Tobacco Use Cessation Clinical Trial
Official title:
Evaluation of the Smoking Cessation and Tobacco Use Exposure Patterns of Head Start Parents in Boston
This project proposes to evaluate the effectiveness of training Head Start staff to discuss tobacco use, shs reduction and cessation in their existing encounters with parents in reducing tobacco use and exposure. Understanding the facilitators and barriers to integrating the intervention into the Head Start system will support future efforts to address tobacco use and exposure in families with small children.
Parental smoking increases children's risk of asthma, infectious illness, sudden infant
death syndrome (SIDS), and other conditions. Accumulating evidence regarding the adverse
effects of total smoke exposure (TSE) led the US Surgeon General to conclude that there is
no safe level of TSE. Parents who smoke endanger themselves, put their children and spouses
at risk for adverse health outcomes, and increase the chance of their children becoming
smokers. However, many parents who smoke are undertreated for their tobacco addiction. Many
parents who smoke are of the age where they have few contacts with primary care physicians
and are often unexposed to counseling and pharmacotherapy offered to older patients.
Strategically identifying sites where trained para-professionals routinely interact with
parents who smoke is vital to making inroads in this high-risk population.
Involuntary secondhand smoke exposure (SHSe) in domestic environments is an entirely
preventable public health threat that disproportionately burdens young children in
communities of low socioeconomic position. Research has indicated that interventions to
reduce SHSe for children delivered through child care settings have been effective. In
addition, client-centered approaches, such as motivational interviewing, have been effective
in helping parents to reduce levels of SHS in the home environment. Following guidelines
from established agencies and organizations, we will also evaluate changes in smoking
cessation rates among parents and staff comparing use prior to and after the training
programs and subsequent family service worker to parent encounters.
Aim 1: Building on Action for Boston Community Development's (ABCD) current system efforts,
support the development and implementation of system changes to accurately and efficiently
document parental smoking and household tobacco use and exposure, using: i) intake form, ii)
Individual Family Plan, and iii) electronic data system.
Aim 2: Collaborate with Legacy and University of Massachusetts (UMass) to train Head Start
staff in skills for encouraging smoking cessation and on a smoke-free home intervention, to
increase staff knowledge of second-hand smoke (SHS) effects and provide skills in
Motivational Interviewing. This will enhance staff confidence in engaging with parents to
assist in efforts to make a sustained quit attempt, reduce children's SHS exposure, and will
provide structure to help staff determine how best to support families on issues of tobacco
use, including referral to cessation services.
Aim 3: Evaluate the effectiveness of sites receiving the a) Motivational Interviewing
intervention for family service workers, b) supervisor education, and c) boosters in
decreasing parent smoking, reducing household tobacco use and children's SHS exposure,
compared with sites receiving only basic tobacco information.
Aim 4: Evaluate the effectiveness of the smoking cessation intervention on the staff most
intimately involved in parent counseling-namely, the family service workers who will attend
the training program (s). We will evaluate their knowledge, attitudes, beliefs, and smoking
practices as well as their confidence and skills in tobacco-related counseling.
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Allocation: Randomized, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
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