Women of Algiers in their Room, by Eugene Delacroix , 1834 .

1. Women of Algiers in their Room, by Eugene Delacroix, 1834. Hookahs in Art. http://www.discoverhookah.com/store/pages.php?pageid=9

2. Second & Third-Hand Smoke Exposure in Private Homes: Current & Future Clinical Interventions & Ecological ContextsThe Johns Hopkins University3/28/11

3. The Behavioral Ecological Model • Based on Biology/Ecology • Selection of Species • Selection of Behavior • Principles of Learning Across All Animal Species • Emphasizes Environment Determinants • Based on Principles of Learning • Contingencies of Reinforcement—incentives or rewards • Hierarchical & interacting contingencies • Meta-and Macro-contjngencies • Motivating operations or Moderating Factors

4. The Problem with Behavior • It is a stream • It’s a stream interacting with the environment • The entire environment is also a stream • Neither will hold still • It’s very hard to measure a stream • It’s almost impossible to measure multiple streams • Measuring Streams is prerequisite to Modifying behavior • Measuring Multiple behaviors from multiple people residing in multiple social networks are the streams to be targeted by behavioral science

6. Social Networks Defined by Contingencies

7. B A C Dad smokes outside A B A B C C Cascading & Interlocking Contingencies Counselor prompts Mom asks Dad to Smoke outside Avoids Criticism; protects child

8. B A C Boss smokes outside A B A B C C Cascading & Interlocking Contingencies Legislative Bans Asks Visitors Not to smoke Thanks/avoids Criticism

9. BEHAVIORAL COUNSELING PROGRAM • Parents contract to reduce their child’s ETS Exposure • Short-term goals • Self-monitoring • Positive feedback • Problem-solving brainstorming • Recruitment of social contingencies • 4-14 sessions in the home and by phone

10. ~ The Role of Clinicians ~ • Nonsmoker Models • Deliver Tobacco Control Services • Contract with parents and other family members • Address ETS as Lead contamination • Promote Policies for reimbursement of tobacco control services • Promote Laws restricting ETS exposure community-wide • Most providers do few of these

11. Cross Validity of Measures Contamination: Exposure: Child Urine Cotinine ------.65------- Indoor Air Nicotine | | | | | | __________ | | .63 _________\___ | .62 | / \ | | .71 .41 | | / \ | Reported Indoor ------.78--------- Reported Smoking in Smoking presence of the child

13. Results: Cotinine (geometric means) • Intervention Phase • Group by time (linear) interaction significant (p<.05) • Follow-up Phase • Group by time interaction nonsignificant

14. Healthy Tots: SHSe and Cessation Counseling

15. Project Sirocco: Counseling and Cotinine Feedbackfor preteens

16. General schematic of Thirdhand smoke (THS) formation and reactions on indoorsurfaces

17. THS Exposure in Homes of Smokers and Nonsmokers No Exposure: Nonsmoking Parents, no known exposure of child Indirect: Smoking parents, no indoor smoking at home Direct: Smoking parents, indoor smoking at home Matt, G.E., et al. (2004). Households contaminated by environmental tobacco smoke: sources of infant exposures. Tobacco Control, 13, 29–37. Chudler, E.H. (2004). Nicotine, Secondhand Smoke and Infants. Smoking outside the home still exposes infants to nicotine. http://faculty.washington.edu/chudler/shs.html.

18. Cascading Contingencies can Change culturesG. Matt et al

19. B A C Decontaminates Home A B A B C C Cascading & Interacting Contingencies Dr Explains Cotinine Parents Decontaminates Home Sells for > $

21. Figure 3 Real Time Telemetry and Feedback: SHS exposure

23. Legislative and other Policies: Macro-contingencies that may alter clinical metacontingencies

24. Tobacco Module #1 Prescription

25. Dose Effect – Tobacco-Use Incidence and Anti-Tobacco Prescriptions * Significant differences between group that received 0-1 prescription.

26. Proportion of participants who initiated tobacco use stratified by experimental group and “friends who think smoking is cool”

27. Study Sites

28. DAILY SHS EXPOSURE

29. Social Criticism in Public Places Percentage of respondents who considered it VERY LIKELY TO BE CRITICIZED for smoking inside public places

30. Secondhand smoke avoidance by preteens:To leave or stay?

31. Conclusions: Anti-tobacco cultures are contagious • Differences in social criticism of tobacco varying by proximity, • Differences in Home bans differ by proximity to California • Workplace bans moderate city effects on home bans • Suggests that the exposure to the California anti-tobacco culture is changing the culture of Tijuana.

32. What do we think? • Counseling can decrease SHSe • Context Enhances or weakens counseling • Measurement reactivity weakens g x t sign • SHSe & THSe requires changes in Social Networks, including Providers • Real time Feedback may enhance SHSe and THSe control • Cascading Contingencies Change Cultures

33. Waterpipe Use among the Youth A young female is smoking the waterpipe in a public pool area in Lebanon. Soweid, RA. (2005). Lebanon: waterpipe line to youth. Tobacco Control, 14(6):363-4.