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Berg CJ, Dekanosidze A, Hayrumyan V, LoParco CR, Torosyan A, Grigoryan L, Bazarchyan A, Haardörfer R, Kegler MC. Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors. Eur J Public Health 2023; 33:864-871. [PMID: 37500602 PMCID: PMC10567255 DOI: 10.1093/eurpub/ckad129] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. METHODS Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. RESULTS In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. CONCLUSIONS SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Ana Dekanosidze
- Georgia National Center for Disease Control and Public Health, Tbilisi, Georgia
| | - Varduhi Hayrumyan
- Turpanjian College of Health Sciences, American University of Armenia, Yerevan, Armenia
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington Cancer Center, George Washington University, Washington, DC, USA
| | - Arevik Torosyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Lilit Grigoryan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Alexander Bazarchyan
- National Institute of Health named after academician S. Avdalbekyan, MOH, Yerevan, Armenia
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michelle C Kegler
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Cui Y, LoParco CR, Bar-Zeev Y, Duan Z, Levine H, Abroms LC, Wang Y, Khayat A, Berg CJ. Theory-based correlates of cannabis use and intentions among US and Israeli adults: a mixed methods study. Subst Abuse Treat Prev Policy 2023; 18:54. [PMID: 37674246 PMCID: PMC10483868 DOI: 10.1186/s13011-023-00562-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND In the US and Israel, non-medical ('recreational') cannabis use is illegal at the national level; however, use rates are high and decriminalization and legalization is spreading. Thus, theory-based intervention efforts, especially for youth prevention, are crucial. METHODS This mixed-methods study of adults in the US (n = 1,128) and Israel (n = 1,094) analyzed: 1) cross-sectional survey data (Fall 2021) to identify theory-based correlates (risk perceptions, social norms) of past-month cannabis use, next-year use intentions, and intentions to use in the home or among children if non-medical cannabis was legal, using multivariable regression; and 2) qualitative interviews regarding perceptions of cannabis policies and use (US n = 40, Israel n = 44). RESULTS 16.7% reported past-month use; 70.5%, 56.3%, and 82.6% indicated "not at all likely" regarding next-year use and use in the home and among children if legal. Lower perceived risk and greater social norms were associated with past-month use, greater use intentions, and greater intentions to use in the home or among children. Past-month use was more prevalent among US (vs. Israeli) participants (22.0% vs. 11.2%); however, in multivariable regression controlling for past-month use, being from Israel was associated with greater use intentions (next-year; in the home/among children). Qualitative themes indicated: concerns about use (e.g., increasing use, health risks, driving-related risks) and legalization (e.g., impact on society/economy, marketing), and perceived benefits of use (e.g., medical) and legalization (e.g., access/safety, economic, individual rights). CONCLUSIONS Despite differences in cannabis perceptions and use across countries, perceived risk and social norms are relevant intervention targets regardless of sociopolitical context.
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Affiliation(s)
- Yuxian Cui
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Cassidy R LoParco
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Zongshuan Duan
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah Medical Center, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA.
