Smoking and asthma are associated with great health risks. Finding and implementing an effective smoking cessation program could improve the health and well-being of both smoker and child.
Addiction to nicotine can be so powerful that some parents smoke even in the presence of a child with asthma.
For smokers who don't know that their habit worsens a child's asthma, and for those who deny it, a team of Brown researchers will compare two stop-smoking programs.
The 288 adults recruited for the study will be the parents of children who recently were either discharged from the hospital or seen by their physicians for asthma-attack treatment. The parents will be enrolled into an in-home one-on-one asthma-education program with a respiratory nurse. The nurse will deliver the program supplemented by stop-smoking sessions.
The study will tap into an existing health-care infrastructure. The asthma-education program is offered as standard care by Neighborhood Health Plans of Rhode Island. This managed-care company covers a largely underserved economically- and culturally-diverse population.
"These home health-care services provide an innovative channel of access," said study leader Belinda Borrelli. "For example, we will be reaching a population who may not necessarily be motivated to quit smoking and who otherwise would not receive intervention for their smoking."
Smoking and asthma are associated with great health risks. Asthmatic children, for example, miss more days of school, experience higher numbers of respiratory infections and have more intensified attacks when one or both parents smoke in the home. Finding and implementing an effective smoking cessation program could improve the health and well-being of both smoker and child.
"Underserved children are at increased risk for severe asthma exacerbations and mortality," Borrelli said. "Parental smoking is an important preventable cause of morbidity and mortality among asthmatic children. A respiratory nurse who delivers asthma education as part of standard practice, supplemented by smoking-cessation counseling, can capitalize on the teachable moment presented by the child's intensified asthma."
Borrelli is a clinical psychologist and assistant professor in Brown's Center for Behavioral and Preventive Medicine. The center, part of the School of Medicine, is located at The Miriam Hospital. Borrelli's co-investigators include Elizabeth McQuaid, an assistant professor of psychiatry and human behavior and a pediatric psychologist at Rhode Island Hospital, where she works with asthmatic youngsters.
Parents in the study will be placed randomly in one of two stop-smoking treatment sessions. The first has guidelines developed by smoking-cessation experts. The guidelines focus on goal-setting, problem-solving, and increasing confidence to quit smoking.
The second treatment will be matched to the smoker's degree of readiness to quit and includes counseling about the way smoking could harm themselves and their children.
"The counseling will take the form of interviewing and feedback to motivate parents to quit smoking," Borrelli said. "We will try to enhance their risk perception in a compassionate way, for themselves and their child. The hope is to show that the benefits far exceed the costs."
The researchers will measure the level of smoke in the homes of families by having an asthmatic child wear a badge-like monitor and by keeping another monitor in the child's bedroom. Monitors will allow respiratory nurses to provide feedback, such as, "Your child was exposed to as much smoke this week as if he or she smoked `X' cigarettes per day," Borrelli said.
Nurses will also discuss how the level of smoke in the home affects the child's asthma, assess the amount of carbon monoxide (a poisonous gas from cigarette smoke) in the lungs of each smoker, and counsel the smoker about how smoking affects their own bodies.
All smokers in the study will receive the nicotine patch for free if they are ready to quit within 30 days.
After the interventions end, the researchers will test the differences between the two groups by examining the number of people who quit smoking; the level of smoke in the air at home; motivation to quit; and improvements in asthma in the children.
The results will help to target quit-smoking treatments to people who have the greatest health risks, such as minorities and those of low income, to improve their health and that of their children, Borrelli said.
"A proactive intervention is needed to reach and improve the health of this relatively untapped population of smokers and their families," she said. "Many of these people would not have the resources to travel to clinics to receive care, highlighting the need for in-home care. We're not waiting for people who need the education the most to come to a clinic. We're going to them."
The National, Heart, Lung, and Blood Institute is funding the $1.9-million study for four years. The grant is part of the NIH Behavioral Change Consortium, which asks grantees to share their results and recommendations regarding mediators and mechanisms of behavior change.