Brief Interventions to Create Smoke-Free Home Policies in Low-Income Households

The burden of tobacco use falls disproportionately on low-income populations, through high rates of primary smoking and exposure to secondhand smoke. The remarkable progress in creating smoke-free environments in the U.S. over the past two decades has left smoker's homes as one of the primary sources of exposure to secondhand smoke for both children and nonsmoking adults. Intervention research that identifies effective and practical strategies for reaching the minority of households that still allow smoking in the home has considerable potential to reduce smoke exposure, but suitable channels to reach low-income families are limited. The proposed research will develop, evaluate and disseminate a brief smoke-free homes intervention through the established national infrastructure of 2-1-1 call centers. 2-1-1 is a nationally designated 3-digit telephone exchange, similar to 9-1-1 for emergencies or 4-1-1 for directory assistance, that links callers to community-based health and social services.

The proposed research has four specific aims: 1) Conduct formative research on intervention messages and materials for promoting smoke-free homes in low-income populations, applicable to both smokers and nonsmokers as household change agents; 2) Conduct a randomized controlled trial in the Atlanta 2-1-1 service area to evaluate the efficacy of a brief intervention to create smoke-free homes among 2-1-1 callers; 3) Conduct replication studies in Houston and North Carolina 2-1-1 systems to systematically test the intervention in varied populations and tobacco control climates, and 4) Disseminate the research-tested smoke-free homes intervention through a variety of mechanisms including a national grants program to 2-1-1 systems and through the Tobacco Technical Assistance Consortium's linkages to the state and local tobacco control infrastructure in the U.S.

Study Overview

• Status: Completed
• Conditions: Chronic Diseases
• Intervention / Treatment: Behavioral: Educational print materials and a coaching call

• Study Type: Interventional
• Enrollment (Actual): 500
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Georgia
    • Atlanta, Georgia, United States, 30322
      • Emory University Rollins School of Public Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Must be 18 years of age or older.
• Must speak and understand English.
• Must smoke and live with at least one other non-smoking person OR be a non-smoker who lives with a smoker(s).
• Must not have a total smoking ban in their home.

Exclusion Criteria:

• None

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Participant receives usual care
Experimental: Intervention; Intervention group participants receive three sets of mailed educational materials about making their home smoke-free and one coaching call.	Behavioral: Educational print materials and a coaching call; Intervention group participants receive three sets of mailed educational materials about making their home smoke-free and one coaching call.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Presence of a total home smoking ban	Change from baseline in reported total home smoking bans at 3-month and 6-month follow-up

Secondary Outcome Measures

Outcome Measure	Time Frame
Weekly secondhand smoke exposure for non-smokers	Change from baseline in reported secondhand smoke exposure for non-smokers at 3-month and 6-month follow-up
Cessation attempts (for smokers)	Change from baseline in reported cessation attempts (for smokers) at 3-month and 6-month follow-up
Stage of change to quit smoking (for smokers)	Change from baseline in stage of change to quit smoking (for smokers) at 3-month and 6-month follow-up
Number of cigarettes smokes (for smokers)	Change from baseline in reported number of cigarettes smoked (for smokers) at 3-month and 6-month follow-up
Successful cessation (for smokers)	Change from baseline in successful cessation (for smokers) at 3-month and 6-month follow-up

Collaborators and Investigators

• Sponsor: Emory University
• Collaborators: National Cancer Institute (NCI); The University of Texas Health Science Center, Houston; Washington University School of Medicine; University of North Carolina, Chapel Hill

Publications and helpful links

General Publications

• Kegler MC, Escoffery C, Bundy L, Berg CJ, Haardorfer R, Yembra D, Schauer G. Pilot study results from a brief intervention to create smoke-free homes. J Environ Public Health. 2012;2012:951426. doi: 10.1155/2012/951426. Epub 2012 May 17.
• Escoffery C, Bundy L, Carvalho M, Yembra D, Haardorfer R, Berg C, Kegler MC. Third-hand smoke as a potential intervention message for promoting smoke-free homes in low-income communities. Health Educ Res. 2013 Oct;28(5):923-30. doi: 10.1093/her/cyt056. Epub 2013 May 13.
• Berg CJ, Bundy L, Escoffery C, Haardorfer R, Kegler MC. Telephone-assisted placement of air nicotine monitors to validate self-reported smoke-free home policies. Public Health. 2013 Apr;127(4):342-4. doi: 10.1016/j.puhe.2013.01.002. Epub 2013 Mar 6.
• Kegler MC, Bundy L, Haardorfer R, Escoffery C, Berg C, Yembra D, Kreuter M, Hovell M, Williams R, Mullen PD, Ribisl K, Burnham D. A minimal intervention to promote smoke-free homes among 2-1-1 callers: a randomized controlled trial. Am J Public Health. 2015 Mar;105(3):530-7. doi: 10.2105/AJPH.2014.302260. Epub 2015 Jan 20.
• Haardorfer R, Kreuter M, Berg CJ, Escoffery C, Bundy LT, Hovell M, Mullen PD, Williams R, Kegler MC. Cessation and reduction in smoking behavior: impact of creating a smoke-free home on smokers. Health Educ Res. 2018 Jun 1;33(3):256-259. doi: 10.1093/her/cyy014.
• Kegler MC, Haardӧrfer R, Berg C, Escoffery C, Bundy L, Williams R, Mullen PD. Challenges in Enforcing Home Smoking Rules in a Low-Income Population: Implications for Measurement and Intervention Design. Nicotine Tob Res. 2016 May;18(5):976-81. doi: 10.1093/ntr/ntv165. Epub 2015 Aug 5.

Study record dates

Study Major Dates

• Study Start: June 1, 2012
• Primary Completion (Actual): July 1, 2013
• Study Completion (Actual): July 1, 2013

Study Registration Dates

• First Submitted: May 31, 2012
• First Submitted That Met QC Criteria: June 19, 2012
• First Posted (Estimate): June 21, 2012

Study Record Updates

• Last Update Posted (Estimate): March 10, 2015
• Last Update Submitted That Met QC Criteria: March 7, 2015
• Last Verified: March 1, 2015

More Information

Terms related to this study

• Keywords: Secondhand smoke exposure; Smoke-free homes; Smoke-free home bans
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Chronic Disease
• Other Study ID Numbers: IRB00056797; U01CA154282-01 (U.S. NIH Grant/Contract)