Secondhand Smoke Exposure Reduction Among Young Children in China
Condition: Secondhand Smoke Exposure; Respiratory Illness; Smoking Cessation
Study type: Interventional

Summary: 
      Second hand smoking (SHS) is a health hazard to infants and children, in whom it is
      associated with lower respiratory tract infections, wheezing, cough, middle ear infections
      and sudden infant death syndrome. Evidence from developed nations suggests that measures to
      reduce exposure to SHS can improve children's health outcomes; this has not been
      systematically studied in a developing country setting. The investigators hypothesize that
      implementation of a package of smoking hygiene intervention measures delivered by community
      health workers (CHWs) will reduce Chinese children's exposure to SHS and improve their
      respiratory health.

      To test this hypothesis, the investigators have identified three specific aims: (1) to obtain
      baseline data on second hand tobacco exposure among young children, health status of young
      children and smoking status of parents and other household members, (2) to generate
      preliminary effectiveness data for CHW-delivered SHI, and (3) to develop culturally
      appropriate biochemical measures to assess children's exposure to household SHS. The
      investigators propose to conduct this study in an urban district in Shanghai, China. After an
      initial assessment, the investigators will conduct a randomized controlled trial of
      households in a community, selected based on important study criteria, within the district.
      The investigators selected this design because it is most likely to produce a scientifically
      valid answer to our primary study question. All eligible smokers in the intervention group
      will receive behavioral counseling to address health hazards of SHS towards children, brief
      advice to quit or to adopt a no smoking policy around children, and educational pamphlets on
      the hazards of SHS, from a trained CHW in their community. A questionnaire will be used for
      data collection at the start and at 2 and 6 months. To assess the extent of total SHS
      exposure, children's urine cotinine (the indicator of nicotine) level will be measured at the
      first contact and at 2-and 6- months. To validate household members reported level of smoking
      the investigators will measure air nicotine levels of a sub-sample (10%) of households via
      passive monitors. The results of this study will provide clinical evidence for the
      development of CHW-delivered interventions designed to reduce exposure to SHS and improve the
      respiratory health of children in a resource-poor community. If successful, the program can
      serve as a model for implementation in other developing country settings. Furthermore,
      successful results could also be used to draft guidelines for health promotion interventions,
      which could be implemented as a policy for all primary health care settings. Finally, the
      study, which would be the first of its type in a developing country setting, will form the
      basis for future research and program development in the area of SHS.
    


Intervention name(s): SHI counseling
Intervention type(s): Behavioral
Intervention description(s): The SHI will be delivered in three different individualized counseling sessions: the initial in person counseling (30-45 minutes), at 1 week in person or telephone counseling (15-30 minutes) and at 1 month in person counseling (15-30 minutes). During the initial counseling, CHWs will emphasize the health hazards of SHS exposure towards young children and its possible illness outcomes. Then subjects will be asked to assess the SHS exposure of children in the household (e.g., estimating the number of hours for SHS exposure on the child per week or day) and the source of SHS. The concept of smoking hygiene and non-smoking household policy will be discussed and any potential barriers ascertained. Furthermore, the CHWs will use the transtheoretical model of Prochaska to assess the stage of readiness of the household member to change smoking behavior existing in the household. Individuals who wish to quit smoking will receive a brief advice on quitting smoking.
Allocation: Randomized
Intervention model: Single Group Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Prevention
Keywords: secondhand smoke; children; Chinese; respiratory symptoms; household smoking policy; Respiratory illnesses among children