Evaluation of an intensive intervention programme to protect children aged 1-5 years from environmental tobacco smoke exposure at home in Turkey

Abstract

The aim of this randomized-controlled trial was to evaluate the effectiveness of an intensive intervention to reduce children's environmental tobacco smoke (ETS) exposure at their home compared with a minimal intervention. The target population of the study was the mothers of children aged 1-5 who lived in the Cengizhan district of Izmir in Turkey, who smoked and/or whose spouses smoked. It was found that at least one parent of a total of 182 children smoked and 80 of these mothers were taken into stratified sampling based on the number of the smoking parents. Mothers were visited at their homes. During the initial visit, they were educated and urine samples were taken from their children. Following this initial visit, mothers were randomized to the intensive intervention (n = 38) or the minimal intervention group (n = 40). The levels of cotinine in the intensive intervention (P = 0.000) and minimal intervention (P = 0.000) groups in the final follow-up were significantly lower than the initial levels. The proportion of mothers reporting a complete smoking ban at home in the final follow-up was higher in the intensive intervention group than the minimal intervention group (P = 0.000). The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children's exposure to ETS at their home.

Interventions to Reduce Harm from Smoking with Families in Infancy and Early Childhood: A Systematic Review

“…The studies targeted families of young children (1–5 years) or those pregnant or caring for infants [ 49 , 50 , 51 , 52 ]. Four studies targeted populations with lower socioeconomic status [ 51 , 52 , 53 , 54 ] and one study targeted parents of infants at high risk for asthma [ 55 , 56 , 57 ].…”

“…One program used a previously validated SHSe intervention program [ 53 ]. The remaining studies developed new interventions or materials using a range of strategies to engage with families such as motivational interviewing [ 50 , 52 , 53 , 54 ] or counselling [ 49 , 51 , 55 , 56 , 57 , 58 , 59 ]. Four studies used some form of biochemical monitoring and feedback as part of the intervention including home air quality [ 50 , 52 , 54 ] and child urine cotinine [ 49 ].…”

“…Eight studies used biochemical measures either as a primary outcome for the study, or as a secondary outcome to validate parental self-report of smoking behaviour, including household and child measures ( Table 3 ). Biochemical measures based in the household included air particulate matter (PM 2.5 ) [ 54 ] and household nicotine levels [ 52 ], while child biochemical measures included urine cotinine [ 49 , 59 ], hair nicotine concentration [ 50 , 59 ] and salivary cotinine [ 54 ]. One study used maternal salivary cotinine as a secondary outcome measure to verify maternal self-report outcomes [ 58 ].…”

“…One study asked parents to estimate the number of maternal cigarettes that the child was exposed to in one week [ 51 ], while another study sought parent reports of the number of household cigarettes that a child was exposed to in one month [ 60 ]. Other approaches included parent estimate of the frequency of SHSe avoidance [ 61 ], the introduction of household smoking bans [ 49 ] or child SHSe exposure before and after birth [ 55 , 56 , 57 ]. Four studies included current parent current smoking or cessation status [ 51 , 52 , 55 , 56 , 57 , 58 ].…”

“…Most studies reported positive results following interventions. These included increased self-reported household restrictions on smoking, decreased cigarette consumption, or avoidance of SHSe [ 49 , 51 , 53 , 60 ]. Some confirmation was validated through decreased cotinine levels [ 52 , 58 , 59 ] or improved air quality [ 54 ].…”