DESCRIPTION (Applicant's Description) Translating effective treatment
approaches for smoking cessation to the pediatric emergency room setting
will allow us to reach populations which are less accessible through more
traditional channels. As children present with acute respiratory tract
problems, including otitis media, pneumonia, and asthma, health care
providers have the unique opportunity to motivate parents/caretakers to quit
smoking as a means of reducing risk of recurrent illness for their children,
as well as for themselves. Therefore, we propose to test the incremental
efficacy of brief physician advice plus a motivational counseling
intervention-and follow-up on parental smoking cessation rates over advice
alone. The defined population will be parents who smoke accompanying
children who present with respiratory problems. This population includes a
high proportion of low income, low education, multiethnic smokers who will
also vary in their readiness to quit smoking. Smokers will be randomly
assigned to one of two intervention conditions, (a) brief physician advice
(standard treatment); and (b) brief physician advice, with the addition of a
tailored motivational intervention, behavioral skills counseling (for
parents willing to make a quit attempt), and tailored follow up mailings to
the parent and to the child's primary care provider to reinforce the key
messages (enhanced intervention). The enhanced intervention is based on a
motivational interviewing approach and stages of change, with multiple
messages from multiple providers. These treatment components were selected
to maximize effectiveness while maintaining cost efficiency and
generalizability for other ER settings. We hypothesize that 6-month 7-day
point prevalence quit rates will be 5 percent and 10 percent in each of the
two treatment groups, respectively. This study is the first to evaluate the
efficacy of smoking cessation intervention for parents in the emergency room
setting. If successful, the results of the study can be generalized to
similar populations in other emergency room settings, where the burden of
smoking-related illness is felt most acutely.
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