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

  1. Naomi Priest1,*,
  2. Rob Roseby2,
  3. Elizabeth Waters3,
  4. Adam Polnay4,
  5. Rona Campbell5,
  6. Nick Spencer6,
  7. Premila Webster7,
  8. Grace Ferguson-Thorne1

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 7 OCT 2008

Assessed as up-to-date: 7 AUG 2008

DOI: 10.1002/14651858.CD001746.pub2


How to Cite

Priest N, Roseby R, Waters E, Polnay A, Campbell R, Spencer N, Webster P, Ferguson-Thorne G. Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD001746. DOI: 10.1002/14651858.CD001746.pub2.

Author Information

  1. 1

    University of Melbourne, The McCaughey Centre, Melbourne School of Population Health, Parkville, VIC, Australia

  2. 2

    Alice Springs Hospital and Flinders University NT Clinical School, Department of Paediatrics, Alice Springs, Northern Territory, Australia

  3. 3

    University of Melbourne, The McCaughey Centre, Melbourne School of Population Health, Parkville , VIC, Australia

  4. 4

    Royal Edinburgh Hospital, Edinburgh, UK

  5. 5

    University of Bristol, Health Services Research, Department of Social Medicine, Bristol, UK

  6. 6

    University of Warwick, School of Health and Social Studies, Coventry, UK

  7. 7

    Department of Public Health, University of Oxford, Health Services Research Unit, Oxford, UK

*Naomi Priest, The McCaughey Centre, Melbourne School of Population Health, University of Melbourne, 5/207 Bouverie St, Parkville, VIC, 3052, Australia. npriest@unimelb.edu.au.

Publication History

  1. Publication Status: Unchanged
  2. Published Online: 7 OCT 2008

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Characteristics of included studies [author-defined order]
Davis 1992

MethodsCountry: USA
Setting: Telephone smoking cessation helpline
RCT. Randomized by day of week, but counsellors blinded to the guide being used.


Participants630 smoking mothers with children under the age of 6 years calling helpline


InterventionsCallers to a telephone smoking cessation assistance service were randomized to receive one of 3 self help guides. One was specifically written for the target audience, one from the American Lung Association, one developed by the National Cancer Institute. Callers to the line received individual stage-based counselling and were sent the guide by mail.


Outcomes6 months later the participant was called and interviewed for 10 mins about the use of guide, opinion of the guide, quit attempts and strategies to quit, and current smoking.


Type of intervention1. Community-based


NotesRetention: 630/ 873 (72%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - unclear

Zhang 1993

MethodsCountry: China
Setting: school
CT; schools in one district received intervention, compared with schools in a second district


Participants20382 children in 44 primary schools.
68.8% of Intervention and 65.5% of Control fathers smoked at baseline


InterventionsIntervention: a tobacco prevention curriculum was introduced comprising social and health consequences of tobacco use, training in refusal skills. Smoking control policies for schools were encouraged. Children in intervention schools wrote letters to their fathers asking them to quit smoking, and monitored their smoking behaviour
Control: usual curriculum.


OutcomesAt 8 months:Self report of smoking cessation by smoking fathers, at interview with health educator.


Type of intervention1. Community-based


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskC - Inadequate

Elder 1996

MethodsCountry: USA
Setting: Schools
RCT. Cluster randomization by school


Participants96 elementary schools in 4 states


InterventionsTrial of school-based cardiovascular health promotion, including an intervention designed to limit child ETS exposure:
Intervention:consisted of promoting the adoption of a formal tobacco-free policy for the school. In addition, there were classroom and home-based programmes for students.
Control: schools participated in the evaluation but received no recommendations for policy, classroom or home-based interventions. Control schools were not restricted from taking up tobacco-free policies.


OutcomesAt 2 years: School principals (or delegates) were surveyed with respect to their school's policy on tobacco and degree to which the policy was observed.


Type of intervention1. Community-based


NotesRetention: 96/96; this is the CATCH study


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Conway 2004

MethodsCountry: USA
Setting: Community
RCT


Participants143 Latino parents of children aged 1-9 who reported smoking at least 6 cigarettes a week.


InterventionsIntervention: 6 home and telephone sessions over a 4 month period delivered by lay trained bicultural and bilingual Latina community health workers. Focused on problem solving aimed at lowering target child's exposure to ETS in the household. Intervention methods included contracting, shaping, positive reinforcement, problem solving, and social support to assist families in achieving their ETS goals.
Control: Survey completion only.


Outcomes3 and 12 month follow up.
Child hair nicotine and cotinine.
Parent report of child's past month exposure from all sources in the household over last 30 days as measured by number of cigarettes.
Confirmed reduction based on both parents' reports and children's hair biomarkers


Type of intervention1. Community-based


NotesRetention: 127/143 (89%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskNo mention of randomization process

Woodward 1987

MethodsCountry: Australia
Setting: maternity hospital
CT: allocation by month of delivery


Participants184 parents of newborn babies whose mothers smoked during pregnancy


InterventionsIntervention: mothers in the maternity hospital were given an information kit about the effects of ETS on children, and ways to quit smoking and a letter from the director of the neonatal Intensive Care Unit urging parents to avoid exposing children to ETS. The kit was given to women by a research worker, who explained the material and answered questions. Women were telephoned at 1 month and asked about their progress, use of the kit, and given further information if required.
Control and Follow up only: did not receive the above intervention.


OutcomesAt 3 months:
Infant urine cotinine levels
Maternal quitting, maternal cotinine


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 157/184 (85%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskC - Inadequate

Greenberg 1994

MethodsCountry: USA
Setting: recruited at maternity hospitals, intervention in family home
RCT


Participants933 mothers (141 who smoked) of newborn babies


InterventionsFactorial design, 'Full' vs 'reduced' data collection. Full group visited at home when infants approximately 3 weeks old and had 2 weekly telephone questionnaire.
Intervention: A study nurse visited homes 4 times for 45mins delivering a programme aimed at developing a mother's skills at maintaining a smoke-free environment for her child: information re child ETS exposure, sources of ETS and required the mother's participation. Written resources were left with the mother. Follow up visits were made 1,3 and 5 months later.
Control: the only contact was for data collection.


Outcomes'Full' subgroup were surveyed and urine collected at baseline Data were collected again in homes when infants were 7 and 12 months old. Data on lower resp symptoms were collected by telephone survey every 2 weeks, in full subgroup


Type of intervention2. 'Well child' (peripartum)


NotesFull data for 583/933 (62%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskA - Adequate

Severson 1997

MethodsCountry: USA
Setting: Hospital & well baby clinics
RCT, randomization by practice


Participants2901 mothers of newborn babies who had smoked prior to pregnancy (1875 smokers, 1026 nonsmokers at enrollment


InterventionsIn the first 1 to 3 days after birth in hospital, mothers received a packet containing a brochure and a letter from the paediatrician about the health affects of passive smoking, and a no-smoking sign.
Intervention: Mothers received further materials and brief oral counselling from the paediatrician at the well baby visits at age 2 weeks and 2, 4, and 6 months. Paediatricians received a 45min training session.
Control: received the hospital packet only.


OutcomesAssessment at 6 and 12 months by mailed questionnaire:
Quit rates (sustained at 6 and 12months, and point prevalence at 12months)
CPD, readiness to quit, likelihood of quit attempt.
Secondary outcomes: knowledge of and attitudes towards ETS


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 2003/2901 (69%)
1-tailed T test employed


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskNot used

Armstrong 2000

MethodsCountry: Australia
Setting: Community (Child health nurse home visits)
Type: RCT


Participants181 women recruited from a post-natal ward who had given birth to a single live infant, identified as 'at risk' (1or more of identified physical domestic violence, identified childhood abuse of either parent, sole parenthood or ambivalence to pregnancy as well as 3 or more of maternal age <18 years, unstable housing, financial stress, poor maternal education, low family income, social isolation, history of mental health disorder, drug or alcohol abuse and domestic violence other than physical abuse).


