Long-term Results From the FRESH RCT: Sustained Reduction of Children's Tobacco Smoke Exposure

Am J Prev Med. 2020 Jan;58(1):21-30. doi: 10.1016/j.amepre.2019.08.021. Epub 2019 Nov 21.

Abstract

Introduction: Standard care interventions to reduce children's tobacco smoke exposure (TSE) may not be sufficient to promote behavior change in underserved populations. A previous study demonstrated the short-term efficacy of an experimental counseling intervention, Family Rules for Establishing Smokefree Homes (FRESH) compared with standard care on boosting low-income children's TSE reduction and maternal smoking at 16-week end of treatment (EOT). This study tested long-term posttreatment efficacy of this treatment through a 12-month follow-up.

Study design: This study was a two-arm RCT.

Setting/participants: Maternal smokers (n=300) not seeking cessation treatment were recruited from low-income, urban communities. Participants exposed their <4-year-old children to tobacco smoke daily. Data collection and analyses occurred from 2006 to 2018.

Intervention: The FRESH behavioral intervention included 2 home visits and 7 phone sessions. FRESH used cognitive behavioral skills training, support, problem-solving, and positive social reinforcement to facilitate the adoption of increasingly challenging TSE-protection behaviors. No nicotine-replacement therapy or medication was provided.

Main outcome measures: Primary outcomes were child cotinine (TSE biomarker) and reported TSE from EOT through 12 months after treatment. A secondary outcome was bioverified maternal smoking cessation.

Results: Compared with controls, children in FRESH had significantly lower cotinine (β= -0.31, p<0.01) and lower maternal-reported TSE (β= -1.48, p=0.001) through the 12-month follow-up. A significant effect of time (β= -0.03, p=0.003) reflected a posttreatment decrease in cotinine. There was no treatment × time interaction, suggesting the treatment effect at EOT was sustained after treatment. Compared with controls, FRESH mothers maintained significantly higher odds of quitting smoking from EOT through 12-month follow-up (OR=8.87, 95% CI=2.33, 33.75).

Conclusions: Study results with a sample of underserved maternal smokers demonstrated that the short-term effect of FRESH counseling at 16-week EOT was maintained through 12 months after treatment-for both bioverified child TSE reduction and maternal smoking cessation. Smokers in low-income communities demonstrate elevated challenges to success in standard smoking treatment. FRESH follow-up results suggest the high potential value of more-intensive behavioral intervention for vulnerable smokers.

Trial registration: This study is registered at www.clinicaltrials.gov NCT02117947.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Behavior Therapy*
  • Child, Preschool
  • Cotinine / analysis
  • Cotinine / urine
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Longitudinal Studies
  • Male
  • Mothers / statistics & numerical data*
  • Poverty
  • Telephone
  • Time Factors
  • Tobacco Smoke Pollution* / prevention & control
  • Tobacco Smoke Pollution* / statistics & numerical data
  • Tobacco Smoking / trends*
  • Vulnerable Populations*

Substances

  • Tobacco Smoke Pollution
  • Cotinine

Associated data

  • ClinicalTrials.gov/NCT02117947