Secondhand Smoke Exposure Reduction Intervention in Chinese Households of Young Children: A Randomized Controlled Trial

Acad Pediatr. Nov-Dec 2015;15(6):588-98. doi: 10.1016/j.acap.2015.06.008. Epub 2015 Aug 20.


Objective: To assess whether a theory-based, community health worker-delivered intervention for household smokers will lead to reduced secondhand smoke exposure to children in Chinese families.

Methods: Smoking parents or caregivers who had a child aged 5 years or younger at home were randomized to the intervention group (n = 164) to receive smoking hygiene intervention or to the comparison group (n = 154). The intervention was delivered by trained community health workers. Outcomes were assessed at 2- and 6- month follow-up.

Results: Of the 318 families randomized, 98 (60%) of 164 intervention group and 82 (53%) of 154 of controls completed 6-month follow-up assessment. At the 6-month follow-up, 62% of intervention and 45% of comparison group households adopted complete smoking restrictions at home (P = .022); total exposure (mean number of cigarettes per week ± standard deviation) from all smokers at home in the past 7 days was significantly lower among children in the intervention (3.29 ± 9.06) than the comparison (7.41 ± 14.63) group (P = .021); and mean urine cotinine level (ng/mL) was significantly lower in the intervention (0.030 ± .065) than the comparison (0.087 ± .027) group, P < .001). Participants rating of the overall usefulness of the intervention was 4.8 + 0.8 (1 standard deviation) on the 5 point scale (1 not at all and 5 = very useful).

Conclusions: The findings of this very first study in China showed that smoking hygiene intervention was effective in reducing children's exposure to secondhand smoke. These findings have implications for the development of primary health care-based secondhand smoke exposure reduction and family oriented smoking cessation interventions as China moves toward a smoke-free society.

Keywords: Chinese; children; randomized controlled trial; secondhand smoke.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child, Preschool
  • China
  • Community Health Workers*
  • Cotinine / urine
  • Family Characteristics*
  • Female
  • Humans
  • Hygiene
  • Infant
  • Infant, Newborn
  • Male
  • Parents*
  • Smoke-Free Policy
  • Smoking / therapy
  • Smoking Cessation*
  • Smoking Prevention*
  • Tobacco Smoke Pollution / prevention & control*


  • Tobacco Smoke Pollution
  • Cotinine