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A Healthy People 2010 objective is to decrease the
prevalence of cigarette smoking among adults to less than
12% (CDC, 2002). Individuals with low income and
socioeconomic status are disproportionately affected by
tobacco (USDHHS, 2008). Kentucky far exceeds the nation in
current smokers among both women of child-bearing age (34.7%
vs 22.4%) and pregnant women (26.3% vs. 10.7%), making this
a significant public health concern. The necessity for
accessible and effective interventions promoting smoking
cessation for low income women and their families within
Kentucky’s public health system is clear.
Kentucky has a well established home visitation program
entitled Health Access Nurturing Development Services
(HANDS) that targets at-risk first time parents. The large
majority of HANDS at-risk parents are below the poverty
level, with ~85% receiving Medicaid. External evaluation of
this program has documented a number of positive birth
outcomes (fewer preterm births, fewer cases of low and very
low birth weight, and reduced child abuse/neglect for
participants in the program relative to a statewide
comparison group. This program does assess smoking status of
clients; however, it has had limited impact on smoking
prevalence.
A randomized controlled trial with repeated measures
design will be conducted to test the effectiveness of
enhancements to an established home visitation program on
prevalence of smoking, quit rates, secondhand smoke
exposure, and home air quality. Pregnant women (N=180) will
be randomly assigned to one of three groups: 1) Usual care:
those that receive the usual smoking cessation protocol by a
HANDS worker; 2) Enhanced l: those that receive smoking
cessation counseling by a HANDS nurse specifically trained
in smoking cessation; and 3) Enhanced ll: those that receive
Enhanced l plus participate in a tailored Cooper/Clayton
smoking cessation class with a designated support person.
Five times during the study, home air quality and expired
carbon monoxide will be measured in all study groups.
The specific aims of this study are:
- To compare cessation rates in low-income women
enrolled in a home visitation program (HANDS) in those
who receive usual care versus two enhanced
interventions;
- To examine the relationship between smoking
cessation and two biomarker measures (home air quality
and expired carbon monoxide) in those who receive usual
care versus two enhanced interventions.
The long-term goal of this project is to decrease smoking
prevalence and secondhand smoke exposure (SHS) in a
high-risk low-income population, thereby improving the
health of women and their families.
This project offers novel individual-level and
organizational systems-level approaches designed to improve
program effectiveness by recognizing the impact that
support-persons have in enhancing smoking cessation
treatment success. The incorporation of a smoking cessation
component into this existing public health program will not
only improve the availability of smoking cessation services
to a high risk low-income population of pregnant women in
Appalachia, but also may result in enhanced birth outcomes
for this population.
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