Establishing smoke-free homes may be a promising approach to support, and perhaps catalyze, smoking
cessation. The inconvenience of going outside, combined with a reduction of environmental cues to smoke in
the home, may result in less smoking and increased efforts to quit. Yet, no rigorous studies have tested the
impact of creating smoke-free homes on cessation outside the context of protecting children from secondhand
smoke exposure. We have developed a brief smoke-free homes intervention, ?Some Things are Better
Outside?, that is very effective in promoting the adoption of total smoking bans in low-income households. As
part of NCI?s State and Community Tobacco Control research initiative, we conducted an efficacy trial, an
effectiveness trial, a generalizability trial and a dissemination trial with positive outcomes in each phase of the
research. Pooled data from our three RCTs, combined with results from a national dissemination study,
document the potential of the intervention to support cessation. We propose to partner with two large federally
qualified health centers (FQHCs) in rural south Georgia to rigorously test the efficacy and potential scalability
of integrating a smoke-free homes intervention into the 5A (Ask, Advise, Assess, Assist, Arrange) approach for
tobacco cessation recommended by the U.S. Preventive Services Task Force. FQHCs serve as the safety net
of primary care for vulnerable populations in the U.S. Most FQHC patients are socioeconomically
disadvantaged and represent a high priority for cessation. Developing and testing an approach for integrating
the intervention into FQHCs from the outset should increase potential use of the intervention if proven
effective. Our first aim is to adapt the intervention for integration into the 5As for tobacco cessation, followed by
an RCT to test the efficacy of integrating the smoke-free homes intervention into the 5A approach for smoking
cessation among FQHC patients. This approach may have broader reach than current approaches as it may
appeal to those not yet ready to quit, as well as provide a social and physical personal environment that
supports increased quit attempts and successful cessation. We also plan to conduct a multi-component
process evaluation that examines implementation outcomes, cost and scalability potential. The proposed
research will be the first to rigorously assess whether the integration of a strong smoke-free homes intervention
into the 5As can encourage sustained smoking cessation in low-income patients.
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