Stephen Lepore

Temple University, Department of Social and Behavioral Sciences, Faculty Member

Temple University, Public Health, Faculty Member

Followers

200

Following

Co-authors

Public Views

Address: Philadelphia, PA

less

Daniel D. Hutto

University of Wollongong

Selçuk İşsever

Ankara University

John Barry

Queen's University Belfast

Enrique Gracia

Universitat de València

Kimberly Acquaviva

The George Washington University

danah boyd

Microsoft Research

Eric S . Kim (UBC)

University of British Columbia

John Clark

Loyola University New Orleans

Christopher M. Layne

Nova Southeastern University

David Seamon

Kansas State University

InterestsView All (17)

Uploads

Papers by Stephen Lepore

Multilevel Intervention for Low-Income Maternal Smokers in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

American Journal of Public Health, Mar 1, 2022

Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel interv... more Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel intervention initiated in a citywide safety net health system to improve low-income maternal smokers’ abstinence and reduce child tobacco smoke exposure.Methods. This randomized controlled trial in Philadelphia, Pennsylvania (2015–2020), recruited low-income maternal smokers who received a brief smoking intervention (Ask, Advise, Refer [AAR]) from nutrition professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children before randomization to (1) a multilevel intervention (AAR + multimodal behavioral intervention [MBI]; n = 199) or (2) an attention control intervention (AAR + control; n = 197).Results. AAR + MBI mothers had significantly higher 12-month bioverified abstinence rates than did AAR + control mothers (odds ratio [OR] = 9.55; 95% confidence interval [CI] = 1.54, 59.30; P = .015). There were significant effects of time (b = −0.15; SE = 0.04; P < .001) and condition by time (b = −0.19; SE = 0.06; P < .001) on reported child exposure favoring AAR + MBI, but no group difference in child cotinine. Presence of other residential smokers was related to higher exposure. Higher baseline nicotine dependence was related to higher child exposure and lower abstinence likelihood at follow-up.Conclusions. The multilevel BLiSS intervention was acceptable and efficacious in a population that experiences elevated challenges with cessation.Public Health Implications. BLiSS is a translatable intervention model that can successfully improve efforts to address the persistent tobacco-related burdens in low-income communities.Trial Registration. Clinical Trials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT02602288","term_id":"NCT02602288"}}NCT02602288. (Am J Public Health. 2022;112(3):472–481. https://doi.org/10.2105/AJPH.2021.306601)

Babies Living Safe & Smokefree: randomized controlled trial of a multilevel multimodal behavioral intervention to reduce low-income children’s tobacco smoke exposure

BMC Public Health, Mar 14, 2017

Background: Addressing children's tobacco smoke exposure (TSE) remains a public health priority. ... more Background: Addressing children's tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations. Methods/Design: This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the "Ask, Advise, Refer (AAR)" best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline. Discussion: This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. Trial registration: Clinicaltrials.gov NCT02602288. Registered 9 November 2015.

Stephen Lepore

Uploads

Papers by Stephen Lepore

Log In