title: Eliminating second-hand smoke from Mexican-American households: outcomes from Project Clean Air-Safe Air (CASA).
abstract: Exposure to second-hand smoke (SHS) is a major public health problem and a risk factor for morbidity and mortality. The objective of this randomized trial was to estimate the impact of a culturally-sensitive intervention to reduce SHS exposure in Mexican-American households.
  
  
  METHODS
  A total of 91 households (with a child under 18 years of age and two adults, one of whom was a smoker) were recruited from a population-based cohort of Mexican-American households and randomized to receive the experimental intervention (EI; n=47) or standard care (SC; n=44). Of these, 74 households (83%) provided baseline, 6-month, and 12-month survey and nicotine monitor data (EI, n=39; SC, n=35). The EI materials, designed to increase the participants' likelihood of adopting a smoke-free indoor home air policy, included one culturally-appropriate bilingual comic book for children and two fotonovelas for adults.
  
  
  RESULTS
  Ambient nicotine levels significantly decreased over the 12 study months (F=13.6, DF=147; p<0.001); with a significantly greater decrease in the EI households compared to the SC households (F=4.1, DF=72; p<0.05). At 12 months, 73% of EI households had banned smoking vs. 56% of SC households. Ambient nicotine levels, measured using nicotine air sampling monitors, were significantly associated with self-reported SHS exposure at the 12-month follow-up. Knowledge of the health effects of SHS increased from baseline to 6 and 12 months in the EI condition but not in the SC condition (F=6.0, DF=238; p<0.01), and smokers and quitters in the EI group reported an increased perception of health vulnerability compared to those in the SC group.
  
  
  CONCLUSIONS
  Our low-cost intervention impacted SHS-related knowledge and exposure among Mexican Americans. This culturally-appropriate intervention has the potential to decrease SHS-related health problems in the target population substantially.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. aprokhor@mdanderson.org
authors.forename: Alexander V
authors.initials: AV
authors.lastname: Prokhorov
authors.forename: Karen Suchanek
authors.initials: KS
authors.lastname: Hudmon
authors.forename: Salma K
authors.initials: SK
authors.lastname: Marani
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Bondy
authors.forename: Leticia A
authors.initials: LA
authors.lastname: Gatus
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Spitz
authors.forename: Anna V
authors.initials: AV
authors.lastname: Wilkinson
authors.forename: S Katharine
authors.initials: SK
authors.lastname: Hammond
authors.forename: Laura M
authors.initials: LM
authors.lastname: Koehly
mesh_terms: D000328:Adult; D000388:Air / Q000032:analysis; D002648:Child; D005190:Family; D005260:Female; D006801:Humans; D019570:Inhalation Exposure / Q000517:prevention & control*; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D009538:Nicotine / Q000032:analysis; D010353:Patient Education as Topic / Q000379:methods*; D012111:Residence Characteristics; D061845:Smoke-Free Policy; D012907:Smoking / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D016896:Treatment Outcome; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution; D009538:Nicotine