Promoting Smoke Free Homes

Secondhand Smoke(SHS) is the tobacco smoke that is exhaled by smokers or is given off by burning tobacco and is inhaled by persons nearby. SHS is a known human carcinogen and health hazard. The home remains the major source of secondhand tobacco smoke exposure(SHSe) for many non-smokers. Various studies were conducted to reduce children”s SHSe in the home. The first and foremost study targeted at smoking cessation but failed as many smokers were unable to sustain cessation. Particles are generated in quantity when tobacco is smoked; a cigarette emits roughly 1.

4mg per minute into the air. The concentration of fine particles with diameters less than 2.5 microns is commonly used as an indicator of the presence of SHS.

In this study a real-time intervention was pilot-tested for promoting behaviour change in homes that reduces second-hand tobacco smoke levels by using a monitor and feedback system called DYLOS DC1100 particle counter integrated with RS232PC interface. The model was targeted at consumer use and was inexpensive.

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The system firm fare was programmed with features for activating auditory( consist of computer-controlled speaker emitting a short beep when a pre-defined mass conc. threshold was exceeded) & visual cues ( consist of computer controlled LEDs which was programmed to display green light below first threshold, flashing yellow/orange light when first threshold was exceeded and large X pattern of flashing red light when second threshold was exceeded).

The system is experimentally evaluated and field tested in homes with smokers and focus groups were conducted to obtain general opinion.

Non-random sampling method was used. The householders were likely to be low-income families of which thirteen participants ( six men and seven women) were recruited to form three focus groups. The focus groups consisted of both smokers and non-smokers who lived in a household in San Diego County containing at least one smoker. Seventy-seven percent of participants had a child living with them. The focus groups were led by trained bilingual moderator. The intervention was field-tested in the apartments of three families followed by obtaining informed consent.

One air monitor was placed in an open living, dining or kitchen area followed by the placement of second monitor in a bedroom where a child or pregnant women slept alongwith placing a small netbook on table. During this baseline period, the light and sound signals of the monitor were not activated to measure the air quality of the home. During the post-baseline session, plots of monitoring time series data from the results of the baseline period were shown to each participant. During both the above periods, adults smoking and non-smoking household members were interviewed to measure changes in behaviour and attitudes regarding SHS. The baseline questionnaire included questions about the physical characteristics of the home, number of smoking and non-smoking occupants, timing of smoking activity, location of smoking, current smoke mitigation activities & cleaning and dusting activities. The post-intervention questionnaire included questions

PROMOTING SMOKE-FREE HOMES

Based on laboratory cigarette experiments, the researchers found that Dylos particle counter had comparable sensitivity, precision and baseline stability compared to the industry standard DustTrak aerosol monitor. Like the DustTrak , the Dylos readings were highly resolved, giving a smooth signal. The Dylos demonstrated little or no drift during near-zero particle environments and did not appear to be impacted by temperature or other environmental conditions. Also the focus groups provided valuable information about the acceptability of using monitors in homes and the participants were interested to learn more about their homes air quality. They were interested in knowing the exact levels of pollution in their home and seeing the level and how to respond them( e.g open windows, what time of day are bad, whether an individual room or the entire home have high pollutants).

Participants liked the feedback provided by lights and sounds from the monitor to alert them of the levels of pollution in their homes. One of the participants suggested musical tone and more visible lights with single LED instead of multiple LEDs. They were also receptive to receiving information via computer or from physician. Based on visual analysis of the baseline data, the researchers selected the first threshold for feedback signals of 60 microgram/m3 which appeared to capture all smoking events but was not triggered by background levels. The researchers selected the second threshold of 100 microgram/m3 to provide a secondary signal on rising intensity of the smoke that falls within the range of our Dylos mass calibration.

The monitor captured smoking events occuring in a separate room e.g. measurements taken in bedroom with smoking activity in living room with levels 10-40 microgram/m3 above background. Since the Dylos response time is fast (under 10 seconds) and it has a mass concentration of approximately 1 microgm/m3 or less, it can potentially be used for precise analysis of the growth and decay of particle concentrations for smoking-associated features.The Dylos monitor has adequate sensitivity to tobacco smoke and adequate accuracy in indicating elevated particle mass concentration levels from smoking events.

The researchers established linear relationship between the Dylos and a mass-measurement device called as DustTrak over the range of feedback signals thresholds of 60 to 100 microgram/m3. Another research team studied the relationship of the Dylos against a similar device (Sidepak, TSI), finding a non-linear relationship that becomes pronounced above 100-200 microgm/m3. The recent findings are consistent with the non-tobacco work of Northcross et al. Dacunto et al reported that the Dylos may be a useful tool for identifying different particle sources in single-room or multi-unit housing. The present system broadly differentiates sources by filtering out particles above 2.5 microns that may be associated with dust rather than tobacco smoke. Such systems would be welcome in households with interest in improving their homes air quality. Once installed, the units can notify occupants of

PROMOTING SMOKE-FREE HOMES

An important future advancement in the SHSe feedback and efforts to test hypothesis from real-time behavioural theory will be the ability to automatically modify feedback parameters( e.g. threshold values, sound, volume, light intensity) following detected changes in SHSe levels. The auto-shaping capability when applied in real-time to SHS intervention would allow the feedback device to follow rules of feedback modification to reduce SHS levels. Future research using controlled trials and larger sample sizes should deploy and evaluate a refined system in smoking homes etc.

Studies should examine the impact of both short term and long term SHSe reduction as compared to other tobacco control approaches e.g. counselling only. The system might also be used to study feedback on aerosol levels from various non-tobacco sources and asthma triggers. Future refinements to the system such as on-device panel controls or LCD display, better tailored lights and sounds, more options for visual and graphical feedback should improve the systems effectiveness and ease of use.