摘要：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. Despite declines in exposure to secondhand smoke (SHS) over the last 2 decades, children and nonsmoking adults who live with a person who smokes still experience significant exposure to SHS. 1–3 SHS exposure causes lung cancer, coronary heart disease, and stroke in nonsmoking adults, aexacerbates asthma, and causes impaired lung function, middle ear disease, respiratory illness, and sudden infant death syndrome in children. 3–5 Exposure differs markedly between those who live with someone who smokes in the home and those who do not. In 2007 and 2008, 93.4% of nonsmoking adults who lived with someone who smoked inside the home had elevated serum cotinine levels compared with 33.4% of those who did not live with someone who smoked inside the home. 6 This pattern was similar, but more striking, for children and youths. 6 Certain subgroups of the US population are less likely to have household smoking restrictions and are disproportionately affected by SHS exposure in the home. For instance, African American nonsmokers have an increased prevalence of detectable serum cotinine compared with other major racial/ethnic groups and are less likely to report home smoking bans. 6–8 Low income families and those with less education are less likely to have full smoking bans. 6,8–11 Other predictors of household smoking bans include the presence of children, the presence of a nonsmoking adult in the home, and fewer friends and family members who smoke. 9,10,12–17 Home smoking bans can lead to lower levels of SHS exposure, less smoking, and increased attempts to quit. 7,13,18–22 The prevalence of smoke-free homes has increased as states and communities have legislated smoke-free public places. 23,24 Intervention studies have typically examined the effects of counseling parents of children with asthma, infants, or medically compromised children on exposure levels. 25–29 Effective interventions involve multiple counseling sessions and often combine smoking cessation and smoke-free home messages. 30–32 Much of the existing intervention research has taken place or recruited participants through clinical settings. 30–33 Minimal interventions to create smoke-free homes in community-based settings have not been adequately studied. 31,33,34 Minimal interventions have the potential for greater reach than more intensive interventions, and thus, have the potential for a greater impact at the population level. 35–38 Similarly, interventions that target general populations, including households with no young children, can help to achieve population-level reductions in SHS exposure. We tested the efficacy of a minimal intervention with callers to the United Way of Greater Atlanta, Georgia, 2-1-1 number. The 2-1-1 information and referral system consists of more than 200 nonprofit state and local call centers operating in all 50 states and connects more than 16 million callers per year to local health and social services. 39 Callers to 2-1-1 are disproportionately low-income, unemployed, uninsured, and have fewer years of education relative to the general population. 40 2-1-1 callers have a higher rate of smoking and lower likelihood of a home smoking ban than the general population. 41,42 Because 2-1-1 provides extensive reach to vulnerable populations, they are strategic partners for testing, delivering, and ultimately sustaining interventions to reduce risk and improve the lives of low-income persons in the United States. 40 We tested the efficacy of a minimal intervention to create smoke-free homes among 2-1-1 callers. Our study builds on formative research on family dynamics related to establishing household smoking bans, 43,44 a pilot study to test a brief intervention, 45 and a cross-site survey of 2-1-1 callers that showed a relatively low prevalence of smoke-free homes. 41 This randomized controlled trial is the first in a series of studies that will move from testing efficacy to effectiveness to dissemination of the intervention through 2-1-1 centers nationally.
