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Kreuter MW, Garg R, Fu Q, Caburnay C, Thompson T, Roberts C, Sandheinrich D, Javed I, Wolff JM, Butler T, Grimes LM, Carpenter KM, Pokojski R, Engelbrecht K, Howard V, McQueen A. Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100529. [PMID: 37408953 PMCID: PMC10319314 DOI: 10.1016/j.lana.2023.100529] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 07/07/2023]
Abstract
Background Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Methods Using a randomized 2 × 2 factorial design, low-income daily cigarette smokers (n = 1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n = 485), Standard Quitline + Social Needs Navigation (n = 484), Specialized Quitline alone (n = 485), or Specialized Quitline + Social Needs Navigation (n = 490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Findings Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline + Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline + Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR = 0.70, 95% CI = 0.50-0.98). Interpretation A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT03194958. Funding National Cancer Institute: R01CA201429.
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Affiliation(s)
- Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Qiang Fu
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Christina Roberts
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Dominique Sandheinrich
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Irum Javed
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Jennifer M. Wolff
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Taylor Butler
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | - Lauren M. Grimes
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
| | | | - Robin Pokojski
- Community Partnerships, United Way of Greater St. Louis, St. Louis, MO, USA
| | | | - Valerie Howard
- Tobacco Prevention and Control Program, Missouri Department of Health and Senior Services, Jefferson City, MO, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School at Washington University in St. Louis, St. Louis, MO, USA
- Division of General Medical Sciences, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Thompson T, Evbuoma-Fike EI, Garg R, McQueen A, Caburnay C, Kreuter MW. Examining Psychosocial Correlates of a Home Smoking Ban Among Low-income Smokers: Analysis of Social Support, Unmet Social Needs, Perceived Stress, and Depressive Symptoms. J Community Health 2022; 47:959-965. [PMID: 35932354 PMCID: PMC9669155 DOI: 10.1007/s10900-022-01094-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 12/26/2022]
Abstract
Home smoking bans reduce exposure to second-hand smoke. Understanding how psychosocial factors are related to having a home smoking ban may lead to better interventions for populations less likely to have home smoking bans, including low-income smokers. In this study, we used baseline data from 1,944 participants in a randomized trial of low-income smokers in Missouri to explore psychosocial correlates of a total home smoking ban. Using logistic regression, we examined associations between psychosocial variables (social support, unmet social needs [e.g., food, housing], perceived stress, and depressive symptoms) and a total home smoking ban. 72% of participants were female, and 58% were Black/African American; 26% reported a home smoking ban. In unadjusted and adjusted models, greater social support was associated with greater likelihood of a home smoking ban. Stress was negatively associated with a ban in adjusted models only. The fact that most participants did not have a home smoking ban highlights the need for further intervention in this population. Results suggest links between social support and having a home smoking ban, although effect sizes were small. Smoke-free home interventions that increase social connectedness or leverage existing support may be especially effective. Tobacco control planners may also consider partnering with agencies addressing social isolation.
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Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130
| | - Ebuwa I. Evbuoma-Fike
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130,Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, 4523 Clayton Avenue, Campus Box 8005, St. Louis, Missouri 63110
| | - Charlene Caburnay
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, 1 Brookings Dr, St. Louis, MO 63130
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Curt A, Khidir H, Ciccolo G, Camargo CA, Samuels-Kalow M. Geographically Indexed Referral Databases to Address Social Needs in the Emergency Department. West J Emerg Med 2021; 22:218-224. [PMID: 33856303 PMCID: PMC7972357 DOI: 10.5811/westjem.2020.11.49250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/23/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Unmet health-related social needs (HRSN) are among the drivers of disparities in morbidity and mortality during public health emergencies such as the novel coronavirus 2019 (Covid-19) pandemic. Although emergency departments (ED) see a high volume of patients with HRSN, ED providers have limited time to complete detailed assessments of patients’ HRSN and are not always able to provide up-to-date and comprehensive information to patients on available community resources. Electronic, geographically indexed resource database systems have the potential to provide an efficient way for emergency physicians to rapidly identify community resources in settings where immediate social work consultation is not accessible. Methods We conducted a systematic review of papers examining the use of geographically indexed resource database systems in healthcare to better understand how these services can be used in emergency care. We then conducted simulated, standardized searches using two nationally available databases (211 and Aunt Bertha), applied to a single metropolitan area (Boston). Results Our systematic review found that most public health and screening interventions using nationally available databases have focused on chronic care needs. A small subset of publications demonstrated that these databases were mobilized during disasters to successfully aid vulnerable populations during Hurricanes Katrina and Rita. A total of 408 standardized searches were conducted to identify community resources related to four domains of social needs (food, transportation, housing, and utilities). Although 99% of the resources identified by both databases were relevant to the search domains queried, a significant proportion of the resources identified by each database were restricted to a specific demographic (eg, veterans). Conclusion Our findings demonstrate that geographically indexed referral databases may be an effective tool to help ED providers connect patients to nearby community resources during public health emergencies. We recommend that EDs select a referral database based on the greatest number of resources that are not demographically restricted.
