Exploring a Cessation Intervention for Low Income Smokers in an Emergency Setting

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DESCRIPTION (provided by applicant): An estimated 6.6 million parents who smoke visit pediatric emergency departments (PED) annually. Up to 50% of these parental smokers are from low-income, racially/ethnically diverse households in which a variety of tobacco-related disparities exist for both the parents and their children. The PED is an ideal and innovative setting in which to address these disparities, which include differences in tobacco use, pediatric second hand smoke exposure (SHSe), quit rates, access to cessation resources, and morbidity such as cancer. The proposed Career Development Award application will facilitate the candidate's growth as an independent cancer control physician scientist conducting research in the PED setting. The long-term career goal of the candidate is to become an effective independent researcher able to conduct parental cessation interventions in the PED that are readily translated into practice. The candidate's immediate career goal is to develop and test a cessation intervention for low-income smokers in the PED. To achieve this goal, the candidate proposes a career development plan that includes professional development, grant preparation, and a research plan to collect pilot data. The proposed research plan extends the candidate's prior smoking cessation work in the PED setting which indicates that parental smokers who visit the PED are aware of the pediatric effects of SHSe, motivated to quit, and eager to receive cessation counseling in this setting. The proposed research will be conducted in two phases. During Phase I, we will explore the types of interventions acceptable to low-income parental smokers via focus groups. Focused interviews of PED nurses, physicians, and hospital administrators will be conducted to explore barriers to intervention sustainability that will assist in future intervention planning. This data will be used to develop a PED-based parental cessation intervention. During Phase II, we will conduct a pilot prospective trial to examine the effectiveness of our screening, brief intervention, and referral to treatment (SBIRT) intervention on parental smoking cessation. Equal numbers of parental smokers who bring their child to the PED for either a SHSe-related illness or non SHSe-related illness will be given a brief intervention using an adapted form of the Clinical Practice Guideline: Treating Tobacco Use and Dependence. Intervention components may include brief cessation counseling using an "Advise, Assess, and Assist" approach; information on SHSe in children; direct connection to the Quitline (QL) in the PED; and/or free administration of nicotine replacement therapy (NRT). The Health Belief Model will be used to explore whether factors unique to this setting (e.g., child's acute illness) moderate the effect of the intervention on cessation outcomes. Outcomes will be assessed following the intervention via phone, email, or text messaging. If effective, this intervention could reduce health disparities related to tobacco use, by improving treatment and preventing tobacco-related morbidities in low-income, racially/ethnically diverse smokers. PUBLIC HEALTH RELEVANCE: The prevalence of tobacco use is disproportionately high among parental smokers who visit the pediatric emergency department (PED) with their children. Up to 50% of these parental smokers are from low-income, racially/ethnically diverse households in which a variety of tobacco-related disparities exist for the adult smokers and for their children who are adversely affected by second hand smoke exposure (SHSe). The proposed study seeks to develop and test a smoking cessation intervention for low-income smokers recruited from the PED. Cessation outcomes will be assessed on parents who have children with and without a SHSe-related complaint.