An Intervention to Reduce Second Hand Smoke Exposure among Pediatric Emergency Patients.

减少儿科急诊患者二手烟暴露的干预措施。

• 批准号: 9119048
• 负责人: E. Melinda Mahabee-Gittens
• 金额: $ 63.83万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-01 至 2020-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9119048
• 关键词: Abstinence; Accident and Emergency department; Accounting; Adult; Applied Research; Attention; Attenuated; Caregivers; Caring; Cessation Research; Child; Child health care; Childhood; Cigarette; Clinical; Clinical Practice Guideline; Complex; Cost Analysis; Cost of Illness; Cost-Benefit Analysis; Cotinine; Counseling; Emergency Care; Emergency Situation; Emergency department visit; Enrollment; Environment; Environmental Tobacco Smoke; Evolution; Exposure to; Funding; Future; Habits; Health; Health Care Costs; High Prevalence; Home environment; Hospitalization; Household; Instruction; Intervention; Manuals; Mediating; Mediator of activation protein; Modeling; Morbidity - disease rate; Motivation; Nodal; Outcome; Outpatients; Participant; Patient Self-Report; Patients; Population; Prevalence; Provider; Randomized; Randomized Controlled Trials; Readiness; Reporting; Research; Resources; Salivary; Site; Smoke; Smoker; Smoking; Smoking Cessation Intervention; Social support; Testing; Time; Tobacco; Tobacco Dependence; Tobacco use; Treatment outcome; Visit; Visual; Writing; base; caregiver interventions; control trial; cost; efficacy testing; environmental tobacco smoke exposure; healthy lifestyle; improved; inner city; innovation; intervention effect; mortality; motivational enhancement therapy; nicotine replacement; operation; packaging material; primary outcome; programs; public health intervention; public health research; quitline; randomized trial; risk perception; screening and brief intervention; secondary outcome; smoking cessation

 DESCRIPTION (provided by applicant): Caregiver smoking is an important cause of morbidity and mortality in both adult smokers and their children who are involuntarily exposed to secondhand smoke (SHSe). Our research has found that caregivers who visit the Pediatric Emergency Department (PED) with their children have a high prevalence of smoking (up to 48%), their children have high levels of SHSe equivalent to that of active smokers, and they regularly use the PED for nonurgent, SHSe-related complaints. These smokers are motivated to quit and eager to receive cessation counseling in this setting. Annually, more than 3 million PED visits involve treatment of children with SHSe- related illnesses. These visits provide a unique "teachable moment" to motivate caregiver quitting, given the relationship between quitting and improvements in their child's health. Because of the long, unavoidable wait times and the frequent use of the PED for non-urgent care, this is an ideal venue for intervening with this population. Moreover, we and others have demonstrated the feasibility of conducting complex randomized trials in PEDs without disrupting clinical flow. Building on our prior research, we propose to conduct the first randomized trial to test whether a cessation intervention in the PED setting can reduce caregiver smoking and decrease children's SHSe. This study will test the efficacy of a cessation intervention for caregivers in a large, inner-city PED that is a major noda site for the federally funded Pediatric Emergency Care Applied Research Network (PECARN). The proposed Screening, Brief Intervention, and Assisted Referral to Treatment (SBIRT) will highlight the effects of SHSe on their child's health. We will randomize 750 caregivers who smoke who present to our PED with their child who has a SHSe-related illness to either one of two conditions: 1) SBIRT; or 2) Healthy Habits Control (HHC). The SBIRT condition will use components shown to be effective in the out- patient setting but not yet tested in the PED setting. It will include a brief form of the Clinical Practice Guideline: Treating Tobacco Use and Dependence, motivational interviewing, engaging and personalized materials on the effects of smoking and SHSe, immediate access to caregivers' choice of cessation resources (e.g., Quitline, smokefree.gov, or txt2quit), a 12-week supply of nicotine replacement therapy and weekly booster materials for 12 weeks. The HHC program has been previously developed and used in the out-patient setting, and will be used as an attention control in which caregivers will receive instruction on healthy lifestyle choices to improve their child's health. Cessation assistance will be offered at the study's conclusion. If effective, the SBIRT model could be routinely used in the PED setting, which could reach at least one million smokers a year, and could result in significant reductions in caregivers' tobacco use, SHSe-related pediatric illness, and costs in this population. In addition, our results will inform the conduct of public health research efforts aimed at adults via the PED. If successful, we will create a comprehensive package of materials for disseminating the implementation of the intervention throughout PECARN and non-PECARN PEDs, and EDs nationwide.

 描述(由申请人提供)：照顾者吸烟是导致成年吸烟者及其子女不由自主地暴露在二手烟(SHSE)中发病和死亡的重要原因。我们的研究发现，带着孩子去儿科急诊科(PED)就诊的照顾者吸烟率很高(高达48%)，他们的孩子的SHSE水平相当于经常吸烟的人，他们经常使用PED来处理非紧急的SHSE相关投诉。这些吸烟者有戒烟的动机，并渴望在这种情况下接受戒烟咨询。每年有300多万次儿科就诊涉及治疗患有SHSE相关疾病的儿童。考虑到戒烟与改善孩子健康之间的关系，这些探访提供了一个独特的“可教的时刻”，以激励照顾者戒烟。由于等待时间长，不可避免，而且经常使用儿科病房进行非紧急护理，这是干预这一人群的理想场所。此外，我们和其他人已经证明了在PEDS中进行复杂的随机试验而不中断临床流程的可行性。在我们先前研究的基础上，我们建议进行第一个随机试验，以测试PED环境中的戒烟干预是否可以减少照顾者吸烟和降低儿童的SHSE。这项研究将在一个大型的内城PED测试对照顾者停止干预的效果，这是联邦资助的儿科急救应用研究网络(PECARN)的一个主要的野田站点。拟议的筛查、简短干预和辅助转诊治疗(SBIRT)将突出SHSE对儿童健康的影响。我们将把750名吸烟的照顾者随机分为两种情况之一：1)SBIRT；或2)健康习惯控制(HHC)。这些人带着患有SHSE相关疾病的孩子来到我们的PED。SBIRT条件将使用在门诊设置中被证明有效但在PED设置中尚未测试的组件。它将包括一份简短的临床实践指南：治疗烟草使用和依赖、激励性访谈、关于吸烟和SHSE影响的引人入胜和个性化的材料、立即获得照顾者选择的戒烟资源(例如，Quitline、Smokefre.gov或txt2戒烟)、12周的尼古丁替代疗法供应和12周的强化材料。HHC计划之前已经开发并在门诊环境中使用，将被用作注意力控制，在其中，照顾者将接受关于健康生活方式选择的指导，以改善他们孩子的健康。在研究结束时，将提供戒烟帮助。如果有效，SBIRT模式可以在PED环境中常规使用，每年至少有100万吸烟者，并可能显著减少照顾者的烟草使用、SHSE相关的儿科疾病和这一人群的成本。此外，我们的结果将为通过PED进行针对成年人的公共卫生研究工作提供信息。如果成功，我们将创建一套全面的材料，在全国范围内的PECARN和非PECARN PED以及ED传播实施干预措施的情况。