Assessment of Biomarkers in Children to Help Parents Quit Tobacco

摘要：在美国，烟草使用是导致发病率和死亡率的唯一最大的可预防原因 每年有48万人死亡，可归因成本达3 000亿美元。四分之一的 吸烟者在他们孩子的初级保健办公室看到，可能没有自己的初级保健医生。 当父母戒烟时，他们的预期寿命增加10年以上，未来与烟草有关的穷人 怀孕的结果是避免，儿童成为吸烟者的风险降低了四倍，家庭 更多的钱用于生活必需品，儿童不太可能因吸烟而患病 （TSE）。在儿科环境中向父母提供烟草控制援助将提供一个主要的 对国家的健康有益。我们以前的系统使用针对二手的临床努力来改变工作 吸烟暴露（CEASE）干预，以识别吸烟的父母，提供尼古丁替代治疗， 并将他们纳入戒烟热线，显示出儿科实践吸收和父母 结果。然而，CEASE干预面临着障碍，例如依赖父母自我报告， TSE，低估了儿童期暴露，以及可变的提供者对提供父母 停止援助。与吸烟者生活在一起的儿童接触二手和三手烟草 吸烟，并可能从使用电子尼古丁输送系统（ENDS）的父母气溶胶。常规 对儿童血液中的可替宁（尼古丁暴露的生物标志物）进行筛查，可以可靠地识别出患有 TSE暴露。现有的铅筛查项目已经成为儿科医疗服务的一部分， 显然，但目前尚未开发的机会，以筛选可替宁在良好的儿童访问。常规可替宁 使用已经采集的血液进行铅检测的儿童测量可以使TSE的管理制度化 in a comparable可比fashion时尚.客观可替宁测试的结果可用于激励供应商和 家长推广控烟及戒烟活动。我们的初步定性和定量工作 表明这种方法是可行的，可接受的，有效的。我们假设提供可替宁生物标志物 结果给儿科医生，个性化的可替宁反馈给父母关于他们孩子的毒素暴露， 支持所有家庭烟草使用者戒烟（生物标志物知情推广（BIO））， 在CEASE干预中增加戒烟援助将增加提供戒烟援助，增加家庭 停止，减少儿童的TSE，并具有成本效益。我们提出了一项在5名儿童中进行的双臂RCT 做法，在孩子的1岁健康儿童访问登记儿童和家长。入组的受试者将 随机分配至CEASE+BIO或CEASE组。为了比较CEASE+BIO与CEASE的有效性， 我们将在2年健康儿童访视时对登记的父母进行随访，以评估父母戒烟率和儿童的 TSE。试验结果可能导致TSE的普遍记录，并引发更有效的戒烟 支持与下一代生活在一起的年轻成年父母群体，他们暴露并影响下一代。

ABSTRACT: Tobacco use is the single greatest preventable cause of morbidity and mortality in the United States, accounting for 480,000 deaths and $300 billion in attributable costs annually. One quarter of all smokers are seen at their child’s primary care office and may not have a primary care doctor of their own. When parents quit smoking, their life expectancy is increased by over 10 years, future tobacco-related poor pregnancy outcomes are avoided, children have a four-fold lower risk of becoming smokers, the family has more money for necessities, and children are less likely to suffer diseases caused by tobacco smoke exposure (TSE). Routinely delivered tobacco control assistance to parents in the pediatric setting would provide a major health benefit to the nation. Our previous systems change efforts using the Clinical Effort Against Secondhand Smoke Exposure (CEASE) intervention to identify parents who smoke, deliver nicotine replacement therapy, and enroll them in the quitline have shown significant improvements in pediatric practice uptake and parent outcomes. However, the CEASE intervention has faced barriers, such as reliance on parental self-report of TSE, which underestimates childhood exposure, and variable provider adherence to delivering parental cessation assistance. Children who live with smokers are exposed to secondhand and thirdhand tobacco smoke, and potentially to aerosol from parents who use electronic nicotine delivery systems (ENDS). Routinely screening children’s blood for cotinine, a biomarker of nicotine exposure, could reliably identify children with TSE exposure. Extant lead screening programs, already part of pediatric healthcare delivery, provide an obvious, yet currently untapped opportunity to screen for cotinine at well-child visits. Routine cotinine measurement in children using blood already collected for lead testing can institutionalize management of TSE in a comparable fashion. Results from objective cotinine testing could be used to motivate both providers and parents to promote tobacco control and cessation activities. Our preliminary qualitative and quantitative work suggests this approach is feasible, acceptable, and effective. We hypothesize that providing cotinine biomarker results to pediatricians, personalized cotinine feedback to parents about their child’s toxin exposure, and offering support to all household tobacco users to quit tobacco use (Biomarker Informed Outreach (BIO)) when added to the CEASE intervention will increase delivery of tobacco cessation assistance, increase household cessation, reduce TSE in children, and be cost-effective. We propose a 2-arm RCT conducted in five pediatric practices, enrolling children and parents at the child’s 1-year well child visit. The enrolled subjects will be randomized to either CEASE+BIO or CEASE arms. To compare the effectiveness of CEASE+BIO vs. CEASE, we will follow-up with enrolled parents at the 2-year well child visit to assess parental quit rate and children’s TSE. Trial results could lead to universal documentation of TSE and trigger more effective tobacco cessation support for the group of young adult parents who live with, expose, and influence the next generation.