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Self-Brown S, Perry EW, Recinos M, Cotner MA, Guastaferro K, Owolabi S, Spears CA, Whitaker DJ, Huang J, Kegler MC. Systematic braiding of Smoke-Free Home SafeCare to address child maltreatment risk and secondhand smoke exposure: findings from a pilot study. Pilot Feasibility Stud 2023; 9:81. [PMID: 37173799 PMCID: PMC10175921 DOI: 10.1186/s40814-023-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Exposure to secondhand tobacco smoke (SHS) and child maltreatment are preventable threats to child health. Few evidence-based interventions target both SHS and child maltreatment risk. The purpose of this paper is to describe the systematic braiding process of two evidence-based programs to address child SHS in the home and maltreatment perpetration risk, and present results from the formative work and pilot study. METHODS The first 4 steps of the systematic braiding process were completed, including the following: (1) the identification of core elements of both programs, (2) the development of an initial draft of the braided curriculum (Smoke-Free Home SafeCare - SFH-SC), (3) an acceptability and feasibility pilot of SFH-SC with caregivers of young children who reported a smoker living in the home (N = 8), and (4) feedback collection on the braided curriculum from SafeCare Providers (N = 9). RESULTS Experts identified common pedagogical and theoretical underpinnings for the two programs and braided Smoke-Free Homes: Some Things Are Better Outside into two SafeCare modules. Caregiver feedback from the pilot demonstrated that participants were engaged with SFH-SC and felt supported and comfortable discussing SHS intervention content with the SFH-SC Provider. Caregiver self-reports indicated a slight increase in smoke-free home rules from baseline to follow-up and a notable reduction in parent stress on the Parent Stress Index of 5.9 points (SD = 10.2). SafeCare Provider feedback following intensive review of the curriculum indicated high feasibility for SFH-SC delivery. CONCLUSIONS Parent and Provider findings suggest SFH-SC is a viable intervention that has potential to reduce the public health impact of SHS and child maltreatment for at-risk families. PROTOCOL The protocol for the pilot is not published elsewhere; however, the full protocol for the hybrid trial can be found here: https://clinicaltrials.gov/ct2/show/NCT05000632 . TRIAL REGISTRATION NCT, NCT05000632. Registered 14 July 2021, there is not a separate registration number for the pilot.
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Affiliation(s)
- Shannon Self-Brown
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA.
| | - Elizabeth W Perry
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Manderley Recinos
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michaela A Cotner
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Kate Guastaferro
- New York University - School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
| | - Shadé Owolabi
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
| | - Claire A Spears
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Daniel J Whitaker
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Jidong Huang
- Georgia State University - School of Public Health, 140 Decatur St. SE, Atlanta, GA, 30303, USA
| | - Michelle C Kegler
- Emory University - Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, USA
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Fernandez ME, Savas LS, Atkinson JS, Ricks KB, Ibekwe LN, Jackson I, Castle PE, Jobe D, Vernon SW. Evaluation of a 2-1-1 Telephone Navigation Program to Increase Cancer Control Behaviors: Results From a Randomized Controlled Trial. Am J Health Promot 2022; 36:1083-1093. [PMID: 35514063 DOI: 10.1177/08901171211041276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate the effectiveness of a telephone navigation intervention for increasing use of cancer control services among underserved 2-1-1 callers. DESIGN Randomized controlled trial. SETTING 2-1-1 call centers in Houston and Weslaco, Texas (located in the Rio Grande Valley near the Mexican border). PARTICIPANTS 2-1-1 callers in need of Pap test, mammography, colorectal cancer screening, smoking cessation counseling, and/or HPV vaccination for a daughter (n = 1,554). A majority were low-income and described themselves as Black or Hispanic. INTERVENTION Participants were randomly assigned to receive either a cancer control referral for the needed service(s) with telephone navigation from a trained cancer control navigator (n = 995) or a referral only (n = 559). MEASURES Uptake of each individual service and any needed service. ANALYSIS Assessed uptake in both groups using bivariate chi-square analyses and multivariable logistic regression analyses, adjusted for sociodemographic covariates. Both per-protocol and intent-to-treat approaches were used. RESULTS Both interventions increased cancer control behaviors. Referral with navigation intervention resulted in significantly greater completion of any needed service (OR = 1.38; p = .042), Pap test (OR = 1.56; p = .023), and smoking cessation counseling (OR = 2.66; p = .044), than referral-only condition. Other outcomes showed the same trend although the difference was not statistically significant: mammography (OR = 1.53; p = .106); colorectal cancer screening (OR = 1.80; p = .095); and HPV vaccination of a daughter (OR = 1.61; p = .331). CONCLUSION Adding cancer control referrals and navigation to an informational service like the 2-1-1 program can increase overall participation in cancer control services.
