Motivation to quit smoking among parents of urban children with asthma

Results 209 parents smoked (39% of sample), and children's mean cotinine was 2.48 ng/ml. Motivation to quit was on average 6.9, and 47% of parents scored ≥8 on the scale. Parents who believed their child's asthma was not under good control, and parents who strongly agreed their child's asthma symptoms would decrease if they stop smoking had higher motivation to quit compared to their counterparts ( p < .05). In a multivariate analysis, parents who believed their child's asthma was not under control had more than twice the odds of reporting high motivation to quit. Conclusion Parents’ perception of the risks of smoking to their child with asthma is associated with motivation to quit. Practice implications Raising awareness about the effect of smoking and quitting on children's asthma might increase motivation to quit among parents. Keywords Asthma Parents Children Smoking cessation Motivation Environmental tobacco smoke 1 Introduction Asthma is one of the most common chronic conditions of childhood [1,2] and is responsible for substantial morbidity, particularly among urban children [3–7] . Environmental tobacco smoke (ETS) is strongly associated with increased morbidity among children with asthma [8–12] including higher requirements for medications, greater symptom severity and more frequent emergency department visits [13,14] . Unfortunately, as many as 50% of urban children with asthma live with at least one smoker [15,16] . Motivation to quit is a key factor in determining success in quitting smoking. Motivation predicts participation in smoking cessation treatment, attempts to quit [17,18] and successful smoking cessation [18] . We sought to examine factors related to motivation to quit among parents of urban children with persistent asthma. 2 Methods 2.1 Participants We collected data from parents of children participating in the School-Based Asthma Therapy (SBAT) trial, a study involving the promotion of medication adherence among 3–10-year-old urban children with persistent asthma in Rochester NY (response rate: 74% [19] ). For the purpose of this study, only baseline data are used. The study was approved by the Institutional Review Board at the University of Rochester Medical School. For this analysis, we included only children with primary caregivers (hereafter referred to as parents) who were smokers ( N = 210). Eligible children had physician-diagnosed asthma and persistent symptoms [20,21] . We excluded one child whose parent provided inconsistent responses about whether or not they smoked. Our final sample included 209 parents who smoke. 2.2 Measurements 2.2.1 Motivation to quit Parent motivation to quit was assessed with a 10-point item (1, not at all motivated to quit/10, very motivated) [22,23] . We used this measure as a continuous variable, and also dichotomized responses at <8 vs. ≥8 to identify parents with motivation levels below and above the 50th percentile for the group. 2.2.2 Smoking history and beliefs about smoking We asked parents how many cigarettes they smoke in a typical 7-day period, the number of smokers living in the child's home, whether the parent planned to quit in the next 30 days (yes/no), and previous quit attempts (yes/no). We also asked whether, in the past month, they had reduced the number of cigarettes smoked (yes/no). We asked parents where they smoked (outside only/inside and outside/mostly inside), and to rate their agreement (strongly agree/agree/disagree/strongly disagree) with the following statement: “if you or other household members stop smoking, it would decrease your child's asthma symptoms”. Lastly, we collected salivary cotinine samples from each child [24,25] . 2.2.3 Asthma symptoms and perception of asthma control Parents reported the number of days in the previous 14 days their child had daytime and nighttime asthma symptoms. Children with ≥5 days or ≥2 nights with symptoms over 2 weeks were considered to have persistent asthma [20] . We assessed parent perception of their child's asthma control by asking how much they agree (strongly agree/agree/disagree/strongly disagree) with the following statement: “My child's asthma is under good control” [26] . 2.2.4 Covariates Covariates consisted of standard demographic variables including the child's age, gender, and insurance (Medicaid/no Medicaid). Parent information included age (<30 years/≥30 years), education (更多