The long-range goal of my research is to test PED-based cessation interventions that are readily translated into practice in large, multi-center trials. However, before this can occur, preliminary data are needed, including analyses of: (1) the types of cessation intervention components that low-income parental smokers regard as essential to their cessation success; (2) perceived organizational barriers to the sustainability of the intervention after the study period ends which will impede translation into practice; (3) factors associated with parental cessation outcomes such as the presence of an acute SHSe-related chief complaint in the child; and (4) the effect size of the intervention. This data will be used to develop a parental cessation intervention that is tailored to low-income parents who are likely to quit. Data from the proposed project will be used in a RO1 application to test the efficacy of this cessation intervention in a large, multi-center randomized trial.
The proposed developmental study will be conducted in three phases. During Phase I, the investigators will conduct focused interviews of PED nurses, physicians, and hospital administrators to explore barriers to intervention sustainability that will assist in future intervention planning. During Phase II, The investigators will conduct a pilot prospective trial to examine the effectiveness of this screening, brief intervention, and assisted referral to treatment (SBIRT) intervention on parental smoking cessation. Equal numbers of parental smokers who bring their child to the PED for either a SHSe-related illness or non SHSe-related illness will be given a brief intervention using an adapted form of the Clinical Practice Guidelines: Treating Tobacco Use and Dependence. Intervention components may include brief cessation counseling using an "Advise, Assess, and Assist" approach; information on SHSe in children; direct connection to the Quitline (QL) in the ED; and/or free administration of nicotine replacement therapy (NRT). The Health Belief Model will be used to explore whether factors unique to this setting (e.g., child's acute illness) moderate the effect of the intervention on cessation outcomes. Outcomes will be assessed following the intervention via phone, email, or text messaging, based on parental preference. In Phase III we will explore the feasibility of a pilot study to collect, send, analyze, and store child saliva samples in twenty five children whose parents consent to the study. The same PED-based SBIRT cessation intervention will be given to these parental smokers as in Specific Aim 2, however, only English-speaking parents and parents of children who are 0-5 years of age who present to the PED with SHSe-related illnesses will be asked if they agree to have their child participate in this baseline and then 1-month after baseline, saliva sample collection. These saliva samples will be analyzed to assess child cotinine levels at baseline and again at 1 month after the SBIRT cessation intervention. Leftover saliva will be stored and frozen indefinitely for possible future research, if parents consent.
