Exposure of minority ethnic groups to second-hand smoke, in England
Sarwat Shah
Team: Kamran Siddiqi, Amanda Amos, Helen Tilbrook, Aziz Sheikh, Caroline FairhurstFunding: Medical Research Council
Outline
• Background to research• Where are we now?• Gaps• Our approach• Findings• Conclusions
SHS- Background to research
1% GBDCardiovascularLung diseases
• 600000 deaths
Middle ear infections
AsthmaALRI
Where we are now?
1974 1978 1982 1986 1990 1994 1998 2002 2006 2010 20120
10
20
30
40
50
60
Prevalence of smoking by sex, 1974 to 2012, Great Britain
All Men Women
Gaps
2 Million children in the UK are routinely exposed to SHS
Why are we conducting this research?
• Significant health inequalities – minority ethnic groups
• South Asians - high susceptibility to cardiovascular diseases
• Higher levels of smoking among Bangladeshi- and Pakistani-origin men compared with national average (Sprotson and Mindell 2004)
• 51% households with at least one smoker (Alwan et al)
Our approach- Smoke free homes
Modalities
Target
Output
Imam guide - the delivery
MCLASS-pilot cluster
Control Group(N = 7)
Do not deliver ‘Smoke Free Homes’
Cluster Randomisation(Minimisation)
Intervention Group(N = 7)
Deliver ‘Smoke Free Homes’
Participants (households) recruited
Participants (households) approached, eligibility
assessed
Household follow up data collection(Questionnaire and saliva sample collection)
Household baseline data collection(Questionnaire and saliva sample collection)
Clusters recruited (min N = 14)
Data collection
Type of households• Households with at least one child resident• Adult only
Study participants• Household survey– Lead adult
• Saliva sample– Non smoking adult OR– Child
Data collection
Outcome• Salivary cotinine– Exposed to SHS= 0.1- 12ng/ml– Unexposed= <0.1 ng/ml
Findings
• Households recruited= 209• Saliva samples=89% (187/209)• Exposed to SHS=61% (114/187:95% CI 54-68)
Findings
Bangladeshi Pakistani Other minority groups
79 7771
21 2329
Prevalence of SHS exposure: ethnicityExposed Unexposed
Mediators/moderators
Anywhere Some rooms One room outside only
90 94
7565
10 6
2535
Smoking behaviourexposed unexposed
Yes No
7973
2127
Outside spaceExposed Unexposed
Yes No
77 70
23 30
Smoker is parent/carer of child
Exposed Unexposed
characteristics of person giving saliva sample
No schooling 18 years of edu Higher edu
8172
63
1928
37
EducationExposed Unexposed
Female Male
78 73
22 27
GenderExposed Unexposed
child adult
8372
1728
Child vs. adultexposed unexposed
Characteristics of smoker
Everyday Sometimes
78
57
22
43
Frequency of smokingExposed Unexposed
Yes No
79 73
21 27
Tried quiting smoking in 12 months
Exposed Unexposed
Female Male
8475
1625
GenderExposed Unexposed
No schooling 18 years education Higher education
79 74 75
21 26 25
Education statusExposed Unexposed
Conclusions
• Exposure of ethnic minorities to SHS is high
• 85% children living with a smoker are exposed as compared to 35% (whose parents are smokers) in general population
