Associate Professor of Health and Social Behavior at the Harvard School of Public Health and the Dana-Farber Cancer Institute, Project KISS (Keeping Infants Safe from Smoke)
Rendez-vous with . . . Karen Emmons
Boston , Massachusetts, USA
By Philippe Boucher
Rendez-vous 105 Tuesday, July 10 , 2001
PB : Thank you Karen for accepting our rendez-vous.
May I ask you to introduce yourself ?
Karen Emmons: I am an Associate Professor of Health and Social Behavior at the Harvard School of Public Health and the Dana-Farber Cancer Institute, and Deputy Director of the Center of Community-Based REsearch at the Dana-Farber. I am trained as a clinical psychologist with a specialty in health psychology, and have focused my research on cancer prevention, particularly with underserved populations. I became interested in tobacco control in college, thanks to a wonderful professor who was focusing his research in this area. Frankly, I started working on tobacco only for the opportunity to work with him rather than because I was particularly interested in tobacco, but soon came to realize what a fascinating and important topic this is. Project KISS (Keeping Infants Safe from Smoke) focused on parents of 291 children, age 3 or younger. Participants were recruited through community health centers in Boston and Providence, R.I. We used passive sampling monitors to test the level of nicotine in the air in various rooms of the families' homes. The monitors provided an objective measure of how the amount of nicotine in the air of the home. Families were randomized to either the motivational intervention group or self-help group. In the motivational condition, parents received a 30- to 45-minute motivational interviewing session with a health educator, and four follow-up counseling calls over the duration of the project. The self-help group received information on quitting smoking and a passive smoke reduction tip sheet, but received no counseling. Nicotine levels were reduced by 30% in the motivational intervention group by the 6-month follow-up, while there were non-significant increases in the household nicotine concentrations in the control group.
Our next steps are to conduct a follow-up study to determine whether these effects can be maintained over the long-term. We are also investigating other strategies for providing feedback that might be more less costly and labor-intensive than the approach used in this study.
Q1.You refer to estimates that 40% of children yournger than 5 years old are exposed to ETS at home. What is the basis of this estimate? Are there differences in states (like California) where media campaigns targeting ETS at home were aired?
KE: These are based on NHIS data, and are overall estimates across the US.
Q2. You mention that smokers knew ETS was bad for their infants but underestimated their own smoking. Can you explain how smokers tend to behave at home when infants are present? Do they mostly rely on trying to increase ventilation?
KE: These parents very much wanted to protect their children's health, and thus engaged in a lot of behaviors that they thought reduced their child's exposure. The most common strategies were opening windows and using fans.
Q3. Can you detail how your motivational intervention was organized? What alternative strategies did you propose to smokers? Were they heavy smokers, as many were (if I read correctly) unemployed?
KE: This sample was largely unemployed. However, overall they were light smokers (M=14 cigs/day). It's unclear to us whether this was a function of their economic situation, which is likely. The motivational intervention worked with parents to figure out different strategies that might work for them, with the focus on smoking outside.
Q4. You recorded as a result of the motivational intervention a decrease in the level of ETS. Was this reduction significant enough to have positive health effects? Did you record any decrease in consumption by the smokers, any quit attempts? Was there any rippling effects on other people living in the home (although it seems almost 50% of the people involved in the study were single moms?)?
KE: There was a 30% reduction in exposure. We did collect health data on the kids and are looking at it now. There was about a 11% quit rate among the smokers, but no differences with the intervention conditions. We did not look at smoking cessation among others in the home, although this is certainly very interesting and important for future studies.
Q4b. I find it interesting that as many people quit without intervention. How many people in the same situation but without any leaflet or intervention would quit? Do you have any idea what the "spontaneous" quit rate is?
KE: Across all smokers the spontaneous quit rate is quite low (about 2%), but I suspect that parents of young children may be more open to considering changes in their smoking.
Q4c. If a brochure on ETS at home makes 11% of the people quit (OK that means 89% don't) it is something worth considering as well, especially compared with the usual results and costs of other methods...
KE: Yes, I think it's very important that parents get these messages. I am not sure that, if on a wide-scale dissemination of just the materials (without the survey that asks about your smoking and your child's health and taking measurements of your home's air quality) that the quit rate would be quite so high, though. That said, this is an important message that should be disseminated!
Q5. How do you compare the cost effectiveness of an individualized approach (like the motivational intervention) with media campaigns focusing on ETS at home?
KE: We did not do a formal cost-effectiveness evaluation in this study. However, I personally think that both approaches are important. The key to the motivational approach is that many parents believed they were already doing enough to protect their child, and for those folks, the media campaign wouldn't have been very helpful. However, for parents who are unaware of the health risks, or who have not considered outdoor smoking as an option, media campaigns might be very useful.
Q6. Is there anything else you would like to add?
KE : I think that this is an important issue, and one that parents are rightly very concerned about. The good news is that even addicted smokers were able to smoke outside, and thus eliminate their child's health risk. Of course, it's better for everyone if the parent quits smoking, but for those who can't or choose not to, smoking outside is the best option.
PB: Thank you Karen for taking the time to be with us today.
Nota: Here is the url for the abstract of the article just published in Pediatrics http://www.pediatrics.org/cgi/content/abstract/108/1/18
Rendez-vous is supported by a contract from the Robert Wood Johnson Foundation
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