Exposing children to second-hand tobacco smoke causes significant harm, and occurs predominantly through smoking by caregivers in the family home. We have undertaken a trial of a complex intervention designed to reduce second-hand smoke exposure of children whose primary carer feels unable or unwilling to quit smoking.
In an open-label randomised controlled trial of 205 families from deprived communities in England, we compared a complex intervention combining personalised feedback on home air quality, behavioural support and nicotine replacement therapy (NRT) for temporary abstinence with usual care. Our primary outcome was change in air quality in the home, measured as average 16-to-24-hour levels of particulate matter of < 2.5µm diameter (PM₂.₅), between baseline and 12 weeks. Secondary outcomes included changes in maximum PM₂.₅, proportion of time PM₂.₅ exceeded World Health Organisation (WHO) recommended levels of maximum exposure of 25µg/mg3, child salivary cotinine, caregivers’ cigarette consumption, nicotine dependence, determination to stop smoking, quit attempts and quitting altogether during the intervention.
Geometric mean PM₂.₅ decreased significantly more (by 35.2%; 95%CI: 12.7-51.9%) in intervention than in usual care households, as did the proportion of time PM₂.₅ exceeded 25µg/mg3, child salivary cotinine concentrations, caregivers’ cigarette consumption in the home, nicotine dependence, determination to quit, and likelihood of having made a quit attempt.
By reducing exposure to second-hand tobacco smoke 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.
UK Smokefree Homes Project
UK Centre for Tobacco and Alcohol Studies
Clinical Sciences Building, City Hospital
Nottingham, NG5 1PB