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: 9300991
• 负责人: E. Melinda Mahabee-Gittens
• 金额: $ 63.79万
• 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/9300991
• 关键词: Abstinence; Accident and Emergency department; Accounting; Adult; Applied Research; Attenuated; Caregivers; Cessation Research; Child; Child health care; Childhood; Cigarette; Clinical; Clinical Practice Guideline; Complex; Cost Analysis; 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; Intervention Trial; 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; attentional control; 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; primary outcome; programs; public health intervention; public health relevance; public health research; quitline; randomized trial; risk perception; screening and brief intervention; secondary outcome; smoking cessation; smoking prevalence

 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）：护理人员吸烟是成年吸烟者及其非自愿暴露于二手烟（SHSe）的儿童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室（PED）的照顾者吸烟率很高（高达48%），他们的孩子的SHSe水平与活跃吸烟者相当，他们经常使用PED治疗非紧急的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。每年有超过300万人次的PED就诊涉及治疗患有SHSe相关疾病的儿童。鉴于戒烟与改善儿童健康之间的关系，这些访问提供了一个独特的“可教时刻”，以激励照顾者戒烟。由于不可避免的漫长等待时间和频繁使用PED进行非紧急护理，这是对这一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对PED进行复杂随机试验的可行性。基于我们先前的研究，我们建议进行第一次随机试验，以测试在PED环境中的戒烟干预是否可以减少护理人员吸烟并减少儿童的SHSe。这项研究将测试一个大型的，内城的PED，是一个主要的noda网站的联邦资助的儿科急诊应用研究网络（PECARN）的护理人员的戒烟干预的疗效。拟议的筛查，简短干预和辅助转诊治疗（SBIRT）将突出SHSe对孩子健康的影响。我们将随机选择750名吸烟的看护者，他们与患有SHSe相关疾病的孩子一起来到我们的PED：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环境中测试的组件。它将包括一个简短的形式的临床实践指南：治疗烟草使用和依赖，动机访谈，从事和个性化的材料对吸烟和SHSe的影响，立即获得护理人员选择的戒烟资源（例如，戒烟热线，smokefree.gov，或txt 2 quit），12周的尼古丁替代疗法和每周助推材料的供应12周。HHC计划以前已经开发并用于门诊环境，并将被用作注意力控制，其中照顾者将接受健康生活方式选择的指导，以改善他们孩子的健康。研究结束时将提供戒烟援助。如果有效，SBIRT模型可以在PED环境中常规使用，每年可以达到至少100万吸烟者，并可以显著减少护理人员的烟草使用，SHSe相关儿科疾病和该人群的费用。此外，我们的研究结果将通过PED为针对成人的公共卫生研究工作提供信息。如果成功，我们将制作一套全面的材料，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。