title: Motivating parents of kids with asthma to quit smoking: the effect of the teachable moment and increasing intervention intensity using a longitudinal randomized trial design.
abstract: We tested two aims: (1) the teachable moment (TM): whether second-hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma versus parents of healthy children (HC); and (2) whether greater intervention intensity [enhanced-precaution adoption model (PAM)] produces greater cessation than a previously tested intervention (PAM).
  
  
  
  Aim 1: two home visits (asthma education or child wellness), and cessation induction using motivational interviewing and SHSe feedback. Aim 2: post-home-visits, parents with asthmatic children were randomized to PAM (n = 171; six asthma education calls) or enhanced-PAM (n = 170; six asthma education/smoking cessation calls + repeat SHSe feedback).
  
  
  
  Rhode Island, USA.
  
  
  
  Parents of asthmatic (n = 341) or healthy (n = 219) children who did not have to want to quit smoking to enroll.
  
  
  
  Measurements were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day point prevalence abstinence (ppa) and SHSe (primary) and asthma morbidity (secondary).
  
  
  
  Aim 1: the TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day [odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.22-5.54] and 7-day ppa (OR = 2.26, 95% CI = 1.13-4.51) at 2 months (primary end-point) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR = 3.60; 95% CI = 1.72-7.55). Aim 2: enhanced-PAM was more likely to achieve 30-day ppa at the primary end-point, 4 months (OR = 2.12, 95% CI 1.09-4.12) and improved asthma outcomes versus PAM.
  
  
  
  Smoking cessation intervention (Motivational Interviewing plus biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes.
authors.affiliation: Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University and The Miriam Hospital, Providence, RI, USA.|Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: Borrelli
authors.affiliation: Bradley/Hasbro Children's Research Center, Rhode Island Hospital, and Alpert Medical School at Brown University, Providence, RI, USA.
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: McQuaid
authors.affiliation: Roger Williams University, Bristol, RI, USA.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Tooley
authors.affiliation: Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University and The Miriam Hospital, Providence, RI, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Busch
authors.affiliation: Environmental Health Sciences Division, School of Public Health, University of California, Berkeley, CA, USA.
authors.forename: S Katharine
authors.initials: SK
authors.lastname: Hammond
authors.affiliation: Department of Emergency Medicine, Rhode Island Hospital and Alpert Medical School at Brown University, Providence, RI, USA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Becker
authors.affiliation: Centers for Behavioral and Preventive Medicine, Alpert Medical School at Brown University and The Miriam Hospital, Providence, RI, USA.
authors.forename: Shira
authors.initials: S
authors.lastname: Dunsiger
mesh_terms: D000328:Adult; D001249:Asthma; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D062405:Motivational Interviewing / Q000379:methods*; D016017:Odds Ratio; D010290:Parents; D012907:Smoking / Q000628:therapy; D016540:Smoking Cessation; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D000073869:Tobacco Smoking / Q000628:therapy*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Feedback; motivational interviewing; pediatric asthma; risk perception; second-hand smoke; smoking cessation; teachable moment