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Lepore SJ , Collins BN , Coffman DL , Winickoff JP , Nair US , Moughan B , Bryant-Stephens T , Taylor D , Fleece D , Godfrey M
Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial
Int J Environ Res Public Health. 2018 Jun 12;15(6)
PMID: 29895740    PMCID: PMC6025102    URL: https://www.ncbi.nlm.nih.gov/pubmed/29895740
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BACKGROUND: Pediatricians following clinical practice guidelines for tobacco intervention (“Ask, Advise, and Refer” [AAR]) can motivate parents to reduce child tobacco smoke exposure (TSE). However, brief clinic interventions are unable to provide the more intensive, evidence-based behavioral treatments that facilitate the knowledge, skills, and confidence that parents need to both reduce child TSE and quit smoking. We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone. METHODS: Pediatricians were trained to implement AAR with parents during clinic visits and reminded via prompts embedded in electronic health records. Following AAR, parents were randomized to intervention (AAR + counseling) or nutrition education attention control (AAR + control). Child TSE and parent quit status were bioverified. RESULTS: Participants (n = 327) were 83% female, 83% African American, and 79% below the poverty level. Child TSE (urine cotinine) declined significantly in both conditions from baseline to 12 months (p = 0.001), with no between-group differences. The intervention had a statistically significant effect on 12-month bioverified quit status (p = 0.029): those in the intervention group were 2.47 times more likely to quit smoking than those in the control. Child age was negatively associated with 12-month log-cotinine (p = 0.01), whereas nicotine dependence was positively associated with 12-month log-cotinine levels (p = 0.001) and negatively associated with bioverified quit status (p = 0.006). CONCLUSIONS: Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation.
1660-4601 Lepore, Stephen J Orcid: 0000-0001-7370-6280 Collins, Bradley N Orcid: 0000-0003-3703-9630 Coffman, Donna L Winickoff, Jonathan P Nair, Uma S Moughan, Beth Bryant-Stephens, Tyra Taylor, Daniel Fleece, David Godfrey, Melissa Journal Article Switzerland R01 CA158361/CA/NCI NIH HHS/ Research Support, N.I.H., Extramural Int J Environ Res Public Health. 2018 Jun 12;15(6). pii: ijerph15061239. doi: 10.3390/ijerph15061239.