Designing Spouse-based Educational Intervention to Reduce Second-hand Smoke For Pregnant Women: A Study Protocol For Randomized Control Trial


  • Siti Hajar Mohamed Zain Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Siti Roshaidai Mohd Arifin Department of Special Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia.
  • Hanida Hani Mokhtar Department of Medical Surgical Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia.
  • Mohd Said Nurumal Department of Critical Care Nursing, Kulliyyah of Nursing, International Islamic University Malaysia, Pahang, Malaysia
  • Mohamad Che' Man Department of Family Health Medicine, Kulliyyah of Medicine, International Islamic University Malaysia, Pahang, Malaysia.



Educational intervention, second-hand smoke, pregnant women, smoking spouse


Introduction: Secondhand smoke (SHS) exposure affects not only the maternal wellbeing but also unborn baby. This study aims to develop a spouse-based educational intervention to reduce SHS exposure by examining the understanding and perception of both pregnant women and their smoking spouses.

Methods: Using a sequential exploratory mixed-method research design, this study will be conducted through four phases. In the first phase, a qualitative study will be conducted to examine the understanding and perception of pregnant women and their smoking spouses regarding secondhand smoke exposure. In the second phase, the content of the educational intervention will be designed based on the outcomes of the first phase and from the literature review. Validation of the designed intervention will be conducted by experts to assess the accuracy of the contents in phase 3. After the validation, a pilot study will be conducted to measure the comprehensiveness of the module. The feasibility and effectiveness of the intervention will be measured in phase four by a pre-test and post-test study design.

Expected outcome and conclusion: The designed educational intervention module of SHS exposure can be used as a breakthrough point to empower non-smoking pregnant women to protect themselves from secondhand smoke exposure, and also to facilitate the smoking spouse to change their smoking behavior, and thus promote the smoke-free home.


Berkat, S. The second-hand smoke in pregnancy and its impact toward low birth weight in the district of Aceh Besar, Aceh province, Indonesia. Malaysia Journal of Public Health Medicine. 2018; 17(2): 117-124.

World Health Organization, World Health Statistics 2008 [Avalaible from

Abdullah, B., Muadz, B., Norizal, M.N., Ismail, N., Kornain, N.K. & Kutty, M. Pregnancy outcome and cord blood cotinine level: A cross-sectional comparative study between secondhand smokers and non-secondhand smokers. European Journal of Obstetrics and Gynecology and Reproductive Biology. 2017.

Ueno, M., Ohara, S., Sawada, N., Inoue, M., Tsugane, S. & Kawaguchi, Y. The association of active and second-hand smoking with oral health in adults: Japan public health center-based study. Tobacco Induced Diseases. 2015. 13:19.

Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—the United States, 2005–2015. Morbidity and Mortality Weekly Report. 2015;65(44):1205–1211.

Öberg, M., Jaakkola, M.S., Woodward, A., Peruga, A. & Prüss-Ustün, A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. 2011; 377: 139–46

Abu-Baker, N.N., Haddad, L.& Savage, C. The Influence of second-hand smoke exposure on Birth Outcomes in Jordan. Int. J. Environ. Res. Public Health. 2010; 7: 616-634.

U.S Department of Health and Human Services (USDHH). The health consequences of smoking: 50 years of progress. A report of the surgeon general. U.S Department of Health and Human Services. 2014 [Available from http://

Leonardi-Bee, J., Britton, J. & Venn, A. Secondhand Smoke and Adverse Fetal Outcomes in Nonsmoking Pregnant women: A meta analysis. Pediatric. 2011.

Norsa’adah, B. & Salinah, O. The effects of second-hand smoke exposure during pregnancy on the newborn weight in Malaysia. Malay J Med Sci. 2014; 21(2): 44-53.

Siti Munira, Y., Mohamad Rodi, Isa., Mohd Ariff, F., Mohammad Idris, Z., Mohamad Ikhsan, S., Aimi Nadira, M.R., Nik Shamsidah. N.I., Zaliha, I.& Abu Bakar, A.M. Support for a Campus Tobacco-Free Policy among Non- Smokers: Findings from a Developing Country. Asian Pac J Cancer Prev 2016, 17 (1), 275-280

Ickes MJ, Hahn EJ, McCann M, et al. Tobacco free take action: increasing policy adherence on a college campus. World medical & health policy 2013, 5, 47-56

Siti Munira, Y., Khairul Mizan, T. & Mohammad Idris, Z. Avoidance of environmental tobacco smoke among non-smoking pregnant women in Malaysia. Asian J. Agri & Biol. 2018: 13-22.

