Steps Toward Scalability: Illustrations From a Smoke-Free Homes Program

• Main Authors: Allen, L. (Author), Bundy, L.T (Author), Haardörfer, R. (Author), Hovell, M.F (Author), Kegler, M.C (Author), Kreuter, M.W (Author), Melanson, T. (Author), Mullen, P.D (Author), Williams, R.S (Author)
• Format: Article
• Language: English
• Published: SAGE Publications Inc. 2019
• Subjects: adult; Adult; African American; Alabama; article; behavior therapy; Behavior Therapy; call center; child; Child; Child, Preschool; controlled study; cost benefit analysis; cost effectiveness analysis; Cost-Benefit Analysis; cost-effectiveness; economics; education; effect size; ethnic group; Ethnic Groups; Family Characteristics; family size; female; Female; Florida; household; human; human experiment; Humans; legislation and jurisprudence; lowest income group; major clinical study; male; Male; methodology; middle aged; Middle Aged; nonsmoker; Ohio; Oklahoma; outcome assessment; passive smoking; patient-reported outcome; poverty; Poverty; preschool child; prevention and control; Research Design; scalability; smoke-free homes; Smoke-Free Policy; smoking ban; smoking cessation; Smoking Cessation; smoking prevention; Smoking Prevention; staff; tobacco control; Tobacco Smoke Pollution; United States
• Online Access: View Fulltext in Publisher

 Scalable interventions remain effective across a range of real-world settings and can be modified to fit organizational and community context. “Smoke-Free Homes: Some Things are Better Outside” has been effective in promoting smoke-free home rules in low-income households in efficacy, effectiveness, generalizability, and dissemination studies. Using data from a dissemination study in collaboration with five 2-1-1 call centers in Ohio, Florida, Oklahoma, and Alabama (n = 2,345 households), this article examines key dimensions of scalability, including effectiveness by subpopulation, secondary outcomes, identification of core elements driving effectiveness, and cost-effectiveness. Evaluated by 2-1-1 staff using a pre–post design with self-reported outcomes at 2 months postbaseline, the program was equally effective for men and women, across education levels, with varying number of smokers in the home, and whether children were present in the home or not. It was more effective for nonsmokers, those who smoked fewer cigarettes per day, and African Americans. Creating a smoke-free home was associated with a new smoke-free vehicle rule (odds ratio [OR] = 3.38, confidence interval [CI 2.58, 4.42]), decreased exposure to secondhand smoke among nonsmokers (b = −2.33, p <.0001), and increased cessation among smokers (OR = 5.8, CI [3.81, 8.81]). Use of each program component was significantly associated with success in creating a smoke-free home. Using an intent-to-treat effect size of 40.1%, program benefits from 5 years of health care savings exceed program costs yielding a net savings of    ,633 for delivery to 100 households. Cost effectiveness, subpopulation analyses, and identification of core elements can help in assessing the scalability potential of research-tested interventions such as this smoke-free homes program. © 2019 Society for Public Health Education.