Dr. Brad Collins, director of the Health Behavior Research Clinic in the Temple University College of Public Health’s department of social and behavioral health interventions and Dr. Stephen Lepore, director of the Social and Behavioral Health Interventions Laboratory and professor and chair of the department of social and behavioral sciences, are the primary investigators of a five-year study based on their “Kids Safe and Smokefree (KiSS) multi-level intervention. The study was published in this month’s special issue of Pediatrics, which deals exclusively with children’s exposure to tobacco.
Funded through a grant from the National Institutes of Health, KiSS was designed to curb the effects of secondhand smoke on children. Researchers partnered with pediatricians serving low-income neighborhoods. It uses the “Ask, Advise, Refer” model, where physicians ask patients about tobacco use, advise them they should quit and refer to services that can help them do so.
For this study, Drs. Collins and Lepore created a five-second speech for doctors to convey secondhand smoke health risks if a parent says people smoke in their house. The pediatrician could also enter a secondhand smoke exposure diagnosis into the child’s electronic medical records and revisit the concern at future appointments.
KiSS addresses a problem that’s becoming increasingly harder to address. Smoking rates and overall exposure to smoke have dropped significantly over the past two decades. However, according to Dr. Lepore, it’s still a major problem for racial minority, low-income and renter populations.
Nationwide, 18 percent of adults smoke, but smoking rates in low-income and minority groups are often more than 30 percent. In those situations, more than 50 percent of children are exposed to secondhand smoke. That exposure can lead to acute problems including ear and respiratory infections, and chronic problems such as asthma.
“Once these behaviors become isolated into very low-income, impoverished neighborhoods in inner cities, it becomes a lot harder to reach those people and offer intervention,” he explained.
So, the researchers took an intensive approach to reach and impact this community. They worked with Temple Pediatrics, Children’s Hospital of Philadelphia and St. Christopher’s Hospital for children, three major pediatric centers in Philadelphia. The “Ask, Advise, Refer” scripting was then customized for each organization based on their existing practices for addressing exposure to tobacco smoke.
A key component, noted Dr. Collins, was involving health professionals that parents in these areas already trust. The brief, simple scripting lets pediatricians in busy inner-city practices quickly and effectively address the problem and follow up if necessary.
The results so far showed the intervention is effective, at least in the short term. The researchers received 2,949 referrals from 334 clinicians. They followed up with 327 people who took part in the telephone counseling and found that 45.8 percent reported eliminating their child’s exposure to secondhand smoke three months after the intervention. This is in contrast to less than 25 percent of people in a control group who received nutrition counseling.