Implementing the Smoke-Free Homes Program through 2-1-1s: Five grant awardees share their experiences Matthew W. Kreuter Lucja Bundy Dayanne Harvey Donnie House Shayne Rittmann Tanya Kahl AIRS 2016 St. Louis, MO May 24. 2016

Last phase of a 5-year collaborative project between 211 and researchers at four universities: Emory, UNC, UTH, WashU What we hope to do in this session is give audience members insights into research collaborations in general, and SFH specifically

Background Very quickly About second hand smoke The Smoke-Free Homes Intervention

Danger in tobacco smoke - 250 harmful chemicals - 69 cause cancer - Small cancer causing particles breathed in - Can penetrate lungs and cells - More smoke = higher levels of harmful chemicals

Consequences - 42,000 heart disease deaths in non-smokers - 3,400 lung cancer deaths in non-smokers - Aggravates asthma in 1 million children - 150,000+ respiratory infections in children - $10 billion per year in cost of care, death Source: American Cancer Society, 2014

- 33% of callers smoke - 53% child in the home Implications for 2-1-1 - 33% of callers smoke - 53% child in the home Sources: Purnell et al, 2012; Kreuter et al, 2013.

What can be done? Reduce exposure to tobacco smoke - in the home - at work - in the car - in public places

- Making rules against smoking in your home Smoke Free Homes (SFH) - Making rules against smoking in your home

How common are SFH rules? - 83% of U.S. households in 2010-11 - 91% of non-smokers - 46% of smokers Source: King et al, 2014

Unequally distributed - By education - 92% of homes with graduate degree - 71% of home with no HS diploma Source: King et al, 2013

Unequally distributed - By race/ethnicity - 91% Asian homes - 88% Hispanic homes - 81% White homes - 74% African American homes Source: King et al, 2013

Studies: SFH for 2-1-1 callers

Research question - Can a brief intervention increase uptake of SFH rules by 2-1-1 callers? Source: King et al, 2013

R Smoke-free homes study Atlanta 2-1-1 Meanwhile, at Emory, another randomized study tested the efficacy of telephone coaching and printed materials vs. no intervention on adoption of smoke-free home rules among 2-1-1 callers in Atlanta.

What is the intervention? Timing Description Week 0 First mailing of print materials Week 2 Coaching call Week 4 Second mailing of print materials Week 6 Third mailing of print materials

First mailing (week 0)

I can help you make your home smoke free! Coaching call (week 2) I can help you make your home smoke free!

Second mailing (week 4)

Third mailing (week 6)

Full household smoking ban 3-month follow-up (n=498) 25 20 15 10 5 Percent The intervention significantly increased the adoption of smoke free home rules. Roughly 1 in 4 callers that received the intervention reported having a full smoking ban at 3-month follow-up. These findings were particularly convincing… P < .005

Full household smoking ban 6-month follow-up (n=498) 30 20 10 Percent The intervention significantly increased the adoption of smoke free home rules. Roughly 1 in 4 callers that received the intervention reported having a full smoking ban at 3-month follow-up. These findings were particularly convincing… P < .05

In-home monitoring (3-mo FU; n=98) Nicotine concentration (µg/m3) 4.0 3.0 2.0 1.0 Mean The findings were particularly convincing… because the Emory team put air monitors in a subset of households, and as this slide shows, reporting a full ban was associated with lower concentrations of nicotine in the home. P < .004

31 211s submitted initial application

5 grantees selected - Representatives from each on the panel today

Charge to panel - Honest, balanced assessment - Challenges and rewards - Sustainability My role as moderator: Pose questions and STAY out of the way! We WELCOME questions from the audience

- Greatest benefit - Greatest challenge Opening remarks - Greatest benefit - Greatest challenge

What might affect SFH implementation?

Staff interest - What staff were involved? - What did they do? - How did they feel about delivering SFH? Prompts: buy-in? Feeling pressure (numbers, time, determining who to screen) Recruiting Different expectations from their regular duties

Caller interest - What did callers think about SFH? - How willing were they to participate? - What helped or hindered their participation? Prompts: What did they LIKE about SFH? What was helpful? Did you use incentives? What role do you think that played? What kind of reactions did you get when asking people to participate? Anyone offended or upset? How would that affect budgeting?

- SFH project tasks - SFH project staff - University partners Management - SFH project tasks - SFH project staff - University partners Prompts: What was challenging? How were university partners helpful (or not)?

- Was SFH a good match for your 2-1-1? - Why or why not? Fit - Was SFH a good match for your 2-1-1? - Why or why not? Prompts:

- Did your approach to SFH evolve over time? - In what ways and why? Quality improvement processes - Did your approach to SFH evolve over time? - In what ways and why? Prompts: What do you know now that you didn’t know at the outset?

- How could SFHs improve for use by 2-1-1s? Recommendations - How could SFHs improve for use by 2-1-1s? Prompts:

- What would be needed for you to continue SFH? Sustainability - What would be needed for you to continue SFH? Prompts:

Lessons learned How has SFH influenced how you think about… - …future research collaboration? - …managing/leading collaborative projects? - …strategic priorities for your 2-1-1? Prompts:

Audience questions?