Clinical Response to Biomarker Documentation of Child Secondhand Smoke Exposure

描述(申请人提供)：吸烟和二手烟(SHS)每年在美国造成近50万可预防的死亡。父母(S)戒烟有益健康，给孩子树立不吸烟(和戒烟)的榜样，停止在家里、汽车和其他地点接触SHS。来自美国儿科学会和美国家庭医生学会的全国性倡议敦促医疗保健提供者对儿童进行SHS接触史筛查，并建议父母停止吸烟并限制在家中吸烟，但这些指导方针的遵从性很差，美国超过25%的儿童继续非自愿地在家中暴露于SHS。需要有效的制度来增加父母戒烟和实施家庭吸烟限制。我们建议进行初步研究，以评估一种实现这些目标的新型干预措施。我们假设，一个定期测量和报告暴露于SHS的儿童尿中烟草毒物(烟草特有致癌物质、尼古丁和可替宁)水平的临床系统将1)增加烟草治疗提供者的提供，2)增加父母对烟草治疗的参与，3)增加父母戒烟，4)减少儿童接触二手烟。我们建议在医疗保健提供者和家长中开展形成性工作，以开发干预措施，并试行测试干预措施对提供者和父母的影响。我们将在工作人员中开展重点小组，以确定培训需求，制定将干预措施与办公室实践相结合的方法，并评估执行方面的障碍。我们还将在家长中开展焦点小组，以评估提供尿样的意愿、最佳反馈形式以及对生物标记物数据的反应。来自焦点小组的结果将被用于制定实验性治疗方案。我们将在明尼苏达大学初级保健诊所的一项两组随机试点研究中测试干预措施。我们将招募80名父母吸烟的0-12岁儿童。我们将为所有家长提供健康生活方式选择的简短行为咨询。其中一个提供者团队将在40对亲子对中实施实验干预，另一个团队将作为对照。在试验组中见到供应商的儿童将提供尿样，以测试亚硝胺(一种烟草特有的致癌物质)、尼古丁和可替宁。我们将使用电子病历将实验室结果传达给供应商，并将这些结果纳入旨在促进戒烟和限制家庭吸烟的父母烟草咨询中。主要结果将是提供者提供戒烟治疗。我们还将在试验组和控制组中衡量父母参与治疗、戒烟和实施家庭吸烟限制的影响。研究团队为该项目带来了在新型烟草干预、卫生服务研究和生物标记物评估方面的丰富经验。儿童尿液中烟草毒物的常规记录有可能极大地改变对吸烟风险家庭的临床护理。公共卫生相关性：该项目测试暴露在二手烟中的儿童尿液中的烟草毒物对提供者和父母行为的影响。这项干预旨在帮助父母戒烟，减少儿童时期接触二手烟的机会。

DESCRIPTION (provided by applicant): Smoking and secondhand smoke (SHS) are responsible for nearly a half-million preventable deaths in the United States every year. Parent(s) who stop smoking incur health benefits, model non-smoking (and quitting) to children and stop exposure to SHS in the home, car and other locations. National initiatives from the American Academy of Pediatrics and the American Academy of Family Physicians urge healthcare providers to screen children for a history of SHS exposure and to recommend that parents stop smoking and restrict smoking at home, but compliance with these guidelines is poor and more than 25% of children in the U.S. continue to be involuntarily exposed to SHS in the home. Effective systems are needed to increase parental smoking cessation and implement home smoking restrictions. We propose preliminary studies to evaluate a novel intervention to accomplish these objectives. We hypothesize that a clinic system that routinely measures and reports levels of tobacco toxicants (tobacco-specific carcinogens, nicotine and cotinine) found in the urine of children exposed to SHS will 1) increase provider delivery of tobacco treatment, 2) increase parental participation in tobacco treatment, 3) increase parental smoking cessation and 4) reduce childhood exposure to secondhand smoke. We propose formative work among healthcare providers and parents to develop the intervention and to pilot test the effects of the intervention on providers and parents. We will conduct focus groups among staff to identify training needs, develop methods to integrate the intervention with office practice and assess barriers to implementation. We will also conduct focus groups among parents to assess willingness to provide urine specimens, optimal feedback format and reactions to biomarker data. Results from focus groups will be used to develop the experimental treatment protocol. We will test the intervention in a two-group randomized pilot study in the University of Minnesota Primary Care Clinic. We will recruit 80 children age 0-12 with a parent who smokes. We will provide brief behavioral counseling in healthy lifestyle options to all parents. One provider team will implement the experimental intervention in 40 parent-child pairs and the other team will serve as the control. Children who see providers in the experimental group will provide a urine sample to test for nitrosamines (a tobacco-specific carcinogen), nicotine and cotinine. We will communicate laboratory results to providers using the electronic medical record and incorporate these results in parental tobacco counseling designed to promote smoking cessation and home smoking restrictions. The primary outcome will be provider delivery of smoking cessation treatment. We will also measure effects on parental engagement in treatment, smoking cessation and institution of home smoking restrictions in both the experimental and control groups. The research team brings extensive experience with novel tobacco interventions, health services research and biomarker assessment to the project. Routine documentation of tobacco toxicants in children's urine has potential to dramatically alter clinical care for families at risk from smoking. PUBLIC HEALTH RELEVANCE: This project tests the effect of demonstrating tobacco toxicants in the urine of children exposed to secondhand smoke on provider and parent behavior. The intervention is designed to help parents stop smoking and reduce childhood exposure to secondhand smoke.