Randomized Trial to Reduce Air Particle Levels in Homes of Smokers and Children.

Introduction: Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children. Design: A randomized trial with two groups-intervention and control. Setting/participants: A total of 298 participants from predominantly low-income households with an adult smoker and a child aged <14 years. Participants were recruited during 2012-2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites. Intervention: The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources. Main outcome measures: In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (415,000 particles/0.01 ft(3)). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016-2017. Results: Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p<0.001). Intervention homes' average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p<0.001). Conclusions: Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles.