A+ Head Start Intervention for Smoke Free Homes

描述（由申请人提供）： 环境烟草烟雾（ETS）暴露已被确定为对儿童呼吸系统健康的重大威胁，并已明确与哮喘，支气管炎，喘息和中耳炎的风险增加有关。在处于或低于贫困水平的家庭中，ETS的暴露率较高，而且还发现同一人群患哮喘病以及其他呼吸道感染的风险显著增加。研究报告说，30-70%参加Head Start计划的低收入哮喘儿童报告家中有吸烟者。由于他们的学生经历的健康风险增加，开端计划有一个任务，以帮助高风险家庭改善他们的学龄前儿童的健康。此外，2007年，环境保护局和“开端”办公室宣布了一项新的倡议，以促进“开端”儿童的无烟家庭。由于这些原因，“先声夺人”计划为接触高风险、低收入的学龄前儿童和进行干预以减少这些儿童接触ETS提供了一个及时而重要的场所。因此，我们建议利用我们与巴尔的摩市的“先声夺人”项目建立的健康和研究合作伙伴关系，在基于EPA的“先声夺人”ETS减少教育项目的背景下，测试具有已证明疗效的ETS减少干预措施的有效性。具体来说，我们将进行一项随机临床试验，与单独的HS级EPA/ETS教育计划相比，结合HS级EPA/ETS教育计划的家庭交付，动机性访谈为基础的ETS减少干预措施，以减少儿童的ETS暴露。我们将从所有17个巴尔的摩市HS项目中招收350名2-5岁的HS学生，他们家中有一名吸烟者。主要研究结果指标将是家庭ETS水平，通过6个月随访时的家庭空气尼古丁水平进行测量。次要结果包括儿童报告的家庭和汽车禁烟令，儿童唾液可替宁水平，儿童呼吸道症状，护理人员戒烟，学校缺勤和医疗保健利用措施。此外，在HS水平，我们将评估HS水平EPA/ETS教育计划的实施程度，所有HS学生中报告在家吸烟的家庭比例的变化，以及HS员工对ETS暴露和减少的知识，态度和做法的变化。如果成功，这一示范和教育项目可能对学校和社区改善儿童长期呼吸系统健康的战略产生重大的公共卫生影响。环境烟草烟雾（ETS）暴露已被确定为对儿童呼吸系统健康的重大威胁，并已明确与哮喘，支气管炎，喘息和中耳炎的风险增加有关。低收入和少数民族儿童更有可能接触二手烟，并患上哮喘等呼吸道疾病。目前的研究将测试一种行为干预措施，以减少参加Head Start的低收入学龄前儿童的ETS暴露，如果成功，该项目可能对学校和社区改善儿童长期呼吸健康的策略产生重大的公共卫生影响。

DESCRIPTION (provided by applicant): Environmental tobacco smoke (ETS) exposure has been identified as a significant threat to children's respiratory health and has been clearly linked to increased risk of asthma, bronchitis, wheeze and otitis media. ETS exposure is higher in households at or below poverty level and this same population has also been found to be at significantly increased risk for asthma morbidity, as well as other respiratory infections. Studies have reported that between 30-70% of low-income children with asthma enrolled in Head Start programs report a smoker in the home. Because of the increased health risks experienced by their students, Head Start programs have a mandate to help high-risk families improve the health of their preschool children. Further, in 2007 the Environmental Protection Agency (EPA) and the Office of Head Start announced a new initiative to promote smoke-free homes for Head Start Children. For these reasons, Head Start programs offer a timely and important venue for reaching high-risk, low-income pre-school children and intervening to reduce these children's exposure to ETS. We therefore propose to draw on our established health and research partnership with Head Start programs in Baltimore City to test the effectiveness of an ETS reduction intervention with demonstrated efficacy, when delivered in the context of an overall EPA-based Head Start ETS reduction education program. Specifically, we will conduct a randomized clinical trial of a home-delivered, motivational interviewing-based ETS reduction intervention combined with a HS-level EPA/ETS education program in reducing children's ETS exposure, compared to a HS-level EPA/ETS education program alone. We will enroll 350 HS students aged 2-5 years with a caregiver-reported smoker in the home from all 17 Baltimore City HS programs. The primary study outcome measure will be household ETS levels, as measured by home air nicotine levels at six month follow-up. Secondary outcomes include caregiver-reported home and car smoking bans, child's salivary cotinine levels, children's respiratory symptoms, caregiver smoking cessation, school absences, and health care utilization measures. In addition, at the HS level we will evaluate the degree of implementation of the HS-level EPA/ETS education program, change in the proportion of families who report smoking in home for all HS students, and change in HS staff knowledge, attitudes and practices related to ETS exposure and reduction. If successful, this demonstration and education project could have significant public health implications for school and community-based strategies to improve children's long-term respiratory health. Environmental tobacco smoke (ETS) exposure has been identified as a significant threat to children's respiratory health and has been clearly linked to increased risk of asthma, bronchitis, wheeze and otitis media. Low-income and minority children are more likely to be exposed to second-hand smoke and to suffer respiratory illnesses, such as asthma. The current study will test a behavioral intervention to reduce ETS exposure among low-income preschool children enrolled in Head Start and if successful, this project could have significant public health implications for school and community-based strategies to improve children's long-term respiratory health.