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Nicotine Tob Res. 2018 Dec 5. doi: 10.1093/ntr/nty256. [Epub ahead of print]

Disseminating a Smoke Free Homes program to low SES households in the US through 2-1-1: Results of a national impact evaluation.

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Rollins School of Public Health, Emory University, Atlanta GA.
George Warren Brown School of Social Work, Washington University, St. Louis MO.
School of Public Health, University of Texas Health Sciences Center, Houston TX.
Gillings School of Global Public Health, Chapel Hill NC.
Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego CA.
Info Line, Akron OH.
Heart of Florida United Way, Orlando FL.
United Way 2-1-1, Cleveland OH.
Community Service Council, Tulsa OK.
United Ways of Alabama, Montgomery AL.
Brown School, Washington University, St. Louis MO.



Given homes are now a primary source of secondhand smoke exposure (SHS) in the US, 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.


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 two-months post baseline.


2,345 households (335 to 605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%), 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 1,148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p<0.0001), with no differences by gender.


Among those reached for two-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.


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 secondhand smoke exposure, and increased cessation rates. While the program delivery capacity demonstrated by these competitively-selected 2-1-1s may not generalize to the broader 2-1-1 network in the US, or social service agencies outside of the US, 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 SES populations in the US.


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