of behavior change by testing multilevel interventions. We propose to provide a clinic-level quality improvement (CQI) intervention based on Clinical Effort Against Secondhand Smoke Exposure (CEASE) to address child SHSe in 4 pediatric clinics in low-income Philadelphia communities. We will then randomize 466 eligible smoking parents visiting these clinics into a home-level behavioral counseling intervention (CQI+BC) based on Family Rules for Establishing Smoke-free Homes (FRESH), or a home-level attention control intervention (CQI+A). CQI+BC merges behavioral counseling (e.g., intensive skills training, support) where SHSe occurs (home/car) with navigation of community-level services to facilitate access to and effective use of no-cost nicotine withdrawal medications. Participants will complete assessments at pre-treatment, 3-month end of treatment, and 12-month follow-up. The primary aim is to test the hypothesis that relative to CQI+A, CQI+BC will result in greater reductions in child cotinine (SHSe biomarker) and reported cigarettes exposed/day. A secondary aim is to test the hypothesis that relative to CQI+A, CQI+BC will result in a higher cotinine-verified, 7-day point prevalence quit rate among parents. We also will test the hypothesis that social support, coping skills, and self-efficacy mediate effects of CQI+BC on smoking outcomes and explore whether other smokers at home, level of nicotine dependence, and depression/anxiety symptoms attenuate treatment effects. The proposed approach is likely to be more effective than existing, single-level approaches because the integrated intervention levels reinforce one another, potentially producing synergistic effects on outcomes. In addition to improving patient care, this model has high potential for dissemination and public health impact by reducing tobacco-related health and cost burdens in target populations that would benefit most from this approach. Findings from mediator and moderator aims will inform theory and future directions in this field by identifying how and for whom the intervention works. PUBLIC HEALTH RELEVANCE: Children's secondhand smoke exposure (SHSe) is a significant, multi-determined public health problem that relates to numerous diseases consequences that are magnified among young children and the medically underserved. Because the failure to develop multilevel approaches to address this complex problem remains an obstacle to progress in this field, we propose an innovative multilevel model for addressing child SHSe by integrating a pediatric clinic-level intervention (improving services to smoking parents), a home-level behavioral counseling intervention (intensive skills training), and community-level systems navigation support (facilitating access and effective use of reimbursable cessation medication.) If shown to be efficacious, the proposed intervention represents a sustainable model for SHSe reduction among underserved populations in which existing community agencies have already expressed interest.

描述（由申请人提供）：儿童二手烟暴露（S​​HSE）是一个重大，复杂的公共卫生问题，与癌症和心血管疾病危险因素以及许多其他健康后果有关，包括哮喘，耳鼻喉炎，SID和牙科携带。随着许多采用公共吸烟禁令的地区，减少房屋水平的吸烟（房屋和汽车）已成为保护儿童免受SHSE的干预堡垒。此外，由于这些人群的发病率增加，减少低收入，医疗服务的社区中的SHSE已成为公共卫生的优先事项。鉴于有证据表明，单层方法（例如，家庭吸烟禁令简短的提供商建议）不足以解决此多个确定问题的许多方面，该提案将测试对具有最高SHSE发病率风险的社区的全面，多层干预。拟议的干预模型整合了跨诊所，家庭和社区服务水平的策略。尽管特定组件是基于证据的，但提出的模型是新颖的，并且与NIH路线图一致，以通过测试多层次干预措施来推动行为改变科学。 我们建议基于针对二手烟雾暴露（SCEAS）的临床努力提供临床水平质量改善（CQI）干预措施，以解决低收入费城社区的4个儿科诊所的儿童SHSE。然后，我们将根据建立无烟房屋（新鲜）或家庭水平的注意力控制干预措施（CQI+A），将466个合格的吸烟父母随机参观这些诊所参观这些诊所的行为咨询干预（CQI+BC）（CQI+BC）（CQI+BC）（CQI+BC）（CQI+BC） ）。 CQI+BC合并了行为咨询（例如，强化技能培训，支持），在此处出现SHSE（家庭/汽车），并通过社区级服务导航，以促进并有效使用无成本的尼古丁戒断药物。参与者将在治疗，3个月的治疗和12个月的随访中完成评估。主要目的是检验以下假设：相对于CQI+A，CQI+BC将导致儿童Cotinine（SHSE BioMarker）的降低，并报告暴露于/DAY的香烟。次要目的是检验以下假设：相对于CQI+A，CQI+BC，将导致较高的Cotinine验证的，7天的7天的患病率退出率。我们还将检验以下假设：社会支持，应对技能和自我效能感会介导CQI+BC对吸烟结果的影响，并探讨其他吸烟者在家中是否有烟，尼古丁依赖水平以及抑郁/焦虑症状减弱治疗的影响。所提出的方法可能比现有的单层方法更有效，因为综合干预水平相互加强，可能会对结果产生协同作用。除了改善患者护理外，该模型还通过降低与烟草相关的健康和目标人群的成本负担，从而从这种方法中受益最大，从而对传播和公共卫生的影响很高。调解员和主持人目标的发现将通过确定干预措施的工作方式和为谁作用，为该领域的理论和未来方向提供信息。 公共卫生相关性：儿童二手烟暴露（S​​HSE）是一个重大的，多重确定的公共卫生问题，与幼儿和医疗服务不足的众多疾病后果有关。由于未能开发多层次的方法解决这一复杂问题仍然是该领域进步的障碍，因此我们提出了一种创新的多层次模型，用于通过整合儿科诊所级别的干预措施来解决儿童SHSE（改善吸烟父母的服务），这是一个家庭 - 级别的行为咨询干预措施（强化技能培训）和社区水平的系统导航支持（促进访问和有效使用可偿还的戒烟药物。）如果证明是有效的，则建议的干预措施代表了降低不足人群的可持续模型现有的社区机构已经表达了兴趣。