Sustaining Cessation in Smokers With Kids With Asthma

描述(申请人提供)：这份申请是我们之前的NHLBI资助的续订，“激励哮喘儿童的父母戒烟。”这项研究比较了两种针对接受哮喘治疗的低收入照顾者的护士提供的家庭戒烟干预措施；一种侧重于通过提供激励访谈和生物标记物反馈(PAM)来增强风险认知，另一种侧重于使用AHRQ指南(BAM)建立自我效能。在2个月的随访中，PAM的戒烟率明显高于BAM，但两组在6个月后的复发率都很高。目前这项研究的第一个目的是利用我们之前证明的戒烟干预(PAM)来检查假设的认知、情感和行为过程，这些过程是有最近哮喘恶化的孩子的吸烟者与有健康孩子的吸烟者的可教时刻的基础。很少有研究对构成可教时刻的假设进行了系统的评估，也没有将没有经历可教时刻的个体纳入适当的比较组。 我们的第二个目标是试图维持我们在第一项研究中发现的出色的短期戒烟率，方法是测试在哮喘儿童的父母中，补充PAM和电话干预是否比PAM加接触控制更能改善和维持戒烟。电话咨询将以理论为基础，针对我们第一项研究中与戒烟相关的结构(感知风险、预防有效性、自我效能)。据我们所知，还没有研究利用电话咨询来激励哮喘儿童的父母戒烟。我们的主要结果：时点患病率、戒断率、复发率、ETS减少、哮喘发病率和医疗保健利用率。我们还将审查调解人和主持人。我们的研究具有公共卫生意义，因为它将在“真实世界”进行，在儿童哮喘治疗过程中，主动接触到可能不会戒烟的吸烟者。

DESCRIPTION (provided by applicant): This application is a renewal of our prior NHLBI grant, "Motivating the Parents of Kids with Asthma to Quit Smoking." This study compared two nurse-delivered home-based smoking cessation interventions for low income caregivers of children receiving asthma treatment; one that focused on augmenting risk perception through the provision of Motivational Interviewing and biomarker feedback (PAM), and one that focused on building self-efficacy using AHRQ guidelines (BAM). PAM achieved significantly greater quit rates than BAM at a 2 month follow-up, but both groups had high relapse rates by 6-months. The first aim of the current study is to utilize our previously demonstrated smoking cessation intervention (PAM) to examine the cognitive, affective, and behavioral processes hypothesized to underlie the Teachable Moment in smokers with kids who had a recent asthma exacerbation vs. smokers with healthy kids. Few, if any studies, have conducted a systematic evaluation of the constructs hypothesized to underlie the Teachable Moment, nor have they included the appropriate comparison groups of individuals not experiencing a teachable moment. Our second aim attempts to sustain the excellent short-term quit rates we found in our first study by testing whether supplementing PAM with a telephone-based intervention improves and sustains quitting more than PAM plus contact control among parents of kids with asthma. The telephone counseling will be theory based, targeting the constructs associated with quitting in our first study (perceived risk, precaution effectiveness, self-efficacy). To our knowledge, no studies have utilized telephone counseling to motivate smoking cessation in the parents of kids with asthma. Our primary outcomes: point prevalence abstinence, relapse, ETS reduction, asthma morbidity, and health care utilization. We will also examine mediators and moderators. Our study has public health significance because it will be conducted in the "real world," during the course of the child's asthma treatment, proactively reaching smokers who may not otherwise quit.