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

Abstract

BackgroundReplication 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.ObjectiveTest the programme's generalisability-external validity in a different context.MethodsA 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.ResultsAt 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.ConclusionsOur 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 numberNCT02097914, Results.

Improving the geographical precision of rural chronic disease surveillance by using emergency claims data: a cross-sectional comparison of survey versus claims data in Sullivan County, New York

“…We also included commercial addresses listed as apartments. This list of mailing addresses was then refined using an address verification service (www.smartystreets.com) to select valid, non-vacant mailable addresses 21. As a substantial proportion of residents do not receive delivered mail in Sullivan County, we also queried the address verification service to find all valid, mailable PO boxes in the county.…”

Randomised controlled trial of real-time feedback and brief coaching to reduce indoor smoking

“…Typically, coaches offer praise or criticism of participants’ self-reported reduction in smoking, but seldom proximal in time to the emitted behaviour. A systematic replication of a coaching intervention for SHS exposure reduction across three sites demonstrated the generalisability of coaching to reduce indoor smoking 32–34. The effectiveness of delayed feedback also has been investigated in studies using objective measures of child cotinine35–39 or of air particle levels in the home 37 38 40 41.…”

Moderators of Establishing a Smoke-Free Home: Pooled Data from Three Randomized Controlled Trials of a Brief Intervention

“…Smoke-Free Homes: Some Things are Better Outside is a brief intervention that has been shown to be highly effective in promoting adoption of smoke-free home rules among lowincome households in three randomized controlled trials (RCTs). [10][11][12] The first RCT was an efficacy trial in which university staff delivered the intervention to clients of United Way of Greater Atlanta's 2-1-1 information and referral (I & R) center. [10] The second was an effectiveness trial in which 2-1-1 I & R specialists delivered the intervention to clients of United Way of North Carolina 2-1-1.…”

“…[11] The third was a generalization trial in which I &R specialists from the Texas/United Way Helpline Gulf Coast 2-1-1 delivered the intervention to a more ethnically diverse set of callers than in the two earlier trials. [12] 2-1-1 is a strategic partner for implementation of smoke-free home interventions given that 2-1-1 I &R specialists connect over 15 million clients to community social and health resources per year, with most of their clients socioeconomically disadvantaged, and therefore, more likely to smoke and less likely to live in a smoke-free home. [13,14] All three trials documented significant intervention effects, with 40.0 to 62.9% of clients reporting a smoke-free home when reached for follow-up at six months post-intervention.…”

“…[13,14] All three trials documented significant intervention effects, with 40.0 to 62.9% of clients reporting a smoke-free home when reached for follow-up at six months post-intervention. [10][11][12] The current paper presents moderator analyses using pooled data from the three trials. Given strong associations between sociodemographic characteristics, household composition and establishment of smoke-free home rules, [15,17] we were interested to learn whether the intervention demonstrated similar levels of effectiveness across subpopulations.…”