A Minimal Intervention to Promote Smoke-Free Homes among 2-1-1 Callers: North Carolina Randomized Effectiveness Trial.
ABSTRACT: This study examined the extent to which delivery of the minimal Smoke-Free Homes intervention by trained 2-1-1 information and referral specialists had an effect on the adoption of home smoking bans in low-income households. A randomized controlled trial was conducted among 2-1-1 callers (n = 500) assigned to control or intervention conditions. 2-1-1 information and referral specialists collected baseline data and delivered the intervention consisting of 3 mailings and 1 coaching call; university-based data collectors conducted follow-up interviews at 3 and 6 months post-baseline. Data were collected from June 2013 through July 2014. Participants were mostly female (87.2%), African American (61.4%), and smokers (76.6%). Participants assigned to the intervention condition were more likely than controls to report a full ban on smoking in the home at both 3- (38.1% vs 19.3%, p = < .001) and 6-month follow-up (43.2% vs 33.2%, p = .02). The longitudinal intent-to-treat analysis showed a significant intervention effect over time (OR = 1.31, p = .001), i.e. OR = 1.72 at 6 months. This study replicates prior findings showing the effectiveness of the minimal intervention to promote smoke-free homes in low-income households, and extends those findings by demonstrating they can be achieved when 2-1-1 information and referral specialists deliver the intervention. Findings offer support for this intervention as a generalizable and scalable model for reducing secondhand smoke exposure in homes.
Project description:BACKGROUND:Replication of intervention research is reported infrequently, limiting what we know about external validity and generalisability. The Smoke Free Homes Program, a minimal intervention, increased home smoking bans by United Way 2-1-1 callers in randomised controlled trials in Atlanta, Georgia and North Carolina. OBJECTIVE:Test the programme's generalisability-external validity in a different context. METHODS:A randomised controlled trial (n=508) of English-speaking callers from smoking-discordant households (?1 smoker and ?1 non-smoker). 2-1-1 Texas/United Way HELPLINE call specialists serving the Texas Gulf Coast recruited callers and delivered three mailings and one coaching call, supported by an online tracking system. Data collectors, blind to study assignment, conducted telephone interviews 3 and 6?months postbaseline. RESULTS:At 3?months, more intervention households reported a smoke-free home (46.6% vs 25.4%, p<0.0001; growth model intent-to-treat OR=1.48, 95% CI 1.241 to 1.772, p<0.0001). At 6?months, self-reported full bans were 62.9% for intervention participants and 38.4% for controls (OR=2.19). Texas trial participants were predominantly women (83%), single-smoker households (76%) and African-American (65%); half had incomes ?US$10?000/year (50%). Texas recruitment was <50% of the other sites. Fewer callers reported having a smoker in the household. Almost twice the callers with a household smoker declined interest in the programme/study. CONCLUSIONS:Our findings in a region with lower smoking rates and more diverse callers, including English-speaking Latinos, support programme generalisability and convey evidence of external validity. Our recruitment experience indicates that site-specific adjustments might improve recruitment efficiency and reach. TRIAL REGISTRATION NUMBER:NCT02097914, Results.
Project description:Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars), and secondhand smoke (SHS) exposure remains prevalent among children and low-socioeconomic status (SES) populations. This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children. The pilot was implemented through Minnesota's National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDPs provide cancer prevention services to low-income individuals experiencing health disparities. We successfully utilized and adapted the Smoke-Free Homes Program (SFHP) to address comprehensive smoke-free rules among households with children. We used two recruitment methods: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. We used descriptive statistics to assess implementation outcomes and hierarchical logistic regression models (HLM) to assess change in smoke-free rules and SHS exposure over the study period. There was no comparison group, and HLM was used to examine within-person change. A total of 64 participants were recruited. Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route. Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.
Project description:Scalable interventions remain effective across a range of real-world settings and can be modified to fit organizational and community context. "Smoke-Free Homes: Some Things are Better Outside" has been effective in promoting smoke-free home rules in low-income households in efficacy, effectiveness, generalizability, and dissemination studies. Using data from a dissemination study in collaboration with five 2-1-1 call centers in Ohio, Florida, Oklahoma, and Alabama (n = 2,345 households), this article examines key dimensions of scalability, including effectiveness by subpopulation, secondary outcomes, identification of core elements driving effectiveness, and cost-effectiveness. Evaluated by 2-1-1 staff using a pre-post design with self-reported outcomes at 2 months postbaseline, the program was equally effective for men and women, across education levels, with varying number of smokers in the home, and whether children were present in the home or not. It was more effective for nonsmokers, those who smoked fewer cigarettes per day, and African Americans. Creating a smoke-free home was associated with a new smoke-free vehicle rule (odds ratio [OR] = 3.38, confidence interval [CI 2.58, 4.42]), decreased exposure to secondhand smoke among nonsmokers (b = -2.33, p < .0001), and increased cessation among smokers (OR = 5.8, CI [3.81, 8.81]). Use of each program component was significantly associated with success in creating a smoke-free home. Using an intent-to-treat effect size of 40.1%, program benefits from 5 years of health care savings exceed program costs yielding a net savings of $9,633 for delivery to 100 households. Cost effectiveness, subpopulation analyses, and identification of core elements can help in assessing the scalability potential of research-tested interventions such as this smoke-free homes program.
