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减少有儿童家庭全面无烟规定中的社会经济差异:通过国家癌症计划实施的一项试点干预。

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

机构信息

Institute for Translational Research in Children's Mental Health, University of Minnesota, Minneapolis, MN 55415, USA.

Department of Behavioral Sciences & Health Education, Rollins School of Public Health of Emory University, Emory University, Atlanta, GA 30322, USA.

出版信息

Int J Environ Res Public Health. 2020 Sep 17;17(18):6787. doi: 10.3390/ijerph17186787.

Abstract

Most households with a smoker do not implement comprehensive smoke-free rules (smoke-free homes 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 ( = 47), smoke-free home rules increased by 50.4 percentage points during the study period ( < 0.001). Among recruited participants who had a vehicle ( = 38), smoke-free car rules increased by 37.6 percentage points ( < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points ( < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure ( < 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.

摘要

大多数有烟民的家庭没有实施全面的无烟规定(无烟家庭和汽车),儿童和社会经济地位较低(SES)人群仍然普遍接触二手烟(SHS)。本试点项目旨在评估一项旨在增加社会经济劣势家庭中儿童无烟规定的干预措施的实施可行性和影响。该试点通过明尼苏达州的国家乳腺癌和宫颈癌早期检测计划(NBCCEDP)实施。NBCCEDP 为面临健康差距的低收入个人提供癌症预防服务。我们成功地利用和改编了无烟家庭计划(SFHP),以解决有儿童的家庭中的全面无烟规定问题。我们使用了两种招募方法:(a)直接邮件(DM)和(b)NBCCEDP 呼叫中心的患者导航员的机会性转介(OR)。我们使用描述性统计来评估实施结果,并使用分层逻辑回归模型(HLM)来评估研究期间无烟规定和 SHS 暴露的变化。没有对照组,HLM 用于检查个体内的变化。共招募了 64 名参与者。结果显示,83%的参与者通过 DM 招募。OR 的招募率很高,DM 招募了更多响应率低但保留率高的参与者。在有数据的招募参与者中(n = 47),无烟家庭规则在研究期间增加了 50.4 个百分点(<0.001)。在有车辆的招募参与者中(n = 38),无烟汽车规则增加了 37.6 个百分点(<0.01),全面无烟规则增加了 40.9 个百分点(<0.01)。家庭 SHS 暴露减少,个体内无烟家庭规则的增加与家庭 SHS 暴露的减少显著相关(<0.05)。通过国家癌症计划来适应和实施基于证据的 SFHP 干预措施是可行的,但目前的试点表明招募是一个挑战。DM 产生的响应率较低,因此 OR 是推荐的招募途径。尽管招募率较低,但我们得出的结论是,SFHP 可以成功地增加社会经济劣势家庭中儿童的全面无烟规定,并减少 SHS 暴露。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ae01/7559315/7f2fd4948e44/ijerph-17-06787-g001.jpg

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