UNDERSTANDING FACTORS AFFECTING ADHERENCE IN A TELEPHONE-BASED INTERVENTION TO REDUCE SECONDHAND SMOKE EXPOSURE TO CHILDREN: AN EXPLORATORY ANALYSIS

Abstract

Background/Purpose: The Kids Safe and Smokefree (KiSS) trial aimed to reduce secondhand smoke exposure to children. The study used a multifaceted approach that included a pediatric clinic-level intervention, individual behavioral counseling and community services for nicotine dependence. This secondary analysis focuses on the individual behavioral counseling portion of the intervention. The purpose of this cross-sectional, secondary analysis is to investigate the factors that affect adherence in a telephone-based intervention to reduce secondhand smoke exposure to children among a low-income population of women. Methods: Of those enrolled in the KiSS study, 163 cases assigned to the intervention group were used in these secondary analyses. After reviewing the literature, 15 variables of interest were identified as potentially having an association with adherence. A Lasso regression was used to select out variables that were insignificant or “unimportant” to predicting the outcome variable, total missed phone sessions. These variables were then used in a Poisson regression to determine if there was any significant correlation with the outcome. Results: Of the 15 variables in the Lasso regression, six variables were found to potentially have an association with total missed phone sessions. These six variables include: education level, total household occupants, total household smokers, life stress score, program support score and smoking self-efficacy score. The Poisson regression determined that three of these variables did have a significant correlation with missed phone sessions. Lower education level, greater program support and smoking cessation self-efficacy related to greater number of missed phone sessions. Conclusion: Those with higher education may complete more phone sessions because they may be more familiar with the importance of not exposing their children to secondhand smoke. Greater reported program support may be related to more missed phone sessions because the participant may feel that they received the support they needed from one or two of the phone sessions and no longer needed to participate. Another reason for this relationship could be that because the participant felt so supported by the phone session counselor, if they had exposed their child to secondhand smoke, their motivation to please would hinder their adherence. Another analysis would be needed in order to confirm this hypothesis. Lastly, the participants confidence in refraining from smoking may have lead them to miss more phone sessions because they felt that they already had the tools to refrain from exposing their children to secondhand smoke exposure. This analysis confirms that there are many barriers involved in good adherence and that adherence is influenced by many factors. There is a lack of conclusive data about what affects adherence. If research could identify what improves or stunts adherence behaviors, the effectiveness of any treatment could be maximized.