This revised proposal is based on reviewers' advice and updated pilot data. Parent counseling reduced children's ETS exposure in our previous studies. This study will determine if interventions directed to preteens alone can reduce ETS exposure. Our original pilot study showed that counseling reduced preteen's ETS exposure. New analyses showed that counseling reduced exposure to preteens in our NIH asthma study. A third pilot showed that counseling plus feedback and incentives reduced preteens' ETS exposure. Based on these results, we decreased the number of counseling sessions to 10, liberalized inclusion criteria, and added recruitment sources to assure feasibility. This trial will determine the effects of counseling+feedback v counseling+ feedback+incentives on ETS exposure and susceptibility to smoking among high-risk preteens. 300 youth 9-12 years old, including African- American, Latino, Anglo, and other racial/ethnic groups, will be recruited. Preteens must be nonsmokers who are exposed to ETS in their home. Youth will be recruited sequentially and assigned to usual education, counseling plus cotinine feedback, or counseling, cotinine feedback and incentives. Outcome measures will be obtained prior to intervention, at 2, 4, 6, 12, and 18 months. Urine samples will be analyzed for cotinine using highly sensitive (detection limit .05 ng/ml) and reliable procedures as employed by CDC (ID-LC/MS/MS). The same measures will be used for cotinine feedback. Repeated measures analyses of differential exposure to ETS will be employed. Mixed effect regression (REML) and GEE models will be used for outcome analyses. Exploratory analyses will address questions about the environmental and social determinants of tobacco use and ETS exposure based on our Behavioral Ecological Model. We also will explore the feasibility of conducting a genetic study of tobacco addiction, and we will collect personnel and other cost data from which later cost/utility analyses can be computed. With increased fidelity, additional recruitment sources, and our past successful ETS studies, we are confident that this trial will be completed successfully and contribute to ETS exposure reduction and possibly smoking prevention in high-risk youth.
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