Innovation for Smoke-Free Homes: Real-Time Feedback

描述(由申请人提供)：二手烟暴露(SHSE)是一个重大的健康风险，特别是对幼儿。超过50%的儿童SHS发生在家里，低收入家庭的儿童更有可能接触SHS。因此，需要以家庭为基础的干预措施来保护儿童免受SHSE的影响。这是第一项通过使用创新的SHS粒子监测器向家庭居民提供实时反馈加上简短的建议/赞扬是否可以降低儿童家庭SSE的有效性研究。这项研究将测试即时反馈和简短建议/赞扬对低收入家庭减少儿童接触尼古丁的能力的有效性，通过可替宁检测来衡量，减少在家中吸烟，并建立家庭禁烟令。学习理论和试点数据表明，来自监测的实时反馈加上简短的建议将促使和强化SHSE减少行为。来自加利福尼亚州圣地亚哥妇女、婴儿和儿童(WIC)项目的400个家庭将被招募。家庭将被随机分配到试验组，试验组从SHS颗粒监测仪获得持续的实时反馈，外加与反馈相关的简短建议/赞扬，以减少他们孩子的暴露，或者被分配到颗粒监测仪不提供反馈的普通护理控制组。在干预阶段，当检测到SHS时，试验组家庭的监控器会发出警示灯和嘟嘟声。主要的具体目标是：1)确定由于实时监测反馈和简短建议而通过儿童可替宁检测方法测量的SHSE水平的不同组变化；2)确定在建立家庭禁烟规定时不同组的变化；以及3)使用尼古丁剂量计和儿童尿可替宁分析来验证SHSE颗粒测量的差异变化。探索性的目的是：确定简短建议加反馈效果的理论调节因素(例如，儿童健康)；评估影响SHSE变化的理论中介因素(例如，建立家庭禁烟令和其他社会意外情况)；通过检查连续几个月的颗粒物监测记录，探索SHSE的动态性质，以确定家庭中的社会背景和微环境作为干预的准确目标(例如，吸烟地点、非吸烟者地点和吸烟时的社交互动)；评估按种族/民族以及按单亲和双亲家庭划分的烟草使用和烟草使用情况的不同变化，以增加对烟草控制方面的差异的了解；并征求家庭的建议，以加强今后对监测仪的使用。这也是对住宅控烟新技术的首次大规模测试，向调查人员提供的实时和遥测反馈将使光和声警报能够立即反馈给家庭，并向调查人员通报吸烟事件或吸烟事件的减少，这些事件值得建议或表扬。因此，这一应用为未来的创新研究开辟了新的方向，使用新技术在一系列微环境中推进SHSE的减少。

DESCRIPTION (provided by applicant): Secondhand smoke exposure (SHSe) is a significant health risk, especially to young children. More than 50 percent of children's SHSe occurs at home and children in low-income households are more likely to be exposed to SHS. Thus, home-based interventions are needed to protect children from SHSe. This is the first efficacy study to test whether children's home SHSe can be reduced by using innovative SHS particle monitors to provide real-time feedback to household residents plus brief advice/praise. This study will test the efficacy of immediate feedback and brief advice/praise on low-income families' ability to reduce children's exposure to nicotine, as measured by cotinine assays, reduce smoking in the home, and establish home smoking bans. Learning theory and pilot data suggest that real-time feedback from the monitor plus brief advice will prompt and reinforce SHSe reduction behaviors. Four hundred families from Women, Infants, and Children (WIC) programs in San Diego, California will be recruited. Households will be randomly assigned to an experimental group that receives continuous real-time feedback from a SHS particle monitor plus feedback-related brief advice/praise to reduce their child's exposure, or to a usual care control group where the particle monitor delivers no feedback. During the intervention phase, monitors in households of the experimental group will produce warning lights and beeps when SHS is detected. The primary specific aims are to: 1) Determine the differential group change in SHSe levels, as measured by child cotinine assays, due to real-time monitor feedback and brief advice; 2) Determine the differential group change in the establishment of home smoking bans; and 3) Validate differential change in particle measures of SHSe using nicotine dosimeters and child urine cotinine assays. The exploratory aims are to: determine theoretical moderators (e.g., child's health) of the effect of brief advice plus feedback; assess the effects of theoretical mediators (e.g., establishment of home smoking bans and other social contingencies) of change in SHSe; explore the dynamic nature of SHSe by examining the continuous particle monitor records over months to identify social contexts and micro- environments in the home as precise targets for intervention (e.g., smoking location, nonsmoker locations, and social interactions while smoking); assess the differential changes in tobacco use and SHSe by racial/ethnic group and by single v two-parent families to increase understanding of disparities for tobacco control; and obtain suggestions from families to enhance future use of the monitors. This is also the first large-scale test of a new technology in residential tobacco control, where real-time and telemetry feedback to investigators will both enable immediate feedback from light and sound alerts to families and inform investigators of smoking events or reduction in smoking events that warrant advice or praise. Thus, this application opens a new direction for future innovative studies using novel technology to advance reduction of SHSe in a range of micro-environments.