Document Type


Publication Date



Published in: Addiction, 111, 1646-1655, 2016.


Aims—We tested two aims: 1) The Teachable Moment (TM): whether second hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma vs. parents of healthy children (HC) and 2) whether greater intervention intensity (Enhanced-PAM) produces greater cessation than a previously tested intervention (Precaution Adoption Model; PAM).

Design and interventions—Aim 1: Two home visits (asthma education or child wellness), and cessation induction using Motivational Interviewing and SHSe feedback. Aim 2: Post home-visits, parents with asthmatic children were randomized to PAM (n=171; 6 asthma education calls) or Enhanced-PAM (n=170; 6 asthma education/smoking cessation calls + repeat SHSe feedback).

Setting—Rhode Island USA.

Participants—Parents of asthmatic (n=341) or healthy (n=219) children who did not have to want to quit smoking to enroll.

Measurements—were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day ppa, and SHSe (primary) and asthma morbidity (secondary).

Findings—Aim 1: The TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day (OR=2.60, 95% CI = 1.22–5.54) and 7-day ppa (OR=2.26, 95% CI=1.13– 4.51) at 2 months (primary endpoint) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR=3.60; 95% CI= 1.72–7.55). Aim 2: Enhanced-PAM was more likely to achieve 30-day ppa at the primary endpoint, 4-months (OR=2.12, 95% CI 1.09–4.12) and improved asthma outcomes vs. PAM.

Conclusions—Smoking cessation interventions (Motivational Interviewing + biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes.