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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 14.2: Smoking in the Household

MCH Best Logo paper cutout people holding a used cigarette

Strategy. Home Visits + Education Materials + Telephone Counseling

Approach. Provide in-person counseling via home visits + educational materials + telephone counseling to reduce child exposure to secondhand smoke in the home.

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Overview. Research indicates that interventions using in-person counseling via home visits + educational materials + telephone counseling can be effective in reducing child exposure to secondhand smoke in the home. Examples of studies with positive outcomes used a variety of counseling approaches, including behavioral theory and social learning theory; and a variety of materials, including pamphlets on quitting and self-help manuals to establish a smoke-free home.1-2

Evidence. Moderate. Research has consistently showed positive results for this strategy. The strategy of using home visits + educational materials + telephone counseling to reduce children’s exposure to secondhand smoke in the home has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Parents/caregivers.

Outcome. Reduction of secondhand tobacco smoke exposure. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are 11 ESMs across all states/jurisdictions that align with components of this intervention strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Provide in-person counseling via home visits + educational materials + telephone counseling to reduce child exposure to secondhand smoke in the home,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of parents/caregivers who receive counseling during home visits to reduce a child’s exposure to secondhand smoke in the home.
  • Number of parents/caregivers who receive educational materials on how to establish smoke-free homes.
  • Number of parents/caregivers who receive text messages on the harms of secondhand smoke to mothers and infants along with home visits and educational materials.
  • Number of parents/caregivers who reported high levels of satisfaction with the text messages received along with home visits and education materials.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of parents/caregivers who receive counseling during home visits to reduce a child’s exposure to secondhand smoke in the home.
  • Percent of parents/caregivers who receive educational materials on how to establish smoke-free homes.
  • Percent of parents/caregivers who receive text messages on the harms of secondhand smoke to mothers and infants along with home visits and educational materials.
  • Percent of parents/caregivers who reported high levels of satisfaction with the text messages received along with home visits and education materials.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of parents/caregivers who report improvements in knowledge around reducing environmental tobacco exposure as a result of individualized counseling and educational materials.
  • Number of parents/caregivers who report increased knowledge on how to reduce child exposure to secondhand smoke in the home as a result of individualized counseling and educational materials.
  • Number of parents/caregivers who increased their knowledge of the harms of secondhand smoke as a result of the text messages received along with home visits and educational materials.
  • Number of parents/caregivers who report new and positive opinions/attitudes about smoking around their infants and in the home.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of parents/caregivers who decrease secondhand smoke within the home.
  • Percent of parents/caregivers who no longer permit smoking in the home.
  • Percent of parents/caregivers who quit smoking.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1 Abdullah ASM, Lam TH, Mak YW, Loke AY. A randomized control trial of a smoking cessation intervention on parents of young children - a preliminary report (POS2-011). Society for Research on Nicotine and Tobacco 10th Annual Meeting, 2005 February 18-21; Phoenix, AZ. 2005:65.

2 Yu S, Duan Z, Redmon PB, Eriksen MP, Koplan JP, Huang C. (2017). mHealth Intervention is Effective in Creating Smoke-Free Homes for Newborns: A Randomized Controlled Trial Study in China. Scientific Reports. 2017 Aug 31;7(1):9276. doi: 10.1038/s41598-017-08922-x.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.