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Affiliation(s)
- Alexa Curt
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Hazar Khidir
- Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts
| | - Gia Ciccolo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts
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Kreuter MW, Garg R, Li L, McNulty L, Thompson T, McQueen A, Luke AA. How Do Social Needs Cluster Among Low-Income Individuals? Popul Health Manag 2020; 24:322-332. [PMID: 32877298 DOI: 10.1089/pop.2020.0107] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Social needs screening in health care settings reveals that many low-income individuals have multiple unmet social needs at the same time. Having multiple simultaneous social needs greatly increases the odds of experiencing adverse health outcomes. To better understand how and which social needs cluster in these cases, the authors examined data from 14,749 low-income adults who completed a social needs assessment in one of 4 separate studies conducted between 2008 and 2019 in the United States. Participants were Medicaid beneficiaries, helpline callers, and daily smokers. Findings were strikingly consistent across the 4 studies. Participants with ≥2 social needs (n = 5621; 38% of total) experienced more stress, depressive symptoms, sleep problems, and chronic diseases and were more likely to rate their health as fair or poor. Social needs reflecting financial strain were highly correlated, such as needing help paying utility bills and needing money for necessities such as food, shelter, and clothing (r = .49 to .71 across studies). Participants experienced 351 distinct combinations of ≥2 social needs. The 10 most common combinations accounted for more than half of all participants with ≥2 needs. Clusters of social needs varied by subgroups. Women with children were more likely than others to need more space in their home and help paying utility bills; low-income men were more likely to be physically threatened and need a place to stay; older, sicker adults were more likely to need money for necessities and unexpected expenses, as well as transportation. Findings are discussed in the context of creating smarter, more efficient social needs interventions.
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Affiliation(s)
- Matthew W Kreuter
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel Garg
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Linda Li
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Laura McNulty
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Tess Thompson
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amy McQueen
- Health Communication Research Laboratory, Brown School, Washington University in St. Louis, St. Louis, Missouri, USA.,Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Alina A Luke
- Cardiovascular Division, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
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Bundy ŁT, Haardörfer R, Kegler MC, Owolabi S, Berg CJ, Escoffery C, Thompson T, Mullen PD, Williams R, Hovell M, Kahl T, Harvey D, Price A, House D, Booker BW, Kreuter MW. Disseminating a Smoke-free Homes Program to Low Socioeconomic Status Households in the United States Through 2-1-1: Results of a National Impact Evaluation. Nicotine Tob Res 2020; 22:498-505. [PMID: 30517679 PMCID: PMC7368345 DOI: 10.1093/ntr/nty256] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 11/29/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Given homes are now a primary source of secondhand smoke (SHS) exposure in the United States, research-tested interventions that promote smoke-free homes should be evaluated in real-world settings to build the evidence base for dissemination. This study describes outcome evaluation results from a dissemination and implementation study of a research-tested program to increase smoke-free home rules through US 2-1-1 helplines. METHODS Five 2-1-1 organizations, chosen through a competitive application process, were awarded grants of up to $70 000. 2-1-1 staff recruited participants, delivered the intervention, and evaluated the program. 2-1-1 clients who were recruited into the program allowed smoking in the home, lived in households with both a smoker and a nonsmoker or child, spoke English, and were at least 18 years old. Self-reported outcomes were assessed using a pre-post design, with follow-up at 2 months post baseline. RESULTS A total of 2345 households (335-605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%) and smokers (76%), and half were African American (54%). Overall, 40.1% (n = 940) reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up (n = 389), days of SHS exposure in the past week decreased from 4.9 (SD = 2.52) to 1.2 (SD = 2.20). Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. CONCLUSIONS Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies. IMPLICATIONS Dissemination of this brief research-tested intervention via a national grants program with support from university staff to five 2-1-1 centers increased home smoking bans, decreased SHS exposure, and increased cessation rates. Although the program delivery capacity demonstrated by these competitively selected 2-1-1s may not generalize to the broader 2-1-1 network in the United States, or social service agencies outside of the United States, partnering with 2-1-1s may be a promising avenue for large-scale dissemination of this smoke-free homes program and other public health programs to low socioeconomic status populations in the United States.
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Affiliation(s)
- Łucja T Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Shadé Owolabi
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Tess Thompson
- George Warren Brown School of Social Work, Washington University, St. Louis, MO
| | | | | | - Mel Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
| | | | | | | | | | | | - Matthew W Kreuter
- George Warren Brown School of Social Work, Washington University, St. Louis, MO
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Alcaraz KI, Vereen RN, Burnham D. Use of Telephone and Digital Channels to Engage Socioeconomically Disadvantaged Adults in Health Disparities Research Within a Social Service Setting: Cross-Sectional Study. J Med Internet Res 2020; 22:e16680. [PMID: 32234699 PMCID: PMC7160701 DOI: 10.2196/16680] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/13/2020] [Accepted: 02/29/2020] [Indexed: 12/28/2022] Open
Abstract
Background Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels. Objective This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type. Methods The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service–focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics. Results A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23%) and the highest survey completion rate (91.24%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14%) yet the lowest survey completion rate (74.0%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95% CI 1.23-1.88), married (aOR 1.52, 95% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95% CI 1.67-2.82), have a household income ≥US $25,000 a year (aOR 2.02, 95% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95% CI 1.27-1.83 for good-to-excellent health). Conclusions Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service–based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health.
