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BMC Public Health
Published in: BMC Public Health 1/2017

Open Access 01-12-2017 | Research article

The impact of multiple interventions to reduce household exposure to second-hand tobacco smoke among women: a cluster randomized controlled trial in Kalutara district, Sri Lanka

Authors: A. M. A. A. P. Alagiyawanna, N. Rajapaksa –Hewageegana, N. Gunawardena

Published in: BMC Public Health | Issue 1/2017

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Abstract

Background

Second-hand smoke (SHS) in households remains a serious public health problem in Sri Lanka, partly due to a lack of voluntary prohibitions of tobacco smoking inside houses. Women are especially at risk of being exposed. Effective community based interventions to reduce the SHS in households targeting women is scarce. The objective of this study was to examine the impact of a multi-component intervention on household SHS exposure among Sri Lankan women.

Methods

Thirty clusters of 25 women (aged 18–65) from 750 households were randomized into the intervention and control groups. Women in the intervention group were exposed to activities which focused on improving knowledge on the health effects of SHS, attitudes towards SHS exposure, right to a smoke-free living and women empowerment against smoking. The duration of the intervention was six months. The comparison group received no intervention. The primary outcome of interest was self-reported SHS exposure in the household within 7 days prior to data collection. The secondary outcomes were exposure in the past 30 days, knowledge of the health risks of exposure, attitudes towards exposure, right to smoke-free living, women empowerment against smoking, and smoking inside the homes.

Results

Final assessment was in 329 (89.6%) in the intervention group and 309 (85.8%) in the comparison group. Following the intervention, significantly lower proportion of women in the intervention group as compared to the control group reported SHS exposure in their households within 7-days (9.2% vs. 15.3%, p = 0.02) and 30-days (13.6% vs. 21.6%, p = 0.008) prior to the post survey. As compared to the control group, significantly higher median scores were observed in the intervention group on the knowledge of the health risks of exposure to SHS (p < 0.001), attitudes on exposure to SHS (p = 0.004), right to smoke free living (p = 0.001) and women empowerment (p < 0.001).

Conclusion

Multi-component intervention activities were effective in reducing household exposure to SHS among women.

