Multilevel tobacco intervention in community clinics for underserved families

在社区诊所为服务不足的家庭进行多层次烟草干预

• 批准号: 8885150
• 负责人: BRADLEY N COLLINS
• 金额: $ 56.01万
• 依托单位: TEMPLE UNIV OF THE COMMONWEALTH
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2020-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8885150
• 关键词: Accounting; Address; Adult; African American; Asthma; Attention; Behavior Therapy; Behavioral; Biological; Biological Markers; Cardiovascular Diseases; Cellular Phone; Cessation of life; Child; Cigarette; Clinic; Clinical Practice Guideline; Cognitive Therapy; Combined Modality Therapy; Communities; Control Groups; Coping Skills; Cotinine; Counseling; Disease; Equilibrium; Evidence based treatment; Family; Feedback; Fostering; Future; Guidelines; Home environment; Improve Access; Income; Individual; Infant; Informal Social Control; Intervention; Link; Low income; Measures; Mediating; Mediator of activation protein; Minority; Modeling; Modification; Morbidity - disease rate; Mothers; Nicotine Dependence; Otitis; Outcome; Parents; Participant; Philadelphia; Population; Poverty; Practice Guidelines; Pregnancy; Prevalence; Printing; Problem behavior; Public Health; Randomized; Reporting; Research; Risk; Science; Self Efficacy; Services; Smoke; Smoker; Smoking; Social Controls; Social support; Source; Sudden infant death syndrome; Symptoms; System; Telefacsimile; Telephone; Testing; Time; Tobacco; Training; Underserved Population; Urine; Weight; Woman; Work; addiction; anxious; base; cancer risk; child bearing; craving; depressive symptoms; design; dosage; environmental tobacco smoke exposure; follow-up; health disparity; high risk; improved; innovation; intervention effect; maternal cigarette smoking; mobile application; mortality; multilevel analysis; nicotine replacement; novel; primary outcome; programs; protective behavior; public health priorities; public health relevance; quitline; secondary outcome; self help; smoking cessation; standard of care; theories; therapy development; tobacco control; tool; treatment effect; uptake; young adult

 DESCRIPTION (provided by applicant): Children's secondhand smoke exposure (SHSe) remains a leading cause of avertible morbidity/mortality, with links to asthma, otitis, SIDS, behavior problems and risk of cancer and cardiovascular disease. Addressing SHSe is a public health priority, particularly in low-income, young children-a group with excess tobacco-related risk and burden. Community clinics (e.g., Women, Infants and Children [WIC]), can reach this population. WIC's standard practice for addressing SHSe includes minimal self-help advice to parents, an approach with inadequate efficacy. Clinical practice guidelines ("AAR") recommend that practitioners "Ask" parents about child SHSe, "Advise" them about harms, and "Refer" smokers to intensive evidence-based treatments that address multiple determinants of smoking. Thus, we propose to test a multilevel, multimodal treatment model that combines a system-level WIC intervention following AAR guidelines with a more intensive, individual-level multimodal behavioral intervention (MBI) that integrates telephone SHSe reduction and cessation counseling with coaching on NCI's QuitPal mobile app and nicotine replacement therapy (NRT) use. We will train staff in Philadelphia WIC clinics to implement AAR with auto-fax referral to the trial. We will then randomize 372 eligible parents to receive AAR+MBI or AAR+CTL (attention control intervention). All participants will receive AAR because it is an easily adoptable, potentil standard of care in community clinics. The primary aim is to test the hypothesis that AAR+MBI compared to AAR+CTL will result in greater reductions in child cotinine (SHSe biomarker) and reported cigarettes exposed/day at 3-month end of treatment and 12-month follow-up. A secondary aim is to test the hypothesis that AAR+MBI vs. AAR+CTL will result in higher bioverified 7-day point prevalence quit rate among parents at 3- and 12-months. We will test the hypothesis that social support, urge coping skills, self-efficacy, and SHSe protective behaviors mediate effects of AAR+MBI on smoking outcomes and explore whether other residential smokers, level of nicotine dependence, depressive/anxious symptoms, weight concerns, intervention dosage, and pregnancy status moderate treatment effects. Our model balances necessary intervention intensity with feasible components (quitline, NRT, QuitPal) already available in under- served communities, thereby facilitating future dissemination. Unlike the NCI Quitline and many state services, the MBI follows best practice guidelines and does so without increasing clinic burden. It also can improve an underserved, high-risk population's access to and engagement in evidence-based treatment. This project has high impact potential: it will result in a novel, efficacious multilevel model for tackling the significant problem of child SHSe. Secondary aims results will inform science and theory by identifying how and for whom the model works. Future dismantling research can assess orthogonal and synergistic effects of intervention components.

 描述（由申请人提供）：儿童的二手烟暴露（SHSe）仍然是可避免的发病率/死亡率的主要原因，与哮喘，耳炎，SIDS，行为问题以及癌症和心血管疾病的风险有关。解决SHSe是一个公共卫生优先事项，特别是在低收入，年幼的儿童，一个过度的烟草相关的风险和负担的群体。社区诊所（例如，妇女、婴儿和儿童[WIC]），可以接触到这一人群。WIC解决SHSe问题的标准做法包括向父母提供最低限度的自助建议，这种方法效果不佳。临床实践指南（“AAR”）建议从业者“询问”父母有关儿童SHSe的情况，“建议”他们有关危害，并“推荐”吸烟者接受针对吸烟的多种决定因素的强化循证治疗。因此，我们建议测试一种多层次、多模式的治疗模型，该模型将遵循AAR指南的系统级WIC干预与更密集的个体级多模式行为干预（MBI）相结合，MBI将电话SHSe减少和戒烟咨询与NCI Quittering移动的应用程序和尼古丁替代疗法（NRT）使用的指导相结合。我们将培训费城WIC诊所的工作人员实施AAR，并通过自动传真转诊至 审判然后，我们将372名合格的父母随机接受AAR+MBI或AAR+CTL（注意力控制干预）。所有参与者都将接受AAR，因为它是社区诊所中易于采用的潜在护理标准。主要目的是检验以下假设：与AAR+CTL相比，AAR+MBI将导致儿童可替宁（SHSe生物标志物）和报告的香烟暴露/天在3个月治疗结束和12个月随访时的更大降低。第二个目的是检验假设，即AAR+MBI与AAR+CTL相比，在3个月和12个月时，父母中的生物等效7天点患病率戒烟率更高。我们将检验这一假设，即社会支持，敦促应对技能，自我效能和SHSe保护行为介导AAR+MBI对吸烟结果的影响，并探讨其他住宅吸烟者，尼古丁依赖水平，抑郁/焦虑症状，体重问题，干预剂量和妊娠状态是否中度治疗效果。我们的模型平衡了必要的干预强度与服务不足社区已经提供的可行组成部分（戒烟线，NRT，戒烟），从而促进未来的传播。与NCI Quitline和许多州服务不同，MBI遵循最佳实践指南，这样做不会增加诊所负担。它还可以改善服务不足的高风险人群获得和参与循证治疗的机会。该项目具有很高的影响潜力：它将导致一个新的，有效的多层次模型，以解决儿童SHSe的重大问题。 次要目标的结果将通过确定模型如何以及为谁工作来为科学和理论提供信息。未来的拆解研究可以评估干预成分的正交和协同效应。