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Affiliation(s)
- Kassandra I Alcaraz
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, United States
| | - Rhyan N Vereen
- Behavioral and Epidemiology Research Group, American Cancer Society, Atlanta, GA, United States
| | - Donna Burnham
- United Way of Greater Atlanta, Atlanta, GA, United States
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Moderators of Establishing a Smoke-Free Home: Pooled Data from Three Randomized Controlled Trials of a Brief Intervention. J Community Health 2020; 44:121-126. [PMID: 30101386 DOI: 10.1007/s10900-018-0561-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Interventions to create smoke-free homes typically focus on parents, involve multiple counseling sessions and blend cessation and smoke-free home messages. Smoke-Free Homes: Some Things are Better Outside is a minimal intervention focused on smokers and nonsmokers who allow smoking in the home, and emphasizes creation of a smoke-free home over cessation. The purpose of this study is to conduct moderator analyses using pooled data from three randomized controlled trials of the intervention conducted in collaboration with 2-1-1 contact centers in Atlanta, North Carolina and Houston. 2-1-1 is a strategic partner for tobacco control as it connects over 15 million clients, largely socio-economically disadvantaged, to social and health resources each year. A total of 1506 2-1-1 callers participated across the three intervention trials. Outcomes from 6 months intent-to-treat analyses were used to examine whether sociodemographic variables and smoking-related characteristics moderated effectiveness of the intervention in establishing full home smoking bans. Intervention effectiveness was not moderated by race/ethnicity, education, income, children in the home or number of smokers in the home. Smoking status of the participant, however, did moderate program effectiveness, as did time to first cigarette. Number of cigarettes per day and daily versus nondaily smoking did not moderate intervention effectiveness. Overall, the intervention was effective across socio-demographic groups and was effective without respect to daily versus nondaily smoking or number of cigarettes smoked per day, although smoking status and level of nicotine dependence did influence effectiveness.
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Kegler MC, Bundy ŁT, Hartman T, Owolabi S, Haardörfer R. Promoting Healthier Home Food Environments Through 2-1-1: A Pilot and Feasibility Study. FAMILY & COMMUNITY HEALTH 2020; 43:276-286. [PMID: 32658029 DOI: 10.1097/fch.0000000000000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Relatively few interventions target the home food environment of adults for weight gain prevention. Using a pretest/posttest design, this study describes the adaptation and pilot testing of Healthy Homes/Healthy Families, a research-tested home food environment intervention, for telephone delivery to 2-1-1 clients (n = 101). The Healthy Eating Index-2015, a measure of diet quality, improved significantly at 4-month follow-up, as did the home food environment, with energy consumption improving in the expected direction. Overall findings suggest the simplified intervention will still be effective, although results may be attenuated and additional efforts may be needed for participant retention among 2-1-1 clients.
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Affiliation(s)
- Michelle C Kegler
- Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia (Drs Kegler and Haardörfer and Mss Bundy and Owolabi); and Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Hartman)
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White A, Sabatino SA, Vinson C, Chambers D, White MC. The Cancer Prevention and Control Research Network (CPCRN): Advancing public health and implementation science. Prev Med 2019; 129S:105824. [PMID: 31473220 PMCID: PMC7032049 DOI: 10.1016/j.ypmed.2019.105824] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/22/2019] [Accepted: 08/28/2019] [Indexed: 12/01/2022]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is one of the thematic networks of the United States' Centers for Disease Control and Prevention's (CDC) Prevention Research Centers. Network members are academic research centers in the United States who collaborate with public health and community partners to accelerate the use of evidence-based interventions in communities to reduce the burden of cancer, especially among underserved populations. CPCRN studies include geographically dispersed populations, cross-institution partnerships, and opportunities for collaborative learning across network centers. Since its inception in 2002, CPCRN has worked to translate research on community-based intervention strategies into practice to improve cancer screening and reduce cancer risk. This commentary describes CPCRN's role in contributing to public health and the field of dissemination and implementation science. In addition, CDC and the National Cancer Institute describe how their joint support of the network contributes to each organization's goals and missions.
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Affiliation(s)
- Arica White
- Centers for Disease Control and Prevention, United States of America
| | - Susan A Sabatino
- Centers for Disease Control and Prevention, United States of America.
| | | | | | - Mary C White
- Centers for Disease Control and Prevention, United States of America
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Kegler MC, Haardörfer R, Melanson T, Allen L, Bundy LT, Kreuter MW, Williams RS, Hovell MF, Mullen PD. Steps Toward Scalability: Illustrations From a Smoke-Free Homes Program. HEALTH EDUCATION & BEHAVIOR 2019; 46:773-781. [PMID: 31165637 DOI: 10.1177/1090198119848767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Scalable interventions remain effective across a range of real-world settings and can be modified to fit organizational and community context. "Smoke-Free Homes: Some Things are Better Outside" has been effective in promoting smoke-free home rules in low-income households in efficacy, effectiveness, generalizability, and dissemination studies. Using data from a dissemination study in collaboration with five 2-1-1 call centers in Ohio, Florida, Oklahoma, and Alabama (n = 2,345 households), this article examines key dimensions of scalability, including effectiveness by subpopulation, secondary outcomes, identification of core elements driving effectiveness, and cost-effectiveness. Evaluated by 2-1-1 staff using a pre-post design with self-reported outcomes at 2 months postbaseline, the program was equally effective for men and women, across education levels, with varying number of smokers in the home, and whether children were present in the home or not. It was more effective for nonsmokers, those who smoked fewer cigarettes per day, and African Americans. Creating a smoke-free home was associated with a new smoke-free vehicle rule (odds ratio [OR] = 3.38, confidence interval [CI 2.58, 4.42]), decreased exposure to secondhand smoke among nonsmokers (b = -2.33, p < .0001), and increased cessation among smokers (OR = 5.8, CI [3.81, 8.81]). Use of each program component was significantly associated with success in creating a smoke-free home. Using an intent-to-treat effect size of 40.1%, program benefits from 5 years of health care savings exceed program costs yielding a net savings of $9,633 for delivery to 100 households. Cost effectiveness, subpopulation analyses, and identification of core elements can help in assessing the scalability potential of research-tested interventions such as this smoke-free homes program.
