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A Zero-vision for Children’s Tobacco Smoke Exposure: Tobacco prevention in Child Health Care
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Adverse health effects in children caused by environmental tobacco smoke (ETS) are well known. Children are primarily exposed by their parents’ smoking in their homes. A comprehensive evidence base shows that parental smoking during pregnancy and ETS exposure in early childhood are associated with an increased risk for a range of adverse health problems. Child Health Care nurses, who meet nearly all families in Sweden with children aged 0-6 years, have thus an important role in tobacco preventive work in order to support parents in their ambitions to protect their children from ETS exposure.

The overall aim of this thesis was to develop, test and evaluate a new model for tobacco preventive work in Child Health Care (CHC) with special focus on areas with a high prevalence of parental smoking. In a first step CHC nurses’ and parents’ views on tobacco preventive work were analysed in two studies based on questionnaires.

The intervention was performed during the second step, based on the results from nurses’ and parents’ experience of the tobacco preventive work in CHC, and with methods from Quality Improvement. An “intervention bundle” was developed which included evidence based methods for prevention of ETS exposure, and four learning sessions for the nurses. The instrument “Smoking in Children’s Environment Test” (SiCET) included in the bundle was evaluated with focus group interviews with the CHC nurses who participated in the intervention. Two urine samples were analysed to measure cotinine levels in children which provide an estimate for ETS exposure. Parents’ answers from the SiCET questionnaire, measurements of cotinine, and data from the nurses’ log-books were used in the evaluation of the effects of the intervention. In areas with a high prevalence of parental smoking 22 nurses recruited 86 families of whom 72 took part for the entire one-year period of the intervention.

The results showed that parents wanted to have information on the harmful effects tobacco smoke have on their children and how they can protect their children from ETS exposure. The nurses saw tobacco preventive work as important but they experienced difficulties to reach certain groups such as fathers, foreign-born parents, and those who are socio-economically disadvantaged. The SiCET instrument provided a basis for dialogue with parents. The main results from the intervention showed that ten parents (11%) quit smoking, thirty-two families (44%) decreased their cigarette consumption in the home, and fewer children were exposed to tobacco smoke. Consequently, more children showed levels of urinary cotinine less than 6 ng/ml (base-line n=43, follow up n=54; p=0.05). The total number of outdoor smokers did not change. Seven of the nurses (30%) had successful results in their areas with a decrease of smokers in families with a child of 8 months, from 20% in 2009 to 12% in 2011. The corresponding figures for the whole county as well as the country did not decrease during the same period.

The sustainability of the intervention has to be followed and thus measures should be followed prospectively over time. The SiCET instrument was found useful and might be applicable in other arenas where children’s ETS exposure is discussed. The development of an instant cotinine test using dipsticks would make it possible to give parents immediate feedback on the effectiveness of taken protective actions. This could work as a pedagogic resource in the dialogue with parents.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2012. , 116 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1313
Keyword [en]
Children, environmental tobacco smoke, child health care, intervention, Quality Improvement, SiCET
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-79331ISBN: 978-91-7519-859-0 (print)OAI: oai:DiVA.org:liu-79331DiVA: diva2:540449
Public defence
2012-08-29, Qulturum, Länssjukhuset Ryhov, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2012-07-10 Created: 2012-07-10 Last updated: 2012-10-03Bibliographically approved
List of papers
1. Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure
Open this publication in new window or tab >>Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure
2010 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 3-4, 507-516 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfares national evaluation in 1997. Background. Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied. Design. Survey. Methods. In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study. Results. Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups. Conclusions. Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions. Relevance to clinical practice. This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.

Keyword
child health services, nurses, passive smoking, prevention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-53685 (URN)10.1111/j.1365-2702.2009.02847.x (DOI)
Available from: 2010-02-01 Created: 2010-02-01 Last updated: 2017-12-12Bibliographically approved
2. Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care
Open this publication in new window or tab >>Parents' attitudes to smoking and passive smoking and their experience of the tobacco preventive work in child health care
2011 (English)In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 15, no 4, 272-286 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to describe parents' attitudes to smoking and their experience of the tobacco preventive work in antenatal care and in Child Health Care (CHC) in Sweden. A population based survey in which 62 percent of 3000 randomly selected parents with 1- and 3-year-old children answered a questionnaire. Fifty-six percent stated that smoking was registered in the health record of the child yet no further discussion regarding passive smoking took place. The parents' educational level and smoking status was related to the attitudes and experiences of the tobacco preventive work. The results indicated that the dialogue with parents regarding children and environmental tobacco smoke (ETS) exposure has to be redesigned and intensified in order to meet the needs of parents with different backgrounds.

Place, publisher, year, edition, pages
Sage Publications, 2011
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-73547 (URN)10.1177/1367493510382243 (DOI)000299562500004 ()
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-12-08
3. "Smoking in children's environment test": a qualitative study of experiences of a new instrument applied in preventive work in child health care
Open this publication in new window or tab >>"Smoking in children's environment test": a qualitative study of experiences of a new instrument applied in preventive work in child health care
2011 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 11, no 113Article in journal (Refereed) Published
Abstract [en]

Background

Despite knowledge of the adverse health effects of passive smoking, children are still   being exposed. Children's nurses play an important role in tobacco preventive work   through dialogue with parents aimed at identifying how children can be protected from   environmental tobacco smoke (ETS) exposure. The study describes the experiences of   Child Health Care (CHC) nurses when using the validated instrument SiCET (Smoking   in Children's Environment Test) in dialogue with parents.

Method

In an intervention in CHC centres in south-eastern Sweden nurses were invited to use   the SiCET. Eighteen nurses participated in focus group interviews. Transcripts were   reviewed and their contents were coded into categories by three investigators using   the method described for focus groups interviews.

Results

The SiCET was used in dialogue with parents in tobacco preventive work and resulted   in focused discussions on smoking and support for behavioural changes among parents.   The instrument had both strengths and limitations. The nurses experienced that the   SiCET facilitated dialogue with parents and gave a comprehensive view of the child's   ETS exposure. This gave nurses the possibility of taking on a supportive role by offering   parents long-term help in protecting their child from ETS exposure and in considering   smoking cessation.

Conclusion

Our findings indicate that the SiCET supports nurses in their dialogue with parents   on children's ETS exposure at CHC. There is a need for more clinical use and evaluation   of the SiCET to determine its usefulness in clinical practice under varying circumstances.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-73802 (URN)10.1186/1471-2431-11-113 (DOI)000300249300001 ()
Note
funding agnencies|Swedish National Institute of Public Health||Futurum - The Academy for Healthcare, Jonkoping County Council||Available from: 2012-01-13 Created: 2012-01-13 Last updated: 2017-12-08
4. How to minimize children’s environmental tobacco smoke exposure: An intervention study in a child health service setting
Open this publication in new window or tab >>How to minimize children’s environmental tobacco smoke exposure: An intervention study in a child health service setting
2013 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 13, no 76Article in journal (Refereed) Published
Abstract [en]

Background: Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. Method: Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. Results: Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. Conclusion: The intensified tobacco prevention in CHC improved smoking parents' ability to protect their children from ETS exposure.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-79330 (URN)10.1186/1471-2431-13-76 (DOI)000319288100001 ()
Available from: 2012-07-10 Created: 2012-07-10 Last updated: 2017-12-07Bibliographically approved

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