While secondhand smoke exposure has been eliminated in most in public spaces, children are still at risk for developing serious health problems when their parents smoke in the home.
With a $2.3 million grant from the National Institutes of Health, Temple University public health professors Stephen Lepore and Bradley Collins are leading an innovative program throughout Philadelphia beginning this fall that will tackle the issue in pediatrician's offices and follow up with intensive counseling by behavioral health counselors to help parents quit smoking.
Secondhand smoke exposure in children causes ear infections, more frequent and severe asthma attacks, respiratory symptoms such as coughing and shortness of breath, respiratory infections such as bronchitis and pneumonia, and increases risk for sudden infant death syndrome (SIDS). It has also been associated with increased risk of cancers, cardiovascular disease, and behavior problems.
Children are particularly vulnerable to the effects of secondhand smoke because they haven’t fully developed physically, have higher breathing rates than adults and have little control over their indoor environments. Collins and Lepore’s program targets medically-underserved communities.
“Children in these communities have the highest risk of suffering from second hand smoke-related diseases and health problems. Their parents often experience significant stressors in their lives and encounter many challenges accessing resources to help them quit,” said Collins, an associate professor in public health and pediatrics and director of Temple’s Health Behavior Research Clinic.
This summer, Collins and Lepore are working with the three major primary pediatric care systems in Philadelphia for the study: Temple Pediatric Care, St. Christopher's Hospital for Children and the Children's Hospital of Philadelphia.
The goal is to boost providers’ adherence to the American Academy of Pediatrics’ practice guidelines for addressing children’s tobacco exposure by including prompts in the electronic medical systems that will remind providers to ask and advise parents about child’s exposure to tobacco. These systems will also automatically fax provider referrals to the smoking cessation counseling program.
“This approach has not been tested before, and could become a national model for reducing children’s exposure to parental tobacco smoke in the home,” said Lepore, a professor of public health and the public health PhD program director. “The pediatrician can refer parents to free counseling services. We want this to become routine, like getting any other vital sign, such as blood pressure, checked.”
About 500 people will be enrolled in the randomized, controlled study. All participants will receive information on smoking and exposure during their clinic visit. Then, a random portion of the group will receive a 12-week smoking cessation program comprising a home visit, telephone counseling and assistance in finding nearby free services.
The counseling will address participants’ addiction and let them know about pharmacological options such as the patch and gum, said Lepore.
“Research has shown that advice from a healthcare provider can increase smokers’ motivation to quit, but alone is not enough to promote long-term smoking cessation,” said Collins. “Our multi-level intervention integrates intensive behavioral counseling with provider advice and follow-up-an approach that should improve quit rates in this high risk population.”
Other participants who are part of the attention control group will receive nutrition counseling to improve their family’s health. The approach will allow researchers to determine the effectiveness of the counseling counseling program.
All participants will be assessed before the program, after three months of intervention and at a 12-month follow up. Researchers will find out if the parents receiving smoking counseling have higher quit rates and children with lower urine cotinine-a biomarker of exposure to tobacco smoke, than parents in the control group.
Even after the 5-year study is complete, the program will be sustainable in the clinics, and many ongoing counseling programs in the community are free, said Lepore.
“Once parents fully realize they have the ability to reduce harm to their child by eliminating secondhand smoke exposure, they’ll have greater motivation to modify their smoking,” Collins said. “The ultimate goal of the program is to get parents to quit and stay quit. The counseling will help parents build skills to manage their urges to smoke and to establish a smoke-free lifestyle.”
Lepore and Collins’ project is just one of many Temple Public Health projects addressing cancer prevention, control, and survivorship. Lepore also researches online support groups for breast cancer survivors and prostate cancer screening in black men. Collins is working with colleagues, such as Freda Patterson, assistant professor of public health, on research that promotes physical activity to help people quit smoking.
Other cancer control researchers in Public Health include Tom Gordon, a professor of public health, and Sarah Bass, an associate professor of public health and director of the undergraduate program in public health, who have studied how to improve low colorectal cancer screening rates among African Americans. Jennifer Ibrahim, an associate professor in public health and associate director of Public Health Law Research program, examines the impact of tobacco policy.
Collins and Lepore’s collaborators on their NIH grant include: Beth Moughan, MD and David Fleece, MD, Temple Pediatric Care; Daniel Taylor, DO, FAAP, St. Christopher's Hospital for Children; Tyra Bryant-Stephens, MD, The Children's Hospital of Philadelphia; and Jonathan Winickoff, MD, Massachusetts General Hospital.
-- Anna Nguyen