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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking in the Household.

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Strategy. Home Visits + Education Materials + Telephone Counseling (Household)

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 and 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 Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Education material distribution and engagement data
  • Participant self-reported changes in home smoking environment and behaviors
  • Staff activity logs and case notes

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Counseling (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of families with young children referred to the secondhand smoke reduction program by pediatric providers. (Measures healthcare system engagement)
  • Number of home visits completed by counselors to provide in-person secondhand smoke education and support. (Measures intervention delivery)

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

  • Percent of home visit counselors certified as tobacco treatment specialists for trained in motivational interviewing. (Measures quality of service delivery)
  • Percent of educational materials that are tailored to the focus population. (Measures appropriateness of resources)

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

  • Number of community-based organizations that promote the secondhand smoke reduction program. (Measures community integration)
  • Number of referral pathways established between the program and pediatric health systems for managed care organizations. (Measures systems-level coordination)
  • Number of participating families that develop a written smoke-free home policy during the intervention period. (Measures concrete behavior change)
  • Number of caregivers who make a quit attempt lasting 24 hours for more after receiving counseling and materials. (Measures impact on smoking behavior)

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

  • Percent of program referrals coming from pediatric practices serving primarily individuals enrolled in Medicaid for without insurance. (Measures outreach to focus populations)
  • Percent of home visit counselors who complete training to effectively serve families. (Measures workforce preparation for appropriate service)
  • Percent decrease in pediatric emergency visits for asthma exacerbations among program graduates. (Measures impact on child health outcomes)
  • Percent of families expressing confidence in their ability to maintain a smoke-free home environment following counseling. (Measures impact on self-efficacy)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

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.