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Thompson T, Kreuter MW, Caito N, Williams RS, Escoffery C, Fernandez ME, Kegler MC. Implementing an Evidence-based Tobacco Control Program at Five 2-1-1 Call Centers: An Evaluation Using the Consolidated Framework for Implementation Research. Nicotine Tob Res 2019; 21:180-187. [PMID: 29059356 PMCID: PMC6329401 DOI: 10.1093/ntr/ntx232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 10/06/2017] [Indexed: 11/14/2022]
Abstract
Introduction The Smoke-Free Homes (SFH) Program is an evidence-based intervention offered within 2-1-1 information and referral call centers to promote smoke-free homes in low-income populations. We used the Consolidated Framework for Implementation Research to conduct a mixed-methods analysis of facilitators and barriers to scaling up SFH to five 2-1-1 sites in the United States. Methods Data were collected from staff in 2015-2016 via online surveys administered before (N = 120) and after SFH training (N = 101) and after SFH implementation (N = 79). Semi-structured telephone interviews were conducted in 2016 with 25 staff to examine attitudes towards SFH, ways local context affected implementation, and unintended benefits and consequences of implementing SFH. Results Post-implementation, 79% of respondents reported that SFH was consistent with their 2-1-1's mission, 70% thought it led to more smoke-free homes in their population, 62% thought it was easy to adapt, and 56% thought participants were satisfied. Composite measures of perceived appropriateness of SFH for 2-1-1 callers and staff positivity toward SFH were significantly lower post-implementation than pre-implementation. In interviews, staff said SFH fit with their 2-1-1's mission but expressed concerns about intervention sustainability, time and resources needed for delivery, and how SFH fit into their workflow. Conclusions Sites' SFH implementation experiences were affected both by demands of intervention delivery and by SFH's perceived effectiveness and fit with organizational mission. Future implementation of SFH and other tobacco control programs should address identified barriers by securing ongoing funding, providing dedicated staff time, and ensuring programs fit with staff workflow. Implications Smoke-free home policies reduce exposure to secondhand smoke. Partnering with social service agencies offers a promising way to scale up evidence-based smoke-free home interventions among low-income populations. We found that the SFH intervention was acceptable and feasible among multiple 2-1-1 delivery sites. There were also significant challenges to implementation, including site workflow, desire to adapt the intervention, time needed for intervention delivery, and financial sustainability. Addressing such challenges will aid future efforts to scale up evidence-based tobacco control interventions to social service agencies such as 2-1-1.
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Affiliation(s)
- Tess Thompson
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
| | - Nicole Caito
- Health Communication Research Laboratory, Washington University in St. Louis, St. Louis, MO, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cam Escoffery
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | | | - Michelle C Kegler
- Department of Behavioral Science and Health Education, Emory University, Atlanta, GA, USA
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Mullen PD, Savas LS, Bundy ŁT, Haardörfer R, Hovell M, Fernández ME, Monroy JAA, Williams RS, Kreuter MW, Jobe D, Kegler MC. Minimal intervention delivered by 2-1-1 information and referral specialists promotes smoke-free homes among 2-1-1 callers: a Texas generalisation trial. Tob Control 2018; 25:i10-i18. [PMID: 27697943 PMCID: PMC5099226 DOI: 10.1136/tobaccocontrol-2016-053045] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 08/02/2016] [Indexed: 01/15/2023]
Abstract
Background Replication 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. Objective Test the programme's generalisability-external validity in a different context. Methods A 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. Results At 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. Conclusions Our 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 number NCT02097914, Results.
