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道健康的重大威胁，并已明显与哮喘、支气管炎、喘息和中耳炎风险增加有关。在贫困水平或以下的家庭中，ETS的暴露程度更高，这一群体也被发现患哮喘和其他呼吸道感染的风险显著增加。研究报告称，在参加Head Start计划的低收入哮喘儿童中，有30%-70%的人报告说家里有吸烟者。由于学生经历的健康风险增加，Head Start计划的任务是帮助高危家庭改善学龄前儿童的健康。此外，2007年，环境保护局(EPA)和Head Start办公室宣布了一项新的倡议，旨在促进Head Start儿童无烟家庭的发展。出于这些原因，Head Start计划提供了一个及时和重要的场所，帮助高风险、低收入的学龄前儿童，并进行干预，减少这些儿童接触ETS的机会。因此，我们建议利用我们与巴尔的摩市Head Start项目建立的健康和研究合作伙伴关系，以测试在基于EPA的整体Head Start ETS减少教育计划的背景下提供的具有证明有效性的ETS减少干预的有效性。具体地说，我们将进行一项随机临床试验，将家庭递送的、基于动机访谈的ETS减少干预与HS级别的EPA/ETS教育计划相结合，以减少儿童的ETS暴露，与仅使用HS级别的EPA/ETS教育计划相比。我们将招收350名2-5岁的HS学生，他们的家中有照顾者报告的吸烟者，这些学生来自巴尔的摩市所有17个HS项目。主要的研究结果衡量标准将是家庭ETS水平，即6个月随访时家庭空气尼古丁水平的衡量标准。次要结果包括照顾者报告的在家和汽车吸烟禁令、儿童唾液可替宁水平、儿童呼吸道症状、照顾者戒烟、缺课和卫生保健利用措施。此外，在HS层面，我们将评估HS-Level EPA/ETS教育计划的实施程度、所有HS学生报告在家中吸烟的家庭比例的变化，以及HS工作人员与ETS暴露和减少相关的知识、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道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道健康的重大威胁，并已明显与哮喘、支气管炎、喘息和中耳炎风险增加有关。低收入和少数族裔儿童更有可能接触二手烟，并患上呼吸道疾病，如哮喘。目前的研究将测试一种行为干预措施，以减少在Head Start注册的低收入学龄前儿童中接触ETS，如果成功，该项目可能会对学校和社区改善儿童长期呼吸健康的战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.