Clinical Response to Biomarker Documentation of Child Secondhand Smoke Exposure

描述（由申请人提供）：在美国，吸烟和二手烟（SHS）每年造成近50万例可预防的死亡。戒烟的父母会带来健康益处，给孩子树立不吸烟（和戒烟）的榜样，并停止在家里、车里和其他地方接触二手烟。美国儿科学会和美国家庭医生学会的国家倡议敦促医疗保健提供者对儿童进行SHS暴露史筛查，并建议父母戒烟和限制在家吸烟，但这些指导方针的遵守程度很低，超过25%的美国儿童继续在家中非自愿地暴露于SHS。需要有效的制度来促进父母戒烟和实施家庭吸烟限制。我们建议进行初步研究，以评估一种新的干预措施来实现这些目标。我们假设，常规测量和报告暴露于SHS儿童尿液中发现的烟草毒物（烟草特异性致癌物质，尼古丁和可替宁）水平的临床系统将1)增加提供者提供烟草治疗，2)增加父母参与烟草治疗，3)增加父母戒烟，4)减少儿童接触二手烟。我们建议在医疗保健提供者和父母之间开展形成性工作，以开发干预措施，并对干预措施对提供者和父母的影响进行试点测试。我们会在员工中进行焦点小组讨论，以确定培训需求，制定方法将干预措施与办公室实践相结合，并评估实施的障碍。我们还将在家长中开展焦点小组，以评估提供尿液样本的意愿、最佳反馈格式以及对生物标志物数据的反应。焦点小组的结果将用于制定实验性治疗方案。我们将在明尼苏达大学初级保健诊所的一项两组随机试点研究中测试干预措施。我们将招募80名父母吸烟的0-12岁儿童。我们将为所有家长提供健康生活方式选择方面的简短行为咨询。一个小组将对40对亲子进行实验性干预，另一个小组作为对照。接受试验组治疗的儿童将提供尿样以检测亚硝胺（一种烟草特有的致癌物）、尼古丁和可替宁。我们将使用电子病历将实验室结果告知提供者，并将这些结果纳入旨在促进戒烟和限制家庭吸烟的父母烟草咨询中。主要结果将是提供者提供戒烟治疗。我们还将在实验组和对照组中测量父母参与治疗、戒烟和家庭吸烟限制制度的影响。研究小组为该项目带来了在新型烟草干预、卫生服务研究和生物标志物评估方面的丰富经验。儿童尿液中烟草毒物的常规记录有可能极大地改变对有吸烟风险家庭的临床护理。公共卫生相关性：本项目测试暴露于二手烟的儿童尿液中烟草毒物对提供者和父母行为的影响。干预的目的是帮助父母戒烟，减少儿童接触二手烟。

DESCRIPTION (provided by applicant): Smoking and secondhand smoke (SHS) are responsible for nearly a half-million preventable deaths in the United States every year. Parent(s) who stop smoking incur health benefits, model non-smoking (and quitting) to children and stop exposure to SHS in the home, car and other locations. National initiatives from the American Academy of Pediatrics and the American Academy of Family Physicians urge healthcare providers to screen children for a history of SHS exposure and to recommend that parents stop smoking and restrict smoking at home, but compliance with these guidelines is poor and more than 25% of children in the U.S. continue to be involuntarily exposed to SHS in the home. Effective systems are needed to increase parental smoking cessation and implement home smoking restrictions. We propose preliminary studies to evaluate a novel intervention to accomplish these objectives. We hypothesize that a clinic system that routinely measures and reports levels of tobacco toxicants (tobacco-specific carcinogens, nicotine and cotinine) found in the urine of children exposed to SHS will 1) increase provider delivery of tobacco treatment, 2) increase parental participation in tobacco treatment, 3) increase parental smoking cessation and 4) reduce childhood exposure to secondhand smoke. We propose formative work among healthcare providers and parents to develop the intervention and to pilot test the effects of the intervention on providers and parents. We will conduct focus groups among staff to identify training needs, develop methods to integrate the intervention with office practice and assess barriers to implementation. We will also conduct focus groups among parents to assess willingness to provide urine specimens, optimal feedback format and reactions to biomarker data. Results from focus groups will be used to develop the experimental treatment protocol. We will test the intervention in a two-group randomized pilot study in the University of Minnesota Primary Care Clinic. We will recruit 80 children age 0-12 with a parent who smokes. We will provide brief behavioral counseling in healthy lifestyle options to all parents. One provider team will implement the experimental intervention in 40 parent-child pairs and the other team will serve as the control. Children who see providers in the experimental group will provide a urine sample to test for nitrosamines (a tobacco-specific carcinogen), nicotine and cotinine. We will communicate laboratory results to providers using the electronic medical record and incorporate these results in parental tobacco counseling designed to promote smoking cessation and home smoking restrictions. The primary outcome will be provider delivery of smoking cessation treatment. We will also measure effects on parental engagement in treatment, smoking cessation and institution of home smoking restrictions in both the experimental and control groups. The research team brings extensive experience with novel tobacco interventions, health services research and biomarker assessment to the project. Routine documentation of tobacco toxicants in children's urine has potential to dramatically alter clinical care for families at risk from smoking. PUBLIC HEALTH RELEVANCE: This project tests the effect of demonstrating tobacco toxicants in the urine of children exposed to secondhand smoke on provider and parent behavior. The intervention is designed to help parents stop smoking and reduce childhood exposure to secondhand smoke.