Promoting Smoke-Free Homes: A Novel Behavioral Intervention Using Real-Time Audio-Visual Feedback on Airborne Particle Levels

Abstract

Interventions are needed to protect the health of children who live with smokers. We pilot-tested a real-time intervention for promoting behavior change in homes that reduces second hand tobacco smoke (SHS) levels. The intervention uses a monitor and feedback system to provide immediate auditory and visual signals triggered at defined thresholds of fine particle concentration. Dynamic graphs of real-time particle levels are also shown on a computer screen. We experimentally evaluated the system, field-tested it in homes with smokers, and conducted focus groups to obtain general opinions. Laboratory tests of the monitor demonstrated SHS sensitivity, stability, precision equivalent to at least 1 µg/m3, and low noise. A linear relationship (R2 = 0.98) was observed between the monitor and average SHS mass concentrations up to 150 µg/m3. Focus groups and interviews with intervention participants showed in-home use to be acceptable and feasible. The intervention was evaluated in 3 homes with combined baseline and intervention periods lasting 9 to 15 full days. Two families modified their behavior by opening windows or doors, smoking outdoors, or smoking less. We observed evidence of lower SHS levels in these homes. The remaining household voiced reluctance to changing their smoking activity and did not exhibit lower SHS levels in main smoking areas or clear behavior change; however, family members expressed receptivity to smoking outdoors. This study established the feasibility of the real-time intervention, laying the groundwork for controlled trials with larger sample sizes. Visual and auditory cues may prompt family members to take immediate action to reduce SHS levels. Dynamic graphs of SHS levels may help families make decisions about specific mitigation approaches.

Benzene Uptake in Hookah Smokers and Non-smokers Attending Hookah Social Events: Regulatory Implications

“…Our results call for longitudinal and experimental studies to determine the extent of cumulative exposure over time and the extent to which such exposure can be reduced or prevented. Such studies guided by our results and our previous research will inform regulatory actions to limit toxicants, including benzene in hookah tobacco and charcoal products, and call to action for the implementation of voluntary smoke-free home rules (80)(81)(82). In the interim, health providers need to include hookah tobacco smoking as a health hazard in their health risk behavior screenings to tailor primary preventive measures to limit exposure to hookah tobacco smoke in all settings including the home.…”

Children’s Exposure to Secondhand and Thirdhand Smoke Carcinogens and Toxicants in Homes of Hookah Smokers

“…Such trials are important in the context of the studies successfully completed in the last 20 years showing that SHS exposure can be reduced when families are coached to do so (Hovell et al, 1994(Hovell et al, , 2000(Hovell et al, , 2002(Hovell et al, , 2009Klepeis et al, 2013;Meltzer, Hovell, Meltzer, Atkins, & de Peyster, 1993).…”

Support for smoke-free policies in the Cyprus hospitality industry

“…proposed for the surveillance of smoke-free homes (Klepeis et al 2013), and they could be potentially applied to the implementation of smoke-free policies in hospitality settings.…”