WIC Families who Smoke: A Behavioral Counseling Study





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Behavioral Ecological Model


The Healthy Tots Project is testing an intervention designed to reduce environmental tobacco smoke exposure (ETS) and adults' smoking among low-income families recruited from the federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Primary Specific Aims: 1) to determine the effects of a family-centered behavioral counseling program on ETS exposure among low-SES young children; 2) to determine the effects of participation on mothers' level of smoking and proportion of mothers who quit smoking; 3) to validate parent-reported ETS exposure measures using urine cotinine assays and environmental nicotine monitors. Secondary Specific Aims: 4) to determine the effects of participation on other parents' and other smokers' living in the home level of smoking and proportion of quits; 5) to explore health outcome measures associated with decreased ETS exposure; 6) to identify possible determinants of ETS exposure and smoking cessation; 7) to examine patterns in repeated baseline children's urine cotinine values; 8) to explore the cost effectiveness of the intervention. This study is a direct extension of our previous research and combines behavioral counseling for ETS reduction with smoking cessation counseling and nicotine replacement therapy. 150 families (with a mother who exposes her non-breastfeeding child under age four to a minimum of three cigarettes per day in the home or car) will be recruited. The study employs a two-group repeated measures design with random assignment. After three baseline measures, families are assigned at random to experimental counseling or "usual care" control condition. The experimental group receives ten in-home and four telephone counseling sessions over six months. Counseling is provided for all mothers in the experimental group. "Other parents" and other smokers living in the home are also encouraged to participate. Counseling incorporates behavioral contracting, shaping, and problem-solving negotiations. Outcome measures are obtained at three baseline measures spaced one week apart, 3, 6, 12, and 18 months. Measures include a detailed interview concerning smoking and exposure rates, key Social Learning Theory variables, and children's health. Children's urine samples will are analyzed for cotinine. An environmental measure of nicotine is collected for a random sample of 40% at baseline and 6 months (with inactive "bogus pipeline" monitoring for the duration of each family's 18 months participation). Self-reported smoking cessation is verified with cotinine analysis, supplemented by anabasine and anatabine assays for participants using NRT. If effective, the intervention could be incorporated into standard care at WIC clinics nation-wide, which serve over 7.3 million low-income women, infants, and children.

Principal Investigator: Mel Hovell, PhD, MPH

Project Coordinator: Joy Zakarian, MPH

Funded 2000-2003

Source: Maternal and Child Health Bureau


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