Financial Incentives to Reduce Pediatric Tobacco Smoke Exposures
Condition: Asthma; Incentives; Tobacco Smoking
Study type: Interventional

Summary: 
      Secondhand smoke exposure (SHSe) is one of the most common and potentially modifiable
      environmental triggers for asthma. Financial incentivization may serve as an effective
      modality to reduce SHSe among pediatric asthmatics with potential down-stream benefits on
      improved asthma control and subsequent reduced healthcare utilization. This study plans on
      testing the feasibility and effectiveness of financial incentives to decrease SHSe, derived
      from primary caregivers and a member of their social network, of children with persistent
      asthma.
    

Detailed description: 
      The impact of continued cigarette usage is profoundly felt not only upon the primary smoker,
      but also among children where SHSe is linked with asthma exacerbations. Children with
      caregivers who are active smokers are more likely to utilize acute healthcare resources and
      miss more days of school due to asthma symptoms. Issues of pediatric smoke exposure are
      notably higher among low-income populations. This particular group has a greater amount of
      financial strain that increases their desire to cease smoking but is among the least
      successful at accomplishing this task. Aggressive marketing campaigns by cigarette companies
      have specifically targeted the urban poor but similar techniques by public health officials,
      though on a much diminished scale, have yet to completely counter the hold that this
      addictive product has on members of lower socioeconomic status. One approach that has
      demonstrated efficacy in reducing smoking in resistant populations emphasizes financial
      incentives. Incentives may provide a substitute for the gratification derived from nicotine
      if they are properly structured. This proposal applies a contingency management schema among
      caregivers of pediatric asthmatics and a member of their caregiver's social network - both of
      whom are likely major contributors to the child's total secondhand smoke exposure. A pilot
      two-arm randomized-control trial will be employed over a 6-month time interval.The study
      population will consist of the primary caregiver and a selected member of their social
      network, both of who are known active smokers, and contemplating smoking cessation; both
      individuals spend time (either indoors or outdoors) with the asthmatic child. We will recruit
      50 caregiver-child-social network triads among a population of children diagnosed with
      uncontrolled, persistent asthma and routinely exposed to high levels of SHSe. Caregivers and
      members of their social network who are both active smokers will be randomized to receive
      standard smoking cessation strategies (n=25 triads) with or without financial incentives
      (n=25 triads). SHSe will be measured directly using salivary cotinine levels from children
      and home air nicotine levels. Caregiver and social network member smoking behaviors will be
      measured by nicotine biomarkers; both test results will be the basis for incentive payments.
      Asthma control will be evaluated using validated questionnaires and review of the
      participant's electronic health record.
    

Intervention name(s): Incentive plan; Smoking cessation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The caregiver and designated social network member can each receive monthly financial incentives over the 6 month time interval. Additional monthly incentives will be received at 3- and 6-months if the participant's previous two monthly biomarker levels were below the lower-limit cutoff.; Participants who wish to quit smoking will be referred upon study recruitment to the smoking cessation program that is provided at no-cost by the Maryland Department of Health and Mental Hygiene (DMMH). The DMMH provides standard counseling and nicotine replacement pharmacotherapies for clients and is offered online or at six health centers throughout Baltimore City.
Other intervention name(s): Contingency management; Tobacco cessation
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research