An Intervention to Reduce Second Hand Smoke Exposure Among Pediatric Emergency Patients

This study will test the efficacy of a cessation intervention for caregivers in a large,
inner-city Pediatric Emergency Department. The proposed Screening, Brief Intervention, and
Assisted Referral to Treatment will highlight the effects of Second Hand Smoke exposure on
the child's health. the investigators will randomize 750 caregivers who smoke who present to
our Pediatric Emergency Department with their child who has a Second Hand Smoke exposure
related illness to either one of two conditions: 1) Screening, Brief Intervention, and
Assisted Referral to Treatment; or 2) Healthy Habits Control. The Screening, Brief
Intervention, and Assisted Referral to Treatment condition will use components shown to be
effective in the out-patient setting but not yet tested in the Pediatric Emergency Department
setting. It will include a brief form of the Clinical Practice Guideline: Treating Tobacco
Use and Dependence, motivational interviewing, engaging and personalized materials on the
effects of smoking and Second Hand Smoke exposure, immediate access to caregivers' choice of
cessation resources (e.g., Quitline, smokefree.gov, or txt2quit), a 12-week supply of
nicotine replacement therapy and weekly booster materials for 12 weeks. The Healthy Habits
Control program has been previously developed and used in the out-patient setting, and will
be used as an attention control in which caregivers will receive instruction on healthy
lifestyle choices to improve their child's health. Cessation assistance will be offered at
the study's conclusion. If effective, the Screening, Brief Intervention, and Assisted
Referral to Treatment model could be routinely used in the Pediatric Emergency Department
setting, which could reach at least one million smokers a year, and could result in
significant reductions in caregivers' tobacco use, Second Hand Smoke exposure related
pediatric illness, and costs in this population. In addition, the investigators' results will
inform the conduct of public health research efforts aimed at adults via the Pediatric
Emergency Department.

Inclusion Criteria:Eligible participants must:

1. be > age 18;

2. be accompanying a child 0-17 years of age who is presenting to the Pediatric Emergency
Department with:

- a stable condition, that is, patients who are not critically ill and do not
require immediate treatment and intervention by the Pediatric Emergency
Department practitioner and

- a potentially Second Hand Smoke exposure related chief complaint (such as
wheezing, difficulty breathing, cough) as outlined by the U.S. Surgeon General;45

3. be a daily smoker;

4. have currently or recently smoked inside their home;

5. speak and read English, and

6. have a permanent address and a working cell or landline number.

7. Live within a 50 mile radius.

8. Child is a non-smoker.

Exclusion Criteria: Caregivers will be excluded if

1. their child has a tracheostomy or

2. if the caregivers are tobacco chewers only,

3. if the caregivers are using pharmacologic cessation treatment,

4. or plan to move within the study period.