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.

Minimal intervention delivered by 2-1-1 information and referral specialists promotes smoke-free homes among 2-1-1 callers: a Texas generalisation trial

“…43 In-person training by Atlanta and NC project coordinators prepared I&R specialists selected as programme coaches (n=2 females). Coaching calls were made 2 weeks after the first mailing, and 12 call attempts, 2 letters/text messages and, if available, 3 call attempts to an emergency contact were permitted.…”

“…NC's results (OR=1.72) were similar to Atlanta's, after considering possible inflation for self-report and a more challenging population profile, for example, NC trial participants had more smokers in their household. 43 To inform dissemination, our trial replicated the NC protocol in the Texas Gulf Coast 2-1-1 centre, which has a larger call volume (25 000 calls/ day) and serves a more diverse population (more Latinos and Asians) and is set in an area with a lower smoking prevalence (Houston Standard Metropolitan Statistical Area=15.6% and Corpus Christi Public Health Region=16.7%). 44 Intervention replication is reported infrequently, thus limiting what we know about the external validity and generalisability of the interventions.…”

Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program

“…Moreover, similar to many EBIs, limited research has tested implementation and dissemination of evidence-based smoke-free interventions in national programs that serve low-income populations and offer potential for population impact. We utilized and adapted the evidenced-based program called the Smoke-Free Homes: Some Things are Better Outside Program (SFHP) that initially focused on increasing smoke-free home rules among 2-1-1 callers (which is a central call center that provides a range of services to low-income households in the U.S.) [ 18 , 21 ]. SFHP consists of direct mail materials and a proactive coaching call that are rooted in health behavior theory.…”

“…SFHP consists of direct mail materials and a proactive coaching call that are rooted in health behavior theory. The program recruited participants by using a referral system in collaboration with the 2-1-1 call center (i.e., operators recruit eligible participants who call 2-1-1 for unrelated reasons), and the intervention has increased smoke-free home rules among low-income populations through multiple 2-1-1 call centers [ 12 , 21 ]. Yet more research is needed on how the intervention translates across settings [ 12 ], and results for smoke-free cars have not been a central focus [ 18 ].…”

“…Yet more research is needed on how the intervention translates across settings [ 12 ], and results for smoke-free cars have not been a central focus [ 18 ]. Adapting the program to address smoke-free rules in cars is an important area of research [ 21 ]. We adapted the SFHP to address comprehensive smoke-free rules and tailored the materials for households with children.…”