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

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.

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).