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Open AccessArticle

Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program

1
Institute for Translational Research in Children’s Mental Health, University of Minnesota, Minneapolis, MN 55415, USA
2
Department of Behavioral Sciences & Health Education, Rollins School of Public Health of Emory University, Emory University, Atlanta, GA 30322, USA
3
Office of Statewide Health Improvement Initiative, Minnesota Department of Health, St. Paul, MN 55101, USA
4
Division of General Pediatrics and Adolescent Health, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN 55414, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(18), 6787; https://doi.org/10.3390/ijerph17186787
Received: 20 July 2020 / Revised: 11 September 2020 / Accepted: 15 September 2020 / Published: 17 September 2020
(This article belongs to the Special Issue Smoking Prevention and Tobacco Control)
Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars), and secondhand smoke (SHS) exposure remains prevalent among children and low-socioeconomic status (SES) populations. This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children. The pilot was implemented through Minnesota’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP). NBCCEDPs provide cancer prevention services to low-income individuals experiencing health disparities. We successfully utilized and adapted the Smoke-Free Homes Program (SFHP) to address comprehensive smoke-free rules among households with children. We used two recruitment methods: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. We used descriptive statistics to assess implementation outcomes and hierarchical logistic regression models (HLM) to assess change in smoke-free rules and SHS exposure over the study period. There was no comparison group, and HLM was used to examine within-person change. A total of 64 participants were recruited. Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route. Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP. View Full-Text
Keywords: smoke-free rules; tobacco-related disparities; socioeconomic disadvantage; secondhand smoke exposure; child and adolescent health smoke-free rules; tobacco-related disparities; socioeconomic disadvantage; secondhand smoke exposure; child and adolescent health
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Parks, M.J.; Kegler, M.C.; Kingsbury, J.H.; Borowsky, I.W. Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program. Int. J. Environ. Res. Public Health 2020, 17, 6787.

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