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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. Telephone Counseling + Education Materials (Household)

Approach. Provide telephone counseling + educational materials to reduce children’s exposure to secondhand smoke in the home

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Overview. Research indicates that using tobacco smoke quit lines, 2-1-1 call centers, for other programs that provide telephone counseling and educational materials to establish a home smoking ban and/or quit for reduce smoking can be effective. Examples of studies with positive outcomes used a variety of educational materials (e.g., a guide to establishing a smoke-free home; materials based on parent’s “stage of change”), and one for more coaching calls with trained counselors.[1,2,3,4]

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:

  • Client intake and assessment data
  • Telephone counseling session records
  • Follow-up surveys or interviews

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

  • 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 pediatric healthcare providers trained in the "Ask, Advise, Refer" (AAR) best practice guidelines for addressing child tobacco smoke exposure. (Training providers is foundational for implementation)
  • Number of AAR-aligned Electronic Health Record (EHR) prompts developed and implemented in pediatric clinics. (EHR integration systematizes the delivery of the intervention)

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

  • Percent of pediatric providers who demonstrate proficiency in motivational interviewing techniques after AAR training. (Skill proficiency ensures high-quality counseling delivery)
  • Percent of educational materials offered to parents/caregivers that are available in their language. (Language concordance enhances understanding and acceptance of materials)

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

  • Number of AAR-trained providers who become champions for the intervention within their pediatric practices. (Provider champions drive clinic-wide adoption and sustainability of AAR)
  • Number of clinic-community partnerships formed to link families to smoking cessation support services after telephone counseling. (Broader linkages extend the intervention's supportive reach)
  • Number of caregivers counseled who report making a quit attempt within 3 months of the telephone intervention. (Quit attempts are a behavioral outcome that can be attributed to AAR)
  • Number of families that receive counseling and materials and subsequently implement a complete home smoking ban. (Home smoking bans are a major milestone in reducing child exposure)

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

  • Percent of pediatric clinics in communities with limited resources that implement the AAR intervention. (Prioritizing clinics serving specific populations directs the intervention to families facing higher health risks)
  • Percent of community health workers trained to reinforce smoke-free home messages during home visits to families referred through AAR. (Measures access to support)
  • Percent reduction in secondhand smoke exposure among children living in multi-unit housing whose families receive telephone counseling. (Exposure reduction in this group facing higher health risks signals impact)
  • Percent decrease in the gap in child tobacco smoke exposure between Medicaid and privately insured families following AAR implementation in safety-net clinics. (Narrowing the exposure gap by insurance status suggests the intervention is promoting health outcomes)

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 Bundy LT, Haardörfer R, Kegler MC, Owolabi S, Berg CJ, Escoffery C, Thompson T, Mullen PD, Williams R, Hovell M, Kahl T, Harvey D, Price A, House D, Booker BW, Kreuter MW. (2018). Disseminating a Smoke Free Homes program to low SES households in the US through 2-1-1: Results of a national impact evaluation. Nicotine & Tobacco Research. 2018 Dec 5. doi: 10.1093/ntr/nty256.

2 Kegler MC, Bundy L, Haardorfer R, Escoffery C, Berg C, Yembra D, et al. A minimal intervention to promote smokefree homes among 2-1-1 callers: a randomized controlled trial. American Journal of Public Health 2015;105(3):530–7.

3 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.

4 Schuck K, Bricker JB, Otten R, Kleinjan M, Brandon TH, Engels RC. Effectiveness of proactive quitline counselling for smoking parents recruited through primary schools: results of a randomized controlled trial. Addiction 2014;109 (5):830–41.

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.