1. 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

2. 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

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

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

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

7. - 33% of callers smoke - 53% child in the home
Implications for 2-1-1
- 33% of callers smoke % child in the home
Sources: Purnell et al, 2012; Kreuter et al, 2013.

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

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

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

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

12. Unequally distributed
- By race/ethnicity % Asian homes % Hispanic homes % White homes % African American homes
Source: King et al, 2013

13. Studies: SFH for 2-1-1 callers

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

15. 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 callers in Atlanta.

16. 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

17. First mailing (week 0)

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

19. Second mailing (week 4)

20. Third mailing (week 6)

21. 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

22. 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

23. 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

25. 31 211s submitted initial application

26. 5 grantees selected
- Representatives from each on the panel today

27. 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

28. - Greatest benefit - Greatest challenge
Opening remarks
- Greatest benefit - Greatest challenge

29. What might affect SFH implementation?

30. 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

31. 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?

32. - 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)?

33. - 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:

34. - 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?

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

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

37. 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:

38. Audience questions?