InterventionsIntervention: Home-based intervention focused on establishing trust with families, enhancing parenting self esteem and confidence, guidance for child development including crying and sleep behaviour, promoting preventive child health care and facilitating access to child health centres. Weekly home nurse visits for first 6 weeks, fortnightly for 3 months and then monthly until 6 months post partum.
Control:Usual care.


OutcomesAt 4 months. Health outcomes only reported at 12 months.
Maternal self report of smoking behaviour and observations by research assistants of smoking behaviour in the home
Child health questionnaire


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 160/181 (88%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskComputer-generated random number table

Emmons 2001

MethodsCountry: USA
Setting: family home
Type: RCT


Participants291 smoking parents (or grandparents) living with a child <3 years old, recruited from hospital labour and delivery logs; community health centres and health care providers; self-referral


InterventionsIntervention: received a 30-45min motivational interview at the parent's home with a trained health educator, and 4 follow-up telephone counselling calls (approx. 10min each), aiming to reduce household ETS exposure and increase the smoker's level of readiness for change. Feedback was provided of baseline household air nicotine, parent's CO level and smoking-related respiratory symptoms. Self-help materials targeting ETS reduction and smoking cessation strategies were also provided.
Control: self-help materials only; cessation manual, ETS reduction tip sheet, resource guide.


OutcomesETS exposure measured by air monitors at baseline and 6 months.
Quitting and CPD by parent


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 247/291 (85%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskA - Adequate

Ratner 2001

MethodsCountry: Canada
Setting: Community
Type: RCT


Participants251 mothers who had quit smoking during pregnancy


InterventionsIntervention: Mothers received nurse-delivered telephone support, relapse prevention training and information resources.
Control: Usual care


OutcomesSelf report of smoking status
Biological verification with exhaled CO.


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 238/251 (95%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskRandom assignment via computer software package

Schonberger 2005

MethodsCountry: Netherlands
Setting: Community
RCT; cluster


Participants476 children seen to be at high risk of asthma recruited during the prenatal period


InterventionsIntervention: 3 home visits (2 prenatal and 1 post-natal) with recommendations to reduce 4 main environmental exposures of mite allergens, pet allergens, food allergens, and passive smoking pre- and post-natally.
Control: Usual care


OutcomesParent report of child ETS exposure
Maternal CO
Child IgE
Tidal airway resistance and lung function
Allergen measures


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 443/ 476 (93%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskClusters by subregional ZIP codes

Wiggins 2005

MethodsCountry: UK
Setting: Community
Type: RCT


Participants731 mothers who lived in deprived London districts and met the inclusion criteria after answering an information leaflet


InterventionsIntervention Group 1: Support Health Visitor intervention consisting of monthly supportive listening visits to the mother's home, beginning when the baby was 10 weeks old. The primary focus was on the mother rather than her child, as well as providing practical support and information.
Intervention Group 2: Assignment to one of eight community groups that offered service for mothers with children less than 5 years in the study area.
Control: Usual care


OutcomesChildhood injury, maternal depression and smoking
Uptake and cost of health services, household resources, maternal and child health, experiences of motherhood and infant feeding


Type of intervention2. 'Well child' (peripartum)


NotesRetention: 601/731


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskComputer generated. Minimisation used for possible confounders.

Chilmonczyk 1992

MethodsCountry: USA
Setting: Well baby check
RCT.


Participants103 mothers smoking >=10 cigs/day with infants presenting to a well baby check


InterventionsUrine was collected from all infants and analysed for cotinine.
Intervention: a report of infants' urinary cotinine level with a personalised letter to the mother to be signed were returned to the child's doctor. The letter outlined ways to reduce child ETS exposure (location of smoking, washing hands after smoking, ensure day care home is smoke-free, ask friends to avoid smoking in the presence of the infant when visiting) but did not discuss cessation. The physician called the mother by telephone to further explain the results.
Control: Usual care


OutcomesAt 2 months all participants were contacted to obtain a second urine sample from the infant for analysis.


Type of intervention2. 'Well child' (child health check)


NotesRetention: 56/103 (54%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Vineis 1993

MethodsCountry: Italy
Setting: Immunization Clinic
CT: Non-random assignment


Participants1015 parents of newborn babies (all mothers including nonsmokers recruited) recruited when attending the clinic for the 3 month vaccination of the infant


InterventionsIntervention: counselled for 15min by a nurse on the health effects of active smoking and ETS, 3 booklets, one of which was about the health effects of ETS on children.
Control: did not receive counselling or booklets.


OutcomesAt 2 and 4 years: self-reported cessation


Type of intervention2. 'Well child' (child health check)


NotesRetention: 747/1015 (74%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskC - Inadequate

Eriksen 1996

MethodsCountry: Norway
Setting: Health centres
RCT


Participants443 families with one or more smoking parent presenting with a child to a well baby check at 6 weeks, 2 or 4 years


InterventionsIntervention: 5min counselling from health visitor on harmful effects of parent smoking on children and how to prevent it (stop smoking indoors/ in living rooms or quit completely). 3 brochures distributed (harm of passive smoking, measures to prevent passive smoking, self-help cessation manual) and a list of smoking cessation courses.
Control: given no information unless participants asked for it, until after the period of study. Physicians were asked to withold their usual advice. Self-completed questionnaires were administered at the visit and 1 month later.


OutcomesParent behaviour by self-report at baseline and 1 month.


Type of intervention2. 'Well child' (child health check)


NotesRetention 363/443 (82%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Fossum 2004

MethodsCountry: Sweden
Setting:  Community, Child Health Centres
CT


Participants41 mothers of newborn infants attending participating child health centres


InterventionsIntervention: 'Smoke free children' counselling provided by nurses
Control: Usual care


Outcomes3 months
Self-reported smoking habits (number of cigarettes smoked)
Maternal cotinine levels


Type of intervention2. 'Well child' (child health check)


NotesRetention: 100% for self-report measures. Cotinine follow-up measures: 85% Intervention, 57% Control.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskNot used

Zakarian 2004

MethodsCountry: USA
Setting: Community
RCT


Participants150 smoking mothers with children aged 4 or younger


InterventionsPrincipal investigator and project co-ordinator met with medical directors from each clinic to plan the investigation implentation and then regularly through the study to 'enlist participation and ongoing support'
Intervention: 7 behavioural counselling sessions (3 in-person and 4 over the telephone) over 6 months. Mothers were assisted with developing plans to re-shape their and other household members' smoking behaviours. Mothers were asked to use pictorial charts and to self monitor their smoking and exposure. If paraticipant asked counsellor for help with quitting smoking they were issued a 'Quit Kit' from the American Cancer Society.
Control: Usual care and 3, 6, and 12 month follow-up measures.


OutcomesMother report of smoking status and child's exposure to ETS
Child urinary cotinine concentrations
Air nicotine monitors


Type of intervention2. 'Well child' (child health check)


NotesRetention: 128/150 (85%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskRandom number generation

Abdullah 2005

MethodsCountry: Hong Kong, China
Setting: Community (maternal and child health centres)
Type: RCT


Participants952 parents from a birth cohort who were listed as smokers in the '1997 Birth Cohort Study' of the Department of Community Medicine, University of Hong Kong.


InterventionsIntervention: 20-30 minutes of telephone counselling with information basd on the individuals needs; no NRT information given unless asked and even still information given was kept minimal. Stage-based printed self-help materials (based on baseline) provided just once.
Control: Recieved stage-based printed self-help material only.


