Reduction in antenatal and early life exposure to secondhand smoke among Chinese children

Lead Research Organisation: University of Glasgow
Department Name: College of Medical, Veterinary, Life Sci


China has been labelled the "smoking dragon". However, while most men smoke, women rarely do so. Therefore, secondhand smoke (SHS) exposure is highest among women and young children. In China, 180 million children and 360 million adults are exposed to SHS. SHS exposure increases the risk of pregnancy complications, childhood illness and death. Most studies aimed at reducing pregnancy and early childhood exposure to SHS have been conducted in western countries and have focused on encouraging smoking women to quit. In China, where few women smoke, interventions need to influence the behaviour of partners. Most women receive antenatal care. This provides a unique opportunity to address the issue of SHS exposure in the home. The aim of this study is to develop an effective intervention that could be embedded in antenatal care in China.

Technical Summary

Antenatal exposure to secondhand smoke (SHS) increases the risk of pregnancy complications including: fetal distress, preterm delivery, low birth weight, intra-uterine growth restriction and low APGAR score. Antenatal and early life exposure increase the risk of neonatal and infant morbidity and mortality, in particular, respiratory conditions including bronchiolitis and asthma. China is the largest consumer of tobacco worldwide. 540 million non-smoking Chinese are regularly exposed to SHS, including 180 million children, two-thirds of women of reproductive age and 60% of never-smoking pregnant women in Guangzhou, with 90% of exposure occurring in homes.1,2 Around 100,000 deaths per annum in China are attributed to SHS exposure. Therefore, effective tobacco control interventions in China could impact greatly on global health. Few studies have focused on interventions to reduce SHS exposure of non-smoking pregnant women. Most have focused on reducing children's exposure by altering women's smoking behavior or home smoking restrictions. In China, smoking prevalence is high (60%) in men but few (4%) women smoke. Therefore, women can only reduce their exposure by negotiating changes in the behavior of partners and other household members. Interventions need to be developed, refined and evaluated to ensure they are feasible, acceptable and effective in China. For example, in China, public awareness of the harmful effects of SHS exposure is much lower and smoking is more common among health professionals. There may be cultural differences in relationships between health-care workers and patients and between women and their partners. China's one-child policy may also influence parental attitudes towards protecting their child's health. This study aims to develop an antenatal intervention and assess its feasibility and acceptability in China with a view to conducting a subsequent pilot study and then multi-centre randomised controlled trial (RCT).


10 25 50
Description Public Health Scotland 
Organisation NHS Scotland
Country United Kingdom 
Sector Public 
PI Contribution study lead, approvals, study methodology, data analysis and interpretation, reporting
Collaborator Contribution data access, participant recruitment
Impact presentations to PHS and Scottish Government, manuscript being drafted
Start Year 2021
Description Invited talks in Longhua, China 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Two of the investigators were invited to give talks in Longhua China to discuss tobacco control interventions and were invited to feed back on interventions planned for that region of China
Year(s) Of Engagement Activity 2015
Description Russell Group - China C9 Workshop 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact We set up and hosted a workshop between representatives of the UK Russell Group universities and the China C9 universities to discuss tobacco control and other major public health threats - the aim was to agree priorities for policy and future research
Year(s) Of Engagement Activity 2015