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Affiliation(s)
- Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Łucja T Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mel Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Maria E Fernández
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Jo Ann A Monroy
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
| | - Rebecca S Williams
- Center for Health Promotion and Disease Prevention and Lineberger Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
| | - Matthew W Kreuter
- Health Communication Research Laboratory, Washington University, St. Louis, Missouri, USA
| | - David Jobe
- 2-1-1 Texas/United Way HELPLINE, United Way of Greater Houston, Houston, Texas, USA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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13
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Escoffery C, Mullen P, Genkin B, Bundy L, Owolabi S, Haard�rfer R, Williams R, Savas L, Kegler M. Coaching to create a smoke-free home in a brief secondhand smoke intervention. HEALTH EDUCATION RESEARCH 2017; 32:555-568. [PMID: 29253133 PMCID: PMC5914313 DOI: 10.1093/her/cyx072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Few community interventions exist to reduce secondhand exposure to tobacco smoke in the home. This study presents the coaching process of a larger intervention to promote smoke-free homes across an efficacy and 2 effectiveness trials. It furthers assesses the coaching call's reach and participants' satisfaction with the call across three intervention sites. The sources of the data were from baseline and 3-month follow-up surveys, coaching forms or online tracking system and interviews with coaches. Reach for the coaching call across trials was fairly high from 72% to 92%. Overall, the majority of participants were highly satisfied with the intervention (M = 3.76) and found it useful in creating a smoke-free home (M = 3.63). Common goals set were changing the environment to support a home smoking ban (e.g. putting up signs, removing ashtrays) (82%) or picking a date (60%). Challenges to a smoke-free home were consistent with other literature on barriers related to household smoking restrictions, including need for assistance in quitting, outside weather and smokers who do not want to quit. Additional research is needed to explore differential reach and reactions to the coaching call as it is disseminated and the impact of coaching call on the outcome of a smoke-free home.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Patricia Mullen
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Brooke Genkin
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Lucja Bundy
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Shade Owolabi
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Regine Haard�rfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Rebecca Williams
- Center for Health Promotion and Disease Prevention , University of North Carolina at Chapel Hill, Chapel Hill, Carrboro, NC 27510, USA
| | - Lara Savas
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Michelle Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
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14
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Williams RS, Stollings JH, Bundy Ł, Haardörfer R, Kreuter MW, Mullen PD, Hovell M, Morris M, Kegler MC. A Minimal Intervention to Promote Smoke-Free Homes among 2-1-1 Callers: North Carolina Randomized Effectiveness Trial. PLoS One 2016; 11:e0165086. [PMID: 27806060 PMCID: PMC5091897 DOI: 10.1371/journal.pone.0165086] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 10/04/2016] [Indexed: 11/23/2022] Open
Abstract
This study examined the extent to which delivery of the minimal Smoke-Free Homes intervention by trained 2-1-1 information and referral specialists had an effect on the adoption of home smoking bans in low-income households. A randomized controlled trial was conducted among 2-1-1 callers (n = 500) assigned to control or intervention conditions. 2-1-1 information and referral specialists collected baseline data and delivered the intervention consisting of 3 mailings and 1 coaching call; university-based data collectors conducted follow-up interviews at 3 and 6 months post-baseline. Data were collected from June 2013 through July 2014. Participants were mostly female (87.2%), African American (61.4%), and smokers (76.6%). Participants assigned to the intervention condition were more likely than controls to report a full ban on smoking in the home at both 3- (38.1% vs 19.3%, p = < .001) and 6-month follow-up (43.2% vs 33.2%, p = .02). The longitudinal intent-to-treat analysis showed a significant intervention effect over time (OR = 1.31, p = .001), i.e. OR = 1.72 at 6 months. This study replicates prior findings showing the effectiveness of the minimal intervention to promote smoke-free homes in low-income households, and extends those findings by demonstrating they can be achieved when 2-1-1 information and referral specialists deliver the intervention. Findings offer support for this intervention as a generalizable and scalable model for reducing secondhand smoke exposure in homes.
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Affiliation(s)
- Rebecca S. Williams
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, United States of America
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, United States of America
- * E-mail:
| | - Jana H. Stollings
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, United States of America
| | - Łucja Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Matthew W. Kreuter
- Health Communication Research Laboratory, Washington University, St. Louis, Missouri, United States of America
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, United States of America
| | - Mel Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, California, United States of America
| | - Marti Morris
- United Way of North Carolina, NC 2-1-1, Cary, North Carolina, United States of America
| | - Michelle C. Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
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15
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Kreuter MW, McQueen A, Boyum S, Fu Q. Unmet basic needs and health intervention effectiveness in low-income populations. Prev Med 2016; 91:70-75. [PMID: 27496395 PMCID: PMC5050133 DOI: 10.1016/j.ypmed.2016.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 04/20/2016] [Accepted: 08/02/2016] [Indexed: 12/29/2022]
Abstract
In the face of unmet basic needs, low SES adults are less likely to obtain needed preventive health services. The study objective was to understand how these hardships may cluster and how the effectiveness of different health-focused interventions might vary across vulnerable population sub-groups with different basic needs profiles. From June 2010-2012, a random sample of low-income adult callers to Missouri 2-1-1 completed a cancer risk assessment and received up to 3 health referrals for needed services (mammography, pap testing, colonoscopy, HPV vaccination, smoking cessation and smoke-free home policies). Participants received either a verbal referral only (N=365), verbal referral+tailored print reminder (N=372), or verbal referral+navigator (N=353). Participants reported their unmet basic needs at baseline and contacts with health referrals at 1-month post-intervention. We examined latent classes of unmet basic needs using SAS. Logistic regression examined the association between latent classes and contacting a health referral, by intervention condition. A 3 class solution best fit the data. For participants with relatively more unmet needs (C2) and those with money needs (C3), the navigator intervention was more effective than the tailored or verbal referral only conditions in leading to health referrals contacts. For participants with fewer unmet basic needs (C1), the tailored intervention was as effective as the navigator intervention. The distribution and nature of unmet basic needs in this sample of low-income adults was heterogeneous, and those with the greatest needs benefitted most from a more intensive navigator intervention in helping them seek needed preventive health services.