OutcomesAt 6 months.
Parental quitting: Self reported 7 day prevalence quit rate, Self reported 24h point prevalence quit rate, Self reported continuous abstinence rate, Bio-chemically validated (either CO or urinine cotinine or both) quit rate. Reported implementation of total or partial smoking ban at home


Type of intervention2. 'Well child' (child health check)


NotesRetention: 837/952


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskserially labelled opaque envelopes

Kallio 2006

MethodsCountry: Finland
Setting: Community, well baby clinics
RCT


Participants1062 families presenting at a well baby clinic in Turku with a child of 5 months old


InterventionsComponent of larger prospective intervention trial aimed at decreasing exposure of children to known environmental cardiovascular risk factors.
Intervention: Parents received booklet about the adverse effects of smoking at age 5 years. Counselling from paediatrician and dietician about major cardiovascular risk factors including smoking generally discussed with parents. Appointment with paediatrician and dietician at 1-3 monthly intervals until age 2 years, then 6 monthly.
Control: Normal health education given to all Finnish families at well baby clinics and through school system. Appointment with paediatrician and dietician at 4-6 monthly intervals until age 2 years, then 6 monthly until age 7, then yearly.


OutcomesFollow up when child 8 years of age.
Parent report of smoking status and habits, reported child exposure to ETS in past 3 days.
Parent serum cotinine.


Type of intervention2. 'Well child' (child health check)


NotesRetention: 625/1062 (59%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskNot described

Winickoff 2008

MethodsCountry: USA
Setting: Hospital and community
Quasi-experimental RCT


Participants101 mothers and fathers of newborns recruited on the post-natal ward who were current smokers or recent quitters


InterventionsIntervention: Brief motivational interview, enrolment in a proactive state quitline, follow-up faxes to their health professionals with tailored treatment measures
Control: Usual care


Outcomes3 month follow up where participants enrolment in the state smoking quit line was assessed and the self-reported smoking status was taken with a salivary cotinine level as confirmation of a self-reported 7-day point prevalence cessation.


Type of intervention2. 'Well child' (child health check)


NotesRetention: 75% Control and 69% Intervention available for follow up


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskEach day of the week was assigned to be control or intervention.

Hughes 1991

MethodsCountry: Canada
Setting: Hospital and home, asthma management programme
RCT


Participants95 children admitted to hospital in the previous 5 years with asthma, and their parents (not all smokers)


InterventionsIntervention: cared for by a paediatric respiratory physician through the 12m study period. In addition, seen at clinic visits and visited at home by a nurse coordinator who provided written information about asthma care and carried out an asthma education session around lung and airway anatomy, asthma episodes and treatment. Patient's home visited at least 3 times. Environmental exposures checklist drawn up; role of cigarette smoke discussed; parents discouraged from smoking in the home and encouraged to participate in a smoking cessation programme.
Control: patients managed by their usual primary care physicians and reviewed by the study physician at intervals.


OutcomesAt 12 months:
Exposure to ETS at home.
(Primary study outcomes were related to asthma management)


Type of intervention3. Child with health problems (respiratory disorders)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

McIntosh 1994

MethodsCountry: USA
Setting: clinic
RCT


Participants92 smoking parents of children with asthma


InterventionsIntervention: child's physician delivered a standardized passive smoking message to parents, consisting of counselling about the effects of passive smoking and advice to quit or smoke outside. Parents given a specifically designed pamphlet that reinforced this message. About 1 month later, parents received a personalized letter from the principal investigator, containing the result and explanation of their child's urine cotinine test. Included was a self-help manual aimed at encouraging smoking outside.
Control: Parents received the physician's message and the pamphlet only.


OutcomesAt 4-6 months:
Self-reported location of smoking, attempts to quit;
Child urine cotinine


Type of intervention3. Child with health problems (respiratory disorders)


NotesRetention: 72/92 (78%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Wahlgren 1997

MethodsCountry: USA
Setting: Paediatric allergy medical clinics
RCT


Participants91 families with children with asthma


InterventionsIntervention: parent and child attended a series of intensive counselling sessions over 6 months designed to reduce child's exposure to parental smoking. Diaries were used in the 2 weeks preceding visits to record parental smoking, child's ETS exposure, child's peak flow readings and child's symptoms. These data were used for tailored counselling.
Control (Monitoring): Used the same monitoring methods but did not receive counselling.
Control (Usual Care): Attended the same frequency of clinics but did not maintain records nor receive counselling.


OutcomesAt 6 months from end of intervention:
Parent self report of cigs smoked in presence of child.
Air nicotine in room with heaviest child exposure measured by environmental monitor.
2 years later, after debriefing about the study, the two comparison groups achieved similar reductions in parent-reported rates of child exposure and the intervention parent-reported child exposure rate was similarly maintained.


Type of intervention3. Child with health problems (respiratory disorders)


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Irvine 1999

MethodsCountry: Scotland
Setting: home
RCT


Participants501 smoking parents of children with asthma


InterventionsIntervention: brief advice from a nurse visiting the family home; information about passive smoking and asthma, financial and health benefits of quitting; information on how to stop smoking; advised to move to a different room or outside the home if they did not intend to quit; advised not to allow visitors to the home to smoke. Given 2 leaflets at baseline- one commercially available and the other to reinforce the brief advice. Questionnaires were completed. Further leaflets were distributed by mail at 4 and 8months after baseline with a letter encouraging them to stop smoking.
Control: participants received the commercial leaflet at baseline but nothing else.


OutcomesAt 12 months: Child's saliva cotinine;
Mother's saliva cotinine
Self-reported quit attempts


Type of intervention3. Child with health problems (respiratory disorders)


NotesRetention: 435/501 (87%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Wilson 2001

MethodsCountry: USA
Setting: Paediatric pulmonary service of a paediatric hospital
RCT


Participants87 parents of children aged 3-12 with asthma and who were ETS exposed. (At baseline 61% of intervention group maternal caregivers smoked vs 42% of controls).


InterventionsAll children examined at baseline by a paediatric pulmonary specialist, and their treatment adjusted as appropriate.
Intervention: Caregiver received 3 nurse-led sessions over a 5 week period, employing behaviour-change strategies and basic asthma and ETS education, along with repeated feedback on the child's urinary cotinine level (measured each session). The child and other family members were sometimes involved.
Control: caregivers received basic asthma advice by a nurse, along with the statement that ETS is to be avoided. Mothers who requested the cotinine result were told whether or not cotinine had been detected.


OutcomesAt 12 months:
Urinary cotinine, acute asthma episodes.
Secondary study outcomes were hospitalisation, prohibition of smoking in the home; CPD; parent-reported exposure of children and asthma control


Type of intervention3. Child with health problems (respiratory disorders)


NotesFollow-up cotinine data obtained in 51/87 (59%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Hovell 2002

MethodsCountry: USA
Setting: Community
Type: RCT


Participants204 families with an asthmatic child from 3 to 17 years of age whose natural parent(s) were Latino or Hispanic, lived with at least 1 smoker and who reported exposure to at least 6 cigarettes in the previous week.


InterventionsIntervention: Asthma management education session delivered in the home including generic advice to reduce child exposure to ETS. Follow-up coaching consisting of 7 in-home sessions of 30-45 mins over 3 months plus follow-up phone call.
Control: Asthma management education session and follow-up visits for measurement only.


OutcomesAt 4, 7, 10 and 13 months.
Parental report of child ETS exposure
Child's urinary cotinine
Air nicotine levels (20% of homes)
Parental saliva cotinine


Type of intervention3. Child with health problems (respiratory disorders)


NotesRetention: 188/204 (92%). 11 participants dropped out prior to randomization, 5 dropped out before outcome measurement.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskExcel spreadsheet

Krieger 2005

MethodsCountry: USA
Setting: Community
Type: RCT


Participants274 low income households containing a child aged 4-12 years who had asthma recruited by media publicity, hospitals and emergency departments.


