Massachusetts Smoke-Free Families Initiative:
Supporting Systems Change in Home Visiting Settings

The Institute for Health and Recovery’s (IHR) Smoke-Free Families Initiative will promote home visits and other services to at-risk families in order to integrate secondhand smoke awareness and cessation messages. IHR proposes to address the following 5 systems/organizations: DTA shelters; Early Intervention (EI); Department of Children and Families (DCF); FOR Families; and Healthy Families. Smoking prevalence and secondhand smoke (SHS) exposure is high among families in these systems, based on the intersection of smoking prevalence and demographics in this population, with such factors as clients’ gender, socioeconomic status, educational status, and likelihood of co-occurring disorders including substance abuse, mental illness, and histories of trauma.

As in other human services fields, it is expected that smoking rates among staff in the targeted agencies are also high. Staff are coping with numerous stressors and, in some cases, are not different than their clients in terms of finances, housing, and stability. Working with high-risk families involves dealing with crisis and survival issues, and addressing nicotine addiction and secondhand smoke exposure are perceived as low priorities. Providers are frequently unaware of the global positive impact of quitting smoking or changing tobacco use patterns. As staff are often focused on meeting basic family needs, the areas of clients’ lives that would  benefit from changing tobacco use (such as improved children’s health, decrease in financial stress, greater access to housing, increased benefit from medications, and improved overall emotional and physical health status) may appear lower priority than day to day survival. Providers may be unaware of resources for assisting with the quitting process, such as free telephone counseling or access to quit smoking medications through MassHealth. They may also mistakenly assume that clients are not interested in stopping smoking.

In order to overcome staff and systems barriers such as these, we will first survey the proposed organizations regarding attitudes and training needs. Agency policies and intakes will be reviewed to determine where SHS messages and information can be incorporated. Technical assistance will be provided on language for policies, support for adoption and enforcement, and strategies for integration. Staff training will provide opportunities for workers to raise concerns about addressing tobacco, gain understanding of the rationale for doing so, and learn and practice tools for talking with clients.

For more information, please contact:

Enid Watson, Acting Project Coordinator
617-661-3991 or enidwatson@healthrecovery.org