Campaigns to promote smoke-free homes may help reduce childhood exposure to ETS in the home if parents who smoke can be encouraged to make their homes smoke-free. The Program Training and Consultation Centre (PTCC) worked with four pilot-site communities in Ontario in 2003/04 to expand the knowledge base for such approaches as part of a multi-year initiative funded by the Ontario Ministry of Health and Long-Term Care under the Asthma Plan of Action.
The campaigns consisted of
* promotion and distribution of a "Steps to make your home smoke-free" pamphlet,
* no-smoking decals to be posted in the home and car,
* a fact sheet highlighting the effects of second-hand smoke,
* print and radio ads to promote the campaign and smoke-free homes/cars, and
* other ways of reaching the public determined at the local level.
All four pilot sites underwent an application selection and review process and were supported by PTCC with resource materials, consultation, and $15,000 to cover media costs. They also agreed to complete a process report that tracked campaign activities and to submit copies of any materials that they produced. This was to facilitate PTCC's Better Practice Toolkit evaluation review of their program (see http://www.ptcc-cfc.on.ca/bpt/bpt.cfm for more information).
In order to examine in detail the impact of such campaigns, the Northwestern Health Unit--Kenora District was selected for a separate evaluation that consisted of a telephone survey conducted before and after their smoke-free homes campaign. Factors considered in selecting the evaluation site community included
* percentage of children under 12 years old in each community,
* smoking rate in each community,
* population size relative to media venues,
* isolation from other media influences and presence of its own radio station,
* likelihood to implement the program well, and
* other initiatives that may influence the media campaign.
The purpose of the evaluation was to determine the impact of the Smoke-free Homes campaign (referred to as the "purple envelope campaign" because the educational materials were distributed in purple envelopes). More specifically, the evaluation was to explore the importance of promoting smoke-free homes, determine the level of awareness of the Smoke-free Homes Campaign, determine the recall of the promotional materials from the Smoke-free Homes Campaign, and determine if there is a change in behavioural intentions and behaviour of the public related to second-hand smoke (SHS) exposure in homes and cars following the campaign.
The NRC+Picker Group Canada, an independent research company, was contracted by PTCC to survey residents of Kenora District who live with children 12 and under at least 50% of the time. A total of 800 randomly selected residents were surveyed. In addition, a quota was set so that half of those surveyed on both the pre- and post-campaign surveys either smoke or live with a smoker and half of those surveyed do not smoke or live with a smoker. The pre-campaign survey took place in January 2004 and the post-campaign survey took place in April 2004. The response rate for the pre-campaign survey was 71% and the response rate for the post-campaign survey was 75%, which is substantially higher than response rates reported for other population telephone surveys. It should be noted that this survey selected parents of children aged 12 and under, which may help to increase the response rate.
II Campaign Description
The Northwestern Health Unit-Kenora District's campaign objectives were as follows:
* Objective 1: Address the common myths about children and exposure to SHS in compelling radio commercials.
* Objective 2: Position a smoke-free home as a good decision for a parent to take on the basis of their children's health and their own convenience (healthier children = less stress for parent).
* Objective 3: Get "smoke-free home and car" window clings in the hands of the parents of children under 12 and encourage them to utilize them through radio commercials.
The overall goal was to increase the number of homes with children under 12 years old where smoking is not allowed.
PTCC provided sample resources and a Campaign Planner worksheet at an orientation meeting to help outline tasks to develop the workplan. A representative from the local radio station participated fully in the planning and implementation of this campaign and the health unit decided to concentrate the media budget on radio only. This allowed for a longer run of commercials and some 60-second spots, which could break though the usual radio pattern of 30-second spots and are harder for the casual listener to ignore. They also considered the recently published 1998 International Adult Literacy Survey (Ontario Ministry of Training, Colleges and Universities, 1998) results that indicated that the prose literacy level (the knowledge and skills to understand and use information from text) of the target audience was very low. This suggested to them that radio would be a much better communication vehicle for their message.
Campaign elements included
* A series of radio ads ran highlighting personal stories of exposure to SHS and the harm it does, with a call to action tagline to call the health unit to get a purple envelope. There were 4 different commercials, 60 seconds each, running 16 times daily for 21 days, February 1 to 21, 2004, plus five different commercials, 30 seconds each, running 16 times daily for 21 days, February 22 to March 15, 2004. There was at least one free spot for every paid one.
* Brochures from PTCC called "Steps to Make Your Home Smoke-free" and a tear-off fact sheet called "Second Hand Smoke Makes Your Child's Asthma Worse, Ask a Smoker to Take it Outside" were both inserted into a purple envelope.
* Purple envelopes were stuffed with above materials and distributed to various sites including schools, childcare/ resource centers, pharmacies, doctors' offices, and satellite NWHU offices. An additional 409 were requested directly by public via 1-888 number during campaign and 280 were requested after the campaign was over for a total distribution of 7,567.
* A 12-minute video called "The Perils of Second-hand Smoke" (The American Academy of Otolaryngology) was distributed to the 10 pre-natal instructors and to the Lake of the Woods Hospital.
