Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: an example of client-centered communication
Introduction
Environmental tobacco smoke (ETS) is an important risk factor for several disorders in all age groups. This is especially a problem during infancy with an increased risk of respiratory tract infections [1], allergic disorders [2], and sudden infant death syndrome [3]. Thus, reduction of ETS in infants is an important public health goal. The most important measures are restrictive legislation and control of price [4], [5], [6], [7]. In addition, communication methods that target maternal behavior change might be relevant. Eight randomized-controlled studies on such methods could be retrieved from Medline, four with proven effects on maternal smoking behavior [8], [9], [10], [11] and four without such effects [12], [13], [14], [15]. In the four studies without behavior effects, the communication was directly focused upon inducing the mothers to reduce their smoking, for example, by imparting information about its harmful effects. These methods were not based on any explicit behavioral theory. In the four “effective” studies [8], [9], [10], [11], the intervention focused on protecting the child from tobacco smoke, regardless of whether or not she smoked. Persuading the mothers to give up smoking was not a primary goal. The outcome variables in these studies were cotinine level (urine) [8], self-reported smoking [8], [9], [10], pulmonary function tests [9], and air measurements (carbon monoxide) [11]. The most important principles used in the four successful studies were communication based on motivation, self-help and self-efficacy [8], [11], behavioral counseling [9], [10], and social learning theory [8].
Thus, communication methods that focus on protecting the child from smoking seem to be promising. These studies, however, were specifically set up to study the effects of the methods used. Yet, in routine use, communication methods often yield smaller effects than in a research situation [16]. Thus, it is desirable to study the effects of a method that focuses on protecting the child in a routine setting. Moreover, due to preventive efforts, smoking during pregnancy is declining in many countries. In Sweden, in the year 2000, only 13% of pregnant mothers smoked [17]. The remaining group of smoking women might be expected to be less amenable to treatment with commonly used methods. Studies of such populations are therefore warranted. In this study, our focus has been on the mothers, since we consider that they have the most and close contact with the newborns, but exposure to ETS can be caused by multiple sources. The aim of this study is to evaluate the effects of the counseling method “Smoke-free children”, which focuses on protecting the infant, by studying the differences between an intervention and a control group.
Section snippets
Methods
Using the principles developed by Greenberg et al. [8], the method “Smoke-free children” [18] was introduced to nurses at Swedish child health centers. The method includes the following five key elements: (1) asking what the mothers themselves know about the effects of smoking on children, (2) suggesting to the mothers that they register how much tobacco smoke there is in the child's proximity, (3) discussing the results of the mothers' survey and asking what they think about present smoking
Results
Twenty-two of the 26 mothers in the intervention group and 8 out of 15 mothers in the control group consented to the measurements of cotinine. The mothers in the control group had slightly less schooling than those in the intervention group and there were more female infants in the control group, otherwise, the two groups were comparable, see Table 1.
Discussion
The findings of this study are conflicting. Before the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. The cotinine levels, however, indicated the opposite, that is, more smoking in the control group. During the course of the study, the mothers' self-reports indicated a slight decrease in smoking both in the intervention and control group. Yet, the cotinine levels indicated a decrease of smoking in the intervention group and an
Acknowledgements
We gratefully acknowledge Associate Professor Lennart Meurling, PhD, Department of Clinical Pharmacology, Huddinge University Hospital, Huddinge, Sweden for excellent help with the analysis of cotinine in saliva. We are also grateful to the “Method-group” at the National Institute of Public Health; Anna Hedin, PhD; Associate Professor Magnus Wickman, MD, PhD; Nurse Inger Kull; Head nurse, Ulla Idenstedt, and Project Manager, Lisen Sylwan, for all their support. Thanks to District nurse Yvonne
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