Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

 

Abstract

Background

Children's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide.

Objectives

To determine the effectiveness of interventions aiming to reduce exposure of children to ETS.

Search methods

We searched the Cochrane Tobacco Addiction Group trials register and conducted additional searches of two health and education databases not included in this specialised register. Date of the most recent search: October 2007.

Selection criteria

Interventions tested using controlled trials with or without random allocation were included in this review if the interventions addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0-12 years). All mechanisms for reduction of children's environmental tobacco smoke exposure, and smoking prevention, cessation, and control programmes were included. These include smoke-free policies and legislation, health promotion, social-behavioural therapies, technology, education and clinical interventions.

Data collection and analysis

Two authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcomes, no summary measures were possible and results were synthesised using narrative summaries.

Main results

Thirty-six studies met the inclusion criteria. Four interventions were targeted at populations or community settings, 16 studies were conducted in the 'well child' healthcare setting and 13 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics do not make clear whether the visits are to well or ill children, and another includes both well and ill child visits. Nineteen of these studies are from North America and 12 in other high income countries. Five studies are from low- or middle-income countries. In 17 of the 36 studies there was reduction of ETS exposure for children in both intervention and comparison groups. In only 11 of the 36 studies was there a statistically significant intervention effect. Four of these successful studies employed intensive counselling interventions targeted to smoking parents. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness and other child illness settings as contexts for parental smoking cessation interventions. One successful intervention was in the school setting, targeting the ETS exposure of children from smoking fathers.

Authors' conclusions

While brief counselling interventions have been identified as successful ifor adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. However, there is limited support for more intensive counselling interventions for parents in such contexts. There is no clear evidence of differences between the respiratory, non-respiratory ill child, well child and peripartum settings as contexts for reduction of children's ETS exposure.

 

Plain language summary

Can interventions for parents and people caring for children reduce children's exposure to tobacco smoke

Currently the evidence does not determine which interventions are most effective for decreasing parental smoking and preventing exposure to tobacco smoke in childhood. Children exposed to cigarette smoke are at greater risk of lung problems, infections and serious complications including sudden infant death syndrome. Preventing exposure to cigarette smoke in infancy and childhood might therefore significantly improve children's health worldwide. Although several interventions, including parental education and counselling programmes, have been used to try to reduce children's tobacco smoke exposure, their effectiveness has not been clearly demonstrated. The review was unable to determine that one intervention reduced parental smoking and child exposure more effectively than others, although four studies were identified that reported intensive counselling provided in clinical settings was effective.

 

摘要

背景

以家庭和照顧者吸菸控制方案以減兒童暴露於吸菸環境

一些兒童不良健康的情形與兒童接觸到其他人的香菸菸霧(吸菸環境，ETS)有關。父母吸菸是常見讓兒童暴露到吸菸環境的來源。預防讓嬰兒和兒童暴露於香菸菸霧有很大的潛力可改善全世界兒童的健康。

目標

要確定減少兒童暴露到吸菸環境的介入效果。

搜尋策略

我們搜尋Cochrane Tobacco Addiction Group 中註冊的試驗及不包括在這資料庫，包含衛生跟教育執行中的其他試驗。最近一次搜尋是在2007年10月。

選擇標準

被納入此回顧是使用有介入的對照隨機試驗或不隨機分配試驗，參與者(父母和其他家庭成員、兒童照顧工作者和教師)參與照顧和教育嬰幼兒(年齡0 – 12歲)。所有的機制，減少兒童暴露於環境菸草菸霧，與吸菸的預防，停止和控制方案都包括在內。這些介入措施包括無菸政策和立法、促進健康、社會行為療法、科技、教育和臨床介入。

資料收集與分析

兩位作者獨立評估研究，並提取資料。由於異質性的研究方法和結果，沒有總結測量的結果，而是以敘述性結論統整結果。

主要結論

36個研究符合納入標準。4個試驗針對人口或社區環境，16個試驗是在健康兒童保健機構進行研究，13個試驗是在生病兒童保健機構進行研究。2個進一步的研究在兒科診所進行，不清楚是否是健康或生病的兒童，另外1個研究是包括健康和生病的兒童。19個這些研究是來自北美州和12個研究則是來自其他高收入國家。5個研究來自低或中等收入國家。36個研究中的17個，在介入和比較兩組都減少兒童吸菸環境暴露。僅在11個研究介入是有統計意義。其中4個研究對吸菸父母以深入密集的諮商輔導處理。我們在健康兒童、有呼吸系統疾病兒童或其他兒童疾病的機構進行父母的戒菸介入，在介入有效性中發現幾乎沒有證據顯示差異。一個成功的介入是在學校機構，主要針對暴露於吸菸環境的兒童的吸菸父親。

作者結論

雖然由醫師來做簡短的諮商輔導介入已被確定為成年人成功的介入方式，但是這不能外推到在兒童健康環境作為父母的成年人。然而，有限的證據支持父母在這種情況下以更深入密集的諮商輔導介入是有效的。減少兒童暴露於吸菸環境，沒有明確的證據顯示在有呼吸的疾患兒童無呼吸疾患的兒童，以及健康兒童和圍產期幼兒的環境機構內有差異。

翻譯人

本摘要由彰化基督教醫院許文郁翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

目前，證據不能確定哪些介入是最有效能減少父母吸菸和防止兒童暴露於吸菸環境。兒童暴露在香菸菸霧加大肺癌問題、感染和嚴重的併發症的風險，包括嬰兒猝死症候群。防止嬰兒和兒童暴露於香菸菸霧的可能會因此明顯改善全世界兒童的健康。儘管一些措施，其中包括：父母的教育和輔導方案，已被用來嘗試減少兒童暴露於香菸菸霧，但是其效果還沒有清楚地呈現出來。回顧未能確定哪一個介入能減少父母吸菸和兒童減少暴露於香菸環境，雖然4項研究確定深入密集的諮商輔導在臨床環境中是有效的。