Use of nicotine replacement therapy to reduce children’s exposure to second-hand smoke in the home: Findings of a pilot randomised controlled trial conducted in Scotland

This pilot study suggests that using nicotine replacement therapy with support may help reduce children's exposure to second-hand smoke, but recruitment challenges limit the ability to recommend larger trials.

Summary and findings

This pilot randomized controlled trial assessed the feasibility of using free nicotine replacement therapy combined with telephone support to reduce children's exposure to second-hand smoke in the home. The study involved parents/carers who smoke and have children aged 0-16 years. Results indicated a reduction in fine particulate matter (PM 2.5) levels in both intervention and control groups.

Abstract

<h4>Introduction</h4> Children’s exposure to second-hand tobacco smoke is a preventable global public health issue, yet there is no consensus on how best to support families to create a smoke-free home. This pilot randomised controlled trial tested the feasibility of use of free nicotine replacement therapy combined with telephone-delivered support to reduce children’s exposure to second-hand smoke in the home, and inform a future full-scale trial. <h4>Methods</h4> Parents/carers aged 18+ years, who smoke in the home and care for one or more children aged 0-16 years were recruited through existing initiatives and social media. Participants were randomised to either the intervention (Group A) or control (Group B) arm. Group A received free posted-to-home nicotine replacement therapy, alongside fortnightly telephone calls to support smoking abstinence in the home. Group B were signposted to the Scottish Government’s ‘Take it Right Outside’ website which provides interactive advice on creating a smoke-free home. To measure second-hand smoke levels, participants installed an air quality monitor in their living room for 7 days to measure fine particulate matter (PM 2.5 ) at baseline and 12-week follow-up. <h4>Results</h4> Approximately one-quarter (n=27/100) of the intended sample size was recruited. Median PM 2.5 concentrations reduced in both the intervention (-36μg/m 3 ) and control (-16mg/m 3 ) groups. Retention rates and adherence rates to nicotine replacement therapy were 70% and above, with no risks and/or safety concerns reported, suggesting this approach is feasible and acceptable to participants. The estimated cost of delivering this 12-week intervention was £244 per individual. <h4>Conclusions</h4> Although recruitment rates were insufficient to recommend progression to a larger trial to test effectiveness of this approach in Scotland, this study could inform trial development in other countries where smoking in the home is commonplace. Insights regarding the alignment of smoke-free home interventions with broader smoking cessation initiatives could inform future policy and public health approaches. <h4>What is already known on this topic</h4> Children’s exposure to second-hand tobacco smoke (SHS) is a preventable global public health issue, and whilst there is no consensus on how best to support families to create a smoke-free home, the use of nicotine replacement therapy (NRT) for temporary abstinence from smoking in the home has shown promise in UK settings. <h4>What this study adds</h4> Use of free posted-to-home NRT alongside behavioural support by telephone to reduce children’s exposure to second-hand smoke in the home is feasible in terms of retention rates, NRT adherence, andDthe practicalities of intervention delivery within an established National Health Service. Recruitment to the study was difficult and participation rates were insufficient to inform the development of a future trial to study intervention effectiveness, which likely reflects a Scotland-wide reduction in the proportion of individuals who smoke in the home in the presence of children, and perceived stigma in acknowledging this practice to healthcare staff. <h4>How this study might affect research, practice or policy</h4> The effectiveness of this approach should be evaluated in countries where smoking in the home is more prevalent, meaning that recruitment is potentially easier, and where NRT is licenced for use. Using NRT for temporary abstinence from smoking in the home creates conditions conducive to subsequent smoking cessation, highlighting the value of integrating smoke-free home interventions within wider tobacco control policies and public health strategies.

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