Secondhand Smoke Exposure Reduction Intervention among Children in Rural China: A Cluster Randomized Controlled Trial

Background: Secondhand smoke (SHS) exposure has direct negative impacts on health, especially for vulnerable infants and young children. With the relatively higher smoking rate and lower levels of cigarette smoking-related knowledge and awareness in rural China, children were facing severe SHS exposure within households. The aim of this study is to assess whether a community health worker (CHW)–delivered tobacco control intervention for household smokers will lead to SHS exposure reduction in children in rural settings through 12-month follow-up. Methods: Households with a child aged 5 years or younger at home were randomized to the intervention group (n = 334) to receive smoking hygiene intervention or to the attention-matched comparison group (n = 334). The intervention was delivered by trained CHWs. Outcomes were assessed at 6- and 12- month follow-up. Multilevel mixed-effects logistic regression was used to access the intervention performance. Results: We found that children were less likely to be exposed to SHS in the intervention group (OR: 0.56 95% CI: .32, 1.00 P=0.049) than the children in the comparison group at 12- months as measured by the self-reported number of days smoker smoked in front of children. Our intervention had minor effect on smoking cessation, smoke-free home restriction, and improvement of children’s respiratory health. Conclusions: The findings of this first study in rural China showed that smoking hygiene intervention was promising in reducing children’s exposure to SHS. These findings have implications for improving smoking cessation and reducing SHS exposure provided by CHWs in rural China.