Assessment of Biomarkers in Children to Help Parents Quit Tobacco

摘要：烟草使用是美国发病率和死亡率的最大可预防原因。 美国每年造成480 000人死亡，造成3 000亿美元的可归属费用。占总数的四分之一 吸烟者在他们孩子的初级保健办公室接受治疗，他们可能没有自己的初级保健医生。 当父母戒烟时，他们的预期寿命增加了10年以上，未来与烟草相关的贫困 避免了怀孕结果，孩子成为吸烟者的风险降低了四分之四，这家人 更多的钱用于生活必需品，儿童不太可能因接触烟草烟雾而患上疾病 (谢霆锋)。在儿科环境中定期向父母提供控烟援助将提供主要的 有益于国家的健康。我们以前的系统使用临床工作来改变对二手产品的努力 吸烟暴露(停止)干预，以识别吸烟的父母，提供尼古丁替代疗法， 并将他们登记在QuiLine中显示出在儿科实践吸收和家长方面的显著改善 结果。然而，停止干预面临障碍，例如依赖父母的自我报告 TSE低估了儿童的暴露，以及可变提供商对交付父母的忠诚度 戒烟援助。与吸烟者同住的儿童接触到二手烟和三手烟。 吸烟，并可能从使用电子尼古丁输送系统的父母那里吸入气雾剂(完)。照例 筛查儿童血液中的可替宁，尼古丁暴露的生物标志物，可以可靠地确定儿童患有 谢天谢地。现有的铅筛查计划，已经是儿科医疗保健服务的一部分，提供了 显然，但目前尚未开发的机会，以筛查可替宁在健康的儿童访问。常规可替宁 使用已经采集的血液进行铅检测的儿童可以使TSE的管理制度化 以一种类似的方式。客观可替宁测试的结果可以用来激励提供者和 鼓励家长开展控烟戒烟活动。我们前期的定性和定量工作 表明这种方法是可行的、可接受的和有效的。我们假设提供可替宁生物标记物 对儿科医生的结果，向父母提供关于他们孩子毒素暴露的个性化可替宁反馈，以及 在下列情况下向所有家庭烟草使用者提供戒烟支持(Biomarker通知外联(BIO)) 加上戒烟干预，将增加戒烟援助的发放，增加家庭 停止，减少儿童的TSE，并具有成本效益。我们建议在五个儿科进行双臂随机对照试验 实践，在孩子一年的好孩子访问中为孩子和父母登记。报名科目为 随机化，要么停止+生物要么停止武器。为了比较停止+生物与停止的效果， 我们将在为期2年的Well儿童访问中与登记的父母进行跟踪，以评估父母离职率和孩子的 谢霆锋。试验结果可能导致对TSE的普遍记录，并引发更有效的戒烟 支持与下一代生活在一起、暴露和影响下一代的年轻成年父母群体。

ABSTRACT: Tobacco use is the single greatest preventable cause of morbidity and mortality in the United States, accounting for 480,000 deaths and $300 billion in attributable costs annually. One quarter of all smokers are seen at their child’s primary care office and may not have a primary care doctor of their own. When parents quit smoking, their life expectancy is increased by over 10 years, future tobacco-related poor pregnancy outcomes are avoided, children have a four-fold lower risk of becoming smokers, the family has more money for necessities, and children are less likely to suffer diseases caused by tobacco smoke exposure (TSE). Routinely delivered tobacco control assistance to parents in the pediatric setting would provide a major health benefit to the nation. Our previous systems change efforts using the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention to identify parents who smoke, deliver nicotine replacement therapy, and enroll them in the quitline have shown significant improvements in pediatric practice uptake and parent outcomes. However, the CEASE intervention has faced barriers, such as reliance on parental self-report of TSE, which underestimates childhood exposure, and variable provider adherence to delivering parental cessation assistance. Children who live with smokers are exposed to secondhand and thirdhand tobacco smoke, and potentially to aerosol from parents who use electronic nicotine delivery systems (ENDS). Routinely screening children’s blood for cotinine, a biomarker of nicotine exposure, could reliably identify children with TSE exposure. Extant lead screening programs, already part of pediatric healthcare delivery, provide an obvious, yet currently untapped opportunity to screen for cotinine at well-child visits. Routine cotinine measurement in children using blood already collected for lead testing can institutionalize management of TSE in a comparable fashion. Results from objective cotinine testing could be used to motivate both providers and parents to promote tobacco control and cessation activities. Our preliminary qualitative and quantitative work suggests this approach is feasible, acceptable, and effective. We hypothesize that providing cotinine biomarker results to pediatricians, personalized cotinine feedback to parents about their child’s toxin exposure, and offering support to all household tobacco users to quit tobacco use (Biomarker Informed Outreach (BIO)) when added to the CEASE intervention will increase delivery of tobacco cessation assistance, increase household cessation, reduce TSE in children, and be cost-effective. We propose a 2-arm RCT conducted in five pediatric practices, enrolling children and parents at the child’s 1-year well child visit. The enrolled subjects will be randomized to either CEASE+BIO or CEASE arms. To compare the effectiveness of CEASE+BIO vs. CEASE, we will follow-up with enrolled parents at the 2-year well child visit to assess parental quit rate and children’s TSE. Trial results could lead to universal documentation of TSE and trigger more effective tobacco cessation support for the group of young adult parents who live with, expose, and influence the next generation.