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Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Lara S Savas
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - John S Atkinson
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Katherine Ball Ricks
- Cecil G. Sheps Center for Health Service Research, University of North Carolina, Chapel Hill, NC, USA
| | - Lynn N Ibekwe
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Inimfon Jackson
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
| | - Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD, USA.,Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, Rockville, MD, USA
| | - David Jobe
- 2-1-1 Texas/United Way HELPLINE, United Way of Greater Houston, Houston, TX, USA
| | - Sally W Vernon
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX, USA
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Durazo A, Hartman-Filson M, Perez K, Alizaga NM, Petersen AB, Vijayaraghavan M. Smoke-Free Home Intervention in Permanent Supportive Housing: A Multifaceted Intervention Pilot. Nicotine Tob Res 2021; 23:63-70. [PMID: 32123908 DOI: 10.1093/ntr/ntaa043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Smoke-free homes (SFHs), the voluntary adoption of home smoking restrictions, are associated with reduced secondhand smoke exposure. However, SFHs are uncommon in permanent supportive housing (PSH) for formerly homeless adults, who have fivefold higher smoking rates than the general population. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. AIMS AND METHODS We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. Rest of the methods, PSH residents (n = 100) and staff (n = 62) from 15 PSH sites participated in the intervention between October 2017 and February 2018. Research staff provided counseling to PSH residents on how to adopt an SFH and trained PSH staff on how to counsel residents on smoking cessation. The primary outcome was self-reported voluntary adoption of an SFH for ≥90 days, and the secondary outcome was carbon monoxide-verified PPA at 6-month follow-up. PSH staff completed the Smoking Knowledge, Attitudes, and Practices survey at baseline and 3-month follow-up. RESULTS At 6 months, 31.3% of PSH residents had adopted an SFH (vs. 13.0% at baseline) and 16.9% reported carbon monoxide-verified PPA. A positive attitude toward an SFH policy was associated with increased odds of SFH adoption (adjusted odds ratio = 8.68, 95% confidence interval: 2.42, 31.17). Voluntary SFH adoption was associated with increased PPA (adjusted odds ratio = 26.27, 95% confidence interval: 3.43, 201.30). PSH staff reported improved attitudes toward and self-efficacy in delivering cessation care, and decreased barriers to discussing smoking cessation among PSH residents between baseline and 3-month follow-up. CONCLUSIONS In this single-arm study, a brief intervention increased SFH adoption and PPA among PSH residents. IMPLICATIONS To date, few interventions have addressed SFHs and their association with tobacco use among PSH residents. A "ground-up" approach that relies on buy-in from residents and that promotes voluntary SFHs is an innovative way to increase smoke-free living environments in PSH. This approach could pave a pathway for smoke-free policy implementation in these sites. PSH can play a role in reducing the burden of tobacco use by empowering its residents to adopt voluntary SFHs, which could increase smoking cessation among residents.
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Affiliation(s)
- Arturo Durazo
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
| | | | - Kenneth Perez
- School of Public Health, University of California, Berkeley, CA
| | | | | | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Division of General Internal Medicine, University of California, San Francisco, CA
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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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7
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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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8
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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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Lee DC, Feldman JM, Osorio M, Koziatek CA, Nguyen MV, Nagappan A, Shim CJ, Vinson AJ, Thorpe LE, McGraw NA. Improving the geographical precision of rural chronic disease surveillance by using emergency claims data: a cross-sectional comparison of survey versus claims data in Sullivan County, New York. BMJ Open 2019; 9:e033373. [PMID: 31740475 PMCID: PMC6887089 DOI: 10.1136/bmjopen-2019-033373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Some of the most pressing health problems are found in rural America. However, the surveillance needed to track and prevent disease in these regions is lacking. Our objective was to perform a comprehensive health survey of a single rural county to assess the validity of using emergency claims data to estimate rural disease prevalence at a sub-county level. DESIGN We performed a cross-sectional study of chronic disease prevalence estimates using emergency department (ED) claims data versus mailed health surveys designed to capture a substantial proportion of residents in New York's rural Sullivan County. SETTING Sullivan County, a rural county ranked second-to-last for health outcomes in New York State. PARTICIPANTS Adult residents of Sullivan County aged 25 years and older who responded to the health survey in 2017-2018 or had at least one ED visit in 2011-2015. OUTCOME MEASURES We compared age and gender-adjusted prevalence of hypertension, hyperlipidaemia, diabetes, cancer, asthma and chronic obstructive pulmonary disease/emphysema among nine sub-county areas. RESULTS Our county-wide mailed survey obtained 6675 completed responses for a response rate of 30.4%. This sample represented more than 12% of the estimated 53 020 adults in Sullivan County. Using emergency claims data, we identified 34 576 adults from Sullivan County who visited an ED at least once during 2011-2015. At a sub-county level, prevalence estimates from mailed surveys and emergency claims data correlated especially well for diabetes (r=0.90) and asthma (r=0.85). Other conditions were not well correlated (range: 0.23-0.46). Using emergency claims data, we created more geographically detailed maps of disease prevalence using geocoded addresses. CONCLUSIONS For select conditions, emergency claims data may be useful for tracking disease prevalence in rural areas and providing more geographically detailed estimates. For rural regions lacking robust health surveillance, emergency claims data can inform how to geographically target efforts to prevent chronic disease.
