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Multilevel tobacco intervention in community clinics for underserved families

在社区诊所为服务不足的家庭进行多层次烟草干预

基本信息

批准号：
9268428
负责人：
BRADLEY N COLLINS
金额：
$ 57.9万
依托单位：
TEMPLE UNIV OF THE COMMONWEALTH
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-05-01 至 2020-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9268428
关键词：
Address Adopted Adult African American Asthma Behavior Therapy Behavioral Biological Biological Markers Cellular Phone Cessation of life Child Cigarette Clinic Clinical Practice Guideline Cognitive Therapy Combined Modality Therapy Communities Control Groups Coping Skills Cotinine Counseling Disease Eligibility Determination Equilibrium Evidence based treatment Family Feedback Female of child bearing age Fostering Future Guidelines Home environment Improve Access Income Individual Infant Informal Social Control Intervention Link Low Income Population Low income Measures Mediating Mediator of activation protein Minority Groups Modeling Modification Morbidity - disease rate Mothers Motivation Nicotine Dependence Otitis Outcome Parents Participant Philadelphia Population Poverty Practice Guidelines Pregnancy Prevalence Problem behavior Randomized Reporting Research Risk Science Self Efficacy Services Smoke Smoker Smoking Social support Source Sudden infant death syndrome System Telefacsimile Telephone Testing Time Tobacco Training Underserved Population Urine Weight Woman Work addiction anxiety symptoms attentional control base cancer risk cardiovascular risk factor craving depressive symptoms design disorder risk dosage environmental tobacco smoke exposure follow-up group intervention health disparity high risk population improved innovation intervention effect lower income families maternal cigarette smoking mobile application mortality multilevel analysis multimodality nicotine replacement novel primary outcome programs protective behavior public health priorities public health relevance quitline secondary outcome self help smoking cessation social standard of care theories therapy development tobacco control tool treatment effect uptake young adult

项目摘要

DESCRIPTION (provided by applicant): Children's secondhand smoke exposure (SHSe) remains a leading cause of avertible morbidity/mortality, with links to asthma, otitis, SIDS, behavior problems and risk of cancer and cardiovascular disease. Addressing SHSe is a public health priority, particularly in low-income, young children-a group with excess tobacco-related risk and burden. Community clinics (e.g., Women, Infants and Children [WIC]), can reach this population. WIC's standard practice for addressing SHSe includes minimal self-help advice to parents, an approach with inadequate efficacy. Clinical practice guidelines ("AAR") recommend that practitioners "Ask" parents about child SHSe, "Advise" them about harms, and "Refer" smokers to intensive evidence-based treatments that address multiple determinants of smoking. Thus, we propose to test a multilevel, multimodal treatment model that combines a system-level WIC intervention following AAR guidelines with a more intensive, individual-level multimodal behavioral intervention (MBI) that integrates telephone SHSe reduction and cessation counseling with coaching on NCI's QuitPal mobile app and nicotine replacement therapy (NRT) use. We will train staff in Philadelphia WIC clinics to implement AAR with auto-fax referral to the trial. We will then randomize 372 eligible parents to receive AAR+MBI or AAR+CTL (attention control intervention). All participants will receive AAR because it is an easily adoptable, potentil standard of care in community clinics. The primary aim is to test the hypothesis that AAR+MBI compared to AAR+CTL will result in greater reductions in child cotinine (SHSe biomarker) and reported cigarettes exposed/day at 3-month end of treatment and 12-month follow-up. A secondary aim is to test the hypothesis that AAR+MBI vs. AAR+CTL will result in higher bioverified 7-day point prevalence quit rate among parents at 3- and 12-months. We will test the hypothesis that social support, urge coping skills, self-efficacy, and SHSe protective behaviors mediate effects of AAR+MBI on smoking outcomes and explore whether other residential smokers, level of nicotine dependence, depressive/anxious symptoms, weight concerns, intervention dosage, and pregnancy status moderate treatment effects. Our model balances necessary intervention intensity with feasible components (quitline, NRT, QuitPal) already available in under- served communities, thereby facilitating future dissemination. Unlike the NCI Quitline and many state services, the MBI follows best practice guidelines and does so without increasing clinic burden. It also can improve an underserved, high-risk population's access to and engagement in evidence-based treatment. This project has high impact potential: it will result in a novel, efficacious multilevel model for tackling the significant problem of child SHSe. Secondary aims results will inform science and theory by identifying how and for whom the model works. Future dismantling research can assess orthogonal and synergistic effects of intervention components.