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Affiliation(s)
- Matthew W Kreuter
- Washington University, School of Social Work, Campus Box 1196, 1 Brookings Dr., St. Louis, MO 63130, United States.
| | - Amy McQueen
- Washington University, School of Medicine, Campus Box 8005, 4523 Clayton Ave., St. Louis, MO 63110, United States.
| | - Sonia Boyum
- Washington University, School of Social Work, Campus Box 1196, 1 Brookings Dr., St. Louis, MO 63130, United States.
| | - Qiang Fu
- Saint Louis University, College for Public Health and Social Justice, Salus Center Room 480, 3545 Lafayette Ave., St. Louis, MO 63104, United States.
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16
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Thompson T, Kreuter MW, Boyum S. Promoting Health by Addressing Basic Needs: Effect of Problem Resolution on Contacting Health Referrals. HEALTH EDUCATION & BEHAVIOR 2016; 43:201-7. [PMID: 26293458 PMCID: PMC5029788 DOI: 10.1177/1090198115599396] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Members of vulnerable populations have heightened needs for health services. One advantage of integrating health risk assessment and referrals into social service assistance systems such as 2-1-1 is that such systems help callers resolve problems in other areas (e.g., housing). Callers to 2-1-1 in Missouri (N= 1,090) with at least one behavioral risk factor or cancer screening need were randomly assigned to one of three health referral interventions: verbal referrals only, verbal referrals + a tailored mailed reminder, or verbal referrals + telephone health navigator. After 1 month, we assessed whether the nonhealth problems that prompted the 2-1-1 call had been resolved. Logistic regression estimated effects of having the problem resolved on calling a health referral. Callers were predominantly female (85%) and had a high school education or less (61%); nearly half (47%) had incomes under $10,000. The most common service requests were for utility assistance (35%), home/family problems (23%), and rent/mortgage assistance (12%). At follow-up, 38% of callers reported that all problems prompting their 2-1-1 call had been resolved, and 24% reported calling a health referral. Resolving all problems prompting the 2-1-1 call was associated with a higher odds of contacting a health referral (odds ratio = 1.44, 95% confidence interval [1.02, 2.05]) compared to people whose problems were not resolved. Multifaceted interventions that help meet non-health-related needs and provide support in reaching health-related goals may promote health in vulnerable populations.
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Affiliation(s)
- Tess Thompson
- Washington University in St. Louis, St. Louis, MO, USA
| | | | - Sonia Boyum
- Washington University in St. Louis, St. Louis, MO, USA
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17
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Escoffery C, Bundy L, Haardoerfer R, Berg CJ, Savas LS, Williams RS, Kegler MC. A process evaluation of an intervention to promote home smoking bans among low income households. EVALUATION AND PROGRAM PLANNING 2016; 55:120-125. [PMID: 26795538 PMCID: PMC4769918 DOI: 10.1016/j.evalprogplan.2015.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 06/05/2023]
Abstract
Exposure to secondhand smoke occurs primarily in the home due to passage of smoke-free legislation. Creation of a total household smoking ban can reduce associated health conditions such as asthma, lung cancer, heart disease and stroke. This paper describes the results of a randomized control trial of a minimal intervention to create smoke-free homes. 2-1-1 callers were invited to participate in the trial and were randomized to an intervention (mailings and a coaching call) or a control group (no intervention). We assessed reach, dose, fidelity, and receptivity to the intervention through program records and a 3-month follow-up survey with intervention participants. For the intervention materials, materials were mailed to 244 participants (99.2%) and 227 participants (92.3%) received the coaching call intervention. 92.3% received all intervention components. Participants who had full household bans at 3 months were more likely to conduct behaviors leading to a smoke-free home (i.e., making a list of reasons, having a family talk, posting a pledge) than were those with no/partial ban. The intervention materials also were rated higher in relevance and usefulness by non-smokers than smokers. Results demonstrate that this minimal intervention had high fidelity to the delivery of components and relatively high receptivity.
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Affiliation(s)
- Cam Escoffery
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Lujca Bundy
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Regine Haardoerfer
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Carla J Berg
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
| | - Lara S Savas
- University of Texas School of Public Health, 7000 Fannin St., Suite 2668, Houston, TX 77030, United States.
| | - Rebecca S Williams
- University of North Carolina at Chapel Hill, 200 N. Greensboro Street, Suite D-13, Carrboro, NC 27510, United States.
| | - Michelle C Kegler
- Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA 30322, United States.
