Developing trial intervention model "children say no to secondhand smoke"

Abstract

Secondhand smoke (SHS) has a detrimental effect on community health, especially children’s health. Symptoms and diseases caused by children’s exposure to SHS include middle ear disease, adverse respiratory symptoms, increased respiratory infections, worsening of asthma, decreased lung function and sudden infant death syndrome (US DHHS, 2006, US DHHS, 2007). In Vietnam, the prevalence of smoking is 47.4% in adult males and 1.4% in adult females (MOH, 2010). The prevalence of in-home smoking is high (Wipfli et al., 2009, Suzuki et al., 2009), resulting in a high prevalence of children exposed to SHS, from 60% to 70% (Suzuki et al., 2009, Minh et al., 2007). Children in Vietnam, especially at primary school age, may be influential in stopping their parents’ smoking in their presence (Trang et al., 2006). Vietnamese parents tend to listen to, learn from and share opinions with their children on different aspects of living (Xuan et al., 2013). Children of primary school age are seen as effective change agents of behaviour in their contacts including parents and peers in relation to issues of health education (Olayiwole et al., 2003, Onyango-Ouma et al., 2005, Rohde and Sadjimin, 1980, Dickman and Melek, 2013). The primary aim of this research is to provide a mechanism to create a home environment free from secondhand smoke for children, by involving primary school children aged 8 to 11 as change agents to decrease the in-home smoking of their parents and hence their exposure to SHS at home. The specific aims of the study were to: 1. explore children’s self-reported exposure to SHS at home pre- and post-intervention 2. evaluate the pre- and post-intervention knowledge, attitudes and practices (KAP) of children aged from 8 to 11 years in relation to the harmful effects of SHS and the prevention of SHS exposure 3. assess the capacity of children to persuade adults not to smoke indoors in their own homes after the intervention 4. implement the intervention model ‘Children Say No to Secondhand Smoke’ in a district in the North of Vietnam and make suggestions for its improvement A quasi-experimental design was used that included 1,288 children aged 8 to 11 years old in grades 3, 4 and 5 in three selected primary schools in the Chuong My district, Hanoi, Vietnam from August 2011 to May 2012. A mixed method approach was used that included quantitative surveys (self-administered questionnaire) of the children pre- and post-intervention and qualitative data acquisition (focus group discussions and in-depth interviews) from the children involved, parents, teachers, and the director of the Department of Education and Training in the district at the end of the intervention. The three schools used in this study were randomly assigned as: full intervention, partial intervention and control. School-based intervention activities were implemented in the full intervention school over a 6 month period and included weekly lessons on the harmful effects of SHS to children’s health and on the persuasions of smokers about not to smoke in-home. Of the 1,288 children surveyed, 66.0% reported living with smokers. The proportions of children who reported the occurrence of in-home smokers were high in all the three selected schools at the baseline survey (83.0%; 77.5% and 75.2% in the full intervention, partial intervention and control schools respectively). A high pre-intervention percentage of children’s self-reported exposure to SHS at home was recorded (86.4%, 70.3% and 83.5% in the three schools). After the intervention program there was a significant reduction of in-home smokers from 83.0% to 59.8% and of children’s self-reported exposure to SHS from 86.4% to 59.8% in the full intervention school while no significant changes were observed in the other two schools. Children’s knowledge on the harmful effects of SHS and their attitudes and practices on the avoidance of SHS exposure were significantly improved in all three schools after the intervention. However, the most impressive increases in knowledge, attitudes and practices of children was seen in the full intervention school between the post- versus the pre-intervention times respectively (81.4% children had good knowledge vs 3.3%; 66.0% had good attitudes vs 38.5%; and 51.9% of children reported good practices vs 9.8%). Post-intervention, the knowledge, attitudes and practices of children in the full intervention school were significantly higher than that of their counterparts in the other two schools. The roles of children as change agents in persuading their smoking fathers and other smokers not to smoke in-home was recognised and supported by all study participants, including teachers, children and children’s parents and the leader of the district Department of Education and Training.