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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. School-based Counseling + Education Materials (Household)

Approach. Provide in-person counseling in a school setting + educational materials to reduce child exposure to secondhand smoke in the home

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Overview. Research indicates that interventions providing individualized counseling to parents/caregivers for group counseling to parent/child dyads in a school setting can produce positive outcomes to reduce children’s exposure to tobacco smoke in their homes and reduce parental cigarette consumption.[1,2]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential 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:

  • Student/family intake and baseline assessment forms
  • In-person counseling session records
  • Follow-up surveys or questionnaires

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 schools offering counseling and education on reducing secondhand smoke exposure. (Measures reach of the intervention across school sites)
  • Number of educational materials on secondhand smoke distributed to families through schools. (Quantifies dissemination of information to support behavior change)

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

  • Percent of participating schools that implement the counseling and education program with high fidelity. (Assesses quality and consistency of intervention delivery)
  • Percent of educational materials that are adapted appropriately for the families served. (Evaluates usability of intervention content)

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

  • Number of school staff trained to deliver counseling and education on secondhand smoke. (Builds workforce capacity to sustain the intervention)
  • Number of community organizations partnering with schools to reinforce secondhand smoke reduction messages. (Engages trusted voices to amplify impact)
  • Number of children with reduced exposure to secondhand smoke who have fewer missed school days due to illness. (Demonstrates health and academic benefits)
  • Number of families reporting improved relationships and reduced conflict after eliminating smoking in the home. (Shows psychosocial and family functioning gains)

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

  • Percent of participating schools that collect and monitor data on child secondhand smoke exposure. (Institutionalized assessment to drive improvement)
  • Percent of families who receive educational materials in their language. (Evaluates access to intervention content)
  • Percent reduction in the prevalence of child secondhand smoke exposure in participating schools. (Assesses population-level impact over time)
  • Percent of children with asthma who report reduced symptoms and use of rescue medications. (Measures health impact for a key subgroup affected by smoke exposure)

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 Caldwell AL, Tingen MS Nguyen JT, Andrews JO, Heath J, Waller JL, Treiber FA. (2018). Parental Smoking Cessation: Impacting Children’s Tobacco Smoke Exposure in the Home. Pediatrics. 2018 Jan;141(Suppl 1):S96-S106. doi: 10.1542/peds.2017-1026M.

2 Chen YT, Hsiao FH, Lee CM, Wang RH, Chen PL. Effects of a parent-child interactive program for families on reducing the exposure of school-aged children to household smoking. Nicotine & Tobacco Research 2016;18(3):330–40.

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.