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