Clinical interventions to reduce secondhand smoke exposure among pregnant women: a systematic review

Abstract

Objective To conduct a systematic review of clinical interventions to reduce secondhand smoke (SHS) exposure among non-smoking pregnant women. Data sources We searched 16 databases for publications from 1990 to January 2013, with no language restrictions. Study selection Papers were included if they met the following criteria: (1) the study population included non-smoking pregnant women exposed to SHS, (2) the clinical interventions were intended to reduce SHS exposure at home, (3) the study included a control group and (4) outcomes included either reduced SHS exposure of non-smoking pregnant women at home or quit rates among smoking partners during the pregnancy of the woman. Data extraction Two coders independently reviewed each abstract or full text to identify eligible papers. Two abstractors independently coded papers based on US Preventive Services Task Force criteria for study quality (good, fair, poor), and studies without biochemically-verified outcome measures were considered poor quality. Data synthesis From 4670 papers, we identified five studies that met our inclusion criteria: four focused on reducing SHS exposure among non-smoking pregnant women, and one focused on providing cessation support for smoking partners of pregnant women. All were randomised controlled trials, and all reported positive findings. Three studies were judged poor quality because outcome measures were not biochemically-verified, and two were considered fair quality. Conclusions Clinical interventions delivered in prenatal care settings appear to reduce SHS exposure, but study weaknesses limit our ability to draw firm conclusions. More rigorous studies, using biochemical validation, are needed to identify strategies for reducing SHS exposure in pregnant women.

Disparities in Maternal Child and Health Outcomes Attributable to Prenatal Tobacco Use

“…Studies (41-45) have consistently found that higher cigarette taxes reduce the prevalence of prenatal smoking and the number of LBW, PTB and SIDS cases, and two studies (42, 43) found the highest price sensitivity for younger pregnant women. Medicaid policies supporting pharmacotherapy and behavioral therapy (46, 47) and more generally behavioral interventions (48, 49) have been found effective in reducing prenatal smoking. Other potentially effective policies are raising the minimum legal purchase age for tobacco to 21 (50), and media campaigns and graphic health warnings directed at discouraging maternal smoking.…”

Update and extension of the Brazil SimSmoke model to estimate the health impact of cigarette smoking by pregnant women in Brazil

“…For example, demand studies 30,31,32,33,34 have obtained prenatal prevalence price elasticities between -0.13 and -0.7, which are consistent with the elasticities used in SimSmoke, and a recent study 34 found higher elasticities for those of low socioeconomic status. Studies have found that other tobacco control policies, including cessation treatment 35,36 , smoke-free air laws 26 , and media campaigns 37 , are effective at reducing prenatal smoking.…”

Smoke-free legislation and child health

“…30 Although very few studies have evaluated the effectiveness of interventions to reduce SHS exposure during pregnancy, 37 it appears that such interventions have the potential to improve birth outcomes, which include reducing the incidence of very low birthweight and very preterm birth. 38 This suggests that, similar to the perinatal health risks associated with active smoking during pregnancy, those related to SHS exposure are indeed avoidable.…”