“Creating Smokefree Living Together”: A Randomized Trial of Chinese American Adult Household Pairs

Introduction: Chinese American men smoke at high rates, which puts household nonsmokers at risk.  These households may need education and support after immigrating to the U.S. in adjusting to smokefree social norms.  This study evaluated the efficacy of a smokefree household intervention targeting adult household pairs.

Method:  A randomized controlled trial, conducted at a San Francisco county clinic, enrolled 205 pairs (n=95 intervention, n=110 control) of a Chinese smoker and household nonsmoker. Intervention participants received two group sessions and three follow-up calls, which emphasized secondhand smoke harms, discussed a lab report of baseline urine NNAL/Creatinine levels (reflects long-term exposure), and strategies for a smokefree household. Control participants received brief baseline education about cessation resources and being smokefree together.  Outcomes at 6 months included self-reported smoker’s 30-day smoking abstinence or reduction, and nonsmoker’s elimination of smoke exposure. 

Results: Participants were middle-aged (smokers: 53 years; nonsmokers: 50 years) and half women (smokers: 0%; nonsmokers: 99.5%), spoke English “not too well/not at all” (smokers: 76.4%; nonsmokers 71.9%), and recently immigrated to the U.S. (smokers: 11 years; nonsmokers: 9 years). Smokers mostly smoked daily (75.5%, average 10 cigarettes).  NNAL was detected in 96.1% of smokers and 70.2% of nonsmokers (median NNAL/Cr:  64.3 pg/mg smokers, 2.4 pg/mg nonsmokers). Although there were no significant differences in 30-day smoking abstinence, more smokers in the intervention group reported reducing cigarettes as a quit strategy (59.1% vs. 43.0%, p=0.02) and reducing daily cigarette consumption (-4.9±7.5 vs. -2.3±5.3, p=0.01).  Smokers in both groups reported increases in smokefree home rules (65% baseline to 76% at 6 months, p=.01).  Nonsmokers in the intervention group reported more attempts to eliminate household smoke (50.5% vs. 35.9%, p=0.04).   

Conclusion: This smokefree intervention demonstrates promising results for smokers reducing tobacco use and nonsmokers reducing smoke exposure in the household at 6 months.