Brief Interventions to Create Smoke-Free Home Policies in Low-Income Households.
To increase protection of healthy children and non-smoking adults from secondhand smoke, exposure, we developed the Smoke-Free Homes Program: Some Things are Better Outside (SFHs). This is a minimally intensive program with three mailings and a single counseling telephone call, implemented in partnership with 2-1-1 social services information and referral (I&R) systems.
Emory University developed a brief program to protect children and non-smoking adults and established a partnership with a United Way 2-1-1 call center to reach the households of low income adults and found that they could increase monitor-verified bans. The universities of North Carolina (U.N.C.) and Texas School of Public Health (UTHSPH) conducted 2 consecutive effectiveness trials of SFHs.
Materials mailed at 2-week intervals focused on a five-step process for establishing a home smoking ban and included a fie-step guide, a photo novella, family pledge, stickers, window cling signs and a fact sheet. A 15-20 minute coaching call following the first mailing emphasized goal setting, problem solving and reinforcement, and rehearsed barriers and possible solutions to creating a ban. The Texas trial was expected to serve a robust test of recruitment generalizability, implementation fidelity, and effectiveness by replicating the U.N.C. protocol and varying only the population and context.
At 3 months, more intervention households reported a smoke-free home (46% 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.
Our findings in a region with lower smoking rates and more diverse callers, including English-speaking Latinos, support program generalizability and convey evidence of external validity.
Patricia D. Mullen, PI
Lara Savas, Co-PI
Maria E. Fernandez, Co-I
Michelle Kegler, PI
Carla Berg, Co-I
Cam Escoffery, Co-I
University of North Carolina at Chapel Hill
Rebecca Williams, PI
Washington University in St. Louis
Matthew Kreuter, PI