Parents Awareness Reducing Exposure to Nicotine and Tobacco (PARENT)

描述（由申请人提供）：家长减少尼古丁和烟草接触的意识（家长）儿童接触二手烟（SHS）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一起生活。在70%以上既有成人吸烟者又有儿童的家庭中，允许在家中吸烟。托儿中心（CCCs）是一个未充分利用的儿童健康促进场所，对父母吸烟行为有潜在的重大影响。近60%的学龄前儿童每天接受非父母照顾。因此，接触到大量儿童和家长的潜力是巨大的。培训幼儿工作者进行戒烟/减少二手烟的简短烟草干预，将使幼儿工作者做好准备，更有效地影响父母的烟草使用行为。因此，我们提出了一项发展可行性研究，以开发和试点测试一种系统干预措施，以减少在六个托儿中心就读的儿童的尼古丁和烟草暴露（PARENT）。PARENT系统干预针对两个人群：1)ccw和2)儿童及其父母/照顾者（P/Cs）。该中心旨在通过以下方式促进以家庭为中心的方法，为整个家庭创造无烟环境：a)对ccw进行简短的戒烟/减少二手烟的干预培训；b)实施常规的二手烟筛查，以识别有风险的儿童；c)在中心环境中增加戒烟/减少二手烟暴露的教育以及家长参与活动。本研究分为四个阶段：第一阶段：形成性研究和干预发展。第二阶段：估算儿童二手烟暴露的吸烟率研究；记录父母对二手烟和吸烟的知识、态度和行为（n~650）；并确定有资格参加试点干预研究的暴露于SHS的儿童。第三阶段：试点干预可行性研究。6个CCCs将被随机分配到父母干预组或比较干预组（在职营养/身体活动）（每个研究条件下有3个CCCs， n=120对父母/儿童，20对/中心）。主要结局指标为：1)儿童唾液可替宁测量的SHS暴露；2)与吸烟和SHS暴露相关的自我报告P/C行为的变化。次要措施包括：1)CCW对P/Cs烟草干预措施的报告，2)CCW收到的干预措施的P/C报告，以及3)CCCs的二手烟暴露筛查率和烟草教育实施情况（系统变化措施）。这些措施背后的假设是，托儿中心的系统性变化将反映在干预地点的儿童中较低的可替宁水平上，这种变化将通过与吸烟和SHS暴露相关的父母/照顾者行为的积极变化来调节。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大小和可行性结果，完善PARENT干预，仪器和研究设计特征，为全动力III期随机对照疗效试验寻求资金。

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.