Intervening With Smoking Parents of Inpatients to Reduce Exposure: The INSPIRE Randomized Controlled Trial
Karen M Wilson1, Angela Moss2, Michelle Lowary3
1University of Rochester School of Medicine, Department of Pediatrics (KM Wilson), Rochester, NY; Julius B. Richmond Center of Excellence, American Academy of Pediatrics (KM Wilson, JD Klein, and JP Winickoff), Itasca, Ill; Department of Pediatrics, University of Colorado Anschutz Medical Campus (KM Wilson, A Moss, and GS Kerby), Aurora, Colo; Children's Hospital Colorado (KM Wilson, A Moss, M Lowary, J Holstein, J Gambino, and GS Kerby), Aurora, Colo.
Insights
Hospitalization offers a chance to help parents quit smoking. A trial showed no significant difference in smoke-free homes or child cotinine, but a trend towards parental quitting was observed.
Area of Science:
- Pediatric Health
- Public Health
- Addiction Medicine
Background:
- Hospitalized children frequently experience secondhand smoke exposure.
- Parents who smoke may be receptive to smoking cessation interventions during their child's hospital stay.
Purpose of the Study:
- To evaluate the effectiveness of a smoking cessation intervention for parents of hospitalized children.
- To assess the impact on smoke-free home rules, child's cotinine levels, and parental smoking cessation.
Main Methods:
- A randomized, single-blind clinical trial was conducted with parents of hospitalized children.
- Intervention included motivational interviewing and nicotine replacement therapy, with both groups referred to a Quitline.
- Outcomes measured included smoke-free home rules, child's cotinine levels, and parental quit rates at 1 year.
Main Results:
- No significant differences were found between groups in establishing smoke-free home rules or child cotinine levels.
- An intention-to-treat analysis showed a trend towards higher parental quitting in the intervention group (15%) versus controls (8%, p=0.07).
- The intervention was deliverable, but engagement strategies need improvement.
Conclusions:
- Hospitalization presents an opportunity for pediatric smoking cessation interventions.
- Current intervention strategies require enhancement for greater effectiveness in tobacco control.
- Further research into optimized engagement is necessary to improve parental quit rates.
Background:
Hospitalized children have high rates of tobacco smoke exposure; parents who smoke may be receptive to interventions during their child's hospitalization.
Objective:
We tested the efficacy of a smoking cessation intervention for parents of hospitalized children.
Methods:
We conducted a randomized, single-blind clinical trial from 12/14-5/18 at the Children's Hospital Colorado. Hospitalized children who had a parent who smoked tobacco were eligible.
Intervention:
Intervention participants received motivational interviewing sessions, 2 weeks of nicotine replacement therapy; both groups received referral to the Quitline Consenting parents completed a questionnaire; urine was collected from the child for measurement of cotinine. Our primary outcome was: 1) increase in reporting "no one is allowed to smoke anywhere" in the home (smoke-free home rule). Additional outcomes included: 2) change in child's cotinine from baseline to 1 year, and 3) parental quitting at 1 year. Data were analyzed using Chi-square and t tests for bivariable data, and multivariable logistic and linear regression.
Results:
Of 1641 eligible families approached, 252 were randomized (15%); 149 families had follow-up data at 12 months (59%). In the adjusted analysis, there was no difference between the groups in smoke free home rules, or child cotinine level; in an intention-to-treat analysis, 15% in the intervention group versus 8% of controls reported quit (p=0.07).
Conclusions:
A smoking cessation intervention can be delivered to parents of hospitalized children. While hospitalization provides an opportunity to help parents quit smoking, more efficient and effective engagement strategies are needed to optimize tobacco control success.
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