Project description:OBJECTIVES:To determine how smoke-free and vape-free home and car policies differ for parents who are dual users of cigarettes and electronic cigarettes (e-cigarettes), who only smoke cigarettes, or who only use e-cigarettes. To identify factors associated with not having smoke-free or vape-free policies and how often smoke-free advice is offered at pediatric offices. METHODS:Secondary analysis of 2017 parental interview data collected after their children's visit in 5 control practices participating in the Clinical Effort Against Secondhand Smoke Exposure trial. RESULTS:Most dual users had smoke-free home policies, yet fewer had a vape-free home policies (63.8% vs 26.3%; P < .01). Dual users were less likely than cigarette users to have smoke-free car (P < .01), vape-free home (P < .001), or vape-free car (P < .001) policies. Inside cars, dual users were more likely than cigarette users to report smoking (P < .001), e-cigarette use (P < .001), and e-cigarette use with children present (P < .001). Parental characteristics associated with not having smoke-free or vape-free home and car policies include smoking ?10 cigarettes per day, using e-cigarettes, and having a youngest child >10 years old. Smoke-free home and car advice was infrequently delivered. CONCLUSIONS:Parents may perceive e-cigarette aerosol as safe for children. Dual users more often had smoke-free policies than vape-free policies for the home. Dual users were less likely than cigarette-only smokers to report various child-protective measures inside homes and cars. These findings reveal important opportunities for intervention with parents about smoking and vaping in homes and cars.
Project description:Although working smoke alarms halve deaths in residential fires, many households do not keep alarms operational. We tested whether theory-based education increases alarm operability.Randomised multiarm trial, with a single arm randomly selected for use each day, in low-income neighbourhoods in Maryland, USA. Intervention arms: (1) Full Education combining a health belief module with a social-cognitive theory module that provided hands-on practice installing alarm batteries and using the alarm's hush button; (2) Hands-on Practice social-cognitive module supplemented by typical fire department education; (3) Current Norm receiving typical fire department education only. Four hundred and thirty-six homes recruited through churches or by knocking on doors in 2005-2008. Follow-up visits checked alarm operability in 370 homes (85%) 1-3.5?years after installation.number of homes with working alarms defined as alarms with working batteries or hard-wired and number of working alarms per home. Regressions controlled for alarm status preintervention; demographics and beliefs about fire risks and alarm effectiveness.Homes in the Full Education and Practice arms were more likely to have a functioning smoke alarm at follow-up (OR=2.77, 95% CI 1.09 to 7.03) and had an average of 0.32 more working alarms per home (95% CI 0.09 to 0.56). Working alarms per home rose 16%. Full Education and Practice had similar effectiveness (p=0.97 on both outcome measures).Without exceeding typical fire department installation time, installers can achieve greater smoke alarm operability. Hands-on practice is key. Two years after installation, for every three homes that received hands-on practice, one had an additional working alarm.http://www.clinicaltrials.gov number NCT00139126.
Project description:Exposure to second-hand smoke (SHS) is associated with various ill-health outcomes for children and adults. Barriers to creating a smoke-free home (SFH) are well-documented. Feasible and effective interventions to create smoke-free homes for disadvantaged households are lacking. Interventions that include providing parents with objective information about the impact of smoking on air quality in their home may be particularly effective. This study describes the development of a novel, theory- and evidence-based smoke-free homes intervention using objectively-assessed air quality feedback. The intervention was developed using the six-step Intervention Mapping (IM) protocol. Findings from literature reviews, focus groups with parents, interviews with health/care professionals, and expert panel discussions shaped intervention content and materials. Findings highlighted the importance of parents receiving personalised information on second-hand smoke levels in their home. Professionals considered the use of non-judgemental language essential in developed materials. Previous literature highlighted the need to address home smoking behaviour at a household rather than individual level. The AFRESH intervention is modular and designed to be delivered face-to-face by healthcare professionals. It includes up to five meetings with parents, two sets of five days' air quality monitoring and personalised feedback, and the option to involve other household members in creating a smoke-free home using educational, motivational, and goal setting techniques. Further research is needed to evaluate the acceptability and effectiveness of the AFRESH intervention and which specific groups of parents this intervention will most likely benefit. IM was a useful framework for developing this complex intervention. This paper does not present evaluation findings.
