Children Learning About Second-hand Smoke: Cluster randomised-controlled trial

吸入他人呼出的烟雾称为二手烟。二手烟(SHS)含有有害化学物质，严重危害非吸烟者的健康。据估计，全球每年有超过80万人死于SHS。儿童受到的影响最大；因接触SHS而死亡的人中几乎有三分之一发生在儿童中。儿童SHS造成的疾病总负担中，有很大一部分是由于哮喘、胸部感染和肺癌等肺部疾病造成的。接触SHS也会导致儿童脑膜炎。与生活在无烟环境中的儿童相比，暴露在SHS环境中的儿童更有可能住院，达不到他们的学习潜力，并开始吸烟。认识到SHS是对公共健康的威胁，大多数国家都禁止在封闭的公共场所吸烟，这大大减少了成年人接触SHS的机会。然而，对于许多儿童来说，汽车和家庭仍然是他们最有可能呼吸SHS的地方。保护他们免受SHS的唯一可能的方法是让汽车和家庭完全无烟。在过去的几年里，我们一直在与学校、家长和儿童合作开发和测试一种基于学校的干预措施，名为“无烟干预”(SFI)。它包括六节由学校教师授课的教学课程，四项有趣的活动和一项教育带回家的资源。教学课程有助于增加学生对吸入二手烟造成的危害的认识。有趣的活动包括讲故事、角色扮演、问答和游戏。这些活动有助于激励儿童采取行动，并在与成年人交谈时感到自信，说服他们不要在家里吸烟。带回家的资源帮助孩子们展示他们在学校学到的东西，并与他们的家人谈判，让他们签署一项自愿合同，让他们的家无烟。这项工作的结果表明，鼓励儿童与家人讨论限制在家中吸烟的方法是可能的。我们的试点研究还表明，有可能招募和留住学校和儿童，并为这类研究收集必要的数据。受我们试点工作的启发，我们现在提议在孟加拉国和巴基斯坦进行一项大型研究，在那里SHS是一个主要的公共卫生问题，也是政策制定者的优先事项。通过我们在这些国家多年的工作，我们与学校、当地社区和政策制定者建立了合作关系。我们希望研究SFI在减少儿童在家中接触SHS方面的有效性。我们还有兴趣了解SFI是否可以改善儿童的肺部健康、学习成绩和总体生活质量，以及是否可以减少他们对医疗服务的使用。为了准确回答这些重要问题，我们将招募66所学校和2,636名9至12岁的儿童。我们会随机将学校分配给两个分支机构：ARM 1和ARM 2。ARM 1的学校教师将接受有关SFI的培训和资源。然后，学校教师将在教室里向孩子们传授SFI。那些在手臂2中的人，不会向孩子们提供任何关于SHS的信息。他们将收到SFI，只有在试验完成后才能交付。我们还将使用客观测量方法，包括测试儿童唾液中的可替宁(一种从尼古丁中提取的化合物)，以评估我们的干预措施是否减少了他们的SHS暴露。我们还将记录他们的咳嗽、喘息等呼吸道症状，并测量他们的肺功能和生活质量。我们将使用国际商定的标准进行如上所述的测量。在研究期间，我们会定期重复这些评估。利用经济学，我们还将评估SFI是否物有所值。我们将与一些儿童组织讨论小组，询问他们谈判无烟家庭的经验；并采访一些家长和教师，调查实施SFI可能存在的障碍。

Breathing in other people's exhaled smoke is called second-hand smoking. Second-hand smoke (SHS) contains harmful chemicals and is a serious health hazard to non-smokers. SHS is estimated to cost more than 800,000 lives per year, worldwide. Children are worst affected; almost a third of deaths from SHS exposure occur in children. A large proportion of the overall burden of diseases due to SHS in children is due to lung diseases such as asthma and chest infections and lung cancer. SHS exposure can also lead to meningitis in children. Children exposed to SHS are more likely to be hospitalised, fall short of their academic potential and take up smoking themselves as compared to those living in smoke-free environments. Recognising SHS as a public health threat, most countries have introduced bans on smoking in enclosed public spaces, which has significantly reduced adults' exposure to SHS. However, for many children, cars and homes remain the most likely places for them to breathe SHS. The only possible way to protect them from SHS is to make cars and homes completely smoke-free.For the last few years, we have been working with schools, parents and children to develop and test a school-based intervention called, 'Smoke-Free Intervention (SFI). It consists of six teaching lessons delivered by schoolteachers, four fun activities and one educational take home resource. Teaching lessons help to increase pupils' knowledge about the harms caused by breathing second-hand smoke. Fun activities include storytelling, role-playing, quizzes and games. These activities help to motivate children to act and feel confident in talking to adults to persuade them not to smoke inside homes. The take-home resource helps children to show what they have learned in school and to negotiate with their families to "sign-up" to a voluntary contract to make their homes smoke-free. The results of this work show that it is possible to encourage children to discuss with their families ways of restricting smoking inside their homes. Our pilot study also showed that it is possible to recruit and retain schools and children and collect the necessary data for such studies. Inspired by our pilot work, we now propose a large study in Bangladesh and Pakistan where SHS is a major public health problem and a priority for policy makers. Through our work in these countries for several years, we have established collaborations with schools, local communities and policy makers. We wish to examine how effective SFI is, in reducing children's exposure to SHS in homes. We are also interested to see if SFI can improve children's lung health, academic performance and general quality of life, and if it can reduce their health service use. To provide accurate answers to these important questions, we will recruit a total of 66 schools and 2,636 children between 9-12 years of age. We will randomly allocate schools to two arms: arm 1 and arm 2. School teachers in arm 1 will receive training and resources on SFI. School teachers will then deliver SFI in classrooms to the children. Those in arm 2, will not deliver anything about SHS to the children. They will receive SFI to deliver only after the completion of the trial. We will also use objective measurements including testing children saliva for cotinine (a chemical compound derived from nicotine) to assess whether our intervention has reduced their SHS exposure. We will also record their respiratory symptoms such as coughing and wheezing and measure their lung functions and quality of life. We will undertake these measurements as described above using internationally agreed standards. During the study, we will repeat these assessments at regular intervals. Using economics, we will also assess whether SFI is value for money. We will run discussion groups with some children to ask about their experience of negotiating a smoke-free home; and interview some parents and teachers to investigate the likely obstacles to implementing SFI.