InterventionsIntervention: High-intensity intervention with community health workers providing in home environmental assessments, education, support for behaviour change (7 sessions) and a full set of resources.
Control: Low-intensity intervention group received a single visit and limited resources.


OutcomesParent self report
Pediatric asthma caregiver quality of life
Self reported asthma related urgent health care service use
Participant report of presence of asthma triggers in the home, including smoking behaviour


Type of intervention3. Child with health problems (respiratory disorders)


NotesRetention: 110/138(80%) in high intensity and 104/136(76%) in low intensity group.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskSequence numbers and group allocation were concealed in sealed, opaque, numbered envelopes prepared centrally and provided sequentially to interviewers.

Groner 2000

MethodsCountry: USA
Setting: hospital
RCT


Participants479 smoking mothers accompanying a child under 12 years to a hospital


InterventionsTwo intervention groups ('Child Health Group' [CHG]; 'Mother's Health Group' [MHG]) and a control group.
Intervention: received a brief (10-15 min) counselling session given by a trained nurse while waiting to see a doctor. Subjects in the CHG were informed of the hazards of ETS on their child, but not themselves; subjects in the MHG were informed of the effects of smoking on their own health but not their child. They were given standard self-help manuals and materials specific to their group allocation. Notably, even mothers in the CHG were not encouraged to change their smoking location. They received reminder postcards at 2 weeks and 4 months post intervention encouraging them to quit.
Control Group: received usual care with no additional advice about smoking.


OutcomesMaternal smoking status; stage of change; CPD; smoking location; knowledge of ETS effects at 6 months.
Assessment by telephone at 1 and 6 months post intervention, blinded assessor, or mailed questionnaire.


Type of intervention3. Child with health problems (ill child health care)


NotesRetention: 232/479 (48%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskB - Unclear

Hovell 2000

MethodsCountry: USA
Setting: Individual counselling in person and by phone
RCT


Participants108 mothers smoking at least 2 CPD with child/ren <4 years, using a supplemental nutrition programme


InterventionsIntervention: Mothers given 7 individualised counselling sessions (3 in person, 4 by phone) designed to reduce child exposure to ETS. Mothers recorded their smoking and child's exposure and were given 'No Smoking' signs and stickers; at subsequent sessions new objectives were set and positive feedback to mothers was given, where appropriate. Total duration 3 months
Control: usual care nutritional and brief advice about smoking and child ETS exposure.


OutcomesChild urine cotinine, reported exposure, parental smoking
Mothers were surveyed at 3, 6 and 12 months, urine collected at baseline, 6 and 12 months .


Type of intervention3. Child with health problems (ill child health care)


NotesRetention: 96/108 (89%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Low riskA - Adequate

Wakefield 2002

MethodsCountry: Australia
Setting: recruited from paediatric outpatient clinics, intervention by mail and phone
CT: alternation by week of attendance at clinic


Participants292 smoking parents of children aged 1-11 with asthma


InterventionsAt baseline urine analysed for cotinine:creatinine ratio.
Intervention: parents sent a letter signed by the study coodinator explaining their child's baseline cotinine-to-creatinine ratio, and encouraging banning smoking at home. 2 booklets enclosed: 1 explained the effects of ETS on children and gave advice to parents on its restriction; the other concerned quitting. The index parent was contacted by telephone 1 week and 1 month later for advice and encouragement.
Control: usual advice about smoking from doctors and nurses.


OutcomesAt 6 months: smoking bans at home:
Secondary study outcomes: parent reports of bans on smoking in car; CPD
child urinary cotinine; parent-reported cessation


Type of intervention3. Child with health problems (ill child health care)


NotesRetention 264/292 (90.4%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskC - inadequate

Kimata 2004

MethodsCountry: Japan
Setting: Hospital outpatient clinic
RCT


ParticipantsChildren with mild atopic eczema/dermatitis syndrome and normal children whose parents smoked 10-15 CPD at home


InterventionsIntervention: Not clear: “Parents of the cessation of passive smoking group agreed to stop smoking”
Control: Usual care


OutcomesAt 1 month:
Child urinary cotinine
Child skin wheal response
Child plasma neurotrophin levels


Type of intervention3. Child with health problems (ill child health care)


NotesNot provided.


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskNot described.

Chan 2005

MethodsCountry: Hong Kong, China
Setting: Hospital (pediatric wards/outpatients)
Type: RCT


Participants80 parents of sick children presenting to a clinic or admitted to a children’s ward of a major Hong Kong hospital


InterventionsIntervention: Individualised motivational intervention for 30 minutes with nurse counsellor; appropriate stage-matched intervention was used to 'increase motivation and lower resistance to quit' telephone reminder 1 week after the intervention.
Control: Healthy diet counseling for their sick children as a placebo intervention.


Outcomes1 month follow up
Parents report of daily cigarette consumption in past 30 days


Type of intervention3. Child with health problems (ill child health care)


NotesRetention: 77/80

Chan 2006a

MethodsCountry: Hong Kong, China
Setting: Hospital (paediatric wards and outpatient departments)
RCT


Participants1483 Mothers of sick children admitted to the ward or attending the outpatient department from all the participating trial centres November 1997 - September 1998.


InterventionsIntervention: Mothers received information from nurses including standardized health advice, booklet about preventing child exposure to passive smoking, booklet to give to fathers on quitting smoking, a no smoking sign to place in the home to remind the father not to smoke and a telephone reminder 1 week later.
Control: Normal care by nurses.


Outcomes3, 6 and 12 month follow up.
Mother self-reports actions taken to reduce child passive smoke exposure.


Type of intervention3. Child with health problems (ill child health care)


NotesRetention:  1273/1483 (86%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskComputer-generated random numbers placed in sealed envelopes. Some possibility of contamination.

Curry 2003

MethodsCountry: USA
Setting:Paediatric clinics serving ethnically diverse population of low income families
RCT


Participants303 Self-identified women smokers whose children received care at participating clinics


InterventionsIntervention: During clinic visit women received brief motivational message from the child’s clinician, a guide to quitting smoking, and a 10 minute interview with a nurse or study interventionist.Women also received as many as 3 outreach telephone counselling calls from the clinic nurse or interventionist in the 3 months following the visit.
Control:Usual care


Outcomes3 and 12 month follow up.
Maternal self-reported 7-day abstinence
Maternal CO testing


Type of intervention4. Mixed / not stated


NotesRetention: 81% at 12 months


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskParticipants chose ping pong ball from brown paper bag

Nuesslein 2006

MethodsCountry: Germany
Setting: Paediatric clinic
RCT


Participants40 mothers attending participating paediatric practice and self reporting smoked at least 10 CPD


InterventionsAll participants received a quit smoking information sheet and had urinary cotinine levels taken.
Intervention: Received results of their cotinine levels within 1 week.
Control: Did not receive results of cotinine levels until completion of data collection.


OutcomesAt 6 weeks.
Maternal self report of tobacco consumption
Urinary cotinine levels


Type of intervention4. Mixed / not stated


NotesRetention: 38/40 (95%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?Unclear riskNot stated.

Yilmaz 2006

MethodsCountry: Turkey
Setting: Hospital
RCT


Participants375 mothers with children attending 'well child' clinic or for any primary complaint


InterventionsIntervention 1: Smoking cessation intervention aimed at child's health
Intervention 2: Smoking cessation intervention aimed at mothers' health
Control: No smoking cessation advice


OutcomesMaternal smoking status
Smoking location change
Post-intervention knowledge change


Type of intervention4. Mixed / not stated


NotesRetention: 128/150 (85%)


Risk of bias

BiasAuthors' judgementSupport for judgement

Allocation concealment?High riskA nurse ‘randomly picked numbers’ from a list of participants to assign the groups

 
Characteristics of excluded studies [ordered by year of study]

StudyReason for exclusion

Philips 1990Met main inclusion criteria but the outcome measure was the report by kindergarten students of their intent to avoid cigarette smoke (leave the room themselves or ask an adult smoker to stop smoking). This outcome measure is believed by the authors to be too unreliable to include this study.

