Contingency Management to Reduce Secondhand Smoke Exposure in Asthmatic Children

描述（由申请人提供）：旨在减少二手烟（SHS）暴露的传统方法通常采用难以采用和维持的方式。对于那些可能能够戒烟的有限照顾者，文献中有足够的证据表明，在哮喘儿童中继续发生其他家庭成员或在家中吸烟的访客的烟雾暴露。什么是不知道的是有效的方法来减少SHS暴露在低收入家庭的儿童哮喘？该项目的主要目标与NIEHS探索环境在健康结果中的作用的使命一致，是确定财政激励措施在减少患有不受控制的哮喘的学龄前儿童家中SHS暴露方面的有效性。这项拨款申请适用于应急管理模式，使用行为经济学和心理学的概念，以修改吸烟行为的照顾者。这可以通过改变看护人的吸烟行为直接发生，和/或通过他们调节家庭成员和访客在家中吸烟的能力间接发生。这项研究的基本原理是，如果得到适当的激励，个人更有可能改变自己的行为。母亲照顾者，谁理想的行为在利他主义的方式对他们的孩子，将被激励的激励措施，以减少室内SHS暴露所产生的自己或其他人在家里设置。通过适度的经济激励来改变行为也可能成为一种高成本效益的方式，以解决SHS相关的儿科哮喘病例中不断上升的医疗费用。这一目标将通过追求以下目标来实现：1）定性评估障碍和激励计划的特点，可以促进家庭禁烟的采用; 2）定量确定财政激励措施在减少家庭SHS暴露和哮喘相关健康结果方面的有效性。焦点小组讨论，包括学龄前哮喘儿童的照顾者，将被用于第一个目标，以确定障碍和可能的手段，以克服这些障碍，在执行家庭禁烟-其结果将通知未来的研究设计。在第二个目标中将采用一项为期6个月的双臂随机对照试验。两个研究组都将受到鼓励，实施家庭禁烟，并为主要照顾者提供标准的戒烟治疗。实验组还将获得6个月的经济奖励，奖励的基础是通过唾液可替宁水平验证的目标哮喘学龄前儿童中SHS暴露的减少。从试点研究中获得的知识将用于评估可行性，并进一步为未来研究的设计提供信息，使用财政激励措施减少SHS。因此，这项研究开辟了一个新的途径，使用应急管理服务的环境哮喘研究。

DESCRIPTION (provided by applicant): Traditional methods aimed at the reduction of secondhand smoke (SHS) exposure often employ modalities that are difficult to adopt and sustain. For those limited caretakers who may be able to abstain from smoking, there is adequate proof in the literature that smoke exposures continue to occur among children with asthma from other household members or visitors who are smoking in the home setting. What is not known are effective ways to reduce SHS exposure in low-income households of children with asthma? The primary objective of the project, which is aligned with the NIEHS mission of exploring the role of the environment in health outcomes, is to determine the effectiveness of financial incentives in reducing SHS exposure in the homes of preschool children with uncontrolled asthma. This grant application applies a contingency management schema, using concepts from behavioral economics and psychology, to modify the smoking behaviors of caregivers. This could occur directly by altering smoking behavior of the caretaker and/or indirectly through their ability to regulate cigarette smoking in the home by household members and visitors. The rationale for the proposed research is that individuals are more likely to alter their behavior if properly incentivized. Maternal caretakers, who ideally act in an altruistic manner toward their children, will be motivated by the incentives to reduce indoor SHS exposures generated by themselves or by others in the home setting. Modifying behaviors through modest financial incentives may also have the potential to be a highly cost-effective modality to address the rising healthcare costs among SHS-associated pediatric asthma cases. This goal will be achieved by pursuit of the following aims: 1) Qualitative assessment of barriers and the characteristics of incentive plans that could enhance the adoption of home smoking bans and 2) Quantitative determination of the effectiveness of financial incentives in reducing home SHS exposure and asthma-related health outcomes. Focus group discussions, consisting of caregivers of preschool asthmatic children, will be used in the first aim to identify the barries and possible means by which to overcome those obstacles in the enforcement of a home smoking ban - the findings of which will inform the design of future studies. A two-arm randomized-control trial will be employed in the second aim over a 6-month time interval. Both study groups will receive encouragement to implement a home smoking ban plus an offer of standard smoking cessation treatment for the primary caregiver. The experimental group will receive in addition the opportunity to earn 6 monthly financial incentives based on reduction in SHS exposures in the target asthmatic preschool child as verified by salivary cotinine levels. The knowledge derived from the pilot study will be used to gauge feasibility and further inform the design of future research using financial incentives for SHS reduction. Thus, the study opens a new avenue for use of contingency management in the service of environmental asthma research.