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Affiliation(s)
- David C Lee
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Justin M Feldman
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Marcela Osorio
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Christian A Koziatek
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Michael V Nguyen
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Ashwini Nagappan
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Christopher J Shim
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Andrew J Vinson
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York City, New York, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York City, New York, USA
| | - Nancy A McGraw
- Sullivan County Public Health Services, Liberty, New York, USA
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10
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Anderson KM, Kegler MC, Bundy LT, Henderson P, Halfacre J, Escoffery C. Adaptation of a brief smoke-free homes intervention for American Indian and Alaska Native families. BMC Public Health 2019; 19:981. [PMID: 31337379 PMCID: PMC6651935 DOI: 10.1186/s12889-019-7301-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/10/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The goal of adaptation is to maintain the effectiveness of the original intervention by preserving the core elements that account for its success while delivering an intervention that is tailored to the new community and/or cultural context. The current study describes the process of adapting an evidence-based smoke-free homes (SFH) intervention for use in American Indian/Alaska Native (AI/AN) households. METHODS We followed a systematic adaptation process. We first assessed the community through focus groups coordinated in collaboration with tribal partners. Because our team included the original developers of the intervention, the steps of understanding the intervention, selecting the intervention and consulting with experts were simplified. Additional steps included consulting with stakeholders through a national work group and collaboratively deciding what needed adaptation. RESULTS A number of key themes pertinent to the adaptation of the SFH intervention were identified in the focus groups. These included the gravity of messaging about commercial tobacco use; respect, familialism, and intergenerationalism; imagery, including significant symbolism, colors, and representative role models; whether and how to address traditional tobacco; and, barriers to a SFH not adequately addressed in the original materials. CONCLUSIONS Adaptation of an intervention to create smoke-free homes in AI/AN families necessitated both surface structure changes such as appearance of role models and deep structure changes that addressed core values, and beliefs and traditions.