Meltzer 1993Multiple-baseline, quasi-experimental design.

Murray 1993Longitudinal study.

Campion 1994The outcomes are assessed by 2 surveys carried out before and after the campaign. This study targeted pregnant women.

Wilson 1996Baseline results only.

Manfredi 1999This study targets predominantly women, some of whom were mothers.

Cookson 2000Before and after study

Spencer 2000Pilot study only. No further results available.

Emmons 2000Quasi-experimental historical comparison design

Arborelius 2001Longitudinal study.

Badger 2003Conference abstract only. Authors contacted and no further study information provided.

Okah 2003Secondary analysis of an RCT of bupropion for smoking cessation.

Morgan 2004Does not include outcome data related to ETS.

Loke 2005Intervention targets pregnant women and their non-smoking spouses during perinatal period only.

Stepans 2006Pilot study only.

Klinnert 2007Does not include outcome data related to ETS.

Burmaz 2007Minimal data on smoking at either baseline or follow up as smoking only very small component of intervention.

 
Characteristics of ongoing studies [ordered by year of study]
Sockrider 2003

Trial name or titleProject PANDA (Parents and Newborns Developing and Adjusting)

MethodsRCT

Participants485 pregnant women at 28 week gestation reported not having smoked in the last 28 days, but had a history of smoking before pregnancy.

InterventionsIntervention: Mothers received 1 video and 5 newsletters; partners received a different set of videos and newsletters; all information was distributed by mail between 28 week gestation and 6 weeks postpartum. Newsletters included information on protecting the infant from ETS, tips on relapse prevention and a sign to designate the home as smoke free.
Control: Usual care, would have received messages about ETS exposure as part of standard counselling from the paediatric care provider or community education.

OutcomesHome Smoking Control Index: 4 interview questions, responses classified home into 1 of 3 categories regarding their home smoking policy.
Reported tobacco smoking in the home: estimate of average number of hours smoking in the home each day
Validation of self-reported smoking in the home: passive nicotine monitors used to validate self report.

Starting dateNote first paper published, no ETS results as yet.

Contact informationDr Patricia Mullen

NotesEmail contact with authors, no reply at time of publication

Borrelli 2004

Trial name or titleParents of Asthmatics Quit Smoking (PAQS) Study

Methods2-group randomized design. Compares the efficacy of 2 theoretically-based interventions, the Behavioural Action Model (BAM) and the Precaution Adoption Model (PAM).

ParticipantsSmokers who are the primary caregivers of children with asthma
Children are receiving nurse-delivered home-asthma care and education services as part of insurers standard of care. Caregiver smokes at least 3 CPD, is >18, speaks English or Spanish and is not receiving treatment for smoking cessation.

InterventionsBoth groups (BAM and PAM) receive the same level of intervention regardless of the cessation counselling group they are in. This comprises:

  • Provision of asthma treatment and the 'Breath Easy' asthma education programme
  • Self-help smoking cessation treatment manuals (American Lung Association)
  • Free nicotine patch therapy, if they are ready to quit in the next 30 days.


BAM: the counselling intervention is delivered through AHCPR guidelines, more action-orientated.
PAM: the counselling intervention is delivered through motivational interview, uses CO feedback and feedback on ETS levels to increase smokers' risk perceptions.

OutcomesPrimary: Smoking status, change in motivation/ stage of change, ETS
Secondary: Asthma symptoms, health care utilization, school days missed, activity limitations

Starting dateMay 2001

Contact informationBelinda Borelli

NotesEmail contact with author - outcome results not yet available.

Wilson 2005

Trial name or titleCincinatti Asthma Prevention (CAP) Study

MethodsBaseline study results only available. Full intervention details not yet reported.

Participants222 children who have been diagnosed with asthma by physician and are exposed to 5+ CPD, in or around the home. Home has electricity and family have no plans to move in the next 12 months

InterventionsNot yet reported.

OutcomesETS exposure self report
ETS exposure biological verification with hair and serum samples tested for cotinine
Housing characteristics collected by an environmental technician and collection of level of particulate matter
Race and sociodemographic covariates

Starting datePart of ongoing CAP study

Contact informationDr Bruce Lanphear

NotesEmail contact with author - study outcomes not yet available.

Chan 2006b

Trial name or titleImplementing smoking hygiene policies in households with infants exposed to secondhand smoke: intervention targeted at non-smoking mothers

MethodsRCT

Participants208 Chinese families with non-smoking mother, smoking father and infant living together in the same household, and attended a maternal and child health centre

InterventionsMulti-step family smoking cessation intervention delivered onsite by a nurse smoking cessation counsellor. Mothers given guidelines and motivated to implement the household no-smoking policy.

OutcomesImplementation of household no-smoking policy

Starting date2005

Contact informationDr Sophia Chan

NotesEmail contact with author - full outcome results not yet available.

Winickoff 2007b

Trial name or titleCEASE (Clinical Effort Against Secondhand Smoke Exposure) study

Methods2 paediatric practices randomly selected from within the Boston area and then randomly allocated to receive the CEASE intervention or usual care.

ParticipantsPaediatric clinicians and parental smokers

InterventionsThe intervention used available systems of care rather than research staff.The primary outcome was rates of paediatric clinicians giving assistance to parental smokers (defined as discussion of cessation methods beyond simple advice, recommendation or prescription of pharmacotherapy, or enrollment in a quitline or local programme).

OutcomesParental behaviour change: number of cigarettes smoked, smoking cessation

Starting dateUnclear

Contact informationDr Jonathan Winickoff

NotesAt time of the review update only limited results available from conference abstract, study author provided a qualitative paper on development of intervention currently in press and reported that full outcome data were not yet available.

Wipfli 2008

Trial name or titleFAMRI Homes Study

MethodsCross-sectional study with Pilot RCT alongside

ParticipantsNon-smoking women and children in developing countries throughout the world.

InterventionsBaseline study only; intervention not yet reported

OutcomesPassive air monitors to measure household air nicotine
Hair nicotine test for personal ETS exposure (taken from primary female caregiver and 1 child <11 years in the house)

Starting date2006

Contact informationvia Dr Sophia Chan

NotesData on cross-sectional study available only; no information currently available regarding pilot RCT

 
Comparison 1. Results

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Main outcomesOther dataNo numeric data

 
Analysis 1.1 Comparison 1 Results, Outcome 1 Main outcomes.
Main outcomes

Study

Abdullah 2005Biochemically validated quit rate: Intervention 47 (10.6) Control 21 (4.5)
Had not quit but had reduced intake: Intervention 145 (32.6) Control 83 (18.1)
Stopped smoking for at least 24 hours: Intervention 145 (32.7) Control 136 (29.7)
Complete restriction: Intervention 113 (24.6) Control 151 (34.1)
Partial restriction: Intervention 278 (62.7) Control 259 (56.4)

Armstrong 2000Smoking in house around infant (maternal self report verified by researcher observation during home visit)
Intervention 8.6% v Control 23.8% (P<0.05)

Chan 2005No statistically significant evidence of effect.
Quit rate at 1 month post intervention: Intervention 7.5% [95%CI: 0 to 21] v 2.5% [95% CI: 0 to 7] control NS
Reduced smoking consumption by half (self report): Intervention: 15% Control: 10% NS
Reported quit attempts in last 30 days: Intervention 20% Control 7.5% NS
Moved up the stage of readiness to quit: Intervention 17.5% Control 10% NS

