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Minimal intervention delivered by 2-1-1 information and referral specialists promotes smoke-free homes among 2-1-1 callers: a Texas generalisation trial
  1. Patricia Dolan Mullen1,
  2. Lara S Savas1,
  3. Łucja T Bundy2,
  4. Regine Haardörfer2,
  5. Mel Hovell3,
  6. Maria E Fernández1,
  7. Jo Ann A Monroy1,
  8. Rebecca S Williams4,
  9. Matthew W Kreuter5,
  10. David Jobe6,
  11. Michelle C Kegler2
  1. 1Center for Health Promotion and Prevention Research, University of Texas School of Public Health, Houston, Texas, USA
  2. 2Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  3. 3Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California, USA
  4. 4Center for Health Promotion and Disease Prevention and Lineberger Cancer Center, University of North Carolina–Chapel Hill, Chapel Hill, North Carolina, USA
  5. 5Health Communication Research Laboratory, Washington University, St. Louis, Missouri, USA
  6. 62-1-1 Texas/United Way HELPLINE, United Way of Greater Houston, Houston, Texas, USA
  1. Correspondence to Dr Patricia Dolan Mullen, University of Texas School of Public Health, 7000 Fannin Street, Suite 2522, Houston, TX 77030, USA; Patricia.D.Mullen{at}


Background Replication of intervention research is reported infrequently, limiting what we know about external validity and generalisability. The Smoke Free Homes Program, a minimal intervention, increased home smoking bans by United Way 2-1-1 callers in randomised controlled trials in Atlanta, Georgia and North Carolina.

Objective Test the programme's generalisability-external validity in a different context.

Methods A randomised controlled trial (n=508) of English-speaking callers from smoking-discordant households (≥1 smoker and ≥1 non-smoker). 2-1-1 Texas/United Way HELPLINE call specialists serving the Texas Gulf Coast recruited callers and delivered three mailings and one coaching call, supported by an online tracking system. Data collectors, blind to study assignment, conducted telephone interviews 3 and 6 months postbaseline.

Results At 3 months, more intervention households reported a smoke-free home (46.6% vs 25.4%, p<0.0001; growth model intent-to-treat OR=1.48, 95% CI 1.241 to 1.772, p<0.0001). At 6 months, self-reported full bans were 62.9% for intervention participants and 38.4% for controls (OR=2.19). Texas trial participants were predominantly women (83%), single-smoker households (76%) and African-American (65%); half had incomes ≤US$10 000/year (50%). Texas recruitment was <50% of the other sites. Fewer callers reported having a smoker in the household. Almost twice the callers with a household smoker declined interest in the programme/study.

Conclusions Our findings in a region with lower smoking rates and more diverse callers, including English-speaking Latinos, support programme generalisability and convey evidence of external validity. Our recruitment experience indicates that site-specific adjustments might improve recruitment efficiency and reach.

Trial registration number NCT02097914, Results.

  • Secondhand smoke
  • Environment
  • Prevention
  • Socioeconomic status

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