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Am J Prev Med. 2015 Oct;49(4):534-44. doi: 10.1016/j.amepre.2015.03.008. Epub 2015 May 28.

Reducing Underserved Children's Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers.

Author information

1
Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania. Electronic address: collinsb@temple.edu.
2
Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
3
Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California.
4
Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
5
Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.

Abstract

INTRODUCTION:

Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure.

DESIGN:

A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded.

SETTING/PARTICIPANTS:

Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline.

INTERVENTION:

Philadelphia Family Rules for Establishing Smoke-free Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smoke-free home.

MAIN OUTCOME MEASURES:

Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status.

RESULTS:

Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ(2)=10.56, p<0.01). There was no moderating effect of other smokers living at home.

CONCLUSIONS:

FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population.

TRIAL REGISTRATION:

This study is registered at www.clinicaltrials.gov NCT02117947.

PMID:
26028355
PMCID:
PMC4575825
DOI:
10.1016/j.amepre.2015.03.008
[Indexed for MEDLINE]
Free PMC Article

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