Chan 2006aThree most frequently reported actions taken by the mother to protect the child from passive smoking at home: opening the windows (N=641, 43.9%), asking the father not to smoke near the child (N=608, 41.6%), and moving the child away from the smoke (N=482, 33%).
Moved the children away when they were exposed to the fathers’ smoke at home at 3-month follow up (78.4% vs. 71.1%; P= 0.01) NS at 6 and 12 months.
Number of smokers (excluding the father) living with the child at 12 month follow up (11%vs13% P=0.049)
Smokers who smoked at home (Excluding Child’s Father), at 12-month follow up (92% vs 93% NS)
Child’s ETS exposure at home by any smoker 3 mths Intervention 37% vs Control 42% (P=0.02) 6mths 51% vs 53% P=0.48 12 mths 52% vs 58% P=0.03

Chilmonczyk 1992No evidence of effect.
Intervention: 27/52 provided follow-up urine. Control 29/51 provided follow-up urine. Mean log urinary cotinine difference x100: Intervention group 2.05, control 2.17. P=0.26

Conway 2004No significant effect.
Hair nicotine (log ng/mg) 3mth Intervention 0.28, Control 0.32;12mth Intervention 0.23, Control0.23 NS
Hair cotinine (logng/mg) 3mth Intervention 0.04, Control 0.04;12mth Intervention 0.02, Control 0.04 NS
Parent report reduction: % confirmed reducers 3mth Intervention 52%, Control 46%; 12mth Intervention 61%, Control 56% NS

Curry 2003Abstinence rates: 3 mth Intervention 7.7% vs Control 3.4%; 12mth Intervention 13.5% vs Control 6.9% - 12 mth difference statistically significant.
Serious attempt to quit at 12 months Adjusted OR 1.53 (95% CI 0.96 to 2.44)
Ever quit for 24h at 12 months Adjusted OR 0.94 (95% CI 0.59 to 1.5)
Prevalent abstinence 3 months Adjusted OR 2.40 (95% CI 0.85 to 7.8) 12 months Adjusted OR 2.77 (95% CI 1.24 to 6.60)
Sustained abstinence (abstinent at 3 and 12 months) Adjusted OR 1.83 (95% CI 0.29 to 14.30)

Davis 1992No evidence of difference between self-help guides.
Self-reported quit attempts: Guide 1 121/198 (61%), Guide 2 122/204 (60%), Guide 3 147/229 (64%);
Self-reported abstinence for last week:
Guide 1 28/198 (14%),
Guide 2 24/204 (12%),
Guide 3 27/229 (12%)
P>0.05

Elder 1996No evidence of effect on tobacco-free school policy after 3 years:
Intervention 78% of 56 schools,
Control 75% of 40 schools

Emmons 2001Quit rates: Intervention 7.5%, Control 10.1%, P>0.05
CPD: no effect
Kitchen and TV room air nicotine (log transformed units): Intervention 3.7 & 3.1 fell to 2.6 & 2.3, Control 3.0 & 3.5 changed to 6.9 & 3.5. * P<0.05,

Eriksen 1996No evidence of effect.
Quit smoking: Intervention 7/222 (3%) vs Control 1/ 221 (0.5%);
Stopped indoor smoking 4/222 vs 4/ 221;
Any positive change 32/222 (14%) vs 34/221 (15%)

Fossum 2004Self-reported smoking (number of cigarettes) 1 month before childbirth: Intervention 13.1 vs Control 10.8 NS; 3 months after childbirth Intervention 12.8 vs Control 8.2 (significant); Past 24 hrs Intervention 11.8 vs Control 7.8 (significant).
Salivary cotinine: Mean for Intervention reduced from 185 ng/ml to 165; mean for Control increased from 245 to 346 ng/ml.
Weak correlation between mother's reported rate of smoking and cotinine levels for both control and intervention groups.

Greenberg 1994Parents report significant reduction in number of CPD: Intervention 12.5 CPD pre vs 7.7 CPD at 12month follow up, Control 12.3 CPD pre vs 13.3 at follow up P=0.01. Child urinary cotinine does not support this. Baseline mean urinary cotinine/ creatinine (nmol/mmol) Intervention 66 vs Control 51; at follow up Intervention 107 vs 98 Control. p=NS
Prevalence of persistent lower respiratory symptoms Intervention 17.8%, Control 30.9% [difference 13.1%, 95% CI -1.0 to 27.0]

Groner 2000No evidence of effect.
Self-reported quit rates: Intervention Child Health Group 7/153, Mother's Health Group 4/164, Control 7/ 162. P=NS
Self-reported CPD reduced in all groups;
Self-reported not smoking indoors reduced: Intervention CHG 24, MHG 12, Control 13. P<0.05

Hovell 2000Reduction in parent-reported child exposure to cigarettes in the home and in total. At home reported exposure Intervention baseline 3.9 CPD, follow up 0.52 CPD vs Control 3.51 CPD baseline, 1.20 CPD follow up. The trend for parent-reported total CPD exposure was similar.
Reports not supported by child urinary cotinine concentrations (ng/ml). Intervention baseline 10.93, follow up 10.47 vs Control baseline 9.43, follow up 17.47; 56% reduction (95% CI 48 to 63)

Hovell 2002No significant effect.
Decline in reported ETS exposure from (Intervention) 97% to 52% vs (Control) 93% to 69% at end of intervention (month 4).
At follow up month 13, 9 months post-intervention (Intervention) 52% to 45% and (Control) 69% to 54%.
Average parent-reported exposure levels declined over the follow-up period from 0.57 to 0.47 CPD (Intervention) and 1.11 to 0.71 CPD (Control). These results show a difference of mean 0.34 CPD reduction in exposure by report.
Biological verification of child exposure reveals a less successful outcome. Child cotinine levels fell in the intervention group immediately post-intervention (month 4) 1.44 to 1.19 ng/mL, and rose in control group 1.17 to 1.35 ng/mL. Between end of intervention and follow up 9 months later levels fell 1.19 to.97 ng/mL (intervention) and 1.35 to 0.86 ng/mL (control). There was no significant difference in the mothers' rate of smoking cessation between groups.

Hughes 1991No evidence of effect on homes with smoker: Intervention baseline 60% of 47 homes, follow up 52% vs Control baseline 57% of 48 homes, follow up 51% P=NS

Irvine 1999No evidence of effect.
Mean decrease in child salivary cotinine (ng/ml): Intervention 0.70 vs Control 0.88. Difference= 0.19, 95% CI -0.86 to 0.48
Mean increase in mothers' salivary cotinine (ng/ml): Intervention 3.1 vs Control 1.8. Difference= 1.3, 95% CI -26.4 to 23.9
Self-reported quit attempts: Intervention 101/213 vs Control 97/222, P=NS

Kallio 2006At child 8 years of age 10.1% (29/287) of mothers and 19.7% (43/218) fathers in the intervention group smoked regularly. The corresponding %s for the control group were 15.1% (45/298) mothers and 25.1% (60/239) fathers. Additionally 5.9% (17/287) of intervention group mothers and 8.3% (18/218) of intervention group fathers smoked occasionally compared with 5.7% (17/298) of control group mothers and 6.7% (16/239) of control group fathers (NS).

Kimata 2004After 1 month urinary cotinine levels reduced 285±43 ngmL-1 to 2.2±0.85 ngmL-1 in AEDS cessation group, 257±31 ngmL-1 to 1.8±52 ngmL-1 in normal child cessation group and 274±42 ngmL-1 vs 298±52 ngmL-1 in control group of children with AEDS. AEDS children showed significant reduction in SCORAD index skin wheal (mm) from 9.9 baseline to 7.5; Control group 9.6 baseline to 9.3. Also significant changes in response to house dust mite & cat dander & lower neutrophil levels.

