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Clinical Trial
. 2000 Aug 5;321(7257):337-42.
doi: 10.1136/bmj.321.7257.337.

Effect of counselling mothers on their children's exposure to environmental tobacco smoke: randomised controlled trial

M F Hovell  1 , J M Zakarian, G E Matt, C R Hofstetter, J T Bernert, J Pirkle
Affiliations
Clinical Trial

Effect of counselling mothers on their children's exposure to environmental tobacco smoke: randomised controlled trial

M F Hovell et al. BMJ. .

Abstract

Objective: To test the efficacy of behavioural counselling for smoking mothers in reducing young children's exposure to environmental tobacco smoke.

Design: Randomised double blind controlled trial.

Setting: Low income homes in San Diego county, California.

Participants: 108 ethnically diverse mothers who exposed their children (aged <4 years) to tobacco smoke in the home.

Intervention: Mothers were given seven counselling sessions over three months.

Main outcome measures: Children's reported exposure to environmental tobacco smoke from mothers in the home and from all sources; children's cotinine concentrations in urine.

Results: Mothers' reports of children's exposure to their smoke in the home declined in the counselled group from 27.30 cigarettes/week at baseline, to 4.47 at three months, to 3.66 at 12 months and in the controls from 24.56, to 12.08, to 8.38. The differences between the groups by time were significant (P=0.002). Reported exposure to smoke from all sources showed similar declines, with significant differences between groups by time (P=0.008). At 12 months, the reported exposure in the counselled group was 41.2% that of controls for mothers' smoke (95% confidence interval 34.2% to 48.3%) and was 45.7% (38.4% to 53.0%) that of controls for all sources of smoke. Children's mean urine cotinine concentrations decreased slightly in the counselled group from 10.93 ng/ml at baseline to 10.47 ng/ml at 12 months but increased in the controls from 9.43 ng/ml to 17.47 ng/ml (differences between groups by time P=0.008). At 12 months the cotinine concentration in the counselled group was 55.6% (48.2% to 63.0%) that of controls.

Conclusions: Counselling was effective in reducing children's exposure to environmental tobacco smoke. Similar counselling in medical and social services might protect millions of children from environmental tobacco smoke in their homes.

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Figures

Figure 1
Figure 1
Flow of participants through trial
Figure 2
Figure 2
Children's reported exposure to mothers' cigarettes in the home (No of cigarettes per week) in families with a young child (<4 years old) and a mother who smoked who received either three months of counselling or standard advice to reduce smoking in the presence of the child. Values are geometric means
Figure 3
Figure 3
Children's urine cotinine concentrations (ng/ml) in families with a young child (<4 years old) and a mother who smoked who received either three months of counselling or standard advice to reduce smoking in the presence of the child. Values are geometric means
See this image and copyright information in PMC

Comment in

  • Protecting children from passive smoking.
    Ferrence R, Ashley MJ. Ferrence R, et al. BMJ. 2000 Aug 5;321(7257):310-1. doi: 10.1136/bmj.321.7257.310. BMJ. 2000. PMID: 10926567 Free PMC article. No abstract available.

References

    1. World Health Organization; Division of Noncommunicable Diseases; Tobacco Free Initiative. International consultation on environmental tobacco smoke (ETS) and child health. Consultation report. Geneva: WHO; 1999. www.who.int/toh/TFI/consult.htm (accessed 26 July 2000).
    1. Pirkle JL, Flegal KM, Bernert JT, Brody DJ, Etzel RA, Maurer KR. Exposure of the US population to environmental tobacco smoke. The third national health and nutrition examination survey, 1988 to 1991. JAMA. 1996;275:1233–1240. - PubMed
    1. Centers for Disease Control. State-specific prevalence of cigarette smoking among adults, and children's and adolescents' exposure to environmental tobacco smoke—United States, 1996. MMWR Morb Mortal Wkly Rev. 1997;46:1038–1043. - PubMed
    1. National Health and Medical Research Council. The health effects of passive smoking. Australia: NHMRC; 1997.
    1. Physicians for a Smoke-Free Canada. Highlight sheet No 1. Smoking in Canadian homes: Are children at risk? 1999. www.smoke-free.ca/eng_home/news_press_Jun99.htm . Available from: www.smoke-free.ca/eng_home/news_press_Jun99.htm (accessed 26 July 2000). (accessed 26 July 2000).

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