Trial registration

Sri Lanka Clinical Trials Registry SLCTR/2014/033.
Appendix
Available only for authorised users
Literature
1.
2.
Rushton L. Health impact of environmental tobacco smoke in the home. Rev Environ Health. 2003;19(3–4):291–309.
3.
4.
Ministry of Healthcare and Nutrition, Brief Profile on Tobacco Control in Sri Lanka, Ministry of Healthcare and Nutrition, Government of Sri Lanka, 2009.
5.
6.
7.
Ministry of Health, Nutrition and Indigenous Medicine. National non communicable disease risk factor survey, STEPS survey Sri Lanka, World Health Organization. Sri Lanka. 2015.
8.
Establishing Smoke Free Zone – 2016, National Authority on Tobacco and Alcohol (NATA).
9.
Sinha DN, Rinchen S, Palipudi KM, Naing Shein NN, de Silva P, Khadka BB, et al. Tobacco use, exposure to second-hand smoke, and cessation training among the third-year medical and dental students in selected member states of South-East Asia region: a trend analysis on data from the Global Health professions student survey, 2005-2011. Indian J Cancer. 2012;49(4):379–86.CrossRefPubMed
10.
Baxter S, Blank L, Everson-Hock ES, Burrows J, Messina J, GuillaUme L, et al. The effectiveness of interventions to establish smoke-free homes in pregnancy and in the neonatal period: a systematic review. Health Educ Res. 2011;26(2):265–82.
11.
Alwan N, Siddiqi K, Thomson H, Lane J, Cameron I. Can a community-based ‘smoke-free homes’ intervention persuade families to apply smoking restrictions at homes? J Public Health. 2010;33(1):48–54.
12.
Zhang L, Hsia J, Tu X, Xia Y, Zhang L, Bi Z, et al. Exposure to secondhand tobacco smoke and interventions among pregnant women in China: a systematic review. Prev Chronic Dis. 2015;12:E35.PubMedPubMedCentral
13.
Nichter M, Padmajam S, Nichter M, Sairu P, Aswathy S, Mini G, et al. Developing a smoke free homes initiative in Kerala, India. BMC Public Health. 2015;15(1):480.CrossRefPubMedPubMedCentral
14.
Siddiqi K, Sarmad R, Usmani R, Kanwal A, Thomson H, Cameron I. Smoke-free homes: an intervention to reduce second-hand smoke exposure in households. Int J Tuberc and Lung Dis. 2010;14(10):1336–41.
15.
16.
Nichter M, Nichter M, Padmawati RS, Ng N. Developing a smoke free household initiative: an Indonesian case study. Acta Obstet Gynecol Scand. 2010;89(4):578–81.CrossRefPubMed
17.
Thomson G, Wilson N, Howden-Chapman P. Population level policy options for increasing the prevalence of smokefree homes. J Epidemiol Community Health. 2006;60(4):298–304.CrossRefPubMedPubMedCentral
18.
Öberg M, Jaakkola MS, Woodward A, Peruga A, Prüss-Ustün A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011;377(9760):139–46.CrossRefPubMed
19.
Gender W. Women, and the tobacco epidemic. Geneva: WHO; 2010.
20.
Rosen LJ, Myers V, Winickoff JP, Kott J. Effectiveness of interventions to reduce tobacco smoke pollution in homes: a systematic review and meta-analysis. Int J Environ Res Public Health. 2015;12(12):16043–59.CrossRefPubMedPubMedCentral
21.
Jackson SF, Perkins F, Khandor E, Cordwell L, Hamann S, Buasai S. Integrated health promotion strategies: a contribution to tackling current and future health challenges. Health Promot Int. 2006;21(suppl 1):75–83.CrossRefPubMed
22.
23.
Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010;4
24.
Pérez-Ríos M, Schiaffino A, López MJ, Nebot M, Galán I, Fu M, et al. Questionnaire-based second-hand smoke assessment in adults. The European Journal of Public Health. 2013;23(5):763–7.CrossRefPubMed
25.
Ekerbicer HC, Celik M, Guler E, Davutoglu M, Kilinc M. Evaluating environmental tobacco smoke exposure in a group of Turkish primary school students and developing intervention methods for prevention. BMC Public Health. 2007;7:202.CrossRefPubMedPubMedCentral
26.
27.
Campbell MK, Piaggio G, Elbourne DR, Altman DG. Consort 2010 statement: extension to cluster randomised trials. 2012.
28.
Hayes R, Bennett S. Simple sample size calculation for cluster-randomized trials. Int J Epidemiol. 1999;28(2):319–26.CrossRefPubMed
29.
30.
Nisar N, Qadri MH, Fatima K, Perveen S, Nisar N, Qadri M, et al. A community based study about knowledge and practices regarding tobacco consumption and passive smoking in Gadap town, Karachi. JPMA The Journal of the Pakistan Medical Association. 2007;57(4):186.PubMed
31.
Ma GX, Tan Y, Fang CY, Toubbeh JI, Shive SE. Knowledge, attitudes and behavior regarding secondhand smoke among Asian Americans. Prev Med. 2005;41(2):446–53.CrossRefPubMed
32.
Jones S, Love C, Thomson G, Green R, Howden-Chapman P. Second-hand smoke at work: the exposure, perceptions and attitudes of bar and restaurant workers to environmental tobacco smoke. Aust N Z J Public Health. 2001;25(1):90–3.CrossRefPubMed
33.
Thomson G, Wilson N. Public attitudes to laws for smoke-free private vehicles: a brief review. Tob Control. 2009;18(4):256–61.CrossRefPubMed
34.
Thomson G, Wilson N, Howden-Chapman P. Attitudes to, and knowledge of, secondhand smoke in New Zealand homes and cars. NZ Med J. 2005;118(1213):9.
35.
Wan YKP, Pilkington PA. Knowledge, attitudes and experiences of Macao's casino workers with regard to second-hand smoke exposure at work. Int Gambl Stud. 2009;9(3):207–24.CrossRef
