Parents Awareness Reducing Exposure to Nicotine and Tobacco (PARENT)

描述(由申请人提供)：父母的意识减少儿童接触尼古丁和烟草(父母)二手烟(SHS)是一个主要的公共卫生问题。多达43%或超过1500万的美国儿童与吸烟者生活在一起。在有成年烟民和儿童的家庭中，超过70%的家庭允许在家中吸烟。儿童保育中心(CCCS)是一个未得到充分利用的促进儿童健康的场所，对父母的吸烟行为有潜在的重大影响。近60%的学龄前儿童每天接受非父母照料。因此，接触到大量儿童和父母的潜力是巨大的。培训儿童保育人员(CCW)进行简短的烟草干预(BI)以戒烟/减少SHS，将使CCW准备更有效地影响父母的烟草使用行为。因此，我们建议开展一项发展可行性研究，以开发和试行一种系统干预措施，以减少在六个托儿中心接受SHS治疗的儿童的暴露，题为《父母意识减少尼古丁和烟草的暴露(父母)》。家长系统干预针对两个人群：1)儿童工作者和2)儿童及其父母/照顾者(P/C)。它旨在促进以家庭为中心的方法，通过a)对CCW进行简短的戒烟/SHS减少干预培训，b)实施常规SHS筛查以识别高危儿童，c)在中心的环境和家长参与活动中增加关于戒烟/SHS暴露减少的教育，从而为整个家庭创造无烟环境。拟议的项目分为四个阶段：第一阶段-形成性研究和干预开发。第二阶段--吸烟率研究，以评估儿童的SHS暴露；记录父母关于SHS和吸烟的知识、态度和行为(n~650)；并确定有资格参加试点干预研究的SHS暴露儿童。第三阶段--试点干预可行性研究。将6个CCC随机分为父母干预或对照干预(在职营养/体力活动)(每个研究条件下3个CCC，n=120对父母/孩子，20对/中心)。主要的结果指标是：1)儿童的SHS暴露，通过唾液可替宁测量；2)与吸烟和SHS暴露有关的自我报告的P/C行为的变化。次级措施包括1)《特定常规武器公约》烟草干预措施的P/C报告，2)从CCW收到的干预措施的P/C报告，以及3)在CCCS进行SHS暴露筛查和实施烟草教育的比率(制度变化措施)。这些措施背后的假设是，儿童保育中心的系统性变化将反映在干预地点儿童中较低的可替宁水平，并且这种变化将通过与吸烟和SHS暴露相关的父母/照顾者行为的积极变化来调节。第四阶段-重复患病率调查，分析数据，并根据先导干预研究的效果大小和可行性结果，细化父母干预、工具和研究设计特征，为全功率第三阶段随机对照疗效试验寻求资金。 烟草使用以及由此导致的死亡和疾病仍然是当今美国公共卫生面临的最大威胁。大多数烟草使用者都是烟民。香烟二手烟(SHS)对公众健康的威胁已经得到了很好的证明。儿童特别容易受到SHS的影响。由于SHS是公认的对公共健康的威胁，以人群为基础的改变吸烟行为和减少SHS的策略是非常相关的。

DESCRIPTION (provided by applicant): Parents' Awareness Reducing Exposure to Nicotine and Tobacco (PARENT) Second hand smoke (SHS) exposure in children is a major public health problem. As many as 43% or more than 15 million U.S. children live with a smoker. In more than 70% of homes with both adult smokers and children, smoking is allowed within the home. Childcare centers (CCCs) are an underutilized venue for child health promotion and have a potentially significant influence on parental smoking behavior. Nearly 60% of preschoolers receive non-parental care on a daily basis. Thus, the potential to reach a large number of children and parents is substantial. Training child care workers (CCWs) to conduct brief tobacco interventions (BI) for smoking cessation/SHS reduction, will prepare CCWs to more effectively influence parental tobacco use behavior. Thus we propose a developmental feasibility study to develop and pilot test a system intervention to reduce SHS exposure in children attending six childcare centers, entitled Parents Awareness Reducing Exposure to Nicotine and Tobacco (PARENT). The PARENT system intervention targets two populations: 1) CCWs and 2) children and their parents/caregivers (P/Cs). It is designed to promote family-centered approaches to creating smoke-free environments for the whole family through a combination of a) brief tobacco cessation/SHS reduction intervention training of CCWs, b) implementation of routine SHS screening to identify children at risk, c) adding education on tobacco cessation/SHS exposure reduction to the center's environment and parent involvement activities. The proposed project has four stages: Stage I - formative research and intervention development. Stage II- smoking prevalence study to estimate children's SHS exposure; document parental knowledge, attitudes, and behaviors with regards to SHS and smoking (n~650); and identify SHS- exposed children who are eligible for the pilot intervention study. Stage III - pilot intervention feasibility study. Six CCCs will be randomized to the PARENT intervention or a comparison intervention (nutrition/physical activity inservice) (3 CCCs in each study condition, n=120 parent/child pairs, 20 pairs/center). Primary outcome measures are: 1) children's' SHS exposure as measured by salivary cotinine and 2) changes in self-reported P/C behaviors related to smoking and SHS exposure. Secondary measures include 1) CCW reports of tobacco interventions with P/Cs, 2) P/C reports of interventions received from CCWs, and 3) rates of SHS exposure screening and implementation of tobacco education at CCCs (measures of system change). The hypotheses underlying these measures are that systemic changes in the childcare center will be reflected in lower cotinine levels among the children in the intervention sites, and that this shift will be mediated by positive changes in parent/caregiver behaviors related to smoking and SHS exposure. Stage IV - repeat the prevalence survey, analyze data, and based on effect sizes and feasibility results from the pilot intervention study, refine the PARENT intervention, instruments and study design features in preparation to seek funding for a fully-powered Phase III randomized controlled efficacy trial. Tobacco use and the resulting death and disease continue to be the single greatest threat to public health in the United States today. Most tobacco users are smokers. The threat to the public health from cigarette second hand smoke (SHS) has been well-documented. Children are especially vulnerable to SHS. Because SHS is an acknowledged threat to public health, population-based strategies to change smoking behavior and reduce SHS are highly relevant.