Eliminating second-hand smoke from Mexican-American households: outcomes from Project Clean Air-Safe Air (CASA)

Addict Behav. 2013 Jan;38(1):1485-92. doi: 10.1016/j.addbeh.2012.06.023. Epub 2012 Aug 17.


Exposure to second-hand smoke (SHS) is a major public health problem and a risk factor for morbidity and mortality. The objective of this randomized trial was to estimate the impact of a culturally-sensitive intervention to reduce SHS exposure in Mexican-American households.

Method: A total of 91 households (with a child under 18 years of age and two adults, one of whom was a smoker) were recruited from a population-based cohort of Mexican-American households and randomized to receive the experimental intervention (EI; n=47) or standard care (SC; n=44). Of these, 74 households (83%) provided baseline, 6-month, and 12-month survey and nicotine monitor data (EI, n=39; SC, n=35). The EI materials, designed to increase the participants' likelihood of adopting a smoke-free indoor home air policy, included one culturally-appropriate bilingual comic book for children and two fotonovelas for adults.

Results: Ambient nicotine levels significantly decreased over the 12 study months (F=13.6, DF=147; p<0.001); with a significantly greater decrease in the EI households compared to the SC households (F=4.1, DF=72; p<0.05). At 12 months, 73% of EI households had banned smoking vs. 56% of SC households. Ambient nicotine levels, measured using nicotine air sampling monitors, were significantly associated with self-reported SHS exposure at the 12-month follow-up. Knowledge of the health effects of SHS increased from baseline to 6 and 12 months in the EI condition but not in the SC condition (F=6.0, DF=238; p<0.01), and smokers and quitters in the EI group reported an increased perception of health vulnerability compared to those in the SC group.

Conclusion: Our low-cost intervention impacted SHS-related knowledge and exposure among Mexican Americans. This culturally-appropriate intervention has the potential to decrease SHS-related health problems in the target population substantially.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Air / analysis
  • Child
  • Family*
  • Female
  • Humans
  • Inhalation Exposure / prevention & control*
  • Male
  • Mexican Americans*
  • Middle Aged
  • Nicotine / analysis
  • Patient Education as Topic / methods*
  • Residence Characteristics
  • Smoke-Free Policy
  • Smoking / therapy
  • Smoking Cessation / methods
  • Tobacco Smoke Pollution / prevention & control*
  • Treatment Outcome
  • United States


  • Tobacco Smoke Pollution
  • Nicotine