Effects of a School-based Intervention Program on Attitude and Knowledge of Household Members Towards a Smoke-free Home: a Cluster Controlled Trial

  • Intarut, Nirun ;
  • Chongsuvivatwong, Virasakdi ;
  • McNeil, Edward
  • Published : 2016.04.11


Background: A school-based smoke free home (SFH) program is useful in empowering the mother and child to reduce secondhand smoke exposure but the effects of pretesting on knowledge and attitude has been largely ignored. We aimed to test whether such a program can be effective in Southern Thailand with an additional assessment of the net effect of the pretest. Materials and Methods: A Solomon four-group design was used. Twelve rural primary schools were assigned to one of the four conditions (each with 3 schools): intervention with and without a pretest, control with and without the same pretest. The intervention was performed in the classroom and home over a period of 1 month. Outcomes were assessed at baseline and 3 months after the intervention on whether the home was smoke free and related knowledge and attitude. Results: The intervention could lead to a smoke-free home without statistical significance. Attitude, knowledge and self-confidence on creating a smoke-free home, and self-confidence in avoidance of secondhand smoke exposure and persuading smokers to not smoke in their home were significantly improved. No pretest effect was observed. Conclusions: Gain in attitude, knowledge and self-confidence among family members from the brief school-based education should be enhanced by other measures.


Smoke-free home;school-based educational intervention;Solomon four-group;Thailand


  1. Alwan N, Siddiqi K, Thomson H, et al (2011). Can a community-based 'smoke-free homes' intervention persuade families to apply smoking restrictions at homes? J Public Health (Oxf), 33, 48-54.
  2. Blanch C, Fernandez E, Martinez-Sanchez JM, et al (2013). Impact of a multi-level intervention to prevent secondhand smoke exposure in schoolchildren: a randomized cluster community trial. Prev Med, 57, 585-90.
  3. Braver MC, & Braver, S.L. (1988). Statistical treatment of the Solomon Four-Group Design:A meta-analytic approach. Psychological Bulletin, 104, 150-4.
  4. Crone MR, Reijneveld SA, Willemsen MC, et al (2003). Prevention of smoking in adolescents with lower education: a school based intervention study. J Epidemiol Community Health, 57, 675-80.
  5. Gao CM, Ding JH, Li SP, et al (2013). Active and passive smoking, and alcohol drinking and breast cancer risk in chinese women. Asian Pac J Cancer Prev, 14, 993-6.
  6. Gehrman CA, Hovell MF (2003). Protecting children from environmental tobacco smoke (ETS) exposure: a critical review. Nicotine Tob Res, 5, 289-301.
  7. Greenberg RA, Strecher VJ, Bauman KE, et al (1994). Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness. J Behav Med, 17, 273-90.
  8. Harutyunyan A, Movsisyan N, Petrosyan V, et al (2013). Reducing children's exposure to secondhand smoke at home: a randomized trial. Pediatrics, 132, 1071-80.
  9. Herbert RJ, Gagnon AJ, O'Loughlin JL, et al (2011). Testing an empowerment intervention to help parents make homes smoke-free: a randomized controlled trial. J Community Health, 36, 650-7.
  10. Huang HL, Yen YY, Lin PL, et al (2012). Household secondhand smoke exposure of elementary schoolchildren in Southern Taiwan and factors associated with their confidence in avoiding exposure: a cross-sectional study. BMC Public Health, 12, 40.
  11. Israsena V (2007). Thai Teachers' Beliefs about Learner-centered Education: Implications for "Success for Life Thailand", University of North Texas.
  12. Kegler MC, Bundy L, Haardorfer R, et al (2015). A minimal intervention to promote smoke-free homes among 2-1-1 callers: a randomized controlled trial. Am J Public Health, 105, 530-7.
  13. Kegler MC, Escoffery C, Bundy L, et al (2012). Pilot study results from a brief intervention to create smoke-free homes. J Environ Public Health, 2012, 951426.
  14. King BA, Mirza SA, Babb SD, et al (2013). A cross-country comparison of secondhand smoke exposure among adults: findings from the Global Adult Tobacco Survey (GATS). Tob Control, 22, 5.
  15. Kurtz ME, Kurtz JC, Contreras D, et al (2003). Knowledge and attitudes of economically disadvantaged women regarding exposure to environmental tobacco smoke: a Michigan, USA study. Eur J Public Health, 13, 171-6.
  16. Lee J, Lee DR, Lee DH, et al (2015). Influence of maternal environmental tobacco smoke exposure assessed by hair nicotine levels on birth weight. Asian Pac J Cancer Prev, 16, 3029-34.
  17. McCambridge J, Butor-Bhavsar K, Witton J, et al (2011). Can research assessments themselves cause bias in behaviour change trials? A systematic review of evidence from solomon 4-group studies. PLoS One, 6, 25223.
  18. Oberg M, Jaakkola MS, Woodward A, et al (2011). Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet, 377, 139-46.
  19. Pimhanam C, Sangrajrang S, Ekpanyaskul C (2014). Tobacco smoke exposure and breast cancer risk in Thai urban females. Asian Pac J Cancer Prev, 15, 7407-11.
  20. Romanow L (2012). The women of Thailand. Global Majority E-Journal, 3, 44-60.
  21. Solomon RL (1949). An extension of control group design. Psychol Bull, 46, 137-50.
  22. Tahlil T, Woodman RJ, Coveney J, et al (2013). The impact of education programs on smoking prevention: a randomized controlled trial among 11 to 14 year olds in Aceh, Indonesia. BMC Public Health, 13, 367.
  23. Task Force on Community Preventive S (2001). Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke. Am J Prev Med, 20, 10-5.
  24. Tobacco Control Research and Knowledge Management Center (2012). Tobacco consumption control situation in Thailand, Bangkok, Jaruenmunkong Publisher.
  25. World Health Organization (2009). WHO Report on the Global Tobacco Epidemic, 2009: Implementing smoke-free environments.
  26. World Health Organization (2013). Guidelines on protection from exposure to tobacco smoke.
  27. Yilmaz G, Caylan N, Karacan CD (2013). Brief intervention to preteens and adolescents to create smoke-free homes and cotinine results: a randomized trial. J Trop Pediatr, 59, 365-71.
  28. Zulkifli A, Abidin NZ, Abidin EZ, et al (2014). Implementation of smoke-free legislation in Malaysia: are adolescents protected from respiratory health effects? Asian Pac J Cancer Prev, 15, 4815-21.

Cited by

  1. Evaluation of the effectiveness of a WHO-5A model based comprehensive tobacco control program among migrant workers in Guangdong, China: a pilot study vol.18, pp.1, 2018,