More than 19 million children in the U.S. are exposed to second-hand smoke (SHS) on a daily basis. Infants are the most susceptible to SHS harm, and for children under five, SHS exposure causes more deaths than all unintentional childhood injuries combined. In response to Healthy People 2010 goals and NCI priorities, this trial aims to reduce infant SHS exposure in an under-served urban African American (AA) population while simultaneously promoting smoking cessation among the postpartum (Pp) mothers. The proposed 16-week trial, """"""""Philadelphia FRESH (Family Rules for Establishing Smoke-free Homes),"""""""" will randomize 450 Pp mothers of children up to two years old into two treatment groups. Mothers randomized to the multimodal, individualized treatment (MIT) will receive 1.) pediatrician advice, 2.) two intensive, family-centered, in-home behavioral counseling sessions, 3.) a culturally-sensitive treatment manual mailed in four sections, biweekly starting week 1, and 4.) seven follow-up phone counseling sessions. Mothers in the standard care control (SCC) group will receive pediatrician assessment, advice, and one comprehensive self-help manual with information on SHS and its reduction, smoking cessation, and relapse prevention. We predict that through 12-month follow-up, the MIT group will demonstrate better infant SHS exposure and maternal smoking outcomes (measured by self-report, infant urine cotinine, and maternal saliva cotinine) than the SCC group. Our trial will also test the mediating influence of social support, perceived infant vulnerability to SHS, and negative affect on smoking outcomes by incorporating treatment components to boost and sustain natural maternal support systems, increase knowledge of SHS risks and benefits of SHS reduction, and improve mood management. We hypothesize that improvements in these variables will positively impact treatment outcome. Finally, our trial will test the moderating effects of baseline weight concerns and depression symptoms. We hypothesize a main effect for baseline weight concerns and depression on outcomes, as well as an interaction: moms with greater baseline weight concern and depression will have better outcomes in MIT compared to SCC. We will use GEE analysis to test hypothesized smoking behavior changes across baseline, 8-week, 16-week (EOT), 3-mo and 12-month follow-up time points and explore the influence of moderating variables. Path analysis will test mediating variables' influence on outcomes.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
1R01CA105183-01A1
Application #
6822787
Study Section
Behavioral Medicine, Interventions and Outcomes Study Section (BMIO)
Program Officer
Bloch, Michele H
Project Start
2004-07-16
Project End
2005-06-30
Budget Start
2004-07-16
Budget End
2005-06-30
Support Year
1
Fiscal Year
2004
Total Cost
$407,700
Indirect Cost
Name
University of Pennsylvania
Department
Psychiatry
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Lavery, Amy M; Nair, Uma; Bass, Sarah Bauerle et al. (2016) The Influence of Health Messaging Source and Frequency on Maternal Smoking and Child Exposure among Low-Income Mothers. J Commun Healthc 9:200-209
Collins, Bradley N; Nair, Uma S; Hovell, Melbourne F et al. (2015) Reducing Underserved Children's Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers. Am J Prev Med 49:534-44
Collins, Bradley N; Nair, Uma S; Shwarz, Michelle et al. (2013) SHS-Related Pediatric Sick Visits are Linked to Maternal Depressive Symptoms among Low-Income African American Smokers: An Opportunity for Intervention in Pediatrics. J Child Fam Stud 22:
Collins, Bradley N; Ibrahim, Jennifer (2012) Pediatric Secondhand Smoke Exposure: Moving Toward Systematic Multi-Level Strategies to Improve Health. Glob Heart 7:161-165
Collins, Bradley N; DiSantis, Katherine Isselmann; Nair, Uma S (2011) Longer previous smoking abstinence relates to successful breastfeeding initiation among underserved smokers. Breastfeed Med 6:385-91
Collins, Bradley N; Wileyto, E Paul; Hovell, Melbourne F et al. (2011) Proactive recruitment predicts participant retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers. Transl Behav Med 1:394-9
DiSantis, Katherine Isselmann; Collins, Bradley N; McCoy, Andrea C S (2010) Associations among breastfeeding, smoking relapse, and prenatal factors in a brief postpartum smoking intervention. Acta Obstet Gynecol Scand 89:582-6
Collins, Bradley N; Ibrahim, Jennifer K; Hovell, Melbourne et al. (2010) Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income, urban African Americans. Health (Irvine Calif) 2:1264-1271
Collins, Bradley N; Nair, Uma; Hovell, Melbourne F et al. (2009) Smoking-related weight concerns among underserved, black maternal smokers. Am J Health Behav 33:699-709
Mueller, Darryl T; Collins, Bradley N (2008) Pediatric otolaryngologists'actions regarding secondhand smoke exposure: pilot data suggest an opportunity to enhance tobacco intervention. Otolaryngol Head Neck Surg 139:348-52

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