Kegler Michelle C, Haardörfer Regine, Melanson Taylor, Allen Lindsey, Bundy Lucja T, Kreuter Matthew W, Williams Rebecca S, Hovell Melbourne F, Mullen Patricia Dolan
Emory University, Atlanta, GA, USA.
West Virginia University, Morgantown, WV, USA.
Health Educ Behav. 2019 Oct;46(5):773-781. doi: 10.1177/1090198119848767. Epub 2019 Jun 5.
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 ( = 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, < .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.
可扩展的干预措施在一系列现实环境中仍然有效，并且可以进行调整以适应组织和社区的背景。“无烟家庭：有些事情在户外更好”在功效、效果、普遍性和传播研究中，对于促进低收入家庭的无烟家庭规则一直很有效。本文利用与俄亥俄州、佛罗里达州、俄克拉何马州和阿拉巴马州的五个2-1-1呼叫中心合作开展的一项传播研究的数据（n = 2345户家庭），考察了可扩展性的关键维度，包括不同亚人群的效果、次要结果、确定推动效果的核心要素以及成本效益。通过2-1-1工作人员采用基线后2个月自我报告结果的前后设计进行评估，该项目对男性和女性、不同教育水平、家中吸烟者数量不同以及家中是否有儿童的家庭同样有效。对不吸烟者、每天吸烟较少的人以及非裔美国人更有效。营造无烟家庭与一项新的无烟车辆规则相关（优势比[OR]=3.38，置信区间[CI 2.58，4.42]），不吸烟者接触二手烟的情况减少（b=-2.33，p<.0001），吸烟者戒烟的情况增加（OR = 5.8，CI[3.81，8.81]）。每个项目组成部分的使用与成功营造无烟家庭显著相关。使用意向性分析效应量为40.1%，该项目5年的医疗保健节省收益超过项目成本，为100户家庭提供服务可实现净节省9633美元。成本效益、亚人群分析以及核心要素的确定有助于评估此类无烟家庭项目等经过研究测试的干预措施的可扩展潜力。
