A Clustered Randomized Controlled Trial to Reduce Secondhand Smoke Exposure Among Nonsmoking Pregnant Women in Sichuan Province, China

Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors

BACKGROUND

Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months.

METHODS

Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home.

RESULTS

In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers.

CONCLUSIONS

SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.

The impact of an online educational program to reduce second-hand exposure to smoke among nonsmoking pregnant women; a hospital-based intervention study

Background

Second-hand smoke is recognized as a public health concern, especially for pregnant women.

Objectives

To compare pregnant women's exposure and perceptions of SHS pre-and post-intervention.

Materials and methods

The study was conducted with a sample of 32 pregnant women at a tertiary university hospital in Jordan. Using a semi-structured questionnaire, researchers asked women about their knowledge, attitude and behavior regarding prenatal exposure to smoke before and after an intervention that included motivation, communication, education and counselling by using a range of media. A cotinine test was conducted to measure levels in second-hand smokers.

Results

The average maternal age was 30.88 ± 1.69 years; 68% were highly educated, 43% were employed, 37% reported not having sufficient income, and 62% did not attend for antenatal care on a regular basis. There was a significant increase in knowledge and awareness regarding second-hand smoking and its effect on pregnancy outcomes after the intervention. More than 90% of pregnant women supported a comprehensive policy in relation to smoking, and 33% of used to leave the room where others smoked. This percentage increased to 70% after the intervention. Cotinine level decreased after the intervention in 81% of cases.

Conclusions

There is an increase in knowledge and awareness regarding second-hand smoking and its effects on pregnancy outcomes after implementation of an educational intervention.

Exposure of second hand smoke in women and children: A narrative review

Second-hand smoke is a neglected public health issue. Every year 1.2 million people die due to this exposure. Second-hand smoke is also related to various other diseases like cardiovascular diseases, lung diseases, low birth weight, maternal depression, etc. The purpose of this review is to look over various studies and to gain an understanding of existing research about second-hand smoke and its adverse effects. In addition, we tried to identify the barriers behind creating a smoke-free environment at home and successful strategies employed and suggestion given in various studies. A comprehensive search of the recent literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications published since 2004 or later on Second-hand smoke exposure in pregnant women. Prevalence of SHS among pregnant women ranged from 24% 92%. Lack of knowledge, absence of comprehensive smoking ban, low status of women was among the main contributing factors. Community awareness and counseling by primary health-care physician was found to be successful strategies. There are various cultural and social barriers behind a smoke-free home for pregnant women. Interventional approaches like focused counseling by primary care physicians can help to overcome this issue. There is a need for behavioral interventions and community awareness to be done in this aspect.

Secondhand smoke (SHS) exposure before and after the implementation of the Tobacco Free Cities (TFC) initiative in five Chinese cities: a pooled cross-sectional study

OBJECTIVES

To assess the levels of secondhand smoke (SHS) exposure before and after the implementation of the Tobacco Free Cities (TFC) initiative.

DESIGN

City-wide representative, cross-sectional surveys (Tobacco Questions for Surveys, TQS) were conducted in each participating city before and after the implementation of TFC.

SETTING

Five large Chinese cities (Chengdu, Chongqing, Wuhan, Xiamen and Xi'an) participated in the TFC initiative.

PARTICIPANTS

A total of 10 184 adults participated in the 2015 TQS survey, and 10 233 adults participated in the 2018 TQS survey, respectively.

INTERVENTIONS

The TFC initiative, which included targeted media campaigns, educational programmes, implementing city-wide smoke-free policies and providing cessation interventions, was implemented in these five cities between 2015 and 2018.

MAIN OUTCOME

Self-reported past 30-day (P30D) SHS exposure in indoor workplaces, restaurants and homes.

DATA ANALYSIS

The pre-TFC and post-TFC SHS exposure levels were compared among all residents and among certain population subgroups. Multivariate logistic regressions were used to estimate the adjusted associations between P30D SHS exposure and individual characteristics.

