Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Abstract

BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P , .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD 20.05, CI 20.13 to 0.03, P = .20).CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement. KEY WORDS secondhand smoke exposure, tobacco smoke exposure, metaanalysis, systematic review, child ABBREVIATIONS CCR-cotinine/creatinine ratio CI-confidence interval CT-controlled trial PREP-parentally reported exposure or protection RCT-randomized controlled trial RD-relative difference RR-relative risk SHS-secondhand smoke THS-thirdhand smoke TSE-tobacco smoke exposure Dr Rosen conceptualized and designed the study, oversaw all aspects of the research, performed the systematic review of the literature, extracted data from the original studies, contributed to the statistical analysis, wrote sections of the manuscript, and edited the entire manuscript; Ms Myers contributed to systematically reviewing the literature, extracted data from the original articles, contributed to the data analysis, and contributed to the writing of the manuscript; Dr Hovell contributed to the design of the meta-analysis and interpretation of the data and edited the manuscript for scientific content; Dr Zucker assisted with various statistical issues in the analysis of the manuscript and edited the manuscript; Ms Ben Noach contributed to the design of the study, the systematic review of the literature, data extraction, data analysis, data interpretation, and writing of the m...

Parental receptivity to child biomarker testing for tobacco smoke exposure: A qualitative study

“…A c c e p t e d M a n u s c r i p t 13 Although most of the parents interviewed in this study believed that biochemical feedback could spur them to change their behaviors, intervention trials reported in the literature found that interventions using biochemical feedback exhibited only a very small benefit [44]. This finding is unsurprising given the notorious gap between intent to change behavior and actual behavior change (as assessed by intervention trials) [46,47].…”

“…Some investigators used biochemical feedback in the context of interventions to help parents reduce exposure to tobacco smoke. Four trials [22,24,42,43] included in a recent meta-analysis [44] assessed the effect of biochemical feedback on exposure levels or protection behaviors. Individually, none of these trials showed a statistically significant effect, while a synthesis of all four trials showed a small advantage in the intervention groups (RR=1.14 [1.03,1.28], p=.02).…”

Habit of Smoking Family Members at Home to Successful Smoking Cessation in Indonesia

“…Children can be protected from smoking initiation and smoking exposure if their parents quit smoking [19]. This study aims to determine smoking family members at home to successful smoking cessation in Indonesia.…”

Measures stated by parents and caregivers of infants, toddlers, and preschoolers to prevent environmental tobacco smoke exposure

“…[3][4][5][6] The consequences are given by the susceptibility of children to smoke toxicity and include a higher risk for sudden infant death, middle ear pathology, severe asthma, acute respiratory infection, pneumonia, and impaired lung function, as well as school absenteeism and restricted activities. 7,8 T h e r e f o r e , t h e d i f f e r e n t governments have implemented policies and interventions aimed at reducing home exposure through education campaigns for parents and at avoiding the exposure of children in public places. 9 This was evidenced in Chile by the implementation of the anti-smoking law (19419 and 20660).…”