Contingency Management to Reduce Secondhand Smoke Exposure in Asthmatic Children

减少哮喘儿童二手烟暴露的应急管理

• 批准号: 8821915
• 负责人: Mandeep Jassal
• 金额: $ 18.46万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-06-01 至 2020-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8821915
• 关键词: 17 year old; Accounting; Address; Adherence; Adopted; Adoption; Air; Altruism; Applications Grants; Asthma; Attitude; Awareness; Baltimore; Behavior; Behavioral; Carbon Monoxide; Caregivers; Characteristics; Child; Childhood; Childhood Asthma; Cigarette; Cities; Cotinine; Counseling; Development; Diagnosis; Disease; Education; Effectiveness; Electronic Health Record; Environment; Environmental Tobacco Smoke; Expenditure; Exposure to; Family; Focus Groups; Funding Mechanisms; Future; Goals; Health; Health Care Costs; Healthcare; Healthy People 2020; Home environment; Household; Incentives; Incidence; Individual; Intervention; Knowledge; Literature; Low income; Measurement; Measures; Methods; Mission; Modality; Morbidity - disease rate; Motivation; National Institute of Environmental Health Sciences; Nicotine; Nursery Schools; Outcome; Participant; Pharmacologic Substance; Pilot Projects; Policies; Population; Preschool Child; Process; Psychology; Public Policy; Questionnaires; Randomized; Randomized Controlled Trials; Recommendation; Recruitment Activity; Research; Role; Salivary; Sampling; Services; Smoke; Smoke-free home; Smoker; Smoking; Smoking Behavior; Stream; Symptoms; Taxes; Techniques; Technology; Testing; United States; Urban Population; Vision; Withholding Treatment; aged; arm; asthmatic; base; behavioral economics; cigarette smoking; cigarette smoking; contingency management; cost effective; cost effectiveness; design; environmental tobacco smoke exposure; financial incentive; health care service utilization; home smoking ban; improved; inner city; insight; interest; low socioeconomic status; member; patient population; payment; public health relevance; smoking cessation; smoking intervention; time interval; urban area

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.

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。对于那些有限的看护者，可能会戒烟的人，文献中有足够的证据表明，在其他家庭成员或在家庭环境中吸烟的哮喘儿童中，烟雾暴露继续发生。尚不清楚的有效方法可以减少哮喘儿童低收入家庭中的SH暴露？该项目的主要目的与NIEHS探索环境在健康成果中的作用的任务保持一致，它是确定经济激励措施在减少哮喘学龄前儿童中SHS暴露中的有效性。该赠款应用程序使用行为经济学和心理学的概念应用了应急管理模式，以修改护理人员的吸烟行为。这可以直接通过使用家庭成员和访客在家中调节烟烟吸烟的能力来直接改变看护人的吸烟行为和/或间接地发生。拟议的研究的理由是，如果适当激励个人，个人更有可能改变其行为。理想地以利他方式对孩子采取行动的母亲看护者将受到减少自身或其他人在家庭环境中其他人产生的室内SHS暴露的动力。通过适中的经济激励措施修改行为也可能有可能成为高度成本效益的方式，以解决与SHS相关的儿科哮喘病例中不断上升的医疗保健费用。该目标将通过追求以下目的来实现：1）对障碍的定性评估以及激励计划的特征，这些计划可以增强家庭吸烟禁令的采用以及2）定量确定经济激励措施在减少家庭SHS暴露和哮喘相关的健康状况中的有效性。焦点小组讨论由学龄前哮喘儿童的护理人员组成，将在第一个目的中使用，以确定在执行家庭吸烟禁令中克服这些障碍的障碍和可能的手段 - 其发现将为未来研究的设计提供信息。在6个月的时间间隔内将采用两臂随机控制试验。这两个研究小组都将鼓励实施家庭吸烟禁令，并为初级护理人员提供标准的戒烟治疗。实验组还将获得基于唾液可替宁水平验证的目标哮喘学龄前儿童中的SHS暴露，以减少SHS暴露，以获得6个每月的经济激励措施。从试点研究中得出的知识将用于评估可行性，并使用SHS减少的经济激励措施进一步为未来研究的设计提供了信息。因此，这项研究开辟了一条新的途径，用于使用应急管理为环境哮喘研究服务。