RESULTS

Across all five cities, the overall rate of self-reported P30D SHS exposure declined in indoor workplaces (from 49.6% (95% CI: 46.4% to 52.8%) to 41.2% (95% CI: 37.7% to 44.7%)), restaurants (from 72.4% (95% CI: 69.8% to 74.9%) to 61.7% (95% CI: 58.7% to 64.7%)) and homes (from 39.8% (95% CI: 36.9% to 42.7%) to 34.7% (95% CI: 31.5% to 37.8%)) from 2015 to 2018. These declines were statistically significant after controlling for individual characteristics. The P30D SHS exposure was associated with sex, age, education level, occupation and current smoking status. The associations varied by venues.

CONCLUSIONS

Our analysis showed that compared with the nationwide SHS exposure levels reported in concurrent national surveys, the declines in P30D SHS exposure in five Chinese cities that implemented the TFC initiative were larger in indoor workplaces and restaurants. Our findings suggest that the TFC initiative was effective in reducing SHS exposure in Chinese cities.

Reducing Secondhand Smoke Exposure Among Nonsmoking Pregnant Women: A Systematic Review

Introduction

Exposure to secondhand smoke (SHS) in pregnancy leads to an increased risk of stillbirths, congenital malformations, and low birth weight. There is a lack of evidence about how best to achieve reductions in SHS exposure among nonsmoking pregnant women. This work systematically reviews individual or household interventions to reduce pregnant women’s exposure to SHS.

Methods

MEDLINE, EMBASE, and CINAHL databases were searched from their dates of inception to April 17, 2019. Studies were included if: participants were nonsmoking pregnant women; involved an intervention to reduce SHS exposure or encourage partner quitting; and measured SHS exposure of pregnant women and/or recorded quit rates among partners. The UK National Institute for Health & Care Excellence (NICE) Quality Appraisal checklist was used to determine internal and external validity.

Results

Nine studies met the inclusion criteria. Educational interventions were primarily targeted at the pregnant woman to change her or others’ behavior, with only two studies involving the partner who smoked. Intervention delivery was mixed, spanning brief discussions through to more involving sessions with role play. The effective interventions involved multiple follow-ups. There was no standardized method of assessing exposure to SHS. Many of the included studies had moderate to high risk of bias.

Conclusion

There is mixed evidence for interventions aimed at reducing pregnant women’s exposure to SHS, though multi-component interventions seem to be more effective. The effectiveness of family-centered approaches involving creating smoke-free homes alongside partner smoking cessation, perhaps involving pharmacological support and/or financial incentives, should be explored.

Implications

• Measures to protect nonsmoking pregnant women from SHS tend to place the responsibility for “avoidance” on the woman.

• There is little work that seeks to involve the smoking partner or other smokers in protecting pregnant women from SHS.

• Interventions to create smoke-free homes and/or smoking partner cessation need to be developed: pharmacological and financial support should be explored.

Disseminating a Smoke-free Homes Program to Low Socioeconomic Status Households in the United States Through 2-1-1: Results of a National Impact Evaluation

INTRODUCTION

Given homes are now a primary source of secondhand smoke (SHS) exposure in the United States, research-tested interventions that promote smoke-free homes should be evaluated in real-world settings to build the evidence base for dissemination. This study describes outcome evaluation results from a dissemination and implementation study of a research-tested program to increase smoke-free home rules through US 2-1-1 helplines.

METHODS

Five 2-1-1 organizations, chosen through a competitive application process, were awarded grants of up to $70 000. 2-1-1 staff recruited participants, delivered the intervention, and evaluated the program. 2-1-1 clients who were recruited into the program allowed smoking in the home, lived in households with both a smoker and a nonsmoker or child, spoke English, and were at least 18 years old. Self-reported outcomes were assessed using a pre-post design, with follow-up at 2 months post baseline.

