Effectiveness of motivational interviewing to reduce head start children's secondhand smoke exposure: A randomized clinical trial

Michelle N. Eakin, Cynthia S. Rand, Belinda Borrelli, Andrew Bilderback, Mel Hovell, Kristin A. Riekert

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Rationale: Secondhand smoke exposure (SHSe) is a significant modifiable risk for respiratory health in children. Although SHSe is declining overall, it has increased for low-income and minority populations. Implementation of effective SHSe interventions within community organizations has the potential for significant public health impact. Objectives: To evaluate the effectiveness of motivational interviewing (MI) delivered in the context of a SHS education reduction initiative within Head Start to reduce preschool children's SHSe. Methods: A total of 350 children enrolled in Baltimore City Head Start whose caregivers reported a smoker living in the home were recruited. Caregivers were randomized to MI + education or education alone. Assessments were conducted at baseline, 3, 6, and 12 months. Measurements and Main Results: The primary outcome measure was household air nicotine levels measured by passive dosimeters. Secondary outcomes included child salivary cotinine, self-report of home smoking ban (HSB), and smoking status. Participants in the MI + education group had significantly lower air nicotine levels (0.29 vs. 0.40 mg), 17% increase in prevalence of caregiver-reported HSBs, and a 13% decrease in caregiver smokers compared with education-alone group (all P values < 0.05). Although group differences in salivary cotinine were not significant, among all families who reported having an HSB, salivary cotinine and air nicotine levels declined in both groups (P < 0.05). Conclusions: MI may be effective in community settings to reduce child SHSe. More research is needed to identify ways to tailor interventions to directly impact child SHSe and to engage more families to make behavioral change. Clinical trial registered with www.clinicaltrials.gov (NCT 00927264).

Original languageEnglish (US)
Pages (from-to)1530-1537
Number of pages8
JournalAmerican journal of respiratory and critical care medicine
Issue number12
StatePublished - Jun 15 2014


  • Community engaged research
  • Preschool children
  • Randomized controlled trial
  • Secondhand smoke

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine


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