P1053 - Reducing Socioeconomic Disparities in Comprehensive Smoke-free Rules among Households with Children: A Pilot Intervention Implemented through a National Cancer Program

Household smoke-free rules can mitigate tobacco-related harm. However, most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes and cars). Furthermore, secondhand smoke (SHS) exposure remains prevalent among youth and low-socioeconomic status (SES) populations, and low-SES populations are less likely to implement comprehensive smoke-free rules. The American Academy of Pediatrics (AAP) Section on Tobacco Control identifies caregiver/parental tobacco use and promoting the adoption of smoke-free rules in homes and cars as public health priorities. Funded by AAP’s Julius B. Richmond Center of Excellence, this 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 project 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 promote comprehensive smoke-free rules, particularly among households with children. We developed two recruitment methods and compared their effectiveness: (a) direct mail (DM) and (b) opportunistic referral (OR) by patient navigators in the NBCCEDP call center. Using data from the NBCCEDP’s central database, mailers were sent to previous NBCCEDP patients who were smokers and nonsmokers who lived with a smoker. Mailers consisted of messages and graphics rooted in the SFHP theme of “somethings are better left outside.” Mailers prompted participants to call the NBCCEDP’s toll-free phone number. OR consisted of the NBCCEDP call center receiving calls related to cancer services and opportunistically offering the intervention to eligible participants. We used descriptive statistics to assess implementation outcomes and hierarchical linear models (HLM) to assess change in smoke-free rules over the study period. HLM analyses included covariates, accounted for the nested data structure, and used full maximum likelihood estimation (accounting for attrition; see Table 1). A total of 64 participants were recruited, and the number of participants at each intervention stage is reported in Figure 1. Results showed 83% of participants were recruited through DM, and DM response rate corresponded to previous research (1%). OR had a high recruitment rate, but DM recruited more participants with higher retention. Among recruited participants with data (N=47), smoke-free home rules increased by 50.4 percentage points during the study period (p<.001). Among recruited participants who had a vehicle (N=38), smoke-free car rules increased by 37.6 percentage points (p<.05) and comprehensive smoke-free rules rose 40.9 percentage points (p<.05). Home SHS exposure declined, and within-person increases in smoke-free home rules was significantly related to less home SHS exposure (p<.05). It is feasible to adapt and implement an evidence-based intervention through a national cancer program, which can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children.