A Clustered Randomized Controlled Trial to Reduce Secondhand Smoke Exposure Among Nonsmoking Pregnant Women in Sichuan Province, China.

INTRODUCTION: Nonsmoking pregnant women in China have significant exposure to secondhand smoke (SHS). Few interventions have focused on pregnant women reducing their SHS exposure. METHODS: This clustered randomized controlled trial, conducted at eight hospitals in Sichuan, China, compared a prenatal health education intervention with usual clinical care as a control. The primary outcome was self-reported "no SHS exposure" before and 3 months after birth. The intervention consisted of three large group educational sessions, standardized clinician advice, brief monthly follow-up calls, and educational materials and resources. A random sample of participants was biochemically validated before birth with hair nicotine, a long-term biomarker of smoke exposure. RESULTS: Overall, 1181 participants were randomized to intervention (n = 526) and control (n = 655) groups. More participants in the intervention group than the control group reported no SHS exposure 3 months after birth (Total: 77.9% vs. 52.6%, P < .001; Home: 81.2% vs. 53.3%, P < .001). The intervention group also had greater changes in improved smoke-free homes and SHS knowledge and attitudes. Controlling for covariates, the intervention group was less likely to report SHS exposure than the control group (Total: OR = 0.47, 95% CI = 0.31 to 0.71; Home: OR = 0.33, 95% CI = 0.21 to 0.53), and this effect was sustained 3 months after birth. The adjusted log concentration of hair nicotine for the intervention group decreased by 0.28 log µg/g more than the control group. CONCLUSIONS: Our smoke-free health education intervention for nonsmoking pregnant women significantly reduced SHS exposure before and after birth. This intervention model can become part of a standard protocol for the care of pregnant women in hospital settings.

Tobacco control and tobacco farming in African countries.

During the past decade, tobacco leaf production has shifted from high-income countries to developing countries, particularly those in Africa. Most African governments promote tobacco farming as a way to alleviate poverty. The economic benefit of tobacco farming has been used by the tobacco industry to block tobacco control policies. The tobacco industry is active in promoting the alleged positive aspects of tobacco farming and in 'protecting' farmers from what they portray as unfair tobacco control regulations that reduce demand. Tobacco farming has many negative consequences for the health and well-being of farmers, as well as for the environment and the long-term well-being of the countries concerned. We provide an overview of tobacco farming issues in Africa. Encompassing multi-dimensional issues of economic development, there is far more to it than tobacco control questions.

WHO Framework Convention on Tobacco Control in China: barriers, challenges and recommendations.

AIM: The aim of this study was to analyze the barriers in the implementation of the Framework Convention on Tobacco Control (FCTC) in China and present recommendations on ways to address these challenges in tobacco control in China. METHODS: We review the available literature on progress and explore the barriers and challenges that impede a speedier pace in the adoption of the effective tobacco control measures, and present recommendations based on in-depth knowledge of decision-making process on the implementation of FCTC in China. RESULTS: The pace of progress in China is too slow. China faces intractable political, structural, economic and social barriers in tobacco control, which make the whole-hearted implementation of FCTC measures a painstaking process. DISCUSSION: The authors recommend a comprehensive approach to speed up the implementation of tobacco control measures. This includes strong political leadership from the top, structural changes to the tobacco industry and government oversight of the tobacco industry, as well as advocacy and support for tobacco control from civil society at the grassroots level.

Potential unintended consequences of smoke-free policies in public places on pregnant women in China.

BACKGROUND: Smoke-free policies in public places have become more common in China. Little is known, however, about the potential unintended consequences of such policies on pregnant women. METHODS: The study was conducted in 2006 in Chengdu, China. Nonsmoking pregnant women (N=55) whose husband were smokers participated in a study of their knowledge about secondhand smoke and smoke-free policies, their exposure to secondhand smoke, and their husbands' smoking status at home. This study presents descriptive statistics, analyses based on family income and pregnant women's education level, and the findings of focus group discussions that examined the potential unintended consequences of the smoke-free policies on pregnant women. RESULTS: Exposure to secondhand smoke at home was reported by 69.1% of the pregnant women. Both family income and the education level of the pregnant women had a significant (p<0.05) association with exposure to secondhand smoke. The four main potential unintended consequences of the smoke-free policies were: (1) increased exposure of pregnant women to secondhand smoke at home; (2) reduced work efficiency; (3) adverse effect on family harmony; and (4) poor air quality at home. CONCLUSIONS: Education is needed to increase knowledge of secondhand smoke among smokers and nonsmokers alike. When the smoking location is shifted from public places and workplaces to home, women, and in particular pregnant women, become the victims. Policymakers should recognize such potential unintended consequences and take necessary measures to increase awareness about the harms of secondhand smoke.

A pilot intervention for pregnant women in Sichuan, China on passive smoking.

OBJECTIVE: The study aimed to reduce women's exposure to passive smoking, which has been linked to increased risk of cancer and other diseases. By exploring the knowledge, attitudes and behaviors of pregnant women with regard to secondhand smoke in the home environment, a model for intervention during the pregnancy was designed with the help of the intended beneficiaries and was piloted. METHODS: The study had two phases. Phase 1 included focus group discussions and an iterative process to design an intervention. Phase 2 was the intervention itself, which included a series of motivational and patient communication activities, a resource booklet, clinician counseling, telephone hotline and regular telephone counseling. Pre- and post-intervention questionnaires were used to measure results. RESULTS: Post-intervention questionnaires showed a significant increase in knowledge, a change in attitudes towards stronger disapproval and an increased likelihood of taking assertive action when exposed to secondhand smoke in the family. PRACTICE IMPLICATIONS: The results of this study point to the fact that there is a need to give emphasis to passive smoking in the home environment and that the women's pregnancy is an effective conduit to increasing knowledge and bringing about change. The intervention model can become a part of the standard protocol for the care of pregnant women in hospital settings.