This project proposes to evaluate the effectiveness of training Head Start staff to
discuss tobacco use, shs reduction and cessation in their existing encounters with
parents in reducing tobacco use and exposure. Understanding the facilitators and barriers
to integrating the intervention into the Head Start system will support future efforts to
address tobacco use and exposure in families with small children.

Families Reduce Exposure to Smoke at Home

Tobacco Use Cessation

Second Hand Tobacco Smoke

Parental smoking increases children's risk of asthma, infectious illness, sudden infant
death syndrome (SIDS), and other conditions. Accumulating evidence regarding the adverse
effects of total smoke exposure (TSE) led the US Surgeon General to conclude that there
is no safe level of TSE. Parents who smoke endanger themselves, put their children and
spouses at risk for adverse health outcomes, and increase the chance of their children
becoming smokers. However, many parents who smoke are undertreated for their tobacco
addiction. Many parents who smoke are of the age where they have few contacts with
primary care physicians and are often unexposed to counseling and pharmacotherapy offered
to older patients. Strategically identifying sites where trained para-professionals
routinely interact with parents who smoke is vital to making inroads in this high-risk
population.

Involuntary secondhand smoke exposure (SHSe) in domestic environments is an entirely
preventable public health threat that disproportionately burdens young children in
communities of low socioeconomic position. Research has indicated that interventions to
reduce SHSe for children delivered through child care settings have been effective. In
addition, client-centered approaches, such as motivational interviewing, have been
effective in helping parents to reduce levels of SHS in the home environment. Following
guidelines from established agencies and organizations, we will also evaluate changes in
smoking cessation rates among parents and staff comparing use prior to and after the
training programs and subsequent family service worker to parent encounters.

Aim 1: Building on Action for Boston Community Development's (ABCD) current system
efforts, support the development and implementation of system changes to accurately and
efficiently document parental smoking and household tobacco use and exposure, using: i)
intake form, ii) Individual Family Plan, and iii) electronic data system.

Aim 2: Collaborate with Legacy and University of Massachusetts (UMass) to train Head
Start staff in skills for encouraging smoking cessation and on a smoke-free home
intervention, to increase staff knowledge of second-hand smoke (SHS) effects and provide
skills in Motivational Interviewing. This will enhance staff confidence in engaging with
parents to assist in efforts to make a sustained quit attempt, reduce children's SHS
exposure, and will provide structure to help staff determine how best to support families
on issues of tobacco use, including referral to cessation services.

Aim 3: Evaluate the effectiveness of sites receiving the a) Motivational Interviewing
intervention for family service workers, b) supervisor education, and c) boosters in
decreasing parent smoking, reducing household tobacco use and children's SHS exposure,
compared with sites receiving only basic tobacco information.

Aim 4: Evaluate the effectiveness of the smoking cessation intervention on the staff most
intimately involved in parent counseling-namely, the family service workers who will
attend the training program (s). We will evaluate their knowledge, attitudes, beliefs,
and smoking practices as well as their confidence and skills in tobacco-related
counseling.

Motivational Interviewing Training

Usual Best Practice

Evaluation of the Smoking Cessation and Tobacco Use Exposure Patterns of Head Start Parents in Boston

Parents and staff will be surveyed to determine the number of quit attempts in the past 6
months.

Senior Lecturer

Parents will be surveyed to determine the number of home smoking bans implemented in the
past 6 months.

Staff at the intervention sites were trained in basic tobacco control and motivational
interviewing. Two booster trainings were held over 6 months.

Staff at the usual best practice sites received basic tobacco control training.

Families Reduce Exposure to Smoke at Home

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Trial Timing

What is this trial about?

What are the participation requirements?