Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania.
Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, Arizona.
Am J Prev Med. 2020 Jan;58(1):21-30. doi: 10.1016/j.amepre.2019.08.021. Epub 2019 Nov 21.
Standard care interventions to reduce children's tobacco smoke exposure (TSE) may not be sufficient to promote behavior change in underserved populations. A previous study demonstrated the short-term efficacy of an experimental counseling intervention, Family Rules for Establishing Smokefree Homes (FRESH) compared with standard care on boosting low-income children's TSE reduction and maternal smoking at 16-week end of treatment (EOT). This study tested long-term posttreatment efficacy of this treatment through a 12-month follow-up.
This study was a two-arm RCT.
SETTING/PARTICIPANTS: Maternal smokers (n=300) not seeking cessation treatment were recruited from low-income, urban communities. Participants exposed their <4-year-old children to tobacco smoke daily. Data collection and analyses occurred from 2006 to 2018.
The FRESH behavioral intervention included 2 home visits and 7 phone sessions. FRESH used cognitive behavioral skills training, support, problem-solving, and positive social reinforcement to facilitate the adoption of increasingly challenging TSE-protection behaviors. No nicotine-replacement therapy or medication was provided.
Primary outcomes were child cotinine (TSE biomarker) and reported TSE from EOT through 12 months after treatment. A secondary outcome was bioverified maternal smoking cessation.
Compared with controls, children in FRESH had significantly lower cotinine (β= -0.31, p<0.01) and lower maternal-reported TSE (β= -1.48, p=0.001) through the 12-month follow-up. A significant effect of time (β= -0.03, p=0.003) reflected a posttreatment decrease in cotinine. There was no treatment × time interaction, suggesting the treatment effect at EOT was sustained after treatment. Compared with controls, FRESH mothers maintained significantly higher odds of quitting smoking from EOT through 12-month follow-up (OR=8.87, 95% CI=2.33, 33.75).
Study results with a sample of underserved maternal smokers demonstrated that the short-term effect of FRESH counseling at 16-week EOT was maintained through 12 months after treatment-for both bioverified child TSE reduction and maternal smoking cessation. Smokers in low-income communities demonstrate elevated challenges to success in standard smoking treatment. FRESH follow-up results suggest the high potential value of more-intensive behavioral intervention for vulnerable smokers.
This study is registered at www.clinicaltrials.gov NCT02117947.
标准的减少儿童接触烟草烟雾（TSE）的干预措施可能不足以促进服务不足人群的行为改变。先前的研究表明，与标准护理相比，一项实验性咨询干预措施“家庭规则建立无烟家庭”（FRESH）在促进低收入儿童减少 TSE 和母亲在治疗结束时（EOT）16 周内戒烟方面具有短期疗效。本研究通过 12 个月的随访测试了这种治疗方法的长期治疗后效果。
这是一项双臂 RCT。
地点/参与者：从低收入城市社区招募不寻求戒烟治疗的吸烟母亲（n=300）。参与者让他们<4 岁的孩子每天接触烟草烟雾。数据收集和分析于 2006 年至 2018 年进行。
FRESH 行为干预包括 2 次家访和 7 次电话会议。FRESH 使用认知行为技能培训、支持、解决问题和积极的社会强化来促进采用越来越具有挑战性的 TSE 保护行为。不提供尼古丁替代疗法或药物。
主要结果是儿童可替宁（TSE 生物标志物）和治疗后 12 个月内报告的 EOT 期间的 TSE。次要结果是生物验证的母亲戒烟。
与对照组相比，FRESH 组儿童的可替宁（β=-0.31，p<0.01）和母亲报告的 TSE（β=-1.48，p=0.001）在 12 个月的随访中均显著降低。时间的显著影响（β=-0.03，p=0.003）反映了治疗后可替宁的下降。没有治疗×时间的相互作用，这表明 EOT 时的治疗效果在治疗后持续存在。与对照组相比，FRESH 母亲从 EOT 到 12 个月的随访期间保持了更高的戒烟几率（OR=8.87，95%CI=2.33，33.75）。
在一个服务不足的吸烟母亲样本中进行的研究结果表明，FRESH 咨询在 16 周 EOT 的短期效果在治疗后 12 个月内保持不变-既可以降低儿童的生物验证 TSE，也可以使母亲戒烟。低收入社区的吸烟者在成功进行标准吸烟治疗方面面临更高的挑战。FRESH 随访结果表明，对弱势吸烟者进行更强化的行为干预具有很高的潜在价值。
本研究在 www.clinicaltrials.gov 上注册，编号为 NCT02117947。
