Exploring a Cessation Intervention for Low Income Smokers in an Emergency Setting

探索紧急情况下低收入吸烟者的戒烟干预措施

• 批准号: 8224408
• 负责人: E. Melinda Mahabee-Gittens
• 金额: $ 19.43万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-22 至 2014-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8224408
• 关键词: Abstinence; Accident and Emergency department; Acute; Address; Adult; Affect; Cancer Control; Carbon Monoxide; Child; Child health care; Childhood; Clinical Practice Guideline; Counseling; Data; Development; Development Plans; Effectiveness; Electronic Health Record; Electronic Mail; Emergency Situation; Environmental Tobacco Smoke; Focus Groups; Future; Goals; Grant; Growth; Health; Hospital Administrators; Household; Intervention; Interview; K-Series Research Career Programs; Low income; Malignant Neoplasms; Methods; Modeling; Morbidity - disease rate; Motivation; Nurses; Outcome; Parents; Patient Self-Report; Phase; Physicians; Preparation; Prevalence; Randomized Controlled Trials; Recruitment Activity; Research; Research Personnel; Resources; Scientist; Smoke; Smoker; Smoking Cessation Intervention; Telephone; Testing; Text; Tobacco; Tobacco Dependence; Tobacco Use Cessation; Tobacco use; Training; Translating; Translations; Visit; Work; base; brief intervention; career; career development; effective intervention; efficacy testing; financial incentive; follow-up; health belief; health disparity; improved; innovation; interest; intervention effect; nicotine replacement; preference; prevent; primary outcome; prospective; quitline; randomized trial; screening and brief intervention; screening, brief intervention, referral, and treatment; secondary outcome; smoking cessation; success; tobacco screening; trend

DESCRIPTION (provided by applicant): An estimated 6.6 million parents who smoke visit pediatric emergency departments (PED) annually. Up to 50% of these parental smokers are from low-income, racially/ethnically diverse households in which a variety of tobacco-related disparities exist for both the parents and their children. The PED is an ideal and innovative setting in which to address these disparities, which include differences in tobacco use, pediatric second hand smoke exposure (SHSe), quit rates, access to cessation resources, and morbidity such as cancer. The proposed Career Development Award application will facilitate the candidate's growth as an independent cancer control physician scientist conducting research in the PED setting. The long-term career goal of the candidate is to become an effective independent researcher able to conduct parental cessation interventions in the PED that are readily translated into practice. The candidate's immediate career goal is to develop and test a cessation intervention for low-income smokers in the PED. To achieve this goal, the candidate proposes a career development plan that includes professional development, grant preparation, and a research plan to collect pilot data. The proposed research plan extends the candidate's prior smoking cessation work in the PED setting which indicates that parental smokers who visit the PED are aware of the pediatric effects of SHSe, motivated to quit, and eager to receive cessation counseling in this setting. The proposed research will be conducted in two phases. During Phase I, we will explore the types of interventions acceptable to low-income parental smokers via focus groups. Focused interviews of PED nurses, physicians, and hospital administrators will be conducted to explore barriers to intervention sustainability that will assist in future intervention planning. This data will be used to develop a PED-based parental cessation intervention. During Phase II, we will conduct a pilot prospective trial to examine the effectiveness of our screening, brief intervention, and referral to treatment (SBIRT) intervention on parental smoking cessation. Equal numbers of parental smokers who bring their child to the PED for either a SHSe-related illness or non SHSe-related illness will be given a brief intervention using an adapted form of the Clinical Practice Guideline: Treating Tobacco Use and Dependence. Intervention components may include brief cessation counseling using an "Advise, Assess, and Assist" approach; information on SHSe in children; direct connection to the Quitline (QL) in the PED; and/or free administration of nicotine replacement therapy (NRT). The Health Belief Model will be used to explore whether factors unique to this setting (e.g., child's acute illness) moderate the effect of the intervention on cessation outcomes. Outcomes will be assessed following the intervention via phone, email, or text messaging. If effective, this intervention could reduce health disparities related to tobacco use, by improving treatment and preventing tobacco-related morbidities in low-income, racially/ethnically diverse smokers. PUBLIC HEALTH RELEVANCE: The prevalence of tobacco use is disproportionately high among parental smokers who visit the pediatric emergency department (PED) with their children. Up to 50% of these parental smokers are from low-income, racially/ethnically diverse households in which a variety of tobacco-related disparities exist for the adult smokers and for their children who are adversely affected by second hand smoke exposure (SHSe). The proposed study seeks to develop and test a smoking cessation intervention for low-income smokers recruited from the PED. Cessation outcomes will be assessed on parents who have children with and without a SHSe-related complaint.

描述（由申请人提供）：估计每年有 660 万吸烟父母到儿科急诊室 (PED) 就诊。这些父母吸烟者中高达 50% 来自低收入、种族/民族多样化的家庭，在这些家庭中，父母及其子女都存在各种与烟草相关的差异。 PED 是解决这些差异的理想和创新环境，其中包括烟草使用、儿童二手烟暴露 (SHSe)、戒烟率、戒烟资源获取以及癌症等发病率方面的差异。拟议的职业发展奖申请将促进候选人成长为一名独立的癌症控制医师科学家，在 PED 环境中进行研究。候选人的长期职业目标是成为一名有效的独立研究人员，能够在 PED 中进行父母戒烟干预，并易于转化为实践。该候选人的近期职业目标是在 PED 中开发和测试针对低收入吸烟者的戒烟干预措施。为了实现这一目标，候选人提出了一个职业发展计划，其中包括专业发展、拨款准备和收集试点数据的研究计划。拟议的研究计划扩展了候选人之前在 PED 环境中的戒烟工作，这表明访问 PED 的父母吸烟者意识到 SHSe 对儿科的影响，有戒烟的动力，并渴望在这种环境中接受戒烟咨询。拟议的研究将分两个阶段进行。在第一阶段，我们将通过焦点小组探讨低收入父母吸烟者可接受的干预措施类型。将对 PED 护士、医生和医院管理人员进行重点访谈，以探讨干预可持续性的障碍，这将有助于未来的干预规划。该数据将用于开发基于 PED 的父母戒烟干预措施。在第二阶段，我们将进行一项试点前瞻性试验，以检查我们的筛查、简短干预和转介治疗 (SBIRT) 干预措施对父母戒烟的有效性。对于因 SHSe 相关疾病或非 SHSe 相关疾病而将孩子带到 PED 的同等数量的父母吸烟者，将使用《临床实践指南：治疗烟草使用和依赖》的改编版进行简短干预。干预措施可能包括使用“建议、评估和协助”方法进行简短的戒烟咨询；有关儿童 SHSe 的信息；直接连接到 PED 中的戒烟热线 (QL)；和/或免费给予尼古丁替代疗法（NRT）。健康信念模型将用于探讨这种情况下特有的因素（例如儿童的急性疾病）是否会调节干预措施对戒烟结果的影响。干预后将通过电话、电子邮件或短信评估结果。如果有效，这种干预措施可以通过改善低收入、种族/民族多样化吸烟者的治疗和预防与烟草相关的发病率来减少与烟草使用相关的健康差异。 公共卫生相关性：在带着孩子去儿科急诊室 (PED) 就诊的父母吸烟者中，烟草使用率异常高。这些父母吸烟者中高达 50% 来自低收入、种族/民族多样化的家庭，其中成年吸烟者及其受二手烟暴露 (SHSe) 不利影响的孩子存在各种与烟草相关的差异。拟议的研究旨在为 PED 招募的低收入吸烟者开发和测试戒烟干预措施。将对有或没有与 SHSe 相关投诉的孩子的父母进行戒烟结果评估。