Krieger 2005Report that 20% of the sample quit smoking and that among smokers who did not go outside to smoke prior to intervention, a quarter did so after education, but data are not provided and it is unclear whether intervention outcomes were different between groups.
Homes where smoking was reported as not allowed at baseline 80% (high intensity group) vs 76% (low intensity group) and at exit 77% (high) vs 80% (low) P=0.33 NS.

McIntosh 1994Number of smokers who moved outside: Intervention 7/30, Control 4/30.
Urinary cotinine concentrations of children of subjects reportedly smoking outside are above 10.0 in 4/6 (range 6.7 to 54) in Intervention children tested, and in 3/3 (range 12.2 to 21.5) control children tested. These levels suggest significant ETS exposure.

Nuesslein 2006Calculated nicotine consumption Intervention: 12 micrograms to 4.65 micrograms vs Control: 12 micrograms to 7.5 micrograms NS
Urinary cotinine levels Intervention 3520 ng/ml to 741 ng/ml vs Control 4572 ng/ml to 724 ng/ml P>0.05 NS
Across the entire sample (both intervention and control groups) there was an overall reduction in self-reported smoking with average number of cigarettes smoked reduced from 17 to 10 per day and significant reduction in calculated nicotine consumption using self report data 12 micrograms to 5.5 micrograms (P<0.05), urinary cotinine 4101 ng/ml to 741 ng/ml (P<0.05).

Ratner 20016 month Follow up: 36% abstinent, 26% occasional, 38% daily smoking. 76% homes smokefree.
12 month Follow up: 20% abstinent, 35% occasional, 46% daily. 76% homes smokefree
No difference between groups.
6 month Follow up abstinence was 41% vs 30% (intervention vs control) but at 12 months abstinence was sustained in 21% vs 18.5% (intervention vs control) NS.
Daily smoking at 6 months was 31% vs 45% (intervention vs control) but at 12 months was 41% vs 50% (intervention vs control). NS
Abstinence reported as 38% vs 27% (treatment vs control) NS.

Schonberger 2005At 6 month Follow up
Maternal post-natal smoking Intervention 52% (14/27) vs. Control 28% (8/30) P=0.04)
Partner smoking Intervention 31% (14/44) vs Control 20% 9/45) NS
Smoking by others Intervention 47% vs Control 50% NS

Severson 1997Cessation at 6 & 12 months: Intervention 25/1073 (2.3%), Control 10/802 (1.2%), P<0.05*, 1-tailed test
Cessation at 12 months: Intervention 59/1073 (5.5%), Control 38/802 (4.7%) NS.
Relapse prevention at 6 & 12 months: Intervention 200/609 (33%). Control 109/417 (26%), P<0.05*, 1-tailed test
Relapse prevention at 12 months: Intervention 261/609 (43%), Control 163/417 (39%)
* when controlling for other variables this effect was lost.
Significant benefits of intervention on CPD, readiness to quit, likelihood of making a quit attempt, attitude towards smoking, knowledge of ETS effects on children.

Vineis 1993Smoking cessation for mothers: Intervention 12/74 vs Control 10/84, OR 1.4, 95%CI 0.6 to 3.5
Smoking cessation for fathers: Intervention 18/173 vs Control 26/244 OR 1.0

Wahlgren 1997Intensive intervention was able to demonstrate a statistically significant but very small reduction in cigarette exposure from parents' cigarettes reported by parents without biological verification. Mean number of parent cigarettes smoked in presence of child fell in Intervention group: 5.8CPD baseline, 3.4CPD at clinic pre-intervention to 1.2 CPD at 6 months following completion of intervention. In control group, parent reported exposure fell from 8.0 baseline, 5.7 pre-intervention to 4.6 CPD at 6 month follow up. P for trend <0.01.
Environmental monitor (1 room with heaviest child exposure) measured air nicotine (mcg/ cubic metre). Intervention group baseline 1.7, follow up 1.9 vs Control baseline 2.3, follow up1.4

Wakefield 2002Home smoking ban:
Intervention 41% at baseline, 49% at Follow up vs Control 40% at baseline, 42% at Follwo up. Relative increase in bans not significant; P=0.40
Car smoking bans: Intervention baseline 33%, Follow up = 52%, Control baseline 37%, Follow up 48%, NS;
Low rates of parental cessation, no difference between groups.
Urinary cotinine measured for 209 children: Mean cotinine/ creatinine Intervention B = 22.8 nmol/mmol Follow up 21.0, Control baseline 25.7, Follow up 21.0, NS, P=0.40

Wiggins 2005No significant effect of either intervention.
Support health visitor group vs control group, RR 0.86 (95% CI 0.86 to 1.19); Community support group RR 0.97 (95% CI 0.72 to 1.33)

Wilson 2001Of 51 children with complete urinary cotinine: creatinine ratio (CCR) data. Log CCR (ng/mg) Intervention baseline 1.82, Follow up 1.27 vs Control baseline 2.34, Follow up 1.93, adjusted Diff -0.38, adjusted P= 0.26.
Proportion with >1 acute asthma visit/ year: Intervention baseline 50, Follow up 29.6, Control baseline 37.2, Follow up 46.5, OR 0.32, P=0.03
No significant differences in hospitalisation, prohibition of smoking in home, or smoking.

Winickoff 2008Prevalence of self-reported 7 day abstinence 38% at baseline and 30% at follow up in the control group vs 31% at baseline and 30% at follow up in the intervention group (Effect size = 13% P=NS) Cotinine-confirmed 7 day abstinence for baseline current smokers NS.
For baseline current smokers 18% in the control and 64% in the intervention group reported making a 24hr quit attempt by follow up (P=.005).

Woodward 1987No evidence of effect.
Mother self-reported quitting: Intervention 6%, Control 2.2%, P=0.25.
Median infant urinary cotinine levels (mcg/litre): Intervention 11.0 (n=48) vs Control 10.0 (n=53), P=NS

Yilmaz 2006Quit smoking: Child intervention group 24.3%; Mother intervention group 13%; Control 0.8%. (χ2 = 29.5, P<0.0001)
Smoking location change: Child intervention: 73%, Mother intervention: 46.6%, Control 11.6% (χ2 =90.1, P<0.0001)
Knowledge change (score on MCQ, possible score 0-100): mean post-intervention score in child intervention 63.51 (±7.35 - not stated whether these ± is standard deviations, or 95% confidence intervals) mother intervention 57.69 (±10.46) control 56.68 (±7.67) (ANOVA showed that these scores differed) P<0.0001
(Note: not an intention-to-treat analysis)

Zakarian 2004Both groups showed significant decline in reported exposure to mother's cigarette's/week (intervention group 18.89 at baseline to 5.41 at 12 months, control group 13.25 at baseline to 5.23 at 12 months) (P<0.001). Total exposure to cigarettes/week (intervention group 53.2 at baseline to 21.99 at 12 months, control 54.48 at baseline to 18.22 at 12 months) (P<0.001) however, no significant difference between groups.
Children's urinary cotinine concentration did not show a sigificant change over time in either group - No significant difference between groups.

