Children Learning About Secondhand Smoke (CLASS II): A Pilot Cluster Randomized Controlled Trial.

Area of Science:

• Public Health
• Environmental Health
• Pediatrics

Background:

• Children exposed to secondhand smoke (SHS) face increased respiratory illness risks.
• Limited evidence exists on interventions to reduce SHS exposure in children, particularly in high smoking prevalence countries.
• School-based interventions offer a novel approach to mitigate SHS exposure.

Purpose of the Study:

• To pilot a Smoke Free Intervention (SFI) and trial methods for primary school children in Bangladesh.
• To assess the feasibility of recruiting, randomizing, and retaining participants in a school-based SHS intervention trial.
• To gather preliminary data on the potential effectiveness of SFI in reducing SHS exposure.

Main Methods:

• A pilot cluster randomized controlled trial was conducted in primary schools.
• Schools were randomized to either usual education (control) or the SFI.
• The SFI involved educational sessions delivered by schoolteachers, with salivary cotinine levels used to verify SHS exposure.

Main Results:

• Recruitment, randomization, and retention of schools and Year-5 children were feasible.
• The study followed up 450 children with cotinine levels indicative of SHS exposure.
• While not statistically significant, the SFI arm showed a lower mean cotinine level (-1.31 ng/ml) compared to the control arm.

Conclusions:

• The Smoke Free Intervention (SFI) is a feasible approach for reducing children's secondhand smoke exposure in a school setting.
• The pilot study provides essential data to inform the design and power calculations for a definitive future trial.
• This school-based strategy holds potential for public health impact in reducing childhood SHS exposure.