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18
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Kegler MC, Haardörfer R, Bundy LT, Escoffery C, Berg CJ, Fernandez M, Williams R, Hovell M. Do partial home smoking bans signal progress toward a smoke-free home? HEALTH EDUCATION RESEARCH 2016; 31:24-35. [PMID: 26661723 PMCID: PMC4883035 DOI: 10.1093/her/cyv066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/06/2015] [Indexed: 06/05/2023]
Abstract
Understanding who establishes partial home smoking bans, what these bans cover, and whether they are an intermediate step in going smoke-free would help to inform smoke-free home interventions. Participants were recruited from United Way of Greater Atlanta's 2-1-1 contact center. Data were collected at baseline, 3 and 6 months via telephone interview. Participants (n = 375) were mostly African American (84.2%) and female (84.3%). The majority (58.5%) had annual household incomes <$10,000. At baseline, 61.3% reported a partial smoking ban and 38.7% reported no ban. Existence of a partial ban as compared with no ban was associated with being female, having more than a high school education, being married and younger age. Partial bans most often meant smoking was allowed only in designated rooms (52.6%). Other common rules included: no smoking in the presence of children (18.4%) and smoking allowed only in combination with actions such as opening a window or running a fan (9.8%). A higher percentage of households with partial bans at baseline were smoke-free at 6 months (36.5%) compared with households with no bans at baseline (22.1%). Households with partial smoking bans may have a higher level of readiness to go smoke-free than households with no restrictions.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322,
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Lucja T Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA 30322
| | - Maria Fernandez
- School of Public Health, University of Texas Health Sciences Center, Houston, TX 77030
| | - Rebecca Williams
- Gillings School of Global Public Health, Chapel Hill, University of North Carolina, Chapel Hill, NC 27510 and
| | - Mel Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA 91941, USA
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Cappelletti ER, Kreuter MW, Boyum S, Thompson T. Basic needs, stress and the effects of tailored health communication in vulnerable populations. HEALTH EDUCATION RESEARCH 2015; 30:591-8. [PMID: 26187910 PMCID: PMC4592353 DOI: 10.1093/her/cyv033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This study examined whether unmet basic needs (food, housing, personal and neighborhood safety, money for necessities) and perceived stress affect recall of and response to a tailored print intervention one month later. Participants (N = 372) were adults who had called 2-1-1 Missouri between June 2010 and June 2012. A series of path analyses using Mplus were conducted to explore the relationships among basic needs, perceived stress, number of health referrals received in a tailored intervention, recalling the intervention and contacting a health referral. Participants were mainly women (85%) and African-American (59%) with a mean age of 42.2 years (SD = 13.3; range 19-86); 41% had annual household income <$10 000. Unmet basic needs were positively associated with increased levels of perceived stress, which, in turn, were negatively associated with recalling the intervention and calling any of the health referrals provided. Tailored printed interventions may be less effective in populations with acute unmet basic needs. More broadly, the effectiveness of minimal contact behavioral interventions might be enhanced by simultaneous efforts to address unmet basic needs.
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Affiliation(s)
- Erika R Cappelletti
- Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo, 1 20126 Milan, Italy and
| | - Matthew W Kreuter
- Health Communication Research Laboratory, The Brown School, Washington University in St. Louis, 700 Rosedale Avenue, Saint Louis, MO 63112, USA
| | - Sonia Boyum
- Health Communication Research Laboratory, The Brown School, Washington University in St. Louis, 700 Rosedale Avenue, Saint Louis, MO 63112, USA
| | - Tess Thompson
- Health Communication Research Laboratory, The Brown School, Washington University in St. Louis, 700 Rosedale Avenue, Saint Louis, MO 63112, USA
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Kegler MC, Bundy L, Haardörfer R, Escoffery C, Berg C, Yembra D, Kreuter M, Hovell M, Williams R, Mullen PD, Ribisl K, Burnham D. A minimal intervention to promote smoke-free homes among 2-1-1 callers: a randomized controlled trial. Am J Public Health 2015; 105:530-7. [PMID: 25602863 DOI: 10.2105/ajph.2014.302260] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We tested the efficacy of a minimal intervention to create smoke-free homes in low-income households recruited through the United Way of Greater Atlanta 2-1-1, an information and referral system that connects callers to local social services. METHODS We conducted a randomized controlled trial (n=498) from June 2012 through June 2013, with follow-up at 3 and 6 months. The intervention consisted of 3 mailings and 1 coaching call. RESULTS Participants were mostly smokers (79.7%), women (82.7%), African American (83.3%), and not employed (76.5%), with an annual household income of $10,000 or less (55.6%). At 6-months postbaseline, significantly more intervention participants reported a full ban on smoking in the home than did control participants (40.0% vs 25.4%; P=.002). The intervention worked for smokers and nonsmokers, as well as those with or without children. CONCLUSIONS Minimal intervention was effective in promoting smoke-free homes in low income households and offers a potentially scalable model for protecting children and adult nonsmokers from secondhand smoke exposure in their homes.
