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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

Author

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  • 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
    Health Promotion Sciences Department, 3950 S. Country Club Rd, Suite 300, PO Box: Abrams 300, Tucson, AZ 85714, 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)

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.

Suggested Citation

  • Stephen J. Lepore & Bradley N. Collins & Donna L. Coffman & Jonathan P. Winickoff & Uma S. Nair & Beth Moughan & Tyra Bryant-Stephens & Daniel Taylor & David Fleece & Melissa Godfrey, 2018. "Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial," IJERPH, MDPI, vol. 15(6), pages 1-16, June.
    • Handle: RePEc:gam:jijerp:v:15:y:2018:i:6:p:1239-:d:151965
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    References listed on IDEAS

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    1. Kenneth F Schulz & Douglas G Altman & David Moher & for the CONSORT Group, 2010. "CONSORT 2010 Statement: Updated Guidelines for Reporting Parallel Group Randomised Trials," PLOS Medicine, Public Library of Science, vol. 7(3), pages 1-7, March.
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    Cited by:

    1. E. Melinda Mahabee-Gittens & Matthew J. Mazzella & John T. Doucette & Ashley L. Merianos & Lara Stone & Chase A. Wullenweber & Stefanie A. Busgang & Georg E. Matt, 2020. "Comparison of Liquid Chromatography Mass Spectrometry and Enzyme-Linked Immunosorbent Assay Methods to Measure Salivary Cotinine Levels in Ill Children," IJERPH, MDPI, vol. 17(4), pages 1-12, February.
    2. Mona L. Baishya & Bradley N. Collins & Stephen J. Lepore, 2022. "Antecedents of Self-Efficacy to Achieve Smoking-Behavior-Change Goals among Low-Income Parents Enrolled in an Evidence-Based Tobacco Intervention," IJERPH, MDPI, vol. 19(20), pages 1-10, October.
    3. Samantha M. Chin & Stephen J. Lepore & Bradley N. Collins & Levent Dumenci & Maria A. Rincon, 2023. "Validation and Psychometric Properties of the Tobacco Urge Management Scale (TUMS)," IJERPH, MDPI, vol. 20(8), pages 1-11, April.
    4. Olivia Wynne & Billie Bonevski, 2018. "Developments in the Research Base on Reducing Exposure to Second-Hand Smoke," IJERPH, MDPI, vol. 15(9), pages 1-4, August.
    5. Tracey J. Brown & Sarah Gentry & Linda Bauld & Elaine M. Boyle & Paul Clarke & Wendy Hardeman & Richard Holland & Felix Naughton & Sophie Orton & Michael Ussher & Caitlin Notley, 2020. "Systematic Review of Behaviour Change Techniques within Interventions to Reduce Environmental Tobacco Smoke Exposure for Children," IJERPH, MDPI, vol. 17(21), pages 1-14, October.

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