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

Stephen J. Lepore, Bradley N. Collins, Donna L. Coffman, Jonathan P. Winickoff, Uma S. Nair, Beth Moughan, Tyra Bryant-Stephens, Daniel Taylor, David Fleece and Melissa Godfrey
Additional contact information
Stephen J. Lepore: 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
Bradley N. Collins: 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
Donna L. Coffman: Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Philadelphia, PA 19122, USA
Jonathan P. Winickoff: Massachusetts General Hospital Division of Pediatrics, 125 Nashua St, Suite 860, Boston, MA 02144, USA
Uma S. Nair: 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
Beth Moughan: Temple Pediatric Care, Temple University School of Medicine, 3509 N. Broad St, Philadelphia, PA 19140, USA
Tyra Bryant-Stephens: Roberts Pediatric Clinical Research Building, Children’s Hospital of Philadelphia, 26 South St, 9th Floor, Philadelphia, PA 19146, USA
Daniel Taylor: Department of Pediatrics, St. Christopher’s Hospital for Children, Front and Erie, Philadelphia, PA 19134, USA
David Fleece: Temple Pediatric Care, Temple University School of Medicine, 3509 N. Broad St, Philadelphia, PA 19140, USA
Melissa Godfrey: 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

IJERPH, 2018, vol. 15, issue 6, 1-16

Abstract: 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.

Keywords: secondhand smoke; pediatric; tobacco control; smoking cessation; intervention (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2018
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (5)

Downloads: (external link)
https://www.mdpi.com/1660-4601/15/6/1239/pdf (application/pdf)
https://www.mdpi.com/1660-4601/15/6/1239/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:15:y:2018:i:6:p:1239-:d:151965

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().