title: Reducing Underserved Children's Exposure to Tobacco Smoke: A Randomized Counseling Trial With Maternal Smokers.
abstract: BACKGROUND
  Addressing maternal smoking and child tobacco smoke exposure is a public health priority. Standard care advice and self-help materials to help parents reduce child tobacco smoke exposure is not sufficient to promote change in underserved populations. We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant's and preschooler's tobacco smoke exposure.
  
  
  METHODS
  A two-arm randomized trial: enhanced behavior counseling (experimental) versus enhanced standard care (control). Assessment staff members were blinded.
  
  
  METHODS
  Three hundred randomized maternal smokers were recruited from low-income urban communities. Participants had a child aged <4 years exposed to two or more maternal cigarettes/day at baseline.
  
  
  METHODS
  Philadelphia Family Rules for Establishing Smoke-free Homes (FRESH) included 16 weeks of counseling. Using a behavioral shaping approach within an individualized cognitive-behavioral therapy framework, counseling reinforced efforts to adopt increasingly challenging tobacco smoke exposure-protective behaviors with the eventual goal of establishing a smoke-free home.
  
  
  METHODS
  Primary outcomes were end-of-treatment child cotinine and reported tobacco smoke exposure (maternal cigarettes/day exposed). Secondary outcomes were end-of-treatment 7-day point-prevalence self-reported cigarettes smoked/day and bioverified quit status.
  
  
  RESULTS
  Participation in FRESH behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ(2)=10.56, p<0.01). There was no moderating effect of other smokers living at home.
  
  
  CONCLUSIONS
  FRESH behavioral counseling reduces child tobacco smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.gov NCT02117947.
authors.affiliation: Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania. Electronic address: collinsb@temple.edu.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Collins
authors.affiliation: Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
authors.forename: Uma S
authors.initials: US
authors.lastname: Nair
authors.affiliation: Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California.
authors.forename: Melbourne F
authors.initials: MF
authors.lastname: Hovell
authors.affiliation: Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
authors.forename: Katie I
authors.initials: KI
authors.lastname: DiSantis
authors.affiliation: Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
authors.forename: Karen
authors.initials: K
authors.lastname: Jaffe
authors.affiliation: Health Behavior Research Clinic, Department of Public Health, College of Health Professions and Social Work, Temple University, Philadelphia, Pennsylvania.
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Tolley
authors.affiliation: Department of Biostatistics and Epidemiology, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: E Paul
authors.initials: EP
authors.lastname: Wileyto
authors.affiliation: Department of Psychiatry, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Janet
authors.initials: J
authors.lastname: Audrain-McGovern
mesh_terms: D002675:Child, Preschool; D003367:Cotinine / Q000652:urine; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D008425:Maternal Behavior; D015143:Philadelphia / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D014028:Tobacco Smoke Pollution / Q000032:analysis / Q000517:prevention & control*; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine