Impact of reduced in-home secondhand smoke exposure on low birth weight prevalence and neonate health

PEER Health Research Project

Dr. Yayi Suryo PrabandariDr. Erik Crankshaw

What is PEER Health?

US-funded program to support partnerships between researchers in countries like Indonesia with US researchers.

Goal: To fill evidence gaps that will help

to address important public health problems.

Presentation Map

Background

Research Question & Objectives

Study Approach and Method

Study Benefit

Expected Policy Impacts

Background

Background

Two out of three Indonesian men smoke. Almost all people are exposed to secondhand

smoke (SHS) in their homes. SHS exposure among pregnant women is

highly correlated with low birth weight (LBW). LBW is a major cause of neonatal mortality

and is associated with other neonatal health problems.

SHS exposure in homes can be reduced by a package of “smoke-free home” interventions.

Research Question & Objectives

Research Question

Does reduced exposure to SHS among pregnant women result in a significant reduction in the prevalence of LBW and neonatal morbidity?

Policy relevance – should active efforts to reduce in-home smoking be integrated as a funded, official public health intervention?

Study Objectives

Show lower proportion of …

1. … LBW in intervention area

2. … neonatal morbidity in intervention area

3. … in-home smoking in the intervention area

Study Approach & Method

The study is innovative for Indonesia

First community-based smoking behavior modification research in Eastern Indonesia.

First use of a 3-level approach to reduce pregnant women’s exposure to in-home SHS.

First large-scale study of the relationship between pregnancy outcomes, neonatal health and SHS.

Quasi-experimental approach

Intervention and control communities.

Formative study prior to the intervention.

Subject identification and enrollment.

Four data collection waves in each enrolled household.

Three stage study intervention

1. Mass media campaign Intervention area only, throughout study period Focus on harm during pregnancy and early

childhood Focus on health benefits of smoke-free home

2. “Smoke-Free Home Community” education and declaration

3. Smoke-Free Home contracts – household level.

Enrollment Selection Algorithm

Final Target Households

Formative Data for Study Design

Community-level information for study design Prenatal, antenatal, postnatal care providers &

practices Smoking behaviors, norms, & perceptions Cooking practices (other environmental smoke

sources) Housing structures Household communication & gender roles

Media mapping

Household data collection: 4 waves

Topic Baseline

6th pregna

ncy month

Birth

1 month post birth

Socio-demographic X update update Update

Smoking behavior, intensity

X X X X

Health care use, pregnancy care

X X X X

Cooking practices X X X X

Secondhand smoke exposure

X X X X

Media practices, exposure

X X X X

Understanding SHS impacts

X X X X

Smoke-free contract compliance

X X X

Mother’s, neonate’s health

X

Final Qualitative Data Collection Assess intervention implementation

Barriers and challenges Effectiveness, social acceptability Impacts on social norms for smoking Lessons learned for scale-up

Methods Focus group discussions In-depth interviews

Intended Policy Impacts

• Community survey• Qualitative

methods for exploring community perception and opinion (in-depth interview, FGD)

Initial program

• Join in existing community meeting• Women group

(PKK)• Men group• Wife and husband

(separate and couple)

• Youth • Community leader

• Coordination meeting

Community approach

• Agreement on establishing local regulation

• Issued a petition

Local policy development

Strategy for community: Implementation of Smoke Free House KampongQuit Tobacco Indonesia works with Provincial & District Health Office

Nichter, M., Nichter, M., Padmawati, RS., & Ng, N. Developing a smoke free household initiative: an Indonesian case study. Acta Obstetricia et Gynecologica. 2010; 89: 578–581

Improve support for community-led public health

While health systems are being strengthened, communities can play an increased role in public health protection.

Promote tobacco education to all age groups

Changing social norms to reduce exposure to SHS

Improving neonatal health

Improving adult respiratory health; lowering cancer risks

Empowering people to encourage smokers to respect rights to a safer, smoke-free environment

Smoke-free home intervention as a low-cost way to improve neonatal health Feasible and replicable at scale. Lowers the prevalence of LBW. Improves neonatal health and reduces

need for illness-related health care. A healthier neonatal period

contributes to long-term gains in child growth and development.

Provides evidence of public demand for district health intervention