Taylor, A.E., Smith, G.D., Bares, C.B., Edwards, A.C. & Munafòa, M.R. Partner smoking and maternal cotinine during pregnancy: Implications for negative control methods. Drug and Alcohol Dependence. 2014; 139: 159–163

Zhang, L., Hsia, J., Tu, X., Xia, Y., Zhang, L., Bi, Z., Liu, H., Li, X. & Stanton, B. Exposure to Second-hand Tobacco Smoke and Interventions Among Pregnant Women in China: A Systematic Review. Prev Chronic Dis. 2015; 12:140377.

Soltani, F., Barzegar, F., Sangestani, G., Roshanaii, G. & Maleki, A. The effectiveness of family counselling on reducing exposure to secondhand smoke at home among pregnant women in Iran. Tobacco Prevention & Cessation. 2019: 5: 41

Nichter, M., Greaves, L., Bloch, M. & Paglia, M. Tobacco use and secondhand smoke exposure during pregnancy in low- and middle-income countries: the need for social and cultural research. Acta Obstetricia et Gynecologica. 2010; 89: 465–477

Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I. & Petticrew, M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008; 337:a1655

Tong, V.T., Dietz, P.M., Rolle, I.V., Kennedy, S.M. & Thomas, W. Clinical interventions to reduce second-hand smoke exposure among pregnant women: a systematic review. Tobacco Control. 2015; 24:217–223.

Bartholomew, L.K., Kok, G. & Markham, C.M. Planning health promotion programs: An intervention mapping approach. 4th ed. John Wiley and Amp; Sons Inc. 2016.

Walthouwer, M.J.L., Oenema, A., Soetens, K., Lechner, L. & Vries, H.D. Systematic development of a text-driven and a video-driven web-based computer-tailored obesity prevention intervention. BMC Public Health. 2013; 13: 978.

Bedfont Scientific Ltd, 2011.

Suriani I, Nor Afiah M.Z, Aidalina M, Nurul Diyana Abu Bakar Al Sidek & Dhevann Raj Ramalingam. Knowledge, attitude, and practices on secondhand smoking among women who are exposed to secondhand smoking at home and workplace. International Journal of Public Health and Clinical Sciences. 2017; 4:1

DiClemente CC, Schlundt D & Gemmell L. Readiness and stages of change in addiction treatment. American Journal on Addictions. 2004; 13:103–119

Wee, L.H., West, R., Bulgiba, A. & Shahab, L. Predictors of 3-month abstinence in smokers attending stop-smoking clinics in Malaysia. Nicotine Tob Res. 2011; 13(2):151-6.

Chi, Y. C., Wub, C.L., Chen, C.Y., Lyu, S.Y., Lo, F.E. & Morisky, D.E. Randomized trial of a secondhand smoke exposure reduction intervention among hospital-based pregnant women. Addictive Behaviour, 2015: 117-123

Huang, C.M., Wu, H.L., Huang, S.H., Chien, L.Y. & Guo, J.L. Transtheoretical model-based passive smoking prevention programme among pregnant women and mothers of young children. European Journal of Public Health. 2013; 23(5): 777-782.

Karimiankakolaki, Z., Mazloomy, S.S., Mahmoodabad., Kazemi, A. & Fallahzadeh, H. Designing an educational intervention on second-hand smoke in smokers men on the exposure of pregnant wives: a protocol for a randomized controlled trial. Reproductive Health. 2019; 16:11.

Kazemi, A.,Ehsanpour, S. & Zahrae, N.S.N. A randomized trial to promote health belief and to reduce environmental tobacco smoke exposure in pregnant women. Health Education Research. 2011; 27(1): 151-159.

Dherani, M., Zehra, S.N., Jackson, C., Satyanaryana, V. & Huque, R. Behaviour change interventions to reduce second-hand smoke exposure at home in pregnant women – a systematic review and intervention appraisal. BMC Pregnancy and Childbirth 2017, 17:378

World Health Organization (WHO) recommendations for the prevention and management of tobacco use and second-hand smoke exposure in pregnancy. 2013 [Avalaible from




How to Cite

Mohamed Zain, S. H., Mohd Arifin, S. R., Mokhtar, H. H., Nurumal, M. S., & Che’ Man, M. (2022). Designing Spouse-based Educational Intervention to Reduce Second-hand Smoke For Pregnant Women: A Study Protocol For Randomized Control Trial. INTERNATIONAL JOURNAL OF CARE SCHOLARS, 5(2), 12–19.




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