Reducing exposure to second-hand smoke for mothers and babies

In India and Bangladesh nearly 50% of women are exposed to second-hand smoke at home. For pregnant women, this exposure is linked to adverse health outcomes such as low birth weight in babies, still birth and sudden infant death syndrome. There is a lack of research on effective and scaleable interventions.

The Newton-Bhabha project team reviewed published information on the issue and interviewed pregnant women, their husbands and family members in rural Comilla in Bangladesh, and urban and semi urban Bangalore in India. They found poor family knowledge of the risks of second-hand smoke and difficulties expressed by women in changing smoking behaviour in the home.

Working with medical experts, psychologists, and behaviour change specialists, the team developed a number of products to support affected pregnant women and educate their families. They produced a picture booklet with information to help the family move towards a smoke-free home, and a letter from the unborn child about the effects of exposure to second-hand smoke. Automated telephone messages to the husband reinforced the key messages. A saliva screening test was introduced for pregnant women to use to show their families their level of exposure to secondhand smoke.

A key outcome was a reduction in cotinine levels in maternal saliva after three months of intervention. The results of this pilot trial, Intervention for Mothers during Pregnancy to Reduce Exposure to Second-hand Smoke (IMPRESS), also indicates that in this small group of women there has been a significant change in the household smoking behaviour of husbands and family members which should improve outcomes for mothers and babies. There has also been valuable learning on the feasibility and acceptability of the tailored interventions that were offered which will be helpful in scaling up the intervention in South Asian countries.

The World Health Organization identifies maternal exposure to second hand tobacco smoke as a major unaddressed public health problem. The intervention developed through our collaborative research holds great promise to address this concern.

Professor Atif Rahman

This project was shortlisted for Newton Prize 2017