This study will evaluate the efficacy of a motivational intervention designed to reduce household nicotine concentrations and to increase parental motivation towards cessation. It is hypothesized that the motivational intervention will yield greater reduction in smoking-related in ices, compared to a usual care comparison condition. It is also predicted that the motivational intervention will differentially impact on cognitive and behavioral mediating mechanisms that are proposed to accelerate behavior change and maintenance. Finally, it is hypothesized that the motivational intervention will yield greater reduction in household exposure to environmental tobacco smoke (ETS), and therefore will also result in a significantly reduced number of children's respiratory illnesses. This study will be conducted utilizing a community health center that serves a low SES population in Rhode Island. The population is approximately 40 %Hispanic and 45% Caucasian. Subjects will be randomized to two intervention conditions:(1) a motivational intervention, that utilizes self-help, telephone counselor calls, and motivational interviewing to provide feedback about children's health status and household concentrations of nicotine; (2) usual care, which includes provision of self-help materials only. A repeated measures design will be used (baseline, 6- and 12-month follow-ups). Outcome measures include household nicotine concentrations, movement through the stages of readiness to change, smoking cessation attempts, point-prevalence abstinence rates, and children's health status. Several important public health priorities for research in lung health and prevention are targeted in this study, including: (1) reduction of ETS exposure among children from low income families, a group that has a particularly h prevalence of chronic ETS exposure;. (2) development and evaluation of an intervention that is specifically tailored to match the characteristics of smokers who are low in motivation to quit smoking, a group that constitutes 80% of the lower SES smoking population, yet that has been largely ignored in smoking research; (3) smoking intervention with an underserved, low-income and ethnic population that has poor access to standard approaches to smoking cessation and a particularly high smoking prevalence (household smoking prevalence = 60%); and (4) assessment of the impact of reductions in household ETS exposure on the respiratory health of children in the context of an ongoing longitudinal study.
