Parents' Self-efficacy for Tobacco Exposure Protection and Smoking Abstinence Mediate Treatment Effects on Child Cotinine at 12-Month Follow-up: Mediation Results from the Kids Safe and Smokefree Trial
Parents' Self-efficacy for Tobacco Exposure Protection and Smoking Abstinence Mediate Treatment Effects on Child Cotinine at 12-Month Follow-up: Mediation Results from the Kids Safe and Smokefree Trial
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DOI：
10.1093/ntr/ntz175
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发表时间：
2020-11-01
影响因子：
4.7
通讯作者：
Sosnowski, David W.
中科院分区：
文献类型：
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作者：
Collins, Bradley N.;Lepore, Stephen J.;Sosnowski, David W.
简介：与一般吸烟人群相比，低收入吸烟者在循证戒烟治疗取得成功方面面临更大的挑战。此外，他们的孩子承受着更大的疾病负担。了解与成功减少儿童烟草烟雾暴露（TSE）相关的行为机制可以为未来对弱势、服务不足的人群进行吸烟干预提供信息。方法：从低收入社区的儿科诊所招募吸烟父母，并随机接受多层次干预，包括最佳临床实践指南（“询问、建议、转介”[AAR]）框架下的儿科诊所干预以及个性化电话咨询（AAR + 咨询）或 AAR + 控制。中介分析包括治疗条件（自变量）、12 个月儿童可替宁（TSE 生物标志物、标准）和四个中介：保护儿童免受 TSE 影响的 3 个月治疗结束自我效能和吸烟冲动应对技巧，以及 12 个月感知计划（治疗中）支持和生物验证的戒烟。对基线尼古丁依赖、抑郁症状、儿童年龄和其他居住吸烟者的存在进行控制分析。结果：参与者 (n = 327) 包括 83% 的女性和 83% 的非裔美国人。多级 AAR + 咨询与所有四种中介的水平显着升高相关 (ps < .05)。基线尼古丁依赖 (p < .05)、3 个月自我效能 (p < .05) 和 12 个月生物验证戒烟率 (p < .001) 与 12 个月儿童可替宁结果显着相关。 AAR + 咨询干预通过儿童 TSE 保护和戒烟的自我效能对可替宁产生间接影响 (ps < .05)，表明通过这些途径进行调节。结论：与 AAR + 对照相比，多水平 AAR + 咨询改善了所有假定的调节因素。研究结果表明，在干预期间培养 TSE 保护自我效能并鼓励父母戒烟可能是促进戒烟难度较高的吸烟者群体中长期减少儿童 TSE 的关键。
Introduction: Compared with the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations.Methods: Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines ("Ask, Advise, Refer" [AAR]) plus individualized telephone counseling (AAR + counseling), or AAR + control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers.Results: Participants (n = 327) included 83% women and 83% African Americans. Multilevel AAR + counseling was associated with significantly higher levels of all four mediators (ps < .05). Baseline nicotine dependence (p < .05), 3-month self-efficacy (p < .05) and 12-month bioverified smoking abstinence (p < .001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR + counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (ps < .05) suggested mediation through these pathways.Conclusions: Compared with AAR + control, multilevel AAR + counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking.