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Original Research: TOBACCO CESSATION AND PREVENTION |

Providing Coaching and Cotinine Results to Preteens to Reduce Their Secondhand Smoke ExposureFeedback to Preteens for Secondhand Smoke Exposure: A Randomized Trial

Melbourne F. Hovell, PhD, MPH; Dennis R. Wahlgren, MA; Sandy Liles, MPH; Jennifer A. Jones, MPH; Suzanne C. Hughes, PhD; Georg E. Matt, PhD; Ming Ji, PhD; Christina N. Lessov-Schlaggar, PhD; Gary E. Swan, PhD; Dale Chatfield, PhD; Ding Ding, MPH
Author and Funding Information

From the Center for Behavioral Epidemiology and Community Health (Drs Hovell and Hughes, Messrs Wahlgren and Liles, Mss Jones and Ding), and the Division of Epidemiology and Biostatistics (Dr Ji), Graduate School of Public Health, the Department of Psychology (Dr Matt), and the Department of Chemistry (Dr Chatfield), San Diego State University, San Diego, CA; the Department of Psychiatry (Dr Lessov-Schlaggar), Washington University School of Medicine, St. Louis, MO; and the Center for Health Sciences (Dr Swan), SRI International, Menlo Park, CA.

Correspondence to: Melbourne F. Hovell, PhD, MPH, Center for Behavioral Epidemiology and Community Health, 9245 Sky Park Ct, Ste 230, San Diego, CA 92123; e-mail: mhovell@projects.sdsu.edu


Funding/Support: This research was supported by the National Institutes of Health [Grants HL066307 (M. F. H.), DA018019 (G. E. S.), DA027046 (C. N. L. S.)] and by discretionary funds from the Center for Behavioral Epidemiology and Community Health (M. F. H., Director).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):681-689. doi:10.1378/chest.10-2609
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Background:  Secondhand smoke exposure (SHSe) poses health risks to children living with smokers. Most interventions to protect children from SHSe have coached adult smokers. This trial determined whether coaching and cotinine feedback provided to preteens can reduce their SHSe.

Methods:  Two hundred one predominantly low-income families with a resident smoker and a child aged 8 to 13 years who was exposed to two or more cigarettes per day or had a urine cotinine concentration ≥ 2.0 ng/mL were randomized to control or SHSe reduction coaching groups. During eight in-home sessions over 5 months, coaches presented to the child graphic charts of cotinine assay results as performance feedback and provided differential praise and incentives for cotinine reductions. Generalized estimating equations were used to determine the differential change in SHSe over time by group.

Results:  For the baseline to posttest period, the coaching group had a greater decrease in both urine cotinine concentration (P = .039) and reported child SHSe in the number of cigarettes exposed per day (child report, P = .003; parent report, P = .078). For posttest to month 12 follow-up, no group or group by time differences were obtained, and both groups returned toward baseline.

Conclusions:  Coaching preteens can reduce their SHSe, although reductions may not be sustained without ongoing counseling, feedback, and incentives. Unlike interventions that coach adults to reduce child SHSe, programs that increase child avoidance of SHSe have the potential to reduce SHSe in all settings in which the child is exposed, without requiring a change in adult smoking behavior.

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