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

描述(由申请人提供)：据估计，每年有660万吸烟的父母到儿科急诊科就诊。这些父母吸烟者中多达50%来自低收入、种族/民族多元化的家庭，在这些家庭中，父母及其子女都存在着与烟草有关的各种差异。PED是解决这些差异的理想和创新环境，这些差异包括烟草使用、儿科二手烟暴露(SHSE)、戒烟率、戒烟资源的获得以及癌症等发病率的差异。拟议的职业发展奖申请将促进候选人作为一名在PED环境下进行研究的独立癌症控制内科科学家的成长。候选人的长期职业目标是成为一名有效的独立研究人员，能够在PED中进行父母戒烟干预，并易于转化为实践。候选人的直接职业目标是为PED的低收入吸烟者开发和测试戒烟干预措施。为了实现这一目标，候选人提出了一项职业发展计划，其中包括专业发展、拨款准备和收集飞行员数据的研究计划。拟议的研究计划扩展了候选人先前在PED环境下的戒烟工作，这表明去PED的父母吸烟者意识到SHSE的儿科影响，有戒烟动机，并渴望在这种环境下接受戒烟咨询。拟议的研究将分两个阶段进行。在第一阶段，我们将通过焦点小组探索低收入父母吸烟者可以接受的干预类型。将对PED护士、医生和医院管理人员进行集中访谈，以探索干预可持续性的障碍，这将有助于未来的干预计划。这些数据将被用来开发基于PED的父母戒烟干预。在第二阶段，我们将进行一项试验性的前瞻性试验，以检验我们的筛查、短暂干预和转介治疗(SBIRT)干预对父母戒烟的有效性。同样数量的带着孩子来PED的父母吸烟者，无论是患有SHSE相关疾病还是非SHSE相关疾病，都将使用修改后的临床实践指南：治疗烟草使用和依赖接受简短的干预。干预措施可能包括使用“建议、评估和协助”方法进行短暂的戒烟咨询；关于儿童SHSE的信息；直接与PED中的Quitline(QL)连接；和/或免费实施尼古丁替代疗法(NRT)。健康信念模型将被用来探索这种环境中特有的因素(例如，儿童的急性疾病)是否缓和了干预对戒烟结果的影响。干预后的结果将通过电话、电子邮件或短信进行评估。如果有效，这种干预措施可以通过改善治疗和预防低收入、种族/族裔多元化吸烟者与烟草有关的疾病，减少与烟草使用有关的健康差距。 公共卫生相关性：在带着孩子去儿科急诊科就诊的父母吸烟者中，烟草使用的流行率高得不成比例。这些父母吸烟者中多达50%来自低收入、种族/民族多元化的家庭，在这些家庭中，成年吸烟者及其受到二手烟暴露(SHSE)不利影响的子女之间存在着各种与烟草有关的差异。这项拟议的研究旨在为从PED招募的低收入吸烟者开发和测试戒烟干预措施。将评估有无SHSE相关症状的孩子的父母的戒烟结果。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The prevalence of tobacco use is disproportionately high among parental smokers who visit the pediatric emergency department (PED) with their children. 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 the adult smokers and for their children who are adversely affected by second hand smoke exposure (SHSe). The proposed study seeks to develop and test a smoking cessation intervention for low-income smokers recruited from the PED. Cessation outcomes will be assessed on parents who have children with and without a SHSe-related complaint.