Exploring a Cessation Intervention for Low Income Smokers in an Emergency Setting

探讨紧急情况下对低收入吸烟者的戒烟干预 据估计，每年有660万吸烟的父母去儿科急诊室就诊。高达50% 这些父母中的吸烟者来自低收入、种族/民族多元化的家庭，在这些家庭中，各种 父母和他们的孩子都存在与烟草有关的差异。PED是一种理想和创新的 解决这些差异的环境，包括烟草使用的差异、儿科二手烟 吸烟暴露(SHSE)、戒烟率、戒烟资源的可获得性以及癌症等发病率。这个 建议的职业发展奖申请将促进候选人作为独立人士的成长 在PED环境下进行研究的癌症控制内科科学家。职业生涯的长期目标是 候选人将成为一名有效的独立研究员，能够在以下领域进行父母戒烟干预 容易转化为实践的PED。候选人的直接职业目标是开发和测试 针对PED低收入吸烟者的戒烟干预。为了实现这一目标，候选人提出了一个 职业发展计划，包括职业发展、拨款准备和研究计划，以 收集飞行员数据。拟议的研究计划将候选人之前的戒烟工作延长到 PED设置，这表明访问PED的父母吸烟者意识到 她有戒烟的动机，并渴望在这种情况下接受戒烟咨询。拟议的研究将 分两个阶段进行。在第一阶段，我们将探讨可接受的干预类型，低- 通过焦点小组向父母吸烟者提供收入。对儿科护士、医生和医院的集中访谈 将对管理人员进行调查，以探索干预可持续性的障碍，这将有助于未来 干预计划。这些数据将被用来开发基于PED的父母戒烟干预。在.期间 第二阶段，我们将进行一项试验性的前瞻性试验，以检查我们筛查的有效性，简要 父母戒烟的干预和转诊治疗(SBIRT)干预。相同数量的 因SHSE相关疾病或非SHSE相关疾病而将孩子带到儿科的父母吸烟者 将使用经修改的临床实践指南的形式进行简短干预：治疗烟草 使用和依赖。干预组件可以包括使用“建议”的短暂戒烟咨询， 评估和协助“方法；关于儿童健康和安全方面的信息；直接连接到Quitline(QL)在 和/或免费给予尼古丁替代疗法(NRT)。健康信念模式将被用于 探索这种环境特有的因素(例如，儿童的急性疾病)是否会缓和干预的效果 关于戒烟结果。干预后的结果将通过电话、电子邮件或短信进行评估 消息传递。如果有效，这种干预措施可以通过改善与烟草使用有关的健康差距 治疗和预防低收入、种族/族裔多元化吸烟者与烟草有关的疾病。

Exploring a Cessation Intervention for Low Income Smokers in an Emergency Setting An estimated 6.6 million parents who smoke visit pediatric emergency departments (PED) annually. Up to 50% of these parental smokers are from low-income, racially/ethnically diverse households in which a variety of tobacco-related disparities exist for both the parents and their children. The PED is an ideal and innovative setting in which to address these disparities, which include differences in tobacco use, pediatric second hand smoke exposure (SHSe), quit rates, access to cessation resources, and morbidity such as cancer. The proposed Career Development Award application will facilitate the candidate's growth as an independent cancer control physician scientist conducting research in the PED setting. The long-term career goal of the candidate is to become an effective independent researcher able to conduct parental cessation interventions in the PED that are readily translated into practice. The candidate's immediate career goal is to develop and test a cessation intervention for low-income smokers in the PED. To achieve this goal, the candidate proposes a career development plan that includes professional development, grant preparation, and a research plan to collect pilot data. The proposed research plan extends the candidate's prior smoking cessation work in the PED setting which indicates that parental smokers who visit the PED are aware of the pediatric effects of SHSe, motivated to quit, and eager to receive cessation counseling in this setting. The proposed research will be conducted in two phases. During Phase I, we will explore the types of interventions acceptable to low- income parental smokers via focus groups. Focused interviews of PED nurses, physicians, and hospital administrators will be conducted to explore barriers to intervention sustainability that will assist in future intervention planning. This data will be used to develop a PED-based parental cessation intervention. During Phase II, we will conduct a pilot prospective trial to examine the effectiveness of our screening, brief intervention, and referral to treatment (SBIRT) intervention on parental smoking cessation. Equal numbers of parental smokers who bring their child to the PED for either a SHSe-related illness or non SHSe-related illness will be given a brief intervention using an adapted form of the Clinical Practice Guideline: Treating Tobacco Use and Dependence. Intervention components may include brief cessation counseling using an "Advise, Assess, and Assist" approach; information on SHSe in children; direct connection to the Quitline (QL) in the PED; and/or free administration of nicotine replacement therapy (NRT). The Health Belief Model will be used to explore whether factors unique to this setting (e.g., child's acute illness) moderate the effect of the intervention on cessation outcomes. Outcomes will be assessed following the intervention via phone, email, or text messaging. If effective, this intervention could reduce health disparities related to tobacco use, by improving treatment and preventing tobacco-related morbidities in low-income, racially/ethnically diverse smokers.