Exposure of minority ethnic groups to
second-hand smoke, in England
Sarwat Shah
Team: Kamran Siddiqi, Amanda Amos,
Helen Tilbrook, Aziz Sheikh,
Caroline Fairhurst
Funding: Medical Research Council
Outline
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Background to research
Where are we now?
Gaps
Our approach
Findings
Conclusions
SHS- Background to research
1% GBD
Cardiovascular
Lung diseases
•
600000
deaths
Middle ear
infections
Asthma
ALRI
Where we are now?
Prevalence of smoking by sex, 1974 to 2012,
Great Britain
60
50
40
30
20
10
0
1974
1978
1982
1986
All
1990
1994
Men
1998
2002
Women
2006
2010
2012
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 Pakistaniorigin 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
Clusters recruited
(min N = 14)
Participants (households)
approached, eligibility
assessed
Participants (households)
recruited
Household baseline data collection
(Questionnaire and saliva sample collection)
Cluster Randomisation
(Minimisation)
Control Group
(N = 7)
Do not deliver ‘Smoke
Free Homes’
Intervention Group
(N = 7)
Deliver ‘Smoke Free
Homes’
Household follow up data collection
(Questionnaire and saliva sample collection)
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
Prevalence of SHS exposure: ethnicity
Exposed
79
Unexposed
77
71
29
23
21
Bangladeshi
Pakistani
Other minority groups
Mediators/moderators
Smoking behaviour
exposed
Smoker is parent/carer of child
unexposed
Exposed
Unexposed
94
90
77
70
75
65
35
30
23
25
10
Anywhere
6
Some rooms
One room
outside only
Yes
No
Outside space
Exposed
Unexposed
79
73
27
21
Yes
No
characteristics of person giving
saliva sample
Gender
Exposed
Child vs. adult
Unexposed
exposed
unexposed
83
78
73
72
28
27
22
17
Female
Male
child
adult
Education
Exposed
Unexposed
81
72
63
37
28
19
No schooling
18 years of edu
Higher edu
Characteristics of smoker
Gender
Exposed
Education status
Unexposed
Exposed
84
79
75
No schooling
Frequency of smoking
Exposed
26
21
16
Male
75
74
25
Female
Unexposed
25
18 years education
Higher education
Tried quiting smoking in 12
months
Unexposed
Exposed
78
79
57
Unexposed
73
43
22
Everyday
27
21
Sometimes
Yes
No
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