Collins Bradley N, Lepore Stephen J
Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA.
BMC Public Health. 2017 Mar 14;17(1):249. doi: 10.1186/s12889-017-4145-7.
Addressing children's tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations.
METHODS/DESIGN: This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the "Ask, Advise, Refer (AAR)" best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline.
This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.
Clinicaltrials.gov NCT02602288 . Registered 9 November 2015.
解决儿童接触烟草烟雾（TSE）问题仍然是公共卫生的重点。然而，治疗的接受率较低且效果不佳，尤其是在面临吸烟行为改变诸多挑战的低收入人群中。一种多层次干预措施，将系统层面的健康信息传递以及在社区诊所提供的关于TSE的建议（这些诊所同时发放妇女、婴儿和儿童特别补充营养计划（WIC））与尼古丁替代疗法以及强化的多模式、个体层面的行为干预相结合，可能会改善此类高危人群对TSE的控制效果。
方法/设计：本试验采用随机两组设计，有三个测量点：基线、3个月和12个月随访。主要结局是经生物验证的儿童TSE；次要结局是经生物验证的母亲戒烟状态。从WIC诊所招募6岁以下儿童的吸烟母亲。所有参与者都接受基于儿科诊所“询问、建议、转介（AAR）”最佳实践指南的WIC系统层面干预。这包括培训所有WIC工作人员了解母亲控烟的重要性；并在日常工作流程中详细说明采用AAR干预提示的诊所，以提醒WIC营养顾问询问所有母亲关于儿童TSE的情况，告知TSE的危害和保护的益处，并将吸烟者转介至戒烟服务机构。在接受系统干预后，母亲们被随机分配接受3个月的额外治疗或注意力控制干预：（1）多模式行为干预（MBI）治疗包括关于减少儿童TSE和戒烟的电话咨询、提供尼古丁替代疗法、支持戒烟努力的移动应用程序以及关于TSE和戒烟的多媒体短信；（2）注意力控制干预提供与MBI同等的接触，包括以营养为重点的电话咨询、移动应用程序以及关于改善营养的多媒体短信。对照条件下的参与者也会被转介至州戒烟热线。
本研究测试了一种创新的基于社区的、多层次且综合的多模式方法，以减少弱势低收入人群中的儿童TSE。该方法具有可持续性且有广泛推广的潜力，因为WIC可以将烟草干预提示纳入日常工作流程，并将吸烟者转介至免费的循证行为咨询干预措施，如州戒烟热线。
Clinicaltrials.gov NCT02602288。于2015年11月9日注册。
