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Motivational Incentives to Reduce Secondhand Smoke in NICU Infants' Homes

减少 NICU 婴儿家里二手烟的激励措施

基本信息

批准号：
9020440
负责人：
Angela L Stotts
金额：
$ 8.62万
依托单位：
UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-03-09 至 2016-02-29
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9020440
关键词：
Academic advising Admission activity Adverse effects Affect Air Asthma Behavior Therapy Behavioral Belief Biological Assay Caring Cessation of life Child Child health care Childhood Chronic Cigarette Clinic Clinic Visits Clinical Investigator Communities Cotinine Coughing Counseling Data Economically Deprived Population Emergency department visit Ensure Environmental Tobacco Smoke Exhibits Extremely Low Birth Weight Infant Family Fathers General Population Growth Health Healthcare Home environment Hospitalization Hospitals Hour Household Incentives Infant Infant Health Intervention Interview Investigation Life Logistic Regressions Low Birth Weight Infant Low income Lung Malignant Childhood Neoplasm Measures Mediating Mediator of activation protein Medical Minority Modeling Monitor Mothers Motivation Neonatal Intensive Care Units Neurocognitive Deficit Nicotine Outcome Parents Population Poverty Preparation Prevalence Preventive Quality of life Race Randomized Recruitment Activity Relative (related person)Reporting Research Research Infrastructure Resources Respiratory Tract Infections Risk Services Severities Smoke Smoker Smoking Smoking Behavior Specific qualifier value Subgroup Sudden infant death syndrome Testing Time TimeLine Tobacco Validation Very Low Birth Weight Infant Wheezing Writing base cost design ear infection effective intervention environmental tobacco smoke exposure experience health care service utilization health disparity high risk high risk behavior high risk infant high risk parents home smoking ban improved infant morbidity/mortality innovation intervention program meetings member middle ear disorder motivational enhancement therapy multidisciplinary post intervention programs pulmonary function respiratory smoking cessation smoking prevalence social success tobacco exposure young adult

项目摘要

DESCRIPTION (provided by applicant): Chronic secondhand smoke exposure (SHSe) in children compromises pulmonary function and contributes to respiratory illness, wheeze, cough, asthma, middle ear disease, and sudden infant death syndrome. Preterm, low birth weight infants admitted to a Neonatal Intensive Care Unit (NICU) are especially vulnerable to the effects of SHSe, with many exhibiting significant respiratory or chronic lung conditions prior to discharge. Because smoking remains concentrated in less educated and impoverished communities, NICU families with household smokers are at significant risk for tobacco-related health disparities--a substantial burden to families with limited resources and the communities in which they reside. The primary aim of this investigation is to evaluate the efficacy of a hospital initiated, behavioral intervention to reduce household SHSe, compared to conventional care practices, in low-income, multi-ethnic parents of NICU infants at particularly high social and medical risk for adverse effects of SHSe. A randomized, controlled, parallel group design will be used to test whether a SHSe program initiated in the hospital and completed in the home using motivational interviewing plus motivational incentives (MI+) is more effective than Conventional Care (CC) with NICU parents. The effects of MI+ versus CC on household smoking and infant smoke exposure are expected to be mediated via motivation to change and treatment participation. A total of 396 families with an infant at high respiratory risk in the NICU who report a household smoker will be randomized. The MI+ intervention will consist of 4 one-hour counseling sessions (2 in the hospital; 2 in the home post-discharge) and incentives for both session attendance and establishing a home smoking ban. CC will involve written materials that include information about the effects of smoking and cessation tips discussed in meetings with a Family Life Coordinator. Counseling and interviews will be conducted in Spanish and English. Primary efficacy variables will include objective and valid measures of SHSe (infant cotinine, household air nicotine monitors, Timeline Followback for SHSe). Outcomes will be assessed at 1 and 6 months post-intervention using generalized linear mixed models, poisson and logistic regression. This will be the first study of an innovative combination of motivational strategies targeting SHSe within the context of a NICU to improve the health of vulnerable infants and their families, potentially saving millions in healthcare dollars. This trial may also demonstrate a practical means of accessing young, minority and economically disadvantaged families for preventive services, who are unlikely to present to traditional clinics for such care. Highly experienced behavioral and clinical investigators, pilot data suggesting intervention feasibility and promise, a large and accessible population, and an extraordinary infrastructure ensure study success.

描述（由申请人提供）：儿童长期接触二手烟（SHSe）会损害肺功能，并导致呼吸道疾病、喘息、咳嗽、哮喘、中耳疾病和婴儿猝死综合症。入住新生儿重症监护病房 (NICU) 的早产儿、低出生体重儿特别容易受到 SHSe 的影响，许多人在出院前表现出严重的呼吸道或慢性肺部疾病。由于吸烟仍然集中在受教育程度较低和贫困的社区，因此有家庭吸烟者的新生儿重症监护室家庭面临着与烟草相关的健康差异的巨大风险，这对资源有限的家庭及其居住的社区来说是一个沉重的负担。本次调查的主要目的是评估医院发起的行为干预措施的效果，与传统护理实践相比，对于 NICU 婴儿的低收入、多民族父母来说，减少家庭 SHSe 的不良影响的社会和医疗风险特别高。将使用随机、对照、平行小组设计来测试在医院启动并在家中完成的 SHSe 计划（使用动机访谈加动机激励 (MI+)）是否比 NICU 父母的传统护理 (CC) 更有效。 MI+ 与 CC 对家庭吸烟和婴儿烟雾暴露的影响预计将通过改变动机和治疗参与来调节。共有 396 个在新生儿重症监护病房 (NICU) 有婴儿呼吸道高风险且报告家庭吸烟者的家庭将被随机分组。 MI+ 干预措施将包括 4 次一小时的咨询课程（2 次在医院；2 次在出院后在家中）以及对出席会议和制定家庭吸烟禁令的奖励。 CC 将涉及书面材料，其中包括有关吸烟影响的信息以及与家庭生活协调员会面时讨论的戒烟技巧。咨询和访谈将以西班牙语和英语进行。主要功效变量将包括 SHSe 的客观有效的测量（婴儿可替宁、家用空气尼古丁监测仪、SHSe 的时间线随访）。将使用广义线性混合模型、泊松和逻辑回归在干预后 1 个月和 6 个月评估结果。这将是第一项针对 NICU 背景下的 SHSe 激励策略的创新组合的研究，以改善弱势婴儿及其家人的健康，可能节省数百万美元的医疗费用。这项试验还可能展示一种为年轻、少数族裔和经济弱势家庭提供预防服务的实用方法，这些家庭不太可能到传统诊所接受此类护理。经验丰富的行为和临床研究人员、表明干预可行性和前景的试点数据、大量且可及的人群以及非凡的基础设施确保了研究的成功。