Eliminating second-hand smoke from Mexican-American households: Outcomes from Project Clean Air–Safe Air (CASA)

Abstract

Exposure to second-hand smoke (SHS) is a major public health problem and a risk factor for morbidity and mortality. The objective of this randomized trial was to estimate the impact of a culturally-sensitive intervention to reduce SHS exposure in Mexican-American households. Method A total of 91 households (with a child under 18 years of age and two adults, one of whom was a smoker) were recruited from a population-based cohort of Mexican-American households and randomized to receive the experimental intervention (EI; n=47) or standard care (SC; n=44). Of these, 74 households (83%) provided baseline, 6-month, and 12-month survey and nicotine monitor data (EI, n=39; SC, n=35). The EI materials, designed to increase the participants' likelihood of adopting a smoke-free indoor home air policy, included one culturally-appropriate bilingual comic book for children and two fotonovelas for adults. Results Ambient nicotine levels significantly decreased over the 12 study months (F=13.6, DF=147; p<0.001); with a significantly greater decrease in the EI households compared to the SC households (F=4.1, DF=72; p<0.05). At 12 months, 73% of EI households had banned smoking vs. 56% of SC households. Ambient nicotine levels, measured using nicotine air sampling monitors, were significantly associated with self-reported SHS exposure at the 12-month follow-up. Knowledge of the health effects of SHS increased from baseline to 6 and 12 months in the EI condition but not in the SC condition (F=6.0, DF=238; p<0.01), and smokers and quitters in the EI group reported an increased perception of health vulnerability compared to those in the SC group. Conclusion Our low-cost intervention impacted SHS-related knowledge and exposure among Mexican Americans. This culturally-appropriate intervention has the potential to decrease SHS-related health problems in the target population substantially.

State-of-the-Art Office-Based Interventions to Eliminate Youth Tobacco Use: The Past Decade

“…108 Smoking in a motor vehicle exposes children to high concentrations of tobacco smoke. 109 Although smoke-free policies can reduce a child's tobacco smoke exposure, 110 they are unlikely to eliminate it as long as close family members and/or caregivers smoke.…”

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

“…Interventions included the following components: self-help materials, 20 studies, 23,25,26,28,29,33,[83][84][85][86][87][88][89][90][91][92][93][94][95]97 ; face-to-face counseling, 26 studies [20][21][22][23][24][25][26][28][29][30][31][32][33][34][84][85][86][87][88][89][90][91][92][95][96][97] ; telephone counseling, 13 studies [21][22][23][24][25]...…”

“…21,28,29,32,[85][86][87]90,[92][93][94]96 Fidelity Seven studies reported high fidelity, with at least 80% of participants receiving the full intervention 23,24,27,84,88,93,96 ; 6 studies had moderate fidelity, with 50% to 79% of participants receiving the intervention 25,[29][30][31][32][33] ; and the remaining 17 studies did not report fidelity. [20][21][22]26,28,34,83,[85][86][87][89][90][91][92]94,95,97 Intervention Effects …”

“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] The trials were published between 1994 and 2013. A flowchart describing the identification process is presented in Fig 1. Study characteristics of included trials are presented in Tables 1 and 2. …”

“…83 1. PREP at follow-up.Seventeen studies (n = 6820), 20,23,[28][29][30][31][32][83][84][85][86]88,[90][91][92][93][94] were included in the analysis of PREP at follow-up (Fig 2A). Benefit was apparent in 88.2% (15/17) of studies, with 29.4% (5/ 17) showing a statistically significant advantage to the intervention group.…”