A Study of Tobacco Smoke and Children With Respiratory Illnesses

Children who are regularly exposed to environmental tobacco smoke (ETS) are at a greater
risk for developing respiratory disease. Given the strong relationship between parental
smoking and child health, many studies have evaluated the efficacy of interventions to
modify parental smoking behavior and thereby reduce children's exposure to second- and
thirdhand tobacco smoke, including the use of cotinine levels in children. There are several
local ETS exposure intervention programs for The Barbara Bush Children's Hospital patient
population and their families. The state of Maine and MaineHealth fund a free 24-hour
tobacco cessation hotline (The Maine Tobacco Helpline) which combines evidence-based
behavioral counseling techniques and free nicotine replacement therapy (gum, lozenge, or
patch). MaineHealth also runs a tobacco cessation campaign (The Breathe Easy Coalition) that
provides print materials and trainings aimed to reduce smoking in public housing, hospitals,
behavioral health facilities, and higher education. The Breathe Easy Coalition's Smoke-Free
Housing program provides education about the effects of secondhand and thirdhand tobacco
smoke and asks families to pledge to keep tobacco smoke out of their home. This study aims
to combine all three of these strategies (child cotinine feedback, tobacco cessation
counseling, and written materials on ETS) to create a cohesive ETS exposure reduction
program for the Barbara Bush Children's Hospital inpatient population, and determine the
feasibility of a future study that would evaluate whether cotinine testing is helpful for
changing smoking behaviors in this target population.

Inclusion Criteria:

- age 0 to 10 years old

- admitted to The Barbara Bush Children Hospital for bronchiolitis, pneumonia,
bronchopulmonary dysplasia, or asthma

- the child lives with an adult who smokes cigarettes

Exclusion Criteria:

- Non-English-speaking and -reading adults will be excluded as our interventions are in
English.

- Children over the age of 10 will be excluded as we wanted to avoid children who
themselves smoke, given that we will not have a confidential way to assess this.

- Breastfeeding children will be excluded as nicotine is transferrable in breast milk.

- Families (meaning the parent or guardian, the child, and any smoking coinhabiting
caregiver) will be excluded if the parent or the smoking adult is a minor, as they
would not be able to give consent for participation.

- Children in foster care or whose guardian is the state will be excluded as we are
unlikely to achieve timely consent.

- Families who do not reside in Maine will be excluded as The Maine Tobacco Helpline is
not able to provide services for out-of-state residents.

- Children readmitted to the hospital during our study period will be excluded if they
have already participated in this study during a previous admission.