Reducing Underserved Children鈥檚 Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers

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• 作者：Bradley N. Collins ; PhD^a ; ^{collinsb@temple.edu" class="auth_mail" title="E-mail the corresponding author} ; Uma S. Nair ; PhD^a ; Melbourne F. Hovell ; PhD ; MPH^d ; Katie I. DiSantis ; PhD^a ; Karen Jaffe ; MSW^a ; Natalie M. Tolley ; PhD^a ; E. Paul Wileyto ; PhD^b ; Janet Audrain-McGovern ; PhD^c
• 刊名：American Journal of Preventive Medicine
• 出版年：2015
• 出版时间：October 2015
• 年：2015
• 卷：49
• 期：4
• 页码：534-544
• 全文大小：560 K

文摘

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 (尾=–0.18, p=0.03) and reported tobacco smoke exposure (尾=–0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (尾=–1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, 蠂²=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.