Reducing Second-hand Smoke Exposure Among Young Children in Rural China

Second-hand smoking (SHS) is a health hazard to infants and children, in whom it is associated with lower respiratory tract infections, wheezing, cough, middle ear infections and sudden infant death syndrome. With a population of 1.2 billion, China is the world's largest producer and consumer of tobacco, with over 350 million smokers. The high prevalence of current smoking among men (60.2%) and women (6.9%) in China, reflect the fact that a large number of young children are exposed to SHS at home. The high exposure to SHS increases children's risk of tobacco-induced morbidity and mortality. Children in the rural setting even are more exposed to SHS due to the lack of tobacco control policy initiative in the rural setting and the high prevalence of smoking among the rural public.

While evidence-based intervention to reduce children's exposure to SHS was proven effective in the United States, data on the effectiveness of evidence-based interventions to reduce SHS exposure among young children (e.g., under age 5) is lacking in rural China.

China's unique public health history and homogeneity of the population provide an unprecedented opportunity to examine the effects of an exposure reduction intervention (we will call this as "smoking hygiene intervention, SHI") among children. Community health workers (CHWs), who play an important role in delivering other health interventions (i.e. vitamin supplementation and treatment for acute respiratory infection), offer a resource for delivery of SHI intervention in the community level.

To address this growing problem and to develop local evidence base, the proposed study will examine the effectiveness of a protection motivation theory (PMT) -based SHI, delivered by community health worker (CHW) in 6 different contacts, to reduce SHS exposure among young children and promote parental quitting in two rural setting of Zhejiang and Shanxi provinces. The results of this study will provide clinical evidence for the development of CHW-delivered interventions designed to reduce exposure to SHS and related morbidity and mortality among children in rural China. The successful results could also be used to draft guidelines for health promotion interventions, which could be implemented as a policy for all primary health care settings in rural China and other developing countries.

The study population will consist of the smoker household members of young children aged 5 years or below in the selected community. Families with at least one smoker in the household (mother, father or other household members) will be invited to participate in the intervention study. Investigators will recruit a total of 400 smoker household members; 200 from rural Zhejiang province and 200 from rural Yunnan province (Dali district).