DESCRIPTION (provided by applicant): Secondhand tobacco smoke (SHS) exposure is an important cause of morbidity and mortality among children; it is related to multiple diseases and increases the risk of hospitalization. Effective interventions exist for smoking cessation. In addition to the need for effective cessation interventions, there is an important role for counseling on exposure reduction, especially as evidence suggests that families with home smoking bans are more likely to quit smoking over time. Several studies have studied effective ways to provide cessation and exposure reduction counseling to parents of children in the outpatient setting and for adult inpatient smokers, including the Clinical Effort Against Secondhand Smoke (CEASE) project. The inpatient stay presents different challenges and opportunities from outpatient practice in the treatment of children's smoke exposure. The hospitalization of a child may present a teachable moment for parents who smoke. Several small studies of parents of hospitalized children have found modest success with inpatient interventions involving counseling, and QuitLine referral or nicotine replacement therapy. Our intervention uses the evidence-based US Public Health Service Treating Tobacco Use and Dependence guidelines coupled with the best evidence specific to using the child's inpatient stay to help parents quit smoking and reduce their children's exposure. We will use the RE-AIM framework to evaluate and maximize our institution's readiness to change, as well as intervention implementation and maintenance. We are proposing a randomized controlled trial to test the efficacy of our intervention bundle. The specific aims of the study are: Aim 1) To assess the efficacy of the intervention in increasing parent report of having smoke-free homes and cars 6 months after hospitalization; Aim 2) To demonstrate whether children whose parents receive the intervention bundle have greater decreases in cotinine levels 6 months post-hospitalization; Aim 3) To assess the efficacy of the intervention in increasing parent quit rates months after hospitalization; Aim 4) To use implementation process measures from the RE-AIM framework to assess the extent that our intervention results in hospital-wide systems change, including automatic screening for tobacco smoke exposure and delivery of tobacco control services. To achieve these aims, we are proposing a randomized controlled trial of our intervention bundle, which is evidence-based, effective in outpatient settings, and pilot-tested within our institution. We will follow both the control and intervention groups for 6 months, and use biological markers of exposure to assess exposure reduction and parent cessation. Understanding whether traditional smoking cessation interventions can help parents of hospitalized children will give inpatient providers an effective toolkit for providing a comprehensive intervention for tobacco cessation and exposure reduction.
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