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Computer Simulation as a Tool for Reducing SHS Exposure

Institution: Education Training and Research Associates, Inc.
Investigator(s): Neil Klepeis,
Award Cycle: 2007 (Cycle 16) Grant #: 16IT-0209 Award: $113,549
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: Inno Dev & Exp Awards (IDEAS)

Initial Award Abstract
This study explores the merit of using computer simulation technology to promote the reduction or elimination of secondhand tobacco smoke (SHS) exposure in cars, homes, and other locations. We will develop a software-based intervention, called “SHS-Sims”, and, for this project, test it with a group of caregivers whose young children who are exposed to SHS in automobiles. If successful for the automobile, we will expand the intervention to the more complex home environment in a future study. Using a state-of-the-art, audio-visual computer platform -- which can be deployed as a small mobile computer in waiting rooms of hospitals, clinics, or medical practices and has integrated electronic data gathering capabilities -- the SHS-Sims intervention draws on traditional health messages and behavior theory and fuses them with easy-to-understand, graphical descriptions of exposure that are reflective of real dynamic situations. The key, novel aspect of SHS-Sims is its presentation of real-time SHS exposure levels in an interactive, multimedia format. It delivers rapid feedback and clear visualization regarding specific SHS exposure scenarios that are selected and controlled by the user. We believe an immersive and responsive approach, such as that offered by SHS-Sims, is likely to achieve greater understanding and retention of information, and, therefore, greater likelihood for modification of unhealthful behavior.

Because millions of children in California, the US, and the world continue to be exposed to SHS in homes and in automobiles – and they suffer negative health impacts as a result -- proven intervention approaches are needed. Although behavioral intervention programs have been developed that show promise for reducing children’s SHS exposure, they are often time-consuming, expensive, and difficult to implement in low-income and minority populations. The SHS-Sims intervention seeks to directly address the need for more affordable, effective, and practical programs by employing innovative methods. It incorporates authoritative information on health and exposure in an accessible and engaging educational experience, which lasts 10 to 20 minutes, does not require supervision, and uses off-the-shelf hardware components. Furthermore, it is designed specifically to target exposure among young children and groups that have historically experienced health disparities.

We hypothesize that the SHS-Sims intervention will impart better learning of SHS-related messages than less dynamic approaches, and better intentions to change behavior. To begin testing this hypothesis, we will develop the technology and core infrastructure of the SHS-Sims content (in English/Spanish) based on existing health and exposure science findings, human behavior theory, and mathematical modeling techniques. The key learning points of the intervention will include the potential for dangerous SHS levels in cars to occur even under a variety of ventilation scenarios, the existence of surface contamination from SHS, and the potential for specific health risks due to SHS exposure (e.g., asthma, respiratory infection). To test and refine the functionality and appropriateness of SHS-Sims, we will conduct focus group discussions and intensive usability testing. After beta testing is complete, we will perform a pilot study using 80+ subjects to assess the feasibility, practicality, and potential merit of the full SHS-Sims intervention program. The subjects will be drawn from low-income, female caregivers who visit a Women, Infant, and Children (WIC) clinic in San Joaquin County, California. They will be randomly assigned to either the “SHS-Sims group” or an educational control group (40+ per group). The “SHS-Sims group” will receive the full “simulator” experience, whereas the control group will be presented with simple text and static images that communicate the same essential learning points as the full intervention. We will gather pre- and post-intervention data, and perform a 1-month follow-up for participants in both groups. To evaluate the success of the intervention, we will analyze the program’s impact on caregivers’ knowledge, attitudes, perceptions, and intentions for behavior change.