36.
Katulanda P, Wickramasinghe K, Mahesh JG, Rathnapala A, Constantine GR, Sheriff R, et al. Prevalence and correlates of tobacco smoking in Sri Lanka. Asia Pac J Public Health. 2011;23(6):861–9.CrossRefPubMed
37.
Harkness JA, Schoua-Glusberg A. Questionnaires in translation. ZUMA-nachrichten spezial. 1998;3(1):87–127.
38.
39.
40.
Rosen LJ, Noach MB, Winickoff JP, Hovell MF. Parental smoking cessation to protect young children: a systematic review and meta-analysis. Pediatrics. 2012;129(1):141–52.CrossRefPubMed
41.
Wiehe SE, Garrison MM, Christakis DA, Ebel BE, Rivara FP. A systematic review of school-based smoking prevention trials with long-term follow-up. J Adolesc Health. 2005;36(3):162–9.CrossRefPubMed
42.
43.
Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, et al. Population tobacco control interventions and their effects on social inequalities in smoking: systematic review. Tob Control. 2008;17(4):230–7.CrossRefPubMedPubMedCentral
44.
Burke H, Leonardi-Bee J, Hashim A, Pine-Abata H, Chen Y, Cook DG, et al. Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis. Pediatrics. 2012;129(4):735–44.CrossRefPubMed
45.
Petrie J, Bunn F, Byrne G. Parenting programmes for preventing tobacco, alcohol or drugs misuse in children< 18: a systematic review. Health Educ Res. 2007;22(2):177–91.CrossRefPubMed
46.
Wiehe SE, Garrison MM, Christakis DA, Ebel BE, Rivara FP. A systematic review of school-based smoking prevention trials with long-term follow-up. The Journal of adolescent health : official publication of the Society for Adolescent Medicine. 2005;36(3):162–9.CrossRef
47.
Cuijpers P. Effective ingredients of school-based drug prevention programs: a systematic review. Addict Behav. 2002;27(6):1009–23.CrossRefPubMed
48.
Garrison MM, Christakis DA, Ebel BE, Wiehe SE, Rivara FP. Smoking cessation interventions for adolescents: a systematic review. Am J Prev Med. 2003;25(4):363–7.CrossRefPubMed
49.
Rigotti NA, Munafo MR, Stead LF. Smoking cessation interventions for hospitalized smokers: a systematic review. Arch Intern Med. 2008;168(18):1950–60.CrossRefPubMedPubMedCentral
50.
Ranney L, Melvin C, Lux L, McClain E, Lohr KN. Systematic review: smoking cessation intervention strategies for adults and adults in special populations. Ann Intern Med. 2006;145(11):845–56.CrossRefPubMed
51.
Ashenden R, Silagy C, Weller D. A systematic review of the effectiveness of promoting lifestyle change in general practice. Fam Pract. 1997;14(2):160–76.CrossRefPubMed
52.
Park E. School-based smoking prevention programs for adolescents in South Korea: a systematic review. Health Educ Res. 2006;21(3):407–15.CrossRefPubMed
53.
Lemmens V, Oenema A, Knut IK, Brug J. Effectiveness of smoking cessation interventions among adults: a systematic review of reviews. Eur J Cancer Prev. 2008;17(6):535–44.CrossRefPubMed
54.
55.
SPSS I. IBM SPSS statistics for windows, version 20.0. New York: IBM Corp; 2011.
56.
Kegler MC, Bundy L, Haardörfer R, Escoffery C, Berg C, Yembra D, et al. A minimal intervention to promote smoke-free homes among 2-1-1 callers: a randomized controlled trial. American Journal of Public Health (ajph)105, no 3 (March 1, 2015): pp 530-537. 2015.
57.
58.
Dolcini MM, Adler NE, Ginsberg D. Factors influencing agreement between self-reports and biological measures of smoking among adolescents. J Res Adolesc. 1996;6(4):515–42.
59.
60.
Brener ND, Billy JO, Grady WR. Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. J Adolesc Health. 2003;33(6):436–57.CrossRefPubMed
61.
Mills AL, Messer K, Gilpin EA, Pierce JP. The effect of smoke-free homes on adult smoking behavior: a review. Nicotine Tob Res. 2009;11(10):1131–41.CrossRefPubMed
62.
Hovell MF, Zakarian JM, Matt GE, Liles S, Jones JA, Hofstetter CR, et al. Counseling to reduce children's secondhand smoke exposure and help parents quit smoking: a controlled trial. Nicotine Tob Res. 2009;11(12):1383–94.CrossRefPubMedPubMedCentral
63.
Hyland A, Higbee C, Travers MJ, Van Deusen A, Bansal-Travers M, King B, et al. Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults. Nicotine Tob Res. 2009;11(6):614–8.CrossRefPubMedPubMedCentral
64.
Messer K, Mills AL, White MM, Pierce JP. The effect of smoke-free homes on smoking behavior in the US. Am J Prev Med. 2008;35(3):210–6.CrossRefPubMed
65.
Forster JL, Widome R, Bernat DH. Policy interventions and surveillance as strategies to prevent tobacco use in adolescents and young adults. Am J Prev Med. 2007;33(6):S335–S9.CrossRefPubMed
66.
Biener L, Nyman AL. Effect of workplace smoking policies on smoking cessation: results of a longitudinal study. J Occup Environ Med. 1999;41(12):1121–7.CrossRefPubMed
Metadata
Title
The impact of multiple interventions to reduce household exposure to second-hand tobacco smoke among women: a cluster randomized controlled trial in Kalutara district, Sri Lanka
Authors
A. M. A. A. P. Alagiyawanna
N. Rajapaksa –Hewageegana
N. Gunawardena
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2017
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-017-4820-8

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