title: Kids Safe and Smokefree (KiSS): a randomized controlled trial of a multilevel intervention to reduce secondhand tobacco smoke exposure in children.
abstract: BACKGROUND
  Secondhand smoke exposure (SHSe) harms children's health, yet effective interventions to reduce child SHSe in the home and car have proven difficult to operationalize in pediatric practice. A multilevel intervention combining pediatric healthcare providers' advice with behavioral counseling and navigation to pharmacological cessation aids may improve SHSe control in pediatric populations.
  
  
  METHODS
  This trial uses a randomized, two-group design with three measurement periods: pre-intervention, end of treatment and 12-month follow-up. Smoking parents of children < 11-years-old are recruited from pediatric clinics. The clinic-level intervention includes integrating tobacco intervention guideline prompts into electronic health record screens. The prompts guide providers to ask all parents about child SHSe, advise about SHSe harms, and refer smokers to cessation resources. After receiving clinic intervention, eligible parents are randomized to receive: (a) a 3-month telephone-based behavioral counseling intervention designed to promote reduction in child SHSe, parent smoking cessation, and navigation to access nicotine replacement therapy or cessation medication or (b) an attention control nutrition education intervention. Healthcare providers and assessors are blind to group assignment. Cotinine is used to bioverify child SHSe (primary outcome) and parent quit status.
  
  
  CONCLUSIONS
  This study tests an innovative multilevel approach to reducing child SHSe. The approach is sustainable, because clinics can easily integrate the tobacco intervention prompts related to "ask, advise, and refer" guidelines into electronic health records and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines.
  
  
  BACKGROUND
  NCT01745393 (clinicaltrials.gov).
authors.affiliation: Department of Public Health, Temple University, 1301 Cecil B, Moore Ave, Ritter Annex, 9th Floor, Philadelphia, PA, 19122, USA. slepore@temple.edu.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Lepore
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Winickoff
authors.forename: Beth
authors.initials: B
authors.lastname: Moughan
authors.forename: Tyra C
authors.initials: TC
authors.lastname: Bryant-Stephens
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Taylor
authors.forename: David
authors.initials: D
authors.lastname: Fleece
authors.forename: Adam
authors.initials: A
authors.lastname: Davey
authors.forename: Uma S
authors.initials: US
authors.lastname: Nair
authors.forename: Melissa
authors.initials: M
authors.lastname: Godfrey
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Collins
mesh_terms: D000328:Adult; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D006266:Health Education; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010290:Parents / Q000193:education*; D015143:Philadelphia; D010818:Practice Patterns, Physicians'; D016032:Randomized Controlled Trials as Topic; D012107:Research Design; D016540:Smoking Cessation; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
chemical_list: D014028:Tobacco Smoke Pollution