Status Of Passive Smoking Of Children In Households In Urban Shanghai And Preliminary Evaluation Of Intervention Effects

Objectives The objective of the present study was to investigate children's exposure to second-hand smoke and smoker's current smoking in households with smokers in Urban Shanghai, to evaluate effects of smoking interventions on the reduction of second hand smoke exposure in households and improvement of smokers'smoking behaviors, as well as to explore a family intervention model for smoking more suitable to our country.Methods Cross-sectional survey was applied to study current status of passive smoking of children in households. Randomized controlled trials were employed to access the effects of intervention. The smoking status was confirmed through combining questionnaire survey and test of urinary cotinine, Methods were described in detail as follows:1. Smokers of Xujiahui and Xietu communities where children under 5 years old were selected by cluster sampling methods and investigated through face-to-face interview.2. Urine samples in the baseline and two months following-up were collected from children in selected smoking families. High performance liquid chromatography was used for measuring the content of cotinine (nicotine metabolites) in children urine samples.3. The participants were divided randomly into intervention and control groups. Smokers in the intervention group accepted two times of home-visits and three times of telephone interviews by community health workers. Health information about the hazards associated with second hand smoking and advice about changing the behavior of smoking were provided to them too. Smokers in the control group accepted one time of home-visit and one telephone interview. Only information about the growing development of children unrelated to the second hand smoking was provided.4. Two months later, questionnaire survey was performed on all the enrollments. Questions included children's exposure to second hand smoke, smoker's current smoking, smoking rules in the family and the assessment of the project. 5. Focused group interview with the community health workers was employed using a semi-structured outline method to evaluate the process of the study.Results1. Current status of second hand smoke:In the present study, the rate of second hand smoke exposure among children in households with smokers in Urban Shanghai was 26.7%.2. Second hand smoke exposure of the children was associated with the educational levels of smokers, smoking-free policies in families, and the attitude towards smoking-free policies inside a car. Relative risk of the exposure of children in households with smokers, whose educational level was junior college and higher, was 0.04 times of those in the family with an illiterate smoker(OR=0.04,95%CI=0.002～0.831). smoking-free policies were useful in reducing the risk of exposure. Relative risk of exposure to second hand smoke in families with smoking-free policies was 0.16 of those without smoke-free policy (OR=0.16,95% CI=0.057～0.418). If the families which was care of the smoking-free policy in a car, the risk of second hand smoke exposure of children was lower compared to those without care of the policy (OR=0.06,95% CI=0.009～0.354).3. In the intervention group, the rate of families with smoking-free policies was raised from 35.7% at baseline to 50.0% after two months' later of the inteevention. The difference was statistically significant (P<0.05). Differences were also found through comparison of control group between the baseline and after intervention, the rate of families with smoking-free policies was raised from from 37.1% to 61.8%(P<0.05).4. The 2-month follow up survey showed that the declined in the two groups before and after the intervention (4.2 declined in intervention group and 2.0 in control group, (P<0.05). No differences were found when the comparison of the number of the daily cigarettes between the two groups before intervention. The daily cigarettes consumption, however, was 3.2 lower than control group after intervention. Conclusions1. Currently, the rate of second hand smoke exposure among children in households in Urban Shanghai is lower than other districts.2. Second hand smoke exposure of the children was associated with the educational levels of smokers, smoking-free policies in families, and the attitude towards smoking-free policies inside a car.3. Smoking intervention based on the protection motivation theory can partly improve smoking behaviors among smokers. The number of daily cigarettes consumption decreased in smoking families with smoking-free policies in their family and smokers. The rate of second hand smoke exposure of children and cotinine of their urines, however, had no significant change, due to the intervention in a relatively short time.Based on the present results, following suggestions are raised:Right now in families, smokers'knowledge of second hand smoke needs to be strengthened. In the future publicity and interventions, we should reinforce propaganda and education on smokers especially on those with low educational level, diffuse the knowledge on hazards of second hand smoking to children's healthy, and provide comprehensive and feasible strategies for reducing children's exposure to second-hand smoke. The smoking intervention program should provide interesting, practical, effective and consistent means to intervent the smokers.