Contingency Management to Reduce Secondhand Smoke Exposure in Asthmatic Children

减少哮喘儿童二手烟暴露的应急管理

• 批准号: 9490347
• 负责人: Mandeep Jassal
• 金额: $ 18.46万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9490347
• 关键词: 17 year old; Address; Adherence; Adopted; Adoption; Air; Altruism; Applications Grants; Asthma; Attitude; Awareness; Baltimore; Behavior; Behavioral; Carbon Monoxide; Caregivers; Characteristics; Child; Childhood; Childhood Asthma; Cigarette; Cities; Cotinine; Counseling; Development; Diagnosis; Disease; Education; Effectiveness; Electronic Health Record; Environment; Environmental Tobacco Smoke; Exposure to; Focus Groups; Funding Mechanisms; Future; Goals; Health; Health Care Costs; Health Expenditures; Healthy People 2020; Home environment; Household; Incentives; Incidence; Income; Individual; Intervention; Knowledge; Literature; Low income; Measurement; Measures; Methods; Mission; Modality; Morbidity - disease rate; Motivation; National Institute of Environmental Health Sciences; Nicotine; Nursery Schools; Outcome; Participant; Pharmacologic Substance; Pilot Projects; Policies; Population; Preschool Child; Process; Psychology; Public Policy; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Research; Role; Salivary; Sampling; Services; Smoke; Smoke-free home; Smoker; Smoking; Smoking Behavior; Smoking Cessation Intervention; Symptoms; Taxes; Techniques; Technology; Testing; United States; Urban Population; Vision; aged; arm; asthmatic; base; behavioral economics; cigarette smoke; cigarette smoking; contingency management; control trial; cost effective; cost effectiveness; design; environmental tobacco smoke exposure; experimental group; financial incentive; health care service utilization; home smoking ban; improved; incentive strategies; inner city; insight; interest; low socioeconomic status; lower income families; member; patient population; payment; primary caregiver; public health relevance; recruit; smoking cessation; time interval; urban area

DESCRIPTION (provided by applicant): Traditional methods aimed at the reduction of secondhand smoke (SHS) exposure often employ modalities that are difficult to adopt and sustain. For those limited caretakers who may be able to abstain from smoking, there is adequate proof in the literature that smoke exposures continue to occur among children with asthma from other household members or visitors who are smoking in the home setting. What is not known are effective ways to reduce SHS exposure in low-income households of children with asthma? The primary objective of the project, which is aligned with the NIEHS mission of exploring the role of the environment in health outcomes, is to determine the effectiveness of financial incentives in reducing SHS exposure in the homes of preschool children with uncontrolled asthma. This grant application applies a contingency management schema, using concepts from behavioral economics and psychology, to modify the smoking behaviors of caregivers. This could occur directly by altering smoking behavior of the caretaker and/or indirectly through their ability to regulate cigarette smoking in the home by household members and visitors. The rationale for the proposed research is that individuals are more likely to alter their behavior if properly incentivized. Maternal caretakers, who ideally act in an altruistic manner toward their children, will be motivated by the incentives to reduce indoor SHS exposures generated by themselves or by others in the home setting. Modifying behaviors through modest financial incentives may also have the potential to be a highly cost-effective modality to address the rising healthcare costs among SHS-associated pediatric asthma cases. This goal will be achieved by pursuit of the following aims: 1) Qualitative assessment of barriers and the characteristics of incentive plans that could enhance the adoption of home smoking bans and 2) Quantitative determination of the effectiveness of financial incentives in reducing home SHS exposure and asthma-related health outcomes. Focus group discussions, consisting of caregivers of preschool asthmatic children, will be used in the first aim to identify the barries and possible means by which to overcome those obstacles in the enforcement of a home smoking ban - the findings of which will inform the design of future studies. A two-arm randomized-control trial will be employed in the second aim over a 6-month time interval. Both study groups will receive encouragement to implement a home smoking ban plus an offer of standard smoking cessation treatment for the primary caregiver. The experimental group will receive in addition the opportunity to earn 6 monthly financial incentives based on reduction in SHS exposures in the target asthmatic preschool child as verified by salivary cotinine levels. The knowledge derived from the pilot study will be used to gauge feasibility and further inform the design of future research using financial incentives for SHS reduction. Thus, the study opens a new avenue for use of contingency management in the service of environmental asthma research.

描述（由申请人提供）：旨在减少二手烟（SHS）暴露的传统方法通常采用难以采用和维持的模式。对于那些可能能够戒烟的有限看护者来说，文献中有足够的证据表明，患有哮喘的儿童中继续存在来自其他家庭成员或在家中吸烟的访客的烟雾暴露。尚不知道的是减少低收入家庭哮喘儿童接触二手烟的有效方法是什么？该项目的主要目标与 NIEHS 探索环境在健康结果中的作用的使命相一致，是确定经济激励措施在减少哮喘不受控制的学龄前儿童家中二手烟暴露方面的有效性。该拨款申请应用了应急管理方案，利用行为经济学和心理学的概念来改变护理人员的吸烟行为。这可以通过改变看护人的吸烟行为直接发生，和/或通过他们控制家庭成员和访客在家中吸烟的能力间接发生。这项研究的基本原理是，如果受到适当的激励，个人更有可能改变自己的行为。母亲看护者最好以无私的方式对待孩子，他们会受到减少自己或家庭环境中其他人产生的室内二手烟暴露的激励措施的激励。通过适度的经济激励来改变行为也可能成为一种极具成本效益的方式，以解决与二手烟相关的小儿哮喘病例不断上涨的医疗费用。这一目标将通过追求以下目标来实现：1) 对能够促进家庭吸烟禁令采用的障碍和激励计划的特征进行定性评估；2) 定量确定经济激励措施在减少家庭二手烟暴露方面的有效性，以及哮喘相关的健康结果。由学龄前哮喘儿童的照顾者组成的焦点小组讨论的首要目标是确定家庭吸烟禁令执行过程中的障碍和克服这些障碍的可能方法，其结果将为家庭吸烟禁令的设计提供信息。未来的研究。第二个目标将采用为期 6 个月的双臂随机对照试验。两个研究小组都将受到鼓励实施家庭吸烟禁令，并为主要护理人员提供标准戒烟治疗。根据唾液可替宁水平验证的目标哮喘学龄前儿童的二手烟暴露量减少情况，实验组还将有机会获得 6 个月的经济奖励。从试点研究中获得的知识将用于评估可行性，并进一步为未来利用财政激励措施减少二手烟的研究设计提供信息。因此，该研究为环境哮喘研究中应急管理的使用开辟了新途径。