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Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial

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Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, 9th Floor Ritter Annex, Philadelphia, PA 19122, USA
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Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Philadelphia, PA 19122, USA
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Massachusetts General Hospital Division of Pediatrics, 125 Nashua St, Suite 860, Boston, MA 02144, USA
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Health Promotion Sciences Department, 3950 S. Country Club Rd, Suite 300, PO Box: Abrams 300, Tucson, AZ 85714, USA
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Temple Pediatric Care, Temple University School of Medicine, 3509 N. Broad St, Philadelphia, PA 19140, USA
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Roberts Pediatric Clinical Research Building, Children’s Hospital of Philadelphia, 26 South St, 9th Floor, Philadelphia, PA 19146, USA
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Department of Pediatrics, St. Christopher’s Hospital for Children, Front and Erie, Philadelphia, PA 19134, USA
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Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2018, 15(6), 1239; https://doi.org/10.3390/ijerph15061239
Received: 29 April 2018 / Revised: 5 June 2018 / Accepted: 7 June 2018 / Published: 12 June 2018
(This article belongs to the Special Issue Reducing Exposure to Second-Hand Tobacco Smoke)
Background: Pediatricians following clinical practice guidelines for tobacco intervention (“Ask, Advise, and Refer” [AAR]) can motivate parents to reduce child tobacco smoke exposure (TSE). However, brief clinic interventions are unable to provide the more intensive, evidence-based behavioral treatments that facilitate the knowledge, skills, and confidence that parents need to both reduce child TSE and quit smoking. We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone. Methods: Pediatricians were trained to implement AAR with parents during clinic visits and reminded via prompts embedded in electronic health records. Following AAR, parents were randomized to intervention (AAR + counseling) or nutrition education attention control (AAR + control). Child TSE and parent quit status were bioverified. Results: Participants (n = 327) were 83% female, 83% African American, and 79% below the poverty level. Child TSE (urine cotinine) declined significantly in both conditions from baseline to 12 months (p = 0.001), with no between-group differences. The intervention had a statistically significant effect on 12-month bioverified quit status (p = 0.029): those in the intervention group were 2.47 times more likely to quit smoking than those in the control. Child age was negatively associated with 12-month log-cotinine (p = 0.01), whereas nicotine dependence was positively associated with 12-month log-cotinine levels (p = 0.001) and negatively associated with bioverified quit status (p = 0.006). Conclusions: Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation. View Full-Text
Keywords: secondhand smoke; pediatric; tobacco control; smoking cessation; intervention secondhand smoke; pediatric; tobacco control; smoking cessation; intervention
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Lepore, S.J.; Collins, B.N.; Coffman, D.L.; Winickoff, J.P.; Nair, U.S.; Moughan, B.; Bryant-Stephens, T.; Taylor, D.; Fleece, D.; Godfrey, M. Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial. Int. J. Environ. Res. Public Health 2018, 15, 1239.

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