Using computer simulation to reduce secondhand smoke exposure in children of low-Income families

There are few social justice issues more relevant to eliminating disparities than children's exposure to secondhand tobacco smoke (SHS). Over 50 years of research have highlighted the health hazards of SHS, especially for children in low-income populations. In the present study, we performed a pilot evaluation of an inexpensive SHS intervention utilizing computer simulation of smoking in automobiles. By communicating key health messages through an interactive, objective-driven experience, the intervention motivates caregivers to take steps to reduce children's SHS exposure, especially by instituting a strict smoking ban. The real-time simulation conveys to adults: (1) the very high levels of SHS that occur almost immediately in the vehicle when they light up, and (2) how long the smoke stays in the vehicle – even when a window is opened. Other messages, which are delivered by a talking animated character, include the acute health effects caused by SHS and the contamination of the car interior, which can expose a child indirectly. To explore feasibility and initial effectiveness, we recruited low-income caregivers who smoke from two locations: (1) n = 49 WIC recipients in Stockton, California; and (2) n = 30 health care recipients in Lexington, Kentucky. Participants used the simulation at kiosk stations while waiting for their appointment and were given before-and-after questionnaires. Approximately 10% of the participants returned for a 2-week follow-up. We interviewed clinic staff on their perception and satisfaction of the intervention. All participants and staff responded positively, although poor retention prevented full evaluation of lasting effects.