TY - JOUR
T1 - Reducing underserved children's exposure to tobacco smoke
T2 - A randomized counseling trial with maternal smokers
AU - Collins, Bradley N.
AU - Nair, Uma S.
AU - Hovell, Melbourne F.
AU - Disantis, Katie I.
AU - Jaffe, Karen
AU - Tolley, Natalie M.
AU - Wileyto, E. Paul
AU - Audrain-McGovern, Janet
N1 - Funding Information:
This study was supported by grants from the National Cancer Institute at the NIH to B. Collins (CA105183 and CA93756). The authors thank the following staff and colleagues who contributed to the project: Linda Kilby, PhD, Jamie Dahm, MS, James Kingham, MS, Lauren Rider, MS, and Darryl Meuller, MD, MPH.
Publisher Copyright:
© 2015 American Journal of Preventive Medicine.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Introduction Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure. Design A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded. Setting/participants Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline. Intervention Philadelphia Family Rules for Establishing Smokefree Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smokefree home. Main outcome measures Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status. Results Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ2=10.56, p<0.01). There was no moderating effect of other smokers living at home. Conclusions FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population. Trial registration This study is registered at www.clinicaltrials.gov NCT02117947.
AB - Introduction Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure. Design A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded. Setting/participants Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline. Intervention Philadelphia Family Rules for Establishing Smokefree Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smokefree home. Main outcome measures Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status. Results Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ2=10.56, p<0.01). There was no moderating effect of other smokers living at home. Conclusions FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population. Trial registration This study is registered at www.clinicaltrials.gov NCT02117947.
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U2 - 10.1016/j.amepre.2015.03.008
DO - 10.1016/j.amepre.2015.03.008
M3 - Article
C2 - 26028355
AN - SCOPUS:84941803062
SN - 0749-3797
VL - 49
SP - 534
EP - 544
JO - American Journal of Preventive Medicine
JF - American Journal of Preventive Medicine
IS - 4
ER -