From Attitude to Action: Identifying the Knowledge and Practice Gap in Smoke-free Home Promotion Among Texas Community Health Workers and Health Education Specialists.

Abstract

IntroductionExposure to secondhand smoke (SHS) poses severe health risks, yet private residences remain a primary site of exposure. Community Health Workers (CHWs) and Health Education Specialists (HESs) are uniquely positioned to advocate for voluntary smoke-free home (SFH) rules. This study assessed the current practices, attitudes, and knowledge of these frontline professionals regarding SFH promotion.MethodsA cross-sectional survey was conducted among 218 Texas-based professionals (179 CHWs; 39 HESs). Participants were evaluated on their SFH intervention practices using the 5A's framework (Ask, Advise, Assess, Assist, Arrange), attitudes toward environmental health advocacy, and technical knowledge of SHS risks and SFH implementation strategies.ResultsWhile 94% of participants reported positive attitudes toward SFH promotion, only 33% (n=72) currently deliver these services. A significant "intervention funnel" was observed: among those currently promoting SFHs, 71% provided advice to create a smoke-free environment, but implementation dropped to 43% for technical assistance and 35% for arranging follow-up support. Knowledge gaps were identified; after adjustment for demographic differences, CHWs remained significantly less likely than HESs to identify risk factors associated with SHS exposure (AOR=0.31, p=.04) and specific strategies for establishing a SFH (AOR=0.44, p=.04), though the overall knowledge score difference was no longer significant after adjustment (p=.18). Notably, CHWs were proportionally more likely than HESs to currently deliver SFH services (36% vs. 21%).ConclusionsA substantial implementation gap exists between positive attitude and technical practice among Texas CHWs and HESs. To effectively protect vulnerable families, future training must shift focus from general SHS risk awareness to actionable skills, prioritizing the "Assist" and "Arrange" components of the 5A's framework.