Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

WIC Families Who Smoke: A Behavioral Counseling Study

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Project Number: R40 MC 02494-04
Grantee: San Diego State University Foundation
Department/Center: Graduate School of Public Health
Project Date: 01/01/2000

Final Report

WIC Families Who Smoke: A Behavioral Counseling Study Final Report (PDF) Exit Disclaimer

Principal Investigator

Melbourne Hovell, Ph.D.
9245 Sky Park Court, Suite 230
San Diego, CA  92123
Phone: (858) 505-4770


  • Women/Maternal
  • Perinatal/Infancy (0-12 months)
  • Toddlerhood (13-35 months)
  • Early Childhood (3-5 years)


This is a competing continuation proposal to complete a trial testing a behavioral intervention designed to reduce environmental tobacco smoke exposure (ETS) and parents' smoking among 150 low-income families recruited from WIC. Primary Aims: 1) to determine the effects of the counseling program on young children's ETS exposure; 2) to determine the effects of participation on mothers' level of smoking and proportion who quit smoking; 3) to validate parent-reported ETS exposure using urine cotinine assays and environmental nicotine monitors. Secondary aims: 4) to determine the effects of participation on other parents' and other smokers' level of smoking and proportion of quits; 5) to explore health outcome measures; 6) to identify possible determinants of ETS exposure and smoking cessation; 7) to examine patterns in repeated baseline children's urine cotinine values; 8) to explore the cost effectiveness of the intervention. This study is an extension of our previous research and combines behavioral counseling for ETS reduction and smoking cessation with nicotine replacement therapy. After 3 baselines, families are assigned at random to the experimental counseling or "usual care" control condition. The experimental group receives 14 counseling sessions over 6 months. Primary participants are mothers, but other parents and other smokers living in the home are encouraged to participate. Counseling incorporates behavioral contracting, shaping, and problem-solving negotiations. Measures are obtained at 3 baselines, 3, 6, 12, and 18 months; and include a detailed interview concerning smoking and exposure rates, key Social Learning Theory variables, and children's health, children's urine samples for cotinine analysis, and environmental nicotine. Self-reported smoking cessation is verified with saliva cotinine or anabasine/anatabine analysis. If effective, the intervention could be incorporated into standard care at WIC clinics nationwide as well as in other settings.


Listed is descending order by year published.

Hovell MF, Zakarian JM, Matt GE, Liles S, Jones JA, Hofstetter CR, Larson SN, Benowitz NL. Counseling to reduce children's secondhand smoke exposure and help parents quit smoking: a controlled trial. Nicotine Tob Res. 2009 Dec;11(12):1383-94.

Liles S, Hovell MF, Matt GE, Zakarian JM, Jones JA. Parent quit attempts after counseling to reduce children's secondhand smoke exposure and promote cessation: main and moderating relationships. Nicotine Tob Res. 2009 Dec;11(12):1395-406.

Johnson-Kozlow M, Hovell MF, Rovniak LS, Sirikulvadhana L, Wahlgren DR, Zakarian JM. Fidelity issues in secondhand smoking interventions for children. Nicotine Tob Res. 2008 Dec;10(12):1677-90.

Matt GE, Hovell MF, Quintana PJE, Zakarian JM, Liles S, Meltzer SB, et al. The variability of urine cotinine levels in young children: implications for measuring ETS exposure. Nicotine Tob Res. 2007 Jan;9(1):83-92.

Matt GE, Quintana PJ, Liles S, Hovell MF, Zakarian JM, Jacob P 3rd, et al. Evaluation of urinary trans-3'-hydroxycotinine as a biomarker of children's environmental tobacco smoke exposure. Biomarkers. 2006 Nov-Dec;11(6):507-23.

Zakarian JM, Hovell MF, Sandweiss RD, Hofstetter CR, Matt GE, Bernert JT, et al. Behavioral counseling for reducing children's ETS exposure: implementation in community clinics. Nicotine Tob Res. 2004 Dec;6(6):1061-74.

Gehrman CA, Hovell MF. Protecting children from environmental tobacco smoke (ETS) exposure: a critical review. Nicotine Tob Res. 2003 Jun;5(3):289-301.



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