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Affiliation(s)
- Katherine M. Anderson
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Michelle C. Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Lucja T. Bundy
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | | | | | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA USA
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11
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A cross-sectional study of the relationship of proximal smoking environments and cessation history, plans, and self-efficacy among low-income smokers. J Smok Cessat 2019; 14:229-238. [PMID: 33777240 DOI: 10.1017/jsc.2019.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable. Aims We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit. Methods This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy). Results Smokers who lived in homes with more restrictive household smoking rules, and/or reported having 'important others' who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting. Conclusions Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
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12
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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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Abstract
BACKGROUND Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES To evaluate the effect of telephone support to help smokers quit, including proactive or reactive counselling, or the provision of other information to smokers calling a helpline. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the ICTRP for studies of telephone counselling, using search terms including 'hotlines' or 'quitline' or 'helpline'. Date of the most recent search: May 2018. SELECTION CRITERIA Randomised or quasi-randomised controlled trials which offered proactive or reactive telephone counselling to smokers to assist smoking cessation. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We pooled studies using a random-effects model and assessed statistical heterogeneity amongst subgroups of clinically comparable studies using the I2 statistic. In trials including smokers who did not call a quitline, we used meta-regression to investigate moderation of the effect of telephone counselling by the planned number of calls in the intervention, trial selection of participants that were motivated to quit, and the baseline support provided together with telephone counselling (either self-help only, brief face-to-face intervention, pharmacotherapy, or financial incentives). MAIN RESULTS We identified 104 trials including 111,653 participants that met the inclusion criteria. Participants were mostly adult smokers from the general population, but some studies included teenagers, pregnant women, and people with long-term or mental health conditions. Most trials (58.7%) were at high risk of bias, while 30.8% were at unclear risk, and only 11.5% were at low risk of bias for all domains assessed. Most studies (100/104) assessed proactive telephone counselling, as opposed to reactive forms.Among trials including smokers who contacted helplines (32,484 participants), quit rates were higher for smokers receiving multiple sessions of proactive counselling (risk ratio (RR) 1.38, 95% confidence interval (CI) 1.19 to 1.61; 14 trials, 32,484 participants; I2 = 72%) compared with a control condition providing self-help materials or brief counselling in a single call. Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate.In studies that recruited smokers who did not call a helpline, the provision of telephone counselling increased quit rates (RR 1.25, 95% CI 1.15 to 1.35; 65 trials, 41,233 participants; I2 = 52%). Due to the substantial unexplained heterogeneity between studies, we downgraded the certainty of the evidence to moderate. In subgroup analysis, we found no evidence that the effect of telephone counselling depended upon whether or not other interventions were provided (P = 0.21), no evidence that more intensive support was more effective than less intensive (P = 0.43), or that the effect of telephone support depended upon whether or not people were actively trying to quit smoking (P = 0.32). However, in meta-regression, telephone counselling was associated with greater effectiveness when provided as an adjunct to self-help written support (P < 0.01), or to a brief intervention from a health professional (P = 0.02); telephone counselling was less effective when provided as an adjunct to more intensive counselling. Further, telephone support was more effective for people who were motivated to try to quit smoking (P = 0.02). The findings from three additional trials of smokers who had not proactively called a helpline but were offered telephone counselling, found quit rates were higher in those offered three to five telephone calls compared to those offered just one call (RR 1.27, 95% CI 1.12 to 1.44; 2602 participants; I2 = 0%). AUTHORS' CONCLUSIONS There is moderate-certainty evidence that proactive telephone counselling aids smokers who seek help from quitlines, and moderate-certainty evidence that proactive telephone counselling increases quit rates in smokers in other settings. There is currently insufficient evidence to assess potential variations in effect from differences in the number of contacts, type or timing of telephone counselling, or when telephone counselling is provided as an adjunct to other smoking cessation therapies. Evidence was inconclusive on the effect of reactive telephone counselling, due to a limited number studies, which reflects the difficulty of studying this intervention.
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Affiliation(s)
| | - José M. Ordóñez‐Mena
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
| | - Jamie Hartmann‐Boyce
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordOxfordshireUKOX2 6GG
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14
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Hovell MF, Bellettiere J, Liles S, Nguyen B, Berardi V, Johnson C, Matt GE, Malone J, Boman-Davis MC, Quintana PJE, Obayashi S, Chatfield D, Robinson R, Blumberg EJ, Ongkeko WM, Klepeis NE, Hughes SC. Randomised controlled trial of real-time feedback and brief coaching to reduce indoor smoking. Tob Control 2019; 29:183-190. [PMID: 30770436 DOI: 10.1136/tobaccocontrol-2018-054717] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Previous secondhand smoke (SHS) reduction interventions have provided only delayed feedback on reported smoking behaviour, such as coaching, or presenting results from child cotinine assays or air particle counters. DESIGN This SHS reduction trial assigned families at random to brief coaching and continuous real-time feedback (intervention) or measurement-only (control) groups. PARTICIPANTS We enrolled 298 families with a resident tobacco smoker and a child under age 14. INTERVENTION We installed air particle monitors in all homes. For the intervention homes, immediate light and sound feedback was contingent on elevated indoor particle levels, and up to four coaching sessions used prompts and praise contingent on smoking outdoors. Mean intervention duration was 64 days. MEASURES The primary outcome was 'particle events' (PEs) which were patterns of air particle concentrations indicative of the occurrence of particle-generating behaviours such as smoking cigarettes or burning candles. Other measures included indoor air nicotine concentrations and participant reports of particle-generating behaviour. RESULTS PEs were significantly correlated with air nicotine levels (r=0.60) and reported indoor cigarette smoking (r=0.51). Interrupted time-series analyses showed an immediate intervention effect, with reduced PEs the day following intervention initiation. The trajectory of daily PEs over the intervention period declined significantly faster in intervention homes than in control homes. Pretest to post-test, air nicotine levels, cigarette smoking and e-cigarette use decreased more in intervention homes than in control homes. CONCLUSIONS Results suggest that real-time particle feedback and coaching contingencies reduced PEs generated by cigarette smoking and other sources. TRIAL REGISTRATION NUMBER NCT01634334; Post-results.
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Affiliation(s)
- Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - John Bellettiere
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Sandy Liles
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Benjamin Nguyen
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Vincent Berardi
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA.,Psychology, Chapman University, Orange, CA, USA
| | | | - Georg E Matt
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA.,Psychology, San Diego State University, San Diego, California, USA
| | - John Malone
- Department of Medicine, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Marie C Boman-Davis
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA.,Community Health, National University, California, USA
| | | | - Saori Obayashi
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Dale Chatfield
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | | | - Elaine J Blumberg
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Weg M Ongkeko
- Surgery, University of California San Diego, La Jolla, California, USA
| | - Neil E Klepeis
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - Suzanne C Hughes
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
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15
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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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16
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Haardörfer R, Kreuter M, Berg CJ, Escoffery C, Bundy ŁT, Hovell M, Mullen PD, Williams R, Kegler MC. Cessation and reduction in smoking behavior: impact of creating a smoke-free home on smokers. HEALTH EDUCATION RESEARCH 2018; 33:256-259. [PMID: 29788227 PMCID: PMC6658707 DOI: 10.1093/her/cyy014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 05/11/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to assess the effect of a creating a smoke-free home (SFH) on cessation and reduction of cigarette smoking on low-income smokers. This secondary data analysis uses data from study participants who were originally recruited through 2-1-1 information and referral call centers in Atlanta (Georgia, 2013), North Carolina (2014) and the Texas Gulf Coast (2015) across three randomized controlled trials testing an intervention aimed at creating SFHs, pooling data from 941 smokers. Participants who reported adopting a SFH were more likely to report quitting smoking than those who did not adopt a SFH. This was true at 3-month follow-up and even more pronounced at 6-month follow-up and persisted when considering only those who consistently reported no smoking at 3 and 6 months. Among those who did not stop smoking, the number of cigarettes per day declined significantly more and quit attempts were more frequent for those who created a SFH compared with those who did not. Findings suggest that creating a SFH facilitates cessation, reduces cigarette consumption and increases quit attempts. Future studies should assess the long-term impact of SFHs on sustaining cessation.
