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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. Clinic-based Counseling + Education Materials

Approach. Provide in-person counseling + educational materials during visits with a health care provider to reduce child exposure to secondhand smoke in the home.

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Overview. Research indicates that counseling parents/caregivers during health visits with their child can be effective in reducing child exposure to secondhand smoke in the home and reducing or eliminating cigarette consumption by parents/caregivers. Examples of studies with positive outcomes followed the American Academy of Pediatrics “Ask Advise Refer” (AAR) best practice guidelines via Electronic Health Record prompts for addressing child tobacco smoke exposure. Clinic-based approaches to counseling also included motivational interviewing or behavioral counseling and were sometimes supplemented with follow-up phone counseling. Parents/caregivers also received a variety of education materials (e.g., pamphlets or self-help manuals to implement a home smoking ban or quite smoking).1-3

Evidence. Emerging. Initial research showed positive results for this strategy, but further research is needed to confirm effects. Other studies using clinic-based individual counseling + education materials were less effective. 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 and parent smoking cessation. 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 currently 5 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 + educational materials during visits with a health care provider 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 providers who implement “AAR” guidelines with parents/caregivers during clinic visits.
  • Number of parents/caregivers who receive counseling, educational materials, and referral for tobacco cessation services to reduce a child’s exposure to secondhand smoke in the home.

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

  • Percent of providers who implement “AAR” guidelines with parents/caregivers during clinic visits.
  • Percent of parents/caregivers who receive counseling, educational materials, and referral for tobacco cessation services to reduce a child’s exposure to secondhand smoke in the home.

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

  • Number of parents/caregivers who report using a referral for tobacco cessation services.

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

  • Percent of parents/caregivers who quit or reduce smoking.
  • Percent of parents/caregivers who reduce a child’s exposure to secondhand smoke in the home.

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 Collins BN, Lepore SJ, Winickoff JP, Nair US, Moughan B, Bryant-Stephens T, Davey A, Taylor D, Fleece D, Godfrey M. (2018). An Office-Initiated Multilevel Intervention for Tobacco Smoke Exposure: A Randomized Trial. Pediatrics. 2018 Jan;141(Suppl 1):S75-S86. doi: 10.1542/peds.2017-1026K

2 Lepore SJ, Collins BN, Coffman DL, Winickoff JP, Nair US, Moughan B, Bryant-Stephens T, Taylor D, Fleece D, Godfrey M. (2018). Kids Safe and Smokefree (KiSS) Multilevel Intervention to Reduce Child Tobacco Smoke Exposure: Long-Term Results of a Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2018 Jun 12;15(6). pii: E1239. doi: 10.3390/ijerph15061239.

3 Chellini E, Gorini G, Carreras G, Da noi non si fuma Study Group. The “Don’t smoke in our home” randomized controlled trial to protect children from second-hand smoke exposure at home. Tumori Journal 2013;99(1):23–9.]

 

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.