Protecting Children from Second-Hand Smoke

描述(由调查人员提供)：尽管继续实施公共政策，尽量减少工作场所和公共场所的环境烟草烟雾(ETS)暴露，但在儿童最有可能暴露于环境烟草烟雾的家庭中，ETS暴露仍然是一个非常令人担忧的问题。我们建议制定一项全面的计划，以促进和协助医疗保健提供者咨询和建议患者如何减少家庭中的ETS暴露。我们的产品包括一个继续医学教育培训部分，一个供提供者和工作人员用于启动和跟进ETS干预的绩效支持工具和程序工具包，一个供提供者提供给患者及其家人的自助工作簿，以及一个在线患者支持组件。我们计划设计一种“中等强度”的干预模式，由临床医生提供建议和简短的咨询，改编自以前的疗效研究中使用的更广泛的服务/产品。多年来，戒烟的临床干预措施已经开发出来。据我们所知，目前还没有针对ETS暴露的类似干预计划，尽管大量临床试验数据表明了临床干预对减少ETS暴露的有效性。我们相信，这些研究的结果足以保证将临床干预措施从实验环境转移到现场。这个SBIR第一阶段项目的目的是开发拟议的住宅ETS减少计划的试点版本，然后对试点产品进行形成性评估。我们将集中精力从供应商和患者那里获得广泛的反馈，使我们能够充分阐述和完善我们的产品。这一反馈将指导程序组件的定制，使其适合于整合到临床医生的日常办公室实践中，并可能比早期疗效研究中所做的更有效、更便宜。我们在形成性评估中获得的信息将为SBIR第二阶段最终产品的设计和开发以及第二阶段的研究设计提供信息。拟议计划的最终目标是减少住宅ETS暴露和戒烟，该计划将在第二阶段进行评估。相关目标包括改变提供者行为以提高ETS暴露干预的速度和有效性，以及改变患者行为以减少ETS暴露或完全戒烟。

DESCRIPTION (provided by investigator): Although public policies continue to be implemented to minimize Environmental Tobacco Smoke (ETS exposure) in the work place and in public places, ETS exposure in the home, where children are most likely to be exposed, remains an issue of great concern. We are proposing to develop a comprehensive program to promote and assist healthcare providers in counseling and advising patients how to reduce ETS exposure in the home. Our product consists of a CME training component, a kit of performance support tools and procedures for providers and staff to use to initiate and follow up on ETS interventions, a self-help workbook for providers to give to patients and their families, and an online patient support component. We plan to design a "moderate intensity" intervention model of clinician-provided advice and brief counseling, adapted from more extensive services/products used in previous efficacy studies. For many years now, clinical interventions for smoking cessation have been developed. To our knowledge, there are no comparable intervention programs that target ETS exposure, although a substantial amount of clinical trial data indicates the efficacy of clinical interventions for ETS exposure reduction. We believe the results from these studies are sufficient to warrant transferring clinical interventions from an experimental setting to the field. The aim of this SBIR Phase I project is to develop a pilot version of the proposed residential ETS reduction program, and then to conduct a formative evaluation of the pilot product. We will focus our efforts on obtaining extensive feedback from providers and patients that will allow us to fully elaborate and refine our product. This feedback will guide the tailoring of the program components to make them suitable for integration into clinicians' daily office practice and potentially more effective and less expensive than what has been done in earlier efficacy studies. The information we obtain in this formative evaluation will inform the design and development of the final product during SBIR Phase II, and the Phase II research design. The end goal of the proposed program, to be evaluated in Phase II, is reduction of residential ETS exposure and smoking cessation. Related objectives include changing provider behavior to increase the rate and effectiveness of ETS exposure interventions, and changing patient behavior to reduce ETS exposure or to stop smoking entirely.