Babies Living Safe & Smokefree: randomized controlled trial of a multilevel multimodal behavioral intervention to reduce low-income children's tobacco smoke exposure.
Babies Living Safe & Smokefree: randomized controlled trial of a multilevel multimodal behavioral intervention to reduce low-income children's tobacco smoke exposure.
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DOI：
10.1186/s12889-017-4145-7
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发表时间：
2017-03-14
影响因子：
4.5
通讯作者：
Lepore SJ
中科院分区：
文献类型：
--
作者：
Collins BN;Lepore SJ
解决儿童烟草烟雾暴露（TSE）问题仍然是公共卫生的优先事项。然而，治疗的采用率较低且无效，特别是在吸烟行为改变面临诸多挑战的低收入人群中。多层次干预结合了系统级健康信息和在社区诊所提供的有关 TSE 的建议，传播妇女、婴儿和儿童特殊补充营养计划 (WIC)，再加上尼古丁替代和强化多模式、个人层面的行为干预，可能会改善此类高危人群的 TSE 控制工作。该试验采用随机两组设计，具有三个测量点：基线、3 个月和 12 个月随访。主要结局是生物验证的儿童 TSE；次要结果是生物验证的母亲戒烟状况。 6 岁以下儿童的吸烟母亲是从 WIC 诊所招募的。所有参与者都会根据儿科诊所的“询问、建议、转介 (AAR)”最佳实践指南接受 WIC 系统级干预。它包括对所有 WIC 工作人员进行关于孕产妇烟草控制重要性的培训；并在日常工作流程中详细说明 AAR 干预提示的诊所，提醒 WIC 营养顾问向所有母亲询问儿童 TSE 的情况，就 TSE 的危害和保护的好处提供建议，并将吸烟者转介至戒烟服务。接受系统干预后，母亲被随机接受3个月的额外治疗或注意力控制干预：（1）多模式行为干预（MBI）治疗包括有关儿童TSE减少和戒烟的电话咨询、提供尼古丁替代疗法、支持戒烟努力的移动应用程序以及有关TSE和戒烟的多媒体短信； (2) 注意力控制干预提供与 MBI 同等的接触，包括以营养为重点的电话咨询、移动应用程序和有关改善营养的多媒体短信。控制条件还会转介至州戒烟热线。本研究测试了一种基于社区、多层次、综合多模式的创新方法，以减少弱势低收入人群中的儿童 TSE。该方法是可持续的，并且具有广泛影响的潜力，因为 WIC 可以将烟草干预提示整合到日常工作流程中，并向吸烟者推荐免费的基于证据的行为咨询干预措施，例如州戒烟热线。临床试验.gov NCT02602288。 2015 年 11 月 9 日注册。
Addressing children’s tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations. This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the “Ask, Advise, Refer (AAR)” best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline. This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. Clinicaltrials.gov NCT02602288. Registered 9 November 2015.