Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Reducing Environmental Tobacco smoke in NICU infants' homes

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Project Number: R40 MC 08962-03
Grantee: University of Texas Health Science Center at Houston
Department/Center: Family and Community Medicine/Medical School
Project Date: 2/1/2008

Final Report

Reducing Environmental Tobacco smoke in NICU infants' homes Final Report (PDF) Exit Disclaimer

Principal Investigator

Angela L. Stotts, Ph.D.
Associate Professor & Director of Research
6431 Fannin Street, JJL 324
Houston, TX  77030
Phone: (713) 500-7590


  • Women/Maternal
  • Perinatal/Infancy (0-12 months)


  • Hispanic/Latino


Approximately 38% of children aged 2 months to 5 years are exposed to environmental tobacco smoke (ETS), and compelling evidence suggests rates are even higher in low¬income, less educated households. The adverse health effects of chronic ETS in children are well documented and include higher risks of delayed lung development, respiratory illnesses, wheeze, cough, asthma, middle ear disease and sudden infant death syndrome. Preterm infants admitted to a Neonatal Intensive Care Unit (NICU) are particularly vulnerable to the effects of ETS, typically exhibiting significant respiratory or chronic lung conditions prior to discharge. The primary aim of this investigation is to develop and verify the feasibility and efficacy of a multi¬component behavioral intervention for reducing ETS exposure in a low¬income, multi¬ethnic population of NICU infants at particularly high social and medical risk for adverse effects of ETS. A randomized, controlled, between groups design will be used to test a hospital¬based ETS reduction program based on motivational interviewing (MI). A total of 118 families with an infant at high respiratory risk in the NICU who report regular household smoking will be randomized to either MI or Usual Care. The MI intervention will include 2 one hour counseling sessions within the 2 weeks prior to infant discharge and one telephone counseling call at two weeks post¬discharge. Counseling and interviews will be conducted in Spanish or English. Primary efficacy variables will include both objective (household air nicotine monitors; infant ETCO levels) and self¬report measures of household ETS exposure. In addition to achieving lower smoke exposure rates in the MI condition, we expect MI will produce significant changes in several domains of functioning (e.g. self¬efficacy, motivation to change). Additional preliminary clinical outcomes will be assessed for the generation of evidence¬based hypotheses, including differential impact on respiratory symptoms and diagnoses (pneumonia, bronchiolitis, otitis media), and healthcare utilization (acute care visits, rehospitalization, emergency department visits). Finally, the impact of having an infant with chronic lung disease (e.g., Bronchopulmonary Dysplasia) on ETS outcomes will be explored as a secondary, hypothesis¬generating aim. Outcomes will be assessed at 1, 3, and 6 months post¬discharge. Objective measures of ETS will be evaluated at six months using an independent samples t¬test. Secondary analyses will assess the time course of the post¬intervention response using repeated¬measures ANOVA for measures at one and six months. Putative mechanisms of treatment will be modeled using path analysis. Additional outcomes including health¬care utilization and respiratory conditions will be examined using Poisson and logistic regression. This initial study addresses the Maternal and Child Health Bureau's (MCHB) Strategic Research Issue #IV, Promoting the healthy development of MCH populations and #II, Eliminating health disparities due to economic and racial barriers. The proposed research brings together highly experienced behavioral and clinical investigators, an extraordinary infrastructure, and a large population easily accessible for intervention prior to discharge. Effective brief, hospital¬based interventions to reduce ETS exposure in households with NICU infants at high respiratory risk could result in substantial decreases in adverse health effects and the very large associated costs.


Listed is descending order by year published.

Northrup, TF, Evans, PW, & Stotts, AL. Depression among mothers of high-risk infants discharged from a neonatal intensive care unit. MCN, The American Journal of Maternal Child Nursing. 2013. 38(2), 89-94.

Stotts, AL, Green, C, Northrup, TF, Dodrill, CL, Evans, P, Tyson, J, Velasquez, M, Hammond, K, & Hovell, MF. Feasibility and Efficacy of an Intervention to Reduce Secondhand Smoke Exposure among Infants Discharged from a Neonatal Intensive Care Unit. Journal of Perinatology. 2013. 1-7. doi: 10.1038/jp.2013.43

Stotts, A., Evans, P., Green, C., Northrup, T.F., Dodrill, C, Fox, J., Tyson, J. & Hovell, M. Secondhand smoke risk in infants discharged from a NICU: Potential for significant health disparities? Nicotine and Tobacco Research. 2011 Nov;13(11):1015-22. Epub 2011 Jun 13. PubMed PMID: 21669959; PubMed Central PMCID: PMC3430443.


Smoking, Infant Illness & Hospitalization, Health Care Utilization, Chronic Illness, Health Disparities

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