Project description:Smoke-free homes reduce exposure to secondhand smoke, contribute to lower levels of consumption, and help smokers to quit. Even when home smoking rules are established however, they may not be consistently enforced.This study uses data from a randomized controlled trial of a brief intervention to create smoke-free homes among callers to the United Way of Greater Atlanta 2-1-1. Participants with partial or full home smoking bans at 6-month follow-up were asked about enforcement challenges, rooms where smoking occurred, and exceptions to the rules. Air nicotine monitors were placed in a subset of homes.Participants (n = 286) were mostly female (84.6%) and African American (84.9%). Most were smokers (79.0%) and reported at least half of their friends and relatives smoked (63.3%). Among those with a full ban, 4.3% reported their rules were broken very often whereas 52.6% stated they were never broken. Bad weather and parties were the most common exceptions to rules. Among nonsmokers with full bans, 16% reported exposure to secondhand smoke in the home 1-3 days in the past week. In multivariate analyses, having a partial ban, being a nonsmoker, and living with three or more smokers predicted higher levels of enforcement challenges.Findings suggest the majority of households with newly adopted smoke-free rules had no or rare enforcement challenges, but about one-fifth reported their rules were broken sometimes or very often. Interventions to create smoke-free homes should address enforcement challenges as newly adopted rules may be fragile in some households.Interventions that promote smoke-free homes should address enforcement challenges.
Project description:We examined the effectiveness of state cigarette price and smoke-free homes on smoking behaviors of low-income and high-income populations in the United States.We used the 2006-2007 Tobacco Use Supplement to the Current Population Survey. The primary outcomes were average daily cigarette consumption and successful quitting. We used multivariable regression to examine the association of cigarette price and smoke-free home policies on these outcomes.High state cigarette price (pack price???$4.50) was associated with lower consumption across all income levels. Although low-income individuals were least likely to adopt smoke-free homes, those who adopted them had consumption levels and successful quit rates that were similar to those among higher-income individuals. In multivariable analysis, both policies were independently associated with lower consumption, but only smoke-free homes were associated with sustained cessation at 90 days.High cigarette prices and especially smoke-free homes have the potential to reduce smoking behaviors among low-income individuals. Interventions are needed to increase adoption of smoke-free homes among low-income populations to increase cessation rates and prevent relapse.
Project description:INTRODUCTION:Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children. DESIGN:A randomized trial with two groups-intervention and control. SETTING/PARTICIPANTS:A total of 298 participants from predominantly low-income households with an adult smoker and a child aged <14 years. Participants were recruited during 2012-2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites. INTERVENTION:The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources. MAIN OUTCOME MEASURES:In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (>15,000 particles/0.01 ft3). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016-2017. RESULTS:Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p<0.001). Intervention homes' average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p<0.001). CONCLUSIONS:Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT01634334.
Project description:This paper aimed to explore the association between rurality and (1) household smoking status and (2) home second-hand smoke exposure, in households with children aged 0-14 years.Cross-sectional study.Households across Australia.Households across the country were randomly selected to provide a nationally representative sample. Respondents were persons aged 12 years or older in each household who were next going to celebrate their birthday.Household smoking status and smoking inside the home.The 2010 Australian National Drug Strategy Household survey data were analysed to explore the prevalence of household smoking and home second-hand smoke exposure in rural and urban households with children. Multivariable logistic regression was used to explore the association of rurality with household smoking and with home second-hand smoke exposure, controlling for potential confounders.Households with children were more likely to be smoking households (35.4%, 95% CI 34.2% to 36.5%) than households without children (32.1%, 95% CI 31.3% to 32.8%). Both household smoking (43.6% (95% CI 41.5% to 45.7%) vs 31.4% (95% CI 30.0% to 32.8%)) and home second-hand smoke exposure (8.0% (95% CI 6.8% to 9.1%) vs 5.2% (95% CI 4.5% to 5.8%)) were significantly more common for rural children. In multivariate analyses controlling for confounding factors, rurality remained associated with smoking households (OR 1.21, 95% CI 1.07 to 1.37), whereas it did not remain associated with children's home second-hand smoke exposure (OR 1.07, 95% CI 0.85 to 1.35). Larger household size, low socioeconomic status and being a single-parent household were the main drivers of home second-hand smoke exposure.The proportion of smoking households with children, and the number of children regularly exposed to second-hand smoke in their homes remain important public health concerns. Smoking cessation support and tobacco control policies might benefit from targeting larger and/or socioeconomically disadvantaged households including single-parent households.