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Affiliation(s)
- Michelle C Kegler
- Michelle C. Kegler, Regine Haardörfer, Cam Escoffery, and Carla Berg are with the Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA. Lucja Bundy and Debbie Yembra are with the Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta. Matthew Kreuter is with the George Warren Brown School of Social Work, Washington University, St. Louis, MO. Mel Hovell is with the Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA. Rebecca Williams is with the Gillings School of Global Public Health, Chapel Hill, NC. Patricia Dolan Mullen is with the School of Public Health, University of Texas Health Sciences Center, Houston. Kurt Ribisl is with the Department of Health Behavior, Gillings School of Global Public Health, Chapel Hill. Donna Burnham is with the United Way of Greater Atlanta, GA
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Hesse BW, Cole GE, Powe BD. Partnering against cancer today: a blueprint for coordinating efforts through communication science. J Natl Cancer Inst Monogr 2014; 2013:233-9. [PMID: 24395998 DOI: 10.1093/jncimonographs/lgt024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
One of the hallmarks of the communication revolution over the past decade has been its support for participation, whether that be in the active engagement of patients searching the Web for answers to vital health questions, or in the collective energies of self-organizing communities through social media. At the same time, some of the major obstacles to achieving a full and equitable reach of evidence-based cancer control knowledge have been traced back to discontinuities in communication either within clinical care or the broader public awareness system. Communication scientists from the National Cancer Institute, the Centers for Disease Control and Prevention, and the American Cancer Society joined forces in 2010 to investigate ways in which communication science can be used to improve coordination and enhance participation in cancer control for the nation. From 2010 to 2013, the three organizations worked together in 1) convening two meetings designed to assess the status of funded research in communication science, 2) completing a systematic review of literature published over the previous 10 years, and 3) authoring a blueprint for coordinated efforts using the implications of communication science. The blueprint consists of three major goals: first, to identify high-yield targets of opportunity using the health impact pyramid articulated by Centers for Disease Control and Prevention Director, Thomas Frieden; second, to leverage opportunities within the new communication environment, including the opportunities catalyzed by national efforts to create an infrastructure for evidence implementation through health information technology; and third, to assist in coordinating efforts across collaborative entities through participative media.
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Affiliation(s)
- Bradford W Hesse
- Health Communication and Informatics Research Branch, National Cancer Institute, 6130 Executive Blvd, EPN 4068, Bethesda, MD 20892.
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22
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Kreuter MW, McBride TD, Caburnay CA, Poor T, Thompson VLS, Alcaraz KI, Eddens KS, Rath S, Perkins H, Casey C. What can health communication science offer for ACA implementation? Five evidence-informed strategies for expanding Medicaid enrollment. Milbank Q 2014; 92:40-62. [PMID: 24597555 DOI: 10.1111/1468-0009.12040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT Implementing the Affordable Care Act (ACA) in 2014 will require effective enrollment and outreach efforts to previously uninsured individuals now eligible for coverage. METHODS From 1996 to 2013, the Health Communication Research Laboratory conducted more than 40 original studies with more than 30,000 participants to learn how to improve the reach to and effectiveness of health information for low-income and racial/ethnic minority populations. We synthesized the findings from this body of research and used them to inform current challenges in implementing the ACA. FINDINGS We found empirical support for 5 recommendations regarding partnerships, outreach, messages and messengers, life priorities of low-income individuals and families, and the information environment. We translated these into 12 action steps. CONCLUSIONS Health communication science can inform the development and execution of strategies to increase the public's understanding of the ACA and to support the enrollment of eligible individuals into Medicaid or the Health Insurance Marketplace.
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Affiliation(s)
- Matthew W Kreuter
- Health Communication Research Laboratory, Washington University in St. Louis; Brown School of Social Work, Washington University in St. Louis
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Hall KL, Stipelman BA, Eddens KS, Kreuter MW, Bame SI, Meissner HI, Yabroff KR, Purnell JQ, Ferrer R, Ribisl KM, Glasgow R, Linnan LA, Taplin S, Fernández ME. Advancing collaborative research with 2-1-1 to reduce health disparities: challenges, opportunities, and recommendations. Am J Prev Med 2012; 43:S518-28. [PMID: 23157775 PMCID: PMC3993989 DOI: 10.1016/j.amepre.2012.09.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 09/14/2012] [Accepted: 09/14/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Kara L Hall
- Science of Research and Technology Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA.
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Linnan LA. Research collaboration with 2-1-1 to eliminate health disparities: an introduction. Am J Prev Med 2012; 43:S415-9. [PMID: 23157758 PMCID: PMC7135801 DOI: 10.1016/j.amepre.2012.09.025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 09/08/2012] [Accepted: 09/14/2012] [Indexed: 11/25/2022]
Affiliation(s)
- Laura A Linnan
- Department of Health Behavior, The University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina 27599, USA.
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Daily LS. Health research and surveillance potential to partner with 2-1-1. Am J Prev Med 2012; 43:S422-4. [PMID: 23157760 PMCID: PMC7135616 DOI: 10.1016/j.amepre.2012.09.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 09/07/2012] [Accepted: 09/13/2012] [Indexed: 11/17/2022]
Affiliation(s)
- Linda S Daily
- United Way Worldwide, Alexandria, Virginia 22314-2045, USA.
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Bennett GG. Connecting eHealth with 2-1-1 to reduce health disparities. Am J Prev Med 2012; 43:S509-11. [PMID: 23157773 DOI: 10.1016/j.amepre.2012.09.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Gary G Bennett
- Department of Psychology and Neuroscience, Duke Global Health Institute, Duke Obesity Prevention Program, Duke University, Durham, North Carolina, USA.
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Eddens KS. Guiding principles for collaborative research with 2-1-1. Am J Prev Med 2012; 43:S512-7. [PMID: 23157774 DOI: 10.1016/j.amepre.2012.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 09/11/2012] [Accepted: 09/13/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Katherine S Eddens
- Department of Health Behavior, College of Public Health, University of Kentucky, Lexington, Kentucky 40536, USA. .
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