RESULTS

A total of 2345 households (335-605 per 2-1-1 center) were enrolled by 2-1-1 staff. Most participants were female (82%) and smokers (76%), and half were African American (54%). Overall, 40.1% (n = 940) reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up (n = 389), days of SHS exposure in the past week decreased from 4.9 (SD = 2.52) to 1.2 (SD = 2.20). Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender.

CONCLUSIONS

Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

IMPLICATIONS

Dissemination of this brief research-tested intervention via a national grants program with support from university staff to five 2-1-1 centers increased home smoking bans, decreased SHS exposure, and increased cessation rates. Although the program delivery capacity demonstrated by these competitively selected 2-1-1s may not generalize to the broader 2-1-1 network in the United States, or social service agencies outside of the United States, partnering with 2-1-1s may be a promising avenue for large-scale dissemination of this smoke-free homes program and other public health programs to low socioeconomic status populations in the United States.

Predictors of toxic metal exposures among US women of reproductive age

BACKGROUND

Arsenic, cadmium, lead, and mercury are ubiquitous toxicants that may be especially harmful to unborn children. We therefore sought to identify temporal trends and predictors of toxic metal biomarkers among US women of reproductive age, including those who were pregnant and/or breastfeeding.

METHODS

Interviews and examinations were performed among a representative sample of women, aged 20-44 years, as part of the 2003-2014 National Health and Nutrition Examination Surveys. A range of sociodemographic, lifestyle, and dietary factors were evaluated as predictors of urinary inorganic arsenic, urinary cadmium, blood mercury, and blood lead concentrations.

RESULTS

Levels of all four toxic metal biomarkers declined during the study period. Older age, racial/ethnic minorities, and a birthplace outside of the US were independently associated with higher toxic metal concentrations. Associations were similar for women who were pregnant or breastfeeding and those who were not.

CONCLUSION

US women of reproductive age were exposed to lower levels of toxic metals in 2013-2014 compared to 2003-2004. However, because the long-term health effects of early life exposures are unclear, public health efforts to address toxic metals should pay particular attention to older, nonwhite, and foreign-born women if they are pregnant or planning to become pregnant.

Impact of a smoke-free-living educational intervention for smokers and household nonsmokers: A randomized trial of Chinese American pairs

BACKGROUND

Chinese American men smoke at a high rate, which puts household nonsmokers at risk. The objective of this study was to evaluate the effectiveness of a brief-intensity versus moderate-intensity smoke-free-living educational intervention for household pairs.

METHODS

The authors conducted a randomized controlled trial of Cantonese-speaking Chinese American smoker and household nonsmoker pairs in San Francisco, California. Pairs were randomized to moderate-intensity or brief-intensity group sessions with their household partner. The moderate-intensity group received 2 group sessions, a laboratory report of their baseline smoke exposure, as measured by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and 3 follow-up calls over 6 months. The brief-intensity group received 1 group session on tobacco-cessation resources. Primary outcomes were biochemically validated, past-month smoking abstinence and elimination of nonsmoker household exposure at 12 months.

RESULTS

Participant pairs (n = 203) were male smokers, one-half of whom did not intend to quit within 6 months, with mostly female spouses as household nonsmokers. Approximately three-quarters of nonsmokers in both groups already had smoke-free home rules. At 12 months, smokers in both groups had similar biochemically validated 30-day abstinence rates (moderate-intensity group, 0%-20.7%; brief-intensity group, 0%-20.0%; P = .002 over time). More smokers in the moderate-intensity group used subsequent cessation group classes (moderate-intensity group, 50%; brief-intensity group, 24%; P = .004). Household nonsmokers in both groups had similar biochemically validated rates of no home exposure (moderate-intensity group, 24.5%-42.2%; brief-intensity group, 24.8%-33.3%; P = .0001 over time).

CONCLUSIONS

A moderate-intensity smoke-free-living educational intervention for Chinese-speaking household pairs was not more effective than a brief-intensity intervention for smoking abstinence and elimination of household nonsmoker exposure. Abstinence rates were similar to those achieved with standard group counseling. Cancer 2018;124:1590-8. © 2018 American Cancer Society.

