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模式。对于那些可能能够戒烟的有限看护人，文献中有充分的证据表明，在家中吸烟的其他家庭成员或访客中，吸烟继续发生在患有哮喘的儿童中。在低收入家庭中减少哮喘儿童接触二手烟的有效方法有哪些尚不为人所知？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是一致的，目的是确定财政激励措施在减少患有未控制哮喘的学龄前儿童家中接触二手烟方面的有效性。本资助申请采用应急管理模式，使用行为经济学和心理学的概念来改变护理人员的吸烟行为。这可以通过改变看护人的吸烟行为直接实现，也可以通过他们调节家庭成员和访客在家中吸烟的能力间接实现。这项拟议研究的基本原理是，如果受到适当的激励，个人更有可能改变自己的行为。理想情况下，母亲照顾者会以利他的方式对待自己的孩子，她们会受到减少自己或家庭环境中其他人产生的室内SHS暴露的激励。通过适度的经济激励来改变行为也可能是一种极具成本效益的方式，以解决与shs相关的儿科哮喘病例中不断上升的医疗费用。这一目标将通过追求以下目标来实现：1)定性评估可能促进家庭禁烟的障碍和激励计划的特点；2)定量确定财政激励在减少家庭二手烟暴露和与哮喘有关的健康结果方面的有效性。由学龄前哮喘儿童的照顾者组成的焦点小组讨论将用于第一个目的，以确定在执行家庭禁烟时的障碍和克服这些障碍的可能方法- -其结果将为今后研究的设计提供信息。第二个目标将采用两组随机对照试验，时间间隔为6个月。两个研究小组都将得到鼓励，实施家庭禁烟，并为主要照顾者提供标准戒烟治疗。此外，实验组还将有机会获得6个月的经济奖励，奖励的基础是通过唾液可替宁水平证实，目标哮喘学龄前儿童的SHS暴露减少。从试点研究中获得的知识将用于衡量可行性，并进一步为利用财政奖励减少SHS的未来研究的设计提供信息。因此，本研究为在环境哮喘研究中使用应急管理开辟了一条新的途径。

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.