Sustaining Cessation in Smokers With Kids With Asthma

描述（由申请人提供）：本申请是我们以前的NHLBI补助金的续期，“激励哮喘儿童的父母戒烟。“这项研究比较了两种护士提供的家庭戒烟干预措施，用于接受哮喘治疗的儿童的低收入照顾者;一种侧重于通过提供动机访谈和生物标志物反馈（PAM）来增强风险感知，另一种侧重于使用AHRQ指南（BAM）建立自我效能。在2个月随访时，PAM的戒烟率显著高于BAM，但两组在6个月时的复发率都很高。本研究的第一个目的是利用我们先前证明的戒烟干预（PAM）来检查认知，情感和行为过程，假设这些过程是最近哮喘急性发作的吸烟者与健康儿童吸烟者的可教时刻的基础。很少有研究（如果有的话）对假设为可教时刻基础的结构进行了系统的评估，也没有包括没有经历可教时刻的个人的适当比较组。 我们的第二个目标试图维持我们在第一项研究中发现的良好的短期戒烟率，通过测试补充PAM与基于电话的干预是否比PAM+哮喘儿童父母的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，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：点患病率戒烟，复发，ETS减少，哮喘发病率和卫生保健利用。我们还将研究调解员和主持人。我们的研究具有公共卫生意义，因为它将在“真实的世界”中进行，在儿童哮喘治疗过程中，主动接触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.