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Affiliation(s)
- R Haardörfer
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - M Kreuter
- George Warren Brown School of Social Work, Washington University, St Louis, MO, USA
| | - C J Berg
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - C Escoffery
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - Ł T Bundy
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
| | - M Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - P D Mullen
- School of Public Health, University of Texas Health Sciences Center, Houston, TX, USA
| | - R Williams
- University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - M C Kegler
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA
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17
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Savas LS, Mullen PD, Hovell MF, Escoffrey C, Fernandez ME, Jones JA, Cavazos J, Gutierrez Monroy JAA, Kegler MC. A Qualitative Study Among Mexican Americans to Understand Factors Influencing the Adoption and Enforcement of Home Smoking Bans. Nicotine Tob Res 2018; 19:1465-1472. [PMID: 27698093 DOI: 10.1093/ntr/ntw270] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 09/28/2016] [Indexed: 11/12/2022]
Abstract
Introduction One-third of Mexican-American children, in addition to nonsmoker adults, are exposed to secondhand smoke at home, yet few interventions target Mexican-American households. An effective, brief English language program, tested with United Way 2-1-1 callers in Atlanta, increased home smoking bans (confirmed by air monitors). Two randomized controlled trials in North Carolina and Texas replicated those results. We explored factors determining adoption and enforcement of smoking bans in Mexican-American households to inform program linguistic and cultural adaptation to broaden program reach and relevance. Methods Bilingual interviewers recruited convenience samples of Mexican-American smokers and nonsmokers living with at least one smoker in Houston and San Diego households and asked open-ended questions regarding conditions for implementing home and vehicle smoking bans and conditions for varying acceptance of bans. Investigators independently reviewed English transcripts and completed a descriptive analysis using ATLAS.ti. Results Participants (n = 43) were predominantly female (n = 31), current smokers (n = 26), interviewed in Spanish (n = 26), had annual household incomes less than $30000 (n = 24), and allowed smoking inside the home (n = 24). Themes related to difficulty creating and enforcing bans included courtesy, respect for guests and heads of household who smoke, and gender imbalances in decision making. Participants viewed protecting children's health as a reason for the ban but not protecting adult nonsmokers' health. Conclusion A dual-language, culturally adapted intervention targeting multigenerational Mexican-American households should address household differences regarding language and consider influences of cultural values on family dynamics and interactions with guests that may weaken bans. Implications Qualitative interviews suggested cultural and family considerations to address in adapting a brief evidence-based smoke-free homes intervention for Mexican Americans, including traditional gender roles, unique contexts of multigenerational households, and language preferences. Our work confirms previous research among Latinos regarding importance of common cultural constructs, such as respeto (deference), simpatia (courtesy and agreeability), and familismo (family attachment), which inform behaviors that may impede or facilitate adopting and enforcing home smoking bans. Decision-making gender imbalances, high regard for head-of-household and guest smokers, and less sensitivity to the health of nonsmoker adults compared with children may lead to permission to smoke indoors.
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Affiliation(s)
- Lara S Savas
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Cam Escoffrey
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Maria E Fernandez
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
| | - Jennifer A Jones
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Jazmine Cavazos
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
| | - Jo Ann A Gutierrez Monroy
- Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, TX
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, GA
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18
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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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19
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Haardörfer R, Berg CJ, Escoffery C, Bundy ŁT, Hovell M, Kegler MC. Development of a scale assessing Beliefs About ThirdHand Smoke (BATHS). Tob Induc Dis 2017; 15:4. [PMID: 28104999 PMCID: PMC5240270 DOI: 10.1186/s12971-017-0112-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Similarly to secondhand smoke (SHS), thirdhand smoke (THS) beliefs may be correlated with smoking behaviors and smokefree policies in the home. Thus, there is a need to develop and validate measures to assess beliefs about THS. METHODS A list of 19 items related to THS were generated by an expert panel and tested in a pilot study. Based on results from an exploratory factor analysis, two factors emerged: THS persistence in the environment and THS impact on health. The scale was reduced to nine items, which showed no differential item functioning by smoking status or smoking ban status in the home. The nine items and the two factor structure were tested in a validation sample from a smoke-free homes intervention that included THS educational materials. RESULTS The 9-item scale showed excellent internal consistency. Confirmatory factor analysis indicated good model fit for the two factor solution in a low-income population. Tests of construct validity indicated differences due to exposure to the smoke-free homes intervention, by smoking status, whether participants own or rent their home, and smoking ban status in the home. CONCLUSIONS The BATHS scale offers researchers a valid and reliable tool to assess THS beliefs.
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Affiliation(s)
- Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 USA
| | - Carla J Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 USA
| | - Łucja T Bundy
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 USA
| | - Melbourne Hovell
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, 9245 Sky Park Court, San Diego, CA 92182 USA
| | - Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322 USA
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