Although not specifically about smoke-free homes, the issue of SHS and exposure of non-smokers, including children, was in the news during the campaign because the Medical Officer of Health had recently attempted to use the Health Protection and Promotion Act to create smoke-free public spaces in the district. The local pharmacy chain delivered a free magazine to most households in the district during the campaign that contained an article on SHS.
Positive comments were received from the public about the radio commercials. They ranged from the simple "it was good" to "it made me think about second-hand smoke in my home."
Pharmacies and doctors' offices were very willing to participate as partners. The small tabletop display holders for the brochures provided by the health unit made it easy for organizations to participate as they took up very little room on their pharmacy counter or reception desk.
Phone requests for the purple envelope through the 1-888 number advertised on the radio commercials yielded some unexpected benefits. An on-reserve First Nations school requested 100 for all of their parents; a taxi-driver in one small community asked for 20 to hand out to her smoking clients, and a few requests came from people who just wanted 2 to 3 to give to specific friends. One such call came from Thunder Bay from a man who had heard the radio commercial while travelling through the area and called when he got home. Requests continued to be received for purple envelopes for several weeks after the campaign was finished. This indicated a level of response much higher than usually experienced for other campaigns.
Left over purple envelopes were sent to regional resource centers and are highlighted in the tobacco resource binder of approved resources for use in local communities. The health unit prenatal nurses use the envelope as a handout to prenatal moms and it is a popular display item for health fair displays.
The issue of protection from second-hand smoke remains high on the health unit list of tobacco use prevention activities. The health unit will continue to seek additional funds to build and maintain awareness and support for smoke-free homes.
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III Discussion of Key Findings
A. Awareness and Recall of the Smoke-free Homes Campaign
There was a high level of awareness of the Smoke-free Homes Campaign both in households with smokers (69%) and no smokers (69%), which indicates that the ways of reaching the public were effective for this community. Both of the primary ways of reaching the public had high levels of recall (radio and pamphlets). The most successful method of disseminating the pamphlet in this community was through the schools.
The majority of those who received the pamphlet also recalled receiving a smoke-free home sign (95%). Of these individuals, 67% reported posting the sign at home and/or in the car. The pamphlet was not only recalled by respondents but also examined enough to remember the smoke-free home sign and possibly post the sign. This pamphlet seems to have effectively reached the target group.
B. Behavioural Intentions
On the post-campaign survey, responses to each question showed improvements from the pre-campaign survey in behavioural intentions related to smoking in the home and second-hand smoke. A significantly higher proportion of respondents to the post-campaign survey reported that they would not be likely to allow smoking on special occasions compared to those on the pre-campaign survey. As well, a significantly higher proportion of those on the post-campaign survey reported that they would be very likely to put up a no-smoking sign compared to respondents on the pre-campaign survey.
The pamphlet included in the Smoke-free Homes campaign encouraged individuals to post the smoke-free homes decals (included in their pamphlet) in their home and car. The significant finding post-campaign that respondents would be very likely to put up a no-smoking sign was important because it was a key focus for this Smoke-free Homes campaign.
C. Behaviour Changes
After this campaign, respondents reported a number of changes to their own or a member of their families' behaviour. For example, respondents reported restricting smoking in their home, talking to people about the campaign, and changing their personal smoking behaviour (or indicated that a member of their family changed their smoking behaviour).
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For this community, radio and pamphlets seem to be an effective way to reach parents of children aged 12 and under. This community does not have many radio stations available to residents, including radio stations from other geographical areas. It is important that other communities think carefully about the channels they use to promote social marketing campaigns prior to implementation to ensure that the channels used reach the target audience of interest.
In terms of household smoking rules, households with no smokers are not very likely to allow smoking in their home (94% pre and post campaign) compared to households with smokers (64% pre-campaign and 73% post-campaign). It is important to try to target the Smoke-free Homes campaign specifically to households with smokers, if possible.
It is recommended that the health unit continue to promote smoke-free homes with this target group (parents with children 12 and under), particularly to those who either smoke or live with smokers in order to continue to encourage behaviour changes that will be sustained over time.
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V Conclusion and Next Steps
This evaluation has provided evidence that the Smoke-free Homes campaign has the ability to reach the target group in Kenora District. It has also provided evidence of a high level of awareness and recall of the campaign in the target group, changes in behavioural intentions, and self-reported behaviour changes. It is recommended that this campaign be evaluated in different communities (e.g., urban/rural and large/small) to determine the campaign's generalizability to other communities.
PTCC is now in the final year of this four-year project, ending March 2005. The final reports and tracking forms from the four pilot sites in 2003/2004 have been submitted and will be synthesized into a summary report to inform future initiatives. Campaign materials will be made available to other communities via PTCC's website and the projects will undergo the Better Practices Review protocol.
At present four new pilot sites have been selected and project orientation and workplan development are underway. Resource materials and the valuable insight gleaned from all eight pilot sites will be easily available through PTCC's website to those interested in using effective approaches for similar campaigns. The findings from this project will contribute to the body of evidence supporting efforts to promote smoke-free homes as part of comprehensive tobacco control programming.