Background
Secondhand smoke (SHS) contains more than 70 carcinogens and is classified as carcinogenic to humans by the International Agency for Research on Cancer. Children are particularly vulnerable to SHS exposure, with evidence linking early-life exposure to increased risk of childhood malignancies and elevated cancer mortality in adulthood. Despite awareness campaigns, parental smoking cessation remains suboptimal. Biomarker-based feedback, such as urinary cotinine, may enhance risk perception and motivate cessation by making children’s exposure visible to parents.
Objective
The objective of this study is to compare the quit rate between the smoking parents who receive tobacco cessation health education along with their child’s urinary cotinine report and those only receive health education.
Methods
A pilot randomized controlled pilot trial was conducted between January and August 2024 in two Indian centres (Chennai and New Delhi). Fifty daily smoking parents with a child aged <10 years were enrolled and randomized into intervention (n=25) and control (n=25) arms. Both groups received standardized tobacco cessation health education. In the intervention arm, urinary cotinine was assessed in both smoking parent and child using a rapid strip test, and results were shared with parents as part of counselling. The control arm received health education alone. Participants were followed telephonically at 1, 2, 4 and 12 weeks. Readiness to quit was assessed using the Contemplation Ladder.
Results
Baseline characteristics were comparable between intervention and control arms. During the follow-up, five participants (20%) quit smoking, and a higher proportion had at least one attempt for smoking cessation in the intervention arm compared with the control arm. At the end of follow-up, parents receiving child urinary cotinine feedback achieved a higher smoking quit rate (20% vs. 0%), quit attempts (40% vs. 0%) and maximum quit duration (15 days vs. 0 days) than controls. Also, the average readiness to quit scores at the end of 12 weeks were higher (7 – I definitely plan to change and ready to make some plans) in the intervention arm than the control arm (5 – I often think, but have no plans to change).
Conclusion/ Impact
Providing parents with objective evidence of their children SHS exposure through urinary cotinine feedback may strengthen smoking cessation efforts and thus has the potential to reduce early-life carcinogenic exposure, particularly in low- and middle-income countries.