Study: Motivational Interviewing Helps Reduce Home Secondhand Smoke Exposure Among Inner City Children at Risk

A Johns Hopkins-led research team has found that motivational interviewing, along with standard education and awareness programs, significantly reduced secondhand smoke exposure among children living with people who smoke.

Motivational interviewing, a counseling strategy that gained popularity in alcoholism treatment, uses a patient-centered counseling approach to help motivate people to change behavior. It stands in contrast to externally driven tactics, experts say. It favors instead working with patients by acknowledging how difficult change is and by helping people devise and implement practical plans for change when they are ready.

In a report published online on June 15 in the American Journal of Respiratory and Critical Care Medicine, the research team says caregivers of children who received motivational interviewing combined with smoking risk education were more likely than a comparison group to set up home smoking bans and reduce harmful secondhand smoke exposure, as measured by air nicotine levels in the homes.

For the study, the investigators recruited 330 children enrolled in the Baltimore City Head Start school program whose caregivers reported a smoker living in the children’s homes. Head Start serves low-income, predominantly minority preschool children and families. All of the caregivers received educational materials and participated in activities created by the Environmental Protection Agency, and all were asked to participate in secondhand smoke exposure education and awareness programs at their Head Start locations.

Some of the caregivers were randomly assigned to also receive motivational interviewing. The motivational interviewing counseling comprised five sessions over three months with a trained health counselor, which were designed to help caregivers set up a home smoking ban and encourage smokers to quit. The homes of those in the motivational interviewing-plus-education group showed significantly lower air nicotine levels compared to the homes of the education-only group. The researchers observed a 17 percent increase in prevalence of home smoking bans in the motivational interviewing group, compared to a 7 percent increase in the education-only group. They also saw a 13 percent decrease in smokers in the motivational interviewing group, compared with a 5 percent decrease in the education-only group.

“The lowered secondhand smoke exposure in the motivational interviewing group is important, because children in Head Start communities are at high risk for asthma and other disorders linked to such exposure,” says report lead author Michelle N. Eakin, Ph.D., assistant professor of medicine in the Division of Pulmonary and Critical Care Medicine in the Johns Hopkins University School of Medicine.

“We know from this study that people can change behavior, but to do so, raising awareness and educating them is not enough.”

Eakin says secondhand smoke exposure is a well-documented and significant threat to children’s respiratory health. It plays a role in sudden infant death syndrome, middle ear disease, pneumonia and bronchitis. Low-income and minority families are at an especially high risk for secondhand smoke exposure, she says.

“We’ve demonstrated the effectiveness of a practical intervention for a vulnerable population,” Eakin says.

The full report is titled “Effectiveness of Motivational Interviewing to Reduce Head Start Children’s Secondhand Smoke Exposure.” It is available online here:

Other authors of the report are Cynthia S. Rand, Ph.D., Andrew Bilderback and Kristin A. Riekert, Ph.D., of the Division of Pulmonary and Critical Care Medicine in the Johns Hopkins University School of Medicine; Belinda Borrelli of Brown University’s Warren Alpert Medical School and The Miriam Hospital in Providence, Rhode Island; and Mel Hovell of the Center for Behavioral Epidemiology and Community Health at San Diego State University.

This research was supported by National Heart, Lung and Blood Institute grant HL092901.

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