Abstract
BackgroundSecondhand smoke exposure (SHSe) harms children’s health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers’ advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations.Methods/designThis trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status.DiscussionThis study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to “ask, advise, and refer” guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.Trial registrationNCT01745393 (clinicaltrials.gov).
Highlights
Secondhand smoke exposure (SHSe) harms children’s health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice
The Kids Safe and Smokefree (KiSS) program addresses these limitations via a multilevel intervention model that integrates a pediatric clinic-level intervention with more intensive individual-level behavioral counseling and navigation to community-level services for nicotine dependence
Prior to beginning telephone counseling related to smoking and child SHSe, KiSS staff members visit participants in their home to provide an orientation to the intervention program, share a program binder that is used in conjunction with the telephone counseling, and collect a baseline urine sample from the target child for cotinine assessment
Summary
Current approaches to pediatric SHSe reduction have limitations that weaken potential effectiveness when implemented at a single level. Findings from the secondary mediator and moderator aims will inform science and theory in this field by identifying how and for whom the intervention works The significance of this multilevel approach could be realized through its influence on improved clinical practice by: a) improving tobacco intervention training and resources, b) simplifying and minimizing steps necessary for pediatric providers to adhere to tobacco intervention guidelines, and c) providing clinics with a parental smoking referral resource that helps parents get tobacco dependence treatment medications and addresses tobacco use and exposure in contexts where children’s SHSe is the greatest.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
