Parents Awareness Reducing Exposure to Nicotine and Tobacco (PARENT)

描述（由申请人提供）：父母的意识减少暴露于尼古丁和烟草（PANITOR）儿童的二手烟（SHS）暴露是一个主要的公共卫生问题。多达43%或超过1500万的美国儿童与吸烟者生活在一起。在超过70%的有成年吸烟者和儿童的家庭中，允许在家中吸烟。儿童保育中心（CCC）是一个未充分利用的场所，促进儿童健康，并有潜在的显着影响父母吸烟行为。近60%的学龄前儿童每天接受非父母照顾。因此，接触到大量儿童和父母的潜力很大。培训儿童保育工作者（CCWs）进行简短的烟草干预（BI）戒烟/SHS减少，将准备CCWs更有效地影响父母的烟草使用行为。因此，我们提出了一个发展的可行性研究，开发和试点测试的系统干预，以减少SHS暴露在儿童参加六个托儿中心，题为家长意识减少暴露于尼古丁和烟草（PAGRESS）。 家庭护理系统的干预措施针对两个群体：（1）儿童保育工作者和（2）儿童及其父母/照顾者。该方案旨在促进以家庭为中心的方法，通过以下方式为整个家庭创造无烟环境：a）对CCW进行简短的戒烟/减少SHS干预培训，B）进行常规SHS筛查，以识别有风险的儿童，c）在中心环境和家长参与活动中增加关于戒烟/减少SHS接触的教育。拟议的项目有四个阶段：第一阶段-形成研究和干预发展。第二阶段-吸烟流行率研究，以估计儿童的SHS暴露;记录父母对SHS和吸烟的知识、态度和行为（n~650）;并确定符合试点干预研究条件的SHS暴露儿童。第三阶段-试点干预可行性研究。将6个CCC随机分配至PABILITY干预或比较干预（在职营养/体力活动）（每种研究条件下3个CCC，n=120对父母/儿童，20对/中心）。主要结局指标为：1）通过唾液可替宁测量儿童的SHS暴露，2）与吸烟和SHS暴露相关的自我报告的P/C行为的变化。次级措施包括：1）《特定常规武器公约》关于烟草干预措施的报告（P/C），2）从《特定常规武器公约》收到的烟草干预措施的P/C报告，以及3）SHS暴露筛查率和在核心社区开展烟草教育的情况（系统变化措施）。这些措施背后的假设是，在托儿中心的系统性变化将反映在较低的可替宁水平的儿童在干预网站，这种转变将介导的积极变化，父母/照顾者的行为与吸烟和SHS暴露。第四阶段-重复患病率调查，分析数据，并根据试点干预研究的效应量和可行性结果，完善PAGINE干预措施，工具和研究设计特征，准备为完全动力的III期随机对照疗效试验寻求资金。 烟草使用及其导致的死亡和疾病仍然是当今美国公共卫生的最大威胁。大多数烟草使用者是吸烟者。香烟二手烟（SHS）对公众健康的威胁已被充分记录。儿童特别容易受到SHS的影响。由于SHS是公认的对公共健康的威胁，因此改变吸烟行为和减少SHS的基于人群的策略具有高度相关性。

DESCRIPTION (provided by applicant): Parents' Awareness Reducing Exposure to Nicotine and Tobacco (PARENT) Second hand smoke (SHS) exposure in children is a major public health problem. As many as 43% or more than 15 million U.S. children live with a smoker. In more than 70% of homes with both adult smokers and children, smoking is allowed within the home. Childcare centers (CCCs) are an underutilized venue for child health promotion and have a potentially significant influence on parental smoking behavior. Nearly 60% of preschoolers receive non-parental care on a daily basis. Thus, the potential to reach a large number of children and parents is substantial. Training child care workers (CCWs) to conduct brief tobacco interventions (BI) for smoking cessation/SHS reduction, will prepare CCWs to more effectively influence parental tobacco use behavior. Thus we propose a developmental feasibility study to develop and pilot test a system intervention to reduce SHS exposure in children attending six childcare centers, entitled Parents Awareness Reducing Exposure to Nicotine and Tobacco (PARENT). The PARENT system intervention targets two populations: 1) CCWs and 2) children and their parents/caregivers (P/Cs). It is designed to promote family-centered approaches to creating smoke-free environments for the whole family through a combination of a) brief tobacco cessation/SHS reduction intervention training of CCWs, b) implementation of routine SHS screening to identify children at risk, c) adding education on tobacco cessation/SHS exposure reduction to the center's environment and parent involvement activities. The proposed project has four stages: Stage I - formative research and intervention development. Stage II- smoking prevalence study to estimate children's SHS exposure; document parental knowledge, attitudes, and behaviors with regards to SHS and smoking (n~650); and identify SHS- exposed children who are eligible for the pilot intervention study. Stage III - pilot intervention feasibility study. Six CCCs will be randomized to the PARENT intervention or a comparison intervention (nutrition/physical activity inservice) (3 CCCs in each study condition, n=120 parent/child pairs, 20 pairs/center). Primary outcome measures are: 1) children's' SHS exposure as measured by salivary cotinine and 2) changes in self-reported P/C behaviors related to smoking and SHS exposure. Secondary measures include 1) CCW reports of tobacco interventions with P/Cs, 2) P/C reports of interventions received from CCWs, and 3) rates of SHS exposure screening and implementation of tobacco education at CCCs (measures of system change). The hypotheses underlying these measures are that systemic changes in the childcare center will be reflected in lower cotinine levels among the children in the intervention sites, and that this shift will be mediated by positive changes in parent/caregiver behaviors related to smoking and SHS exposure. Stage IV - repeat the prevalence survey, analyze data, and based on effect sizes and feasibility results from the pilot intervention study, refine the PARENT intervention, instruments and study design features in preparation to seek funding for a fully-powered Phase III randomized controlled efficacy trial. Tobacco use and the resulting death and disease continue to be the single greatest threat to public health in the United States today. Most tobacco users are smokers. The threat to the public health from cigarette second hand smoke (SHS) has been well-documented. Children are especially vulnerable to SHS. Because SHS is an acknowledged threat to public health, population-based strategies to change smoking behavior and reduce SHS are highly relevant.