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）：看护者吸烟是成年吸烟者及其非自愿接触二手烟 (SHSe) 的孩子发病和死亡的一个重要原因。我们的研究发现，带着孩子去儿科急诊室 (PED) 的护理人员吸烟率很高（高达 48%），他们的孩子的 SHSe 水平与活跃吸烟者相当，并且他们经常使用 PED 来处理与 SHSe 相关的非紧急投诉。这些吸烟者有戒烟动机并渴望在这种环境下接受戒烟咨询。每年，超过 300 万的 PED 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，这些访问提供了一个独特的“教育时刻”来激励看护者戒烟。由于漫长且不可避免的等待时间以及频繁使用 PED 进行非紧急护理，因此这是对该人群进行干预的理想场所。此外，我们和其他人已经证明了在不中断临床流程的情况下在 PED 中进行复杂随机试验的可行性。基于我们之前的研究，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看护者吸烟并降低儿童的 SHSe。这项研究将测试大型市中心 PED 中护理人员戒烟干预的效果，该 PED 是联邦政府资助的儿科紧急护理应用研究网络 (PECARN) 的主要节点。拟议的筛查、简短干预和辅助转诊治疗 (SBIRT) 将强调 SHSe 对孩子健康的影响。我们将随机抽取 750 名吸烟的看护者，他们带着患有 SHSe 相关疾病的孩子向我们的 PED 报告，并接受以下两种情况之一：1) SBIRT；或 2) 健康习惯控制 (HHC)。 SBIRT 条件将使用在门诊环境中显示有效但尚未在 PED 环境中测试的成分。它将包括一份简短的临床实践指南：治疗烟草使用和依赖、动机性访谈、关于吸烟和 SHSe 影响的引人入胜的个性化材料、立即获取护理人员选择的戒烟资源（例如 Quitline、smokefree.gov 或 txt2quit）、为期 12 周的尼古丁替代疗法供应以及为期 12 周的每周加强材料。 HHC 计划之前已在门诊环境中开发和使用，并将用作注意力控制，护理人员将接受有关健康生活方式选择的指导，以改善孩子的健康。研究结束后将提供戒烟援助。如果有效，SBIRT 模型可以在 PED 环境中常规使用，每年可以覆盖至少 100 万吸烟者，并可能导致护理人员的烟草使用、SHSe 相关儿科疾病以及该人群的费用显着减少。此外，我们的结果将为通过 PED 开展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，用于在全国范围内的 PECARN 和非 PECARN PED 以及 ED 中传播干预措施的实施情况。