Financial Incentives to Reduce Pediatric Tobacco Smoke Exposures

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.

Inclusion Criteria:

- Primary caregiver aged greater than 18 years who is an active smoker.

- Child aged 2-12 years of age who meets clinical criteria for persistent asthma and has
nicotine biomarker levels consistent with secondhand smoke exposure

- Designated social network member who is an active smoker

- Residence in Baltimore City

Exclusion Criteria:

- Child has current diagnosis of another major pulmonary disease or other significant
medical co-morbidity

- Use of electronic cigarettes (e-cigarettes) by the adult-enrolled participants