A randomized controlled trial of a family intervention to reduce secondhand smoke (SHS) exposure in babies

Abstract

Objective: A randomized controlled trial to evaluate the effectiveness of a proactive family smoking cessation intervention to non-smoking mothers and smoking fathers to protect the infants and mothers from SHS exposure, and to help the fathers quit. Methods: This is a multi-centered randomized controlled trial undertaken at the Maternal and Child Healthcare centres (MCHCs) in Hong Kong. Both qualitative and quantitative methodologies were employed. Formative research including qualitative telephone interviews of mothers who participated in the pilot study were conducted to obtain information to guide the development of the intervention. A conceptual framework was developed using the transtheorectical model to help fathers to quit smoking; social-cognitive theory to empower the mother to execute household no-smoking policy and socialecological theory to facilitate the development of a family intervention. Baseline and follow-up questionnaires for both father and mother were developed, and intervention materials such as the health educational packet were designed. A pilot study was carried out from 21/4-18/6, 2008, to test the feasibility of the study. Results: 5 themes were identified from the in-depth interviews including Household smoking conditions; Mothers' efforts in motivating the father to quit; Implementation of household no-smoking policy by mother; Maintaining family health and harmony and the role of health care providers. We screened a total of 2,205 mothers in the pilot study, with 150 mothers meeting the inclusion criteria and consented to participation. 133 families were successfully randomized, with 66 in the intervention group and 67 in the control group. 15 families from the intervention group (15/66, 22.7%) joined the family intervention. 81% of fathers were daily smokers and they mainly smoked at washroom (35.8%), kitchen (22.3%) and contemplation stage. About 55% of the mothers opened the windows when the fathers smoked at home and only 5.4% actually stopped them from smoking at home. 19.6% did not provide any help when their husbands tried to quit and 15.5% provided no spiritual support to the fathers during quitting process. Conclusion: The qualitative interviews indicated that the mothers were satisfied with their husbands' smoking behavior and they thought it was acceptable to smoke at home, as long as the fathers were smoking away from the babies. Furthermore, they felt reducing smoking among the husbands is good enough as they were not sure how to support them to quit smoking completely. The pilot study confirmed the feasibility of this study to be carried out in the MCHCs. The baseline data showed that few mothers took an active role in helping the father to stop smoking, and hence an empowerment intervention was designed to facilitate the mothers to implement the household no-smoking policy at home, as well as to support the fathers to quit smoking.