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 (SHSe) 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（包括哮喘、中耳炎、婴儿猝死综合症和牙病）有关。随着许多地区实行公共场所禁烟令，减少家庭吸烟（家庭和汽车）已成为保护儿童免受二手烟侵害的最后堡垒。此外，由于低收入、医疗服务不足的社区的 SHSe 发病负担增加，减少这些人群的 SHSe 发病率已成为公共卫生优先事项。鉴于有证据表明单层方法（例如家庭吸烟禁令和提供者的简要建议）不足以解决这一多方面问题，本提案将在 SHSe 发病风险最高的社区测试全面、多层次的干预措施。所提出的干预模型整合了诊所、家庭和社区服务层面的策略。虽然具体组成部分是基于证据的，但所提出的模型是新颖的，并且与 NIH 路线图一致，通过测试多层次干预来推进行为改变科学。 我们建议在针对二手烟暴露的临床努力 (CEASE) 的基础上提供临床质量改进 (CQI) 干预措施，以解决费城低收入社区 4 个儿科诊所的儿童 SHSe 问题。然后，我们将根据建立无烟之家的家庭规则 (FRESH) 将 466 名符合资格的吸烟父母随机分配到这些诊所接受家庭级行为咨询干预 (CQI+BC) 或家庭级注意力控制干预 (CQI+A) ）。 CQI+BC 将 SHSe 发生地（家庭/汽车）的行为咨询（例如强化技能培训、支持）与社区级服务导航相结合，以促进免费尼古丁戒断药物的获取和有效使用。参与者将在治疗前、治疗结束后 3 个月和随访 12 个月时完成评估。主要目的是检验以下假设：相对于 CQI+A，CQI+BC 将导致儿童可替宁（SHSe 生物标志物）和报告的每天接触香烟数量的更大减少。第二个目的是检验以下假设：相对于 CQI+A，CQI+BC 将导致父母中经可替宁验证的 7 天点戒烟率更高。我们还将检验社会支持、应对技巧和自我效能介导 CQI+BC 对吸烟结果的影响的假设，并探讨家里的其他吸烟者、尼古丁依赖程度和抑郁/焦虑症状是否会减弱治疗效果。所提出的方法可能比现有的单级方法更有效，因为综合干预水平相互加强，可能对结果产生协同效应。除了改善患者护理之外，该模式还具有很大的传播潜力和公共卫生影响力，可以减少目标人群中与烟草相关的健康和成本负担，而目标人群将从这种方法中受益最多。调解员和调解员目标的调查结果将通过确定干预措施如何发挥作用以及为谁发挥作用，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 (SHSe) 是一个重大的、多因素决定的公共卫生问题，与多种疾病后果有关，这些后果在幼儿和医疗服务不足的人群中更为严重。由于未能开发出多层次方法来解决这一复杂问题仍然是该领域取得进展的障碍，因此我们提出了一种创新的多层次模型，通过整合儿科诊所级别的干预措施（改善对吸烟父母的服务）、家庭干预措施来解决儿童 SHSe 问题。水平的行为咨询干预（强化技能培训）和社区水平的系统导航支持（促进可报销戒烟药物的获取和有效使用。）如果被证明是有效的，则拟议的干预措施代表了减少SHSe的可持续模式现有社区机构已表示感兴趣的服务不足的人群。