A randomised controlled trial of a complex intervention to reduce children’s exposure to secondhand smoke in the home

Ratschen, Elena; Thorley, Rebecca; Jones, Laura L.; Opazo Breton, Magdalena; Cook, Juliette; McNeill, Ann; Britton, John; Coleman, Tim; Lewis, Sarah

Abstract

Objectives: Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. We report a trial of a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.

Design: An open-label, parallel, randomised controlled trial.

Setting: Deprived communities in Nottingham City and County, England


Participants: Caregivers resident in Nottingham City and County in England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home.

Interventions: We compared a complex intervention combining personalised feedback on home air quality, behavioural support and nicotine replacement therapy for temporary abstinence with usual care.

Main outcomes: The primary outcome was change in air quality in the home, measured as average 16–24 hours levels of particulate matter of <2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM2.5, proportion of time PM2.5 exceeded WHO recommended levels of maximum exposure of 25 µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention.

Results: Geometric mean PM2.5 decreased significantly more (by 35.2%; 95% CI 12.7% to 51.9%) in intervention than in usual care households, as did the proportion of time PM2.5 exceeded 25 µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit and likelihood of having made a quit attempt.

Conclusions: By reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm.

Trial registration number ISRCTN81701383.

This trial was funded by the UK National Institute for Health Research (NIHR): RP-PG-0608-10020

http://dx.doi.org/10.1136/tobaccocontrol-2016-053279

Citation

Ratschen, E., Thorley, R., Jones, L. L., Opazo Breton, M., Cook, J., McNeill, A., Britton, J., Coleman, T., & Lewis, S. (2018). A randomised controlled trial of a complex intervention to reduce children’s exposure to secondhand smoke in the home. Tobacco Control, 27(2), 155-162. https://doi.org/10.1136/tobaccocontrol-2016-053279

• Journal Article Type: Article
• Acceptance Date: Mar 7, 2017
• Online Publication Date: Apr 21, 2017
• Publication Date: Mar 1, 2018
• Deposit Date: Apr 26, 2017
• Publicly Available Date: Apr 26, 2017
• Journal: Tobacco Control
• Print ISSN: 0964-4563
• Electronic ISSN: 1468-3318
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 27
• Issue: 2
• Pages: 155-162
• DOI: https://doi.org/10.1136/tobaccocontrol-2016-053279
• Public URL: https://nottingham-repository.worktribe.com/output/962431
• Publisher URL: https://tobaccocontrol.bmj.com/content/27/2/155
• Contract Date: Apr 26, 2017