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

Michael J Parks,John H Kingsbury,Michelle C Kegler,Iris W Borowsky

doi:10.3390/ijerph17186787

Abstract

Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars), and secondhand smoke (SHS) exposure remains prevalent among children and low-socioeconomic status (SES) populations. This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children. The pilot was implemented through Minnesota’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDPs provide cancer prevention services to low-income individuals experiencing health disparities. We successfully utilized and adapted the Smoke-Free Homes Program (SFHP) to address comprehensive smoke-free rules among households with children. We used two recruitment methods: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. We used descriptive statistics to assess implementation outcomes and hierarchical logistic regression models (HLM) to assess change in smoke-free rules and SHS exposure over the study period. There was no comparison group, and HLM was used to examine within-person change. A total of 64 participants were recruited. Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route. Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.

Highlights

Exposure to secondhand smoke (SHS) has declined in the U.S [1], but SHS is common among youth, as nearly 40% of children and one-third of adolescents exhibit biological evidence of recentSHS exposure [2,3]
28.5% of the participants were smokers who lived with a nonsmoker, 18.7% were smokers who lived with another smoker, and the majority were nonsmokers who lived with a smoker (51.8%)
All Sage staff (100% of staff) agreed that: Smoke-Free Homes Program (SFHP) was easy to adapt to the Sage population, implementation was not difficult, it would be easy to make the program a permanent part of Sage, SFHP was consistent with Sage’s mission, they were comfortable recruiting and conducting eligibility screening, tasks for the intervention were similar to normal Sage-related tasks, their skills were a good fit for SFHP, it was not time-consuming to deliver SFHP, and SFHP was seen as an important part of

Summary

Introduction

Exposure to secondhand smoke (SHS) has declined in the U.S [1], but SHS is common among youth, as nearly 40% of children and one-third of adolescents exhibit biological evidence of recent. SHS exposure [2,3]. There are marked disparities in SHS exposure. Low-socioeconomic status (SES) is associated with higher prevalence of SHS exposure, and SHS exposure is more common among populations of color [4]. Smoke-free policies can prohibit smoking in public places and reduce. SHS exposure, and such policies have increased across the U.S [5]. Smoke-free public policies do not necessarily apply to private spaces, and SHS exposure occurs most commonly in private locations, for children [6,7,8]. The most critical private locations are homes and cars [7,9,10]

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