Children Learning About Second-Hand Smoking: A Feasibility Cluster Randomized Controlled Trial

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Abstract

Background:

Exposure to second-hand smoke is a threat to children’s health. We developed a school-based smoke-free intervention (SFI) to support families in implementing smoke-free homes in Bangladesh, and gathered preliminary evidence of its effectiveness.

Methods:

A feasibility cluster randomized controlled trial of SFI was conducted in 24 schools in Mirpur, an urban area within Dhaka. Using simple stratified randomization, schools were allocated to: Arm A (SFI only), Arm B (SFI plus reminders), and Arm C (the control group). A total of 781 year-5 children (10–12 years old) in the consenting schools, participated in the study. Outcomes including “smoke-free homes” and “social visibility” that is, not smoking in front of children at home were assessed through questionnaire-based children’s surveys, administered by researchers, at baseline and at weeks 1, 12, 27, and 52 in all arms.

Results:

“Smoke-free homes” were significantly higher in Arm A (odds ratio [OR] = 4.8; 95% CI = 2.6–9.0) and in Arm B (OR = 3.9; 95% CI = 2.0–7.5) than in Arm C, when controlled for the baseline levels, at year 1. Similarly, “social visibility” was significantly reduced in Arm A (OR = 5.8; 95% CI = 2.8–11.7) and in Arm B (OR = 7.2; 95% CI = 3.3–15.9) than Arm C, when controlled for the baseline levels, at year 1. We observed an increasing trend (Cochrane Armitage test statistic [Z] = 3.8; p < .0001) in homes becoming smoke-free with increasing intensity of the intervention (control < Arm A < Arm B), and a decreasing trend (Z = −5.13; p < .0001) in social visibility at homes.

Conclusion:

SFI has the potential to encourage children to negotiate a smoke-free environment in their homes.

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