DESCRIPTION (provided by applicant): Nearly 25 million US adults and 6.4 million children living today will die prematurely from tobacco-attributable diseases unless adults are successful with cessation and rates of child tobacco use are halted. Fifteen million US children <18 years old are exposed to environmental tobacco smoke (ETS) mostly in their homes and parent modeling of smoking is identified as an important factor for the 4,000 children who initiate tobacco use each day. With widening gaps in health disparities for African Americans (AAs) related to the health effects of tobacco use, culturally sensitive approaches that may be effective need to be fully tested. Based on concepts from Social Cognitive Theory and taking a social ecological perspective, this research will investigate the effects of a family approach that includes child and parent/guardian (PIG) interventions on tobacco control. Subjects will include 4th grade AA children (N=400) and Ps/Gs; 50% rural and 50% inner-city. Using a two group design with repeated measures, schools (20) will be randomly assigned to treatment or control. Children and Ps/Gs in the treatment group will receive a yearly intervention for two years and the control group will receive matched contact and attention on general health education. The child intervention (Botvin's LifeSkills (BLS) consist of 8 classroom sessions taught during 4th and 5th grades (16 total sessions) by trained school personnel. The PIG intervention (BLS Parent) consists of 8 home-based modules during the 4th and 5th grades that promote PIG use of anti- tobacco socialization in the home and reinforce the school-based child intervention. Ps/Gs who smoke will also receive motivational interviewing and nicotine replacement therapy based on their readiness to quit. Behavioral change will be measured by self-report in children and Ps/Gs at baseline, 12 weeks (short-term) and 9 months (long-term) after each year of intervention (2) and also via salivary cotinine at three time points (baseline, at year 2 and at year 4). We propose this family approach will foster development of personal and environmental protective factors in children and their Ps/Gs for tobacco control. The primary hypotheses are: Children and Ps/ Gs in the treatment group will have improved behavioral outcomes of: 1) lower ETS exposure in children; 2) lower rates of tobacco experimentation in children; 3) higher PIG self-efficacy in delivering anti-tobacco socialization in the home; and 4) higher tobacco cessation rates in Ps/Gs. This research addresses a significant public health concern, tobacco use, which remains the single most preventable cause of morbidity and mortality. Consistent with both the NCI and the NICHD, this application targets the advancement of socio-cultural behavioral treatments for children and their families, the prevention of tobacco-related diseases, particularly cancer, and the elimination of health disparities among an ethnic minority group-AA. The need for theory-based effective interventions validated by biochemical measures is imperative for tobacco control. If effective, implementation of this family approach via the school systems as the primary point of entry is highly probable.
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