Smoke-Free Home Intervention in Permanent Supportive Housing: A Multi-Faceted Intervention Pilot

INTRODUCTION: Smoke-free homes (SFHs), the voluntary adoption of home smoking restrictions, are associated with reduced secondhand smoke exposure. However, SFHs are uncommon in permanent supportive housing (PSH) for formerly homeless adults, who have fivefold higher smoking rates than the general population. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. METHODS: PSH residents (n=100) and staff (n=62) from 15 PSH sites participated in the intervention between October 2017 to February 2018. Research staff provided counseling to PSH residents on how to adopt a SFH and trained PSH staff on how to counsel residents on smoking cessation. The primary outcome was self-reported voluntary adoption of a SFH for >/=90-days and the secondary outcome was carbon monoxide (CO)-verified PPA at 6-months follow-up. PSH staff completed the Smoking Knowledge, Attitudes, and Practices survey at baseline and 3-months follow-up. RESULTS: At 6-months, 31.3% of PSH residents had adopted a SFH (versus 13.0% at baseline) and 16.9% reported CO-verified PPA. A positive attitude toward a SFH policy was associated with increased odds of SFH adoption (Adjusted Odds Ratio [AOR] 8.68, 95% CI 2.42, 31.17). Voluntary SFH adoption was associated with increased PPA (AOR 26.27, 95% CI: 3.43, 201.30). PSH staff reported improved attitudes toward and self-efficacy in delivering cessation care, and decreased barriers to discussing smoking cessation among PSH residents between baseline and 3-months follow-up. CONCLUSIONS: In this single-arm study, a brief intervention increased SFH adoption and PPA among PSH residents.