Establishing smoke-free homes with families involved in child protective services: An effectiveness-implementation trial of an integrated program

Project Abstract Child exposure to secondhand smoke (SHS) is linked to multiple forms of cancer throughout the lifespan. Young children living in low-socioeconomic status households are at increased risk for SHS exposure. Families involved with the child protection system as the result of substantiated child maltreatment are an especially high-risk group for SHS, as these families are often living in poverty and report high daily smoking rates. Importantly, child maltreatment victimization also increases risk of cancer and premature death from cancer, independent of parent smoking behavior. Identifying ways to broadly disseminate effective SHS prevention programs to these high-risk families is an important strategy for reducing cancer disparities. We propose an effectiveness-implementation hybrid trial type 1 to examine the impact of integrating two evidence-based programs, Some Things are Better Outside (SHS prevention program) and SafeCare® (Child Maltreatment Prevention Program), on establishing a smoke-free home and on implementation process outcomes. Aim 1 focuses on the refinement of the standardized integration (systematic braiding) of the two programs into “Smoke-Free SafeCare (SFSC).” Aims 2 and 3 focus on the hybrid trial. Fifty certified SafeCare Providers will be recruited and randomly assigned to deliver either SFSC or Standard SafeCare. Providers will each serve ten research families (N = 500) who meet the inclusion criteria (Mother or another person residing in the home smokes at home). The primary outcome, smoke-free home status, will be measured via self-report at 4-timepoints (baseline, 8-weeks, 20-weeks, and 1-year), and validated via air nicotine monitor at 8 weeks and 1-year (Aim 2). Process measures will be collected to examine how the braided intervention impacts provider fidelity, delivery time and costs, and other process measures (Aim 3). If effective, SFSC can be efficiently disseminated for widespread adoption by the National SafeCare Training and Research Center to the over 100 accredited SafeCare agencies across the United States and worldwide that serve parents involved with child protection services, reducing cancer risk and disparities for a high-risk population.