Social Environmental Influences on Smoking and Cessation: Qualitative Perspectives Among Chinese-Speaking Smokers and Nonsmokers in California

This qualitative study examines the social environmental influences on smoking and cessation from the perspectives of Chinese smokers and household nonsmokers in California. Seven focus groups were conducted with 63 participants. Three culturally influenced levels of potential intervention emerged from constant comparative analysis. At the individual level, participants focused more on irritating odor than health harms of exposure and had inaccurate beliefs about harms of smoking and cessation. At the relational level, peers kept smokers connected to pro-smoking norms. There was conflict in the home about smoking and failed cessation, but smokers recognized the benefits of cessation for family harmony and children's health. Physicians encouraged cessation but this tended to be insufficient to prompt action unless a smoker felt ill. At the societal level, participants recognized changes in social acceptability and environmental regulation of smoking upon immigration. Better implementation of smokefree policies, plus culturally nuanced strategies for equipping both nonsmokers and smokers to become smokefree, are needed.

Non-smoker assertive behaviour against smoke exposure: Chinese and Korean American non-smokers

INTRODUCTION AND AIMS

Non-smokers' assertive behaviour towards smokers by asking them not to smoke is important in promoting smoke-free environments. Korean and Chinese Americans come from countries where most women are non-smokers and assertive behaviour may not be prevalent but may increase after migration because of social-ecological factors. This study assessed the extent to which Korean and Chinese American non-smokers ask someone not to smoke and associated factors.

DESIGN AND METHODS

The 2003 California Chinese American and Korean American Tobacco Use Surveys were analysed. Multivariate logistic regression analyses examined factors related to non-smoker self-reports that they asked someone not to smoke within the past year.

RESULTS

About 40% reported past-year assertive behaviour against smoking, with higher rates among Koreans than Chinese (60.4% vs. 34.5%), those living with smokers (63.5%), ever exposed with a smoke-free home rule (62.3%), recently exposed at work without a smoke-free work policy (67.6%) and regularly exposed at other locations (52.3%). In combined multivariate analyses of both ethnic groups, assertive behaviour was associated with individual factors (single vs. married; tobacco exposure knowledge), family factors (living with smokers, exposed at home despite a smoke-free rule), community factors (exposed at work with no smoke-free policy, exposed at other locations) and cultural factors (Korean vs. Chinese ethnicity; lower acculturation).

DISCUSSION AND CONCLUSIONS

Chinese and Korean American non-smokers report assertive behaviour against smoking, which is associated with social-ecological factors. Results help identify target groups and strategies for future intervention, including the need to implement or enforce smoke-free environments and promote empowerment. [Saw A, Tang H, Tsoh JY, Chen MS Jr, Tong EK. Non-smoker assertive behaviour against smoke exposure: Chinese and Korean American non-smokers.

Brief Counseling on Secondhand Smoke Exposure in Pregnant Women in Argentina and Uruguay

Argentina and Uruguay have a high prevalence of smoking during pregnancy, as well as of secondhand smoke (SHS) exposure. In this secondary analysis of a trial to implement brief smoking cessation counseling during antenatal care in Argentina and Uruguay, we aim to evaluate the effects of the intervention on the rates of self-reported SHS exposure at home and at work, and on attitudes recalled by non-smoker women enrolled in the intervention group compared with the control group. We randomly assigned (1:1) 20 antenatal care clusters in Argentina and Uruguay to receive a multifaceted intervention to implement brief smoking cessation counseling, which also included questions and counseling regarding SHS exposure, or to receive the standard of care. There was not a statistically significant difference between groups of the intervention’s effect (reduction of exposure to SHS) on any of the three exposure outcome measures (exposure at home, work or other indoor areas) or on the attitudes of women regarding exposure (avoiding breathing SHS and having rooms where smoking is forbidden). This analysis shows that we should not expect reductions in SHS exposure with this modest intervention alone. To achieve such reductions, strategies engaging partners and other household members may be more effective.