DESCRIPTION (provided by investigator): Exposure to parents' environmental
tobacco smoke (ETS) is a significant behavioral health problem that poses
serious medical risks for patients who are being treated for cancer. Pediatric
cancer patients are at risk for cardiopulmonary and respiratory complications
secondary to treatment-related toxicities, and exposure to ETS can exacerbate
these adverse health outcomes. Despite these risks, many parents smoke around
their child who is undergoing curative cancer therapy. Therefore, the primary
objective of this project is to determine the differential efficacy of a
parent-based behavioral counseling intervention for reduction of ETS exposure
as compared to a Standard Care Control (SCC) condition, as measured by parent
report and a biological urine cotinine assay. We will also examine the impact
of our intervention on psychosocial variables related to ETS exposure as well
as health outcomes in the pediatric cancer patient.
Our counseling intervention is a behavioral shaping program that is
specifically tailored to account for the features that are unique to the
child's diagnosis of cancer and addresses ETS exposure in the context of unique
cancer-related circumstances. The components of the intervention include: 1)
health counseling focused on ETS-related health problems of children undergoing
cancer therapy, 2) behavioral skills counseling involving goal setting, problem
solving, shaping, positive feedback and stress management, 3) telephone
counseling, 4) physician feedback, and 5) written worksheets to reinforce the
counseling sessions. Development of the counseling program is based on the
components of the Health Belief Model and Social Learning Theory.
Following program development, feedback from a parent advisory panel, and pilot
testing, 154 parents of cancer patients with a primary diagnosis of malignancy
between the ages of 3 to 17 years, will be randomized to either a Standard Care
Control (SCC) or an intervention group. Parents in the SCC group will be
advised about the risks associated with ETS exposure and encouraged to stop
smoking in the child's environment. Parents in the intervention group will
participate in the counseling intervention described above. The impact of our
intervention on parent reported ETS exposure and urinary cotinine assays will
be evaluated at baseline, 3, 6, 9, and 12 months. Our planned clinical trial
may verify the effectiveness of an important clinical service for this
vulnerable population that can be adapted for other pediatric oncology
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