Zhang 1993Number (proportion) of smoking fathers: Intervention baseline 6843/9953 (68.8%) & follow up 60.7% vs Control baseline 6274/9580 (65.5%), follow up "approximately the same" [numbers are not stated]
Proportion of fathers who quit smoking for at least 180 days:
Intervention 800/9953 (11.7%), Control 14/6274 (0.2%)

 
Table 1. MEDLINE and CINAHL search strategy

1. randomized controlled trial.pt.
2. randomized controlled trials/
3. random allocation/
4. controlled clinical trial.pt.
5. clinical trial.pt.
6. exp clinical trials/
7. (clin$ adj5 trial$).tw.
8. double blind method/
9. single blind method/
10. ((singl$ or doubl$ or trebl$ or tripl$) adj5 (blind$ or mask$)).tw.
11. placebos/
12. placebo$.tw.
13. random$.tw.
14. research design/
15. follow up studies/
16. exp evaluation studies/
17. prospective studies/
18. retrospective studies/
19. comparative study/
20. Cross-Sectional Studies/
21. (control$ or prospectiv$ or volunteer$).tw.
22. or/1-21
23. exp Smoking/
24. Tobacco Smoke Pollution/
25. 23 or 24
26. Smoking Cessation/
27. Environmental Medicine/
28. exp Environmental Pollution/
29. Public Health/
30. Health Education/
31. Health Promotion/
32. Psychotherapy/
33. or/26-32
34. exp Family/
35. Schools, Nursery/
36. Child Day Care Centers/
37. Child Care/
38. (child$ or carer$ or caregiver$ or parent$ or famil$ or brother or sister or sib$ or nanny).tw.
39. or/34-38
40. 22 and 25 and 33 and 39
41. limit 40 to (newborn infant or infant <1 to 23 months> or preschool child <2 to 5 years> or child <6 to 12 years>)

 
Table 2. EMBASE search strategy

Searched Oct 2007

S1 RANDOMIZED CONTROLLED TRIAL
S2 RANDOMIZATION
S3 CONTROLLED STUDY!
S4 EVIDENCE BASED MEDICINE!
S5 CLINICAL TRIAL!
S6 CLIN? (5W) TRIAL?
S7 ((SINGL? OR DOUBL? OR TREBL? OR TRIPL?) (5W) (BLIND? OR MASK?))
S8 PLACEBOS
S9 PLACEBO?
S10 RANDOM?
S11 METHODOLOGY
S12 COMPARATIVE STUDY!
S13 EVALUATION AND FOLLOW UP
S14 PROSPECTIVE STUDY
S15 CONTROL? OR PROSPECTIV? OR VOLUNTEER?
S16 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15
S17 SMOKING/maj
S18 SMOKING CESSATION/maj
S19 ENVIRONMENTAL HEALTH/maj
S20 POLLUTION/maj
S21 PUBLIC HEALTH/maj
S22 HEALTH EDUCATION!/maj
S23 PSYCHOTHERAPY/maj
S24 S18 OR S19 OR S20 OR S21 OR S22 OR S23
S25 FAMILY!/maj
S26 SCHOOLS/maj
S27 SCHOOL/maj
S28 NURSERY/maj
S29 NURSERIES/maj
S30 DAY CARE/maj
S31 CHILD CARE/maj
S32 HOUSE/maj
S33 HOME/maj
S34 CARER? OR CAREGIVER? OR PARENT? OR FAMIL? OR BROTHER? OR SISTER? OR SIBLING? OR NANNY OR NANNIES
S35 S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34
S36 CHILD!
S37 NEWBORN!
S38 S36 OR S37
S39 S16 AND S17 AND S24 AND S35 AND S38
S1 RANDOMIZED CONTROLLED TRIAL
S2 RANDOMIZATION
S3 CONTROLLED STUDY!
S4 EVIDENCE BASED MEDICINE!
S5 CLINICAL TRIAL!
S6 CLIN? (5W) TRIAL?
S7 ((SINGL? OR DOUBL? OR TREBL? OR TRIPL?) (5W) (BLIND? OR MASK?))
S8 PLACEBOS
S9 PLACEBO?
S10 RANDOM?
S11 METHODOLOGY
S12 COMPARATIVE STUDY!
S13 EVALUATION AND FOLLOW UP
S14 PROSPECTIVE STUDY
S15 CONTROL? OR PROSPECTIV? OR VOLUNTEER?
S16 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15
S17 SMOKING/maj
S18 SMOKING CESSATION/maj
S19 ENVIRONMENTAL HEALTH/maj
S20 POLLUTION/maj
S21 PUBLIC HEALTH/maj
S22 HEALTH EDUCATION!/maj
S23 PSYCHOTHERAPY/maj
S24 S18 OR S19 OR S20 OR S21 OR S22 OR S23
S25 FAMILY!/maj
S26 SCHOOLS/maj
S27 SCHOOL/maj
S28 NURSERY/maj
S29 NURSERIES/maj
S30 DAY CARE/maj
S31 CHILD CARE/maj
S32 HOUSE/maj
S33 HOME/maj
S34 CARER? OR CAREGIVER? OR PARENT? OR FAMIL? OR BROTHER? OR SISTER? OR SIBLING? OR NANNY OR NANNIES
S35 S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32 OR S33 OR S34
S36 CHILD!
S37 NEWBORN!
S38 S36 OR S37
S39 S16 AND S17 AND S24 AND S35 AND S38

 
Table 3. HealthStar search strategy

Searched Oct 2001

1. randomized controlled trial.pt.
2. randomized controlled trials/
3. random allocation/
4. controlled clinical trial.pt.
5. clinical trial.pt.
6. exp clinical trials/
7. (clin$ adj5 trial$).tw.
8. double blind method/
9. single blind method/
10. ((singl$ or doubl$ or trebl$ or tripl$) adj5 (blind$ or mask$)).tw.
11. placebos/
12. placebo$.tw.
13. random$.tw.
14. research design/
15. follow up studies/
16. exp evaluation studies/
17. prospective studies/
18. retrospective studies/
19. comparative study/
20. Cross-Sectional Studies/
21. (control$ or prospectiv$ or volunteer$).tw.
22. or/1-21
23. exp Smoking/
24. Tobacco Smoke Pollution/
25. 23 or 24
26. Smoking Cessation/
27. Environmental Medicine/
28. exp Environmental Pollution/
29. Public Health/
30. exp Health Education/
31. Health Promotion/
32. exp Psychotherapy/
33. or/26-32
34. exp Family/
35. exp schools/
36. child day care centers/
37. child care/
38. home$.mp.
39. house$.mp.
40. (child$ or carer$ or caregiver$ or parent$ or famil$ or brother or sister or sib$ or nanny).tw.
41. or/34-40
42. 22 and 25 and 33 and 41
43. limit 42 to (newborn infant or infant <1 to 23 months> or preschool child <2 to 5 years> or child <6 to 12 years>)

 
Table 4. PsycINFO search strategy

Searched Oct 2007

1. randomized controlled trial.pt.
2. randomized controlled trials/
3. random allocation/
4. controlled clinical trial.pt.
5. clinical trial.pt.
6. exp clinical trials/
7. (clin$ adj5 trial$).tw.
8. double blind method/
9. single blind method/
10. ((singl$ or doubl$ or trebl$ or tripl$) adj5 (blind$ or mask$)).tw.
11. placebos/
12. placebo$.tw.
13. random$.tw.
14. research design/
15. follow up studies/
16. exp evaluation studies/
17. prospective studies/
18. retrospective studies/
19. comparative study/
20. Cross-Sectional Studies/
21. (control$ or prospectiv$ or volunteer$).tw.
22. or/1-21
23. exp Smoking/
24. Tobacco Smoke Pollution/
25. 23 or 24
26. Smoking Cessation/
27. Environmental Medicine/
28. exp Environmental Pollution/
29. Public Health/
30. Health Education/
31. Health Promotion/
32. Psychotherapy/
33. or/26-32
34. exp Family/
35. Schools, Nursery/
36. Child Day Care Centers/
37. Child Care/
38. (child$ or carer$ or caregiver$ or parent$ or famil$ or brother or sister or sib$ or nanny).tw.
39. or/34-38
40. 22 and 25 and 33 and 39
41. limit 40 to (newborn infant or infant <1 to 23 months> or preschool child <2 to 5 years> or child <6 to 12 years>)