DESCRIPTION (provided by applicant): Parents' Awareness Reducing Exposure to Nicotine and Tobacco (PARENT) Second hand smoke (SHS) exposure in children is a major public health problem. As many as 43% or more than 15 million U.S. children live with a smoker. In more than 70% of homes with both adult smokers and children, smoking is allowed within the home. Childcare centers (CCCs) are an underutilized venue for child health promotion and have a potentially significant influence on parental smoking behavior. Nearly 60% of preschoolers receive non-parental care on a daily basis. Thus, the potential to reach a large number of children and parents is substantial. Training child care workers (CCWs) to conduct brief tobacco interventions (BI) for smoking cessation/SHS reduction, will prepare CCWs to more effectively influence parental tobacco use behavior. Thus we propose a developmental feasibility study to develop and pilot test a system intervention to reduce SHS exposure in children attending six childcare centers, entitled Parents Awareness Reducing Exposure to Nicotine and Tobacco (PARENT). The PARENT system intervention targets two populations: 1) CCWs and 2) children and their parents/caregivers (P/Cs). It is designed to promote family-centered approaches to creating smoke-free environments for the whole family through a combination of a) brief tobacco cessation/SHS reduction intervention training of CCWs, b) implementation of routine SHS screening to identify children at risk, c) adding education on tobacco cessation/SHS exposure reduction to the center's environment and parent involvement activities. The proposed project has four stages: Stage I - formative research and intervention development. Stage II- smoking prevalence study to estimate children's SHS exposure; document parental knowledge, attitudes, and behaviors with regards to SHS and smoking (n~650); and identify SHS- exposed children who are eligible for the pilot intervention study. Stage III - pilot intervention feasibility study. Six CCCs will be randomized to the PARENT intervention or a comparison intervention (nutrition/physical activity inservice) (3 CCCs in each study condition, n=120 parent/child pairs, 20 pairs/center). Primary outcome measures are: 1) children's' SHS exposure as measured by salivary cotinine and 2) changes in self-reported P/C behaviors related to smoking and SHS exposure. Secondary measures include 1) CCW reports of tobacco interventions with P/Cs, 2) P/C reports of interventions received from CCWs, and 3) rates of SHS exposure screening and implementation of tobacco education at CCCs (measures of system change). The hypotheses underlying these measures are that systemic changes in the childcare center will be reflected in lower cotinine levels among the children in the intervention sites, and that this shift will be mediated by positive changes in parent/caregiver behaviors related to smoking and SHS exposure. Stage IV - repeat the prevalence survey, analyze data, and based on effect sizes and feasibility results from the pilot intervention study, refine the PARENT intervention, instruments and study design features in preparation to seek funding for a fully-powered Phase III randomized controlled efficacy trial.
Tobacco use and the resulting death and disease continue to be the single greatest threat to public health in the United States today. Most tobacco users are smokers. The threat to the public health from cigarette second hand smoke (SHS) has been well-documented. Children are especially vulnerable to SHS. Because SHS is an acknowledged threat to public health, population-based strategies to change smoking behavior and reduce SHS are highly relevant.
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