Parental smoking cessation to protect young children: a systematic review and meta-analysis

Authors:
ROSEN Laura J.;, et al
Journal article citation:
Pediatrics, 129(1), January 2012, pp.141-152.
Publisher:
American Academy of Pediatrics

The evidence from 18 controlled trials indicates that smoking cessation interventions aimed at the parents of young children produce a moderate increase in cessation rates compared to controls, but that the overwhelming majority of participants in both control and control groups continue to smoke.

Extended abstract:
Author

ROSEN Laura J.; et al.;

Title

Parental smoking cessation to protect young children: a systematic review and meta-analysis.

Journal citation/publication details

Pediatrics, 129(1), January 2012, pp.141-152.

Summary

The evidence from 18 controlled trials indicates that smoking cessation interventions aimed at the parents of young children produce a moderate increase in cessation rates compared to controls, but that the overwhelming majority of participants in both control and control groups continue to smoke.

Context

Effective cessation programmes have been successful in reducing tobacco-related morbidity and mortality, but for many smokers quitting remains an elusive goal. As the provision of accurate information on the health risks related to smoking has helped some smokers, the notion of focusing on the health of others exposed to tobacco smoke may be even more beneficial, especially when smokers consider the health of their own children. The aim of this study was to systematically  review parental quit rates following interventions that were ‘designed to protect children from tobacco smoke exposure through parental cessation or modification of parental smoking patterns, and that evaluated cessation among smoking parents of young children’.

Methods

What sources were searched?
Medline, PsycINFO, Web of Science, and the Cochrane Library database were searched up to the end of March 2011, and the reference lists of review articles were screened for additional studies.

What search terms/strategies were used?
Databases were searched using a combination of search terms and Medical Subject Headings for environmental tobacco smoke and passive smoking, children, and intervention studies. The terms used are listed in the text but there are no examples of specific search strategies.

What criteria were used to decide on which studies to include?
Only randomised controlled trials, or controlled trials, of interventions aimed at the reduction or cession of parental smoking to benefit children, or reduce child tobacco exposure, were eligible for inclusion. Study outcomes had to include quit rates for parents, mothers, or fathers of children up to the age of six years. The minimum length of observation allowed was one month from the beginning of the intervention.

Who decided on their relevance and quality?
Records identified from the search process were screened after the removal of duplicates and those deemed to be potentially relevant were obtained in full. Methodological quality was assessed using the following five parameters: study design, blinding of observers, biochemical validation of quit rates, follow-up, and fidelity to treatment. Two named authors were responsible for assessing the quality characteristics but it is not clear who carried out initial screening.

How many studies were included and where were they from?
There were 468 articles remaining after the removal of duplicates. Initial screening resulted in a total of 65 papers which were then retrieved in full. Eighteen studies met the inclusion criteria and were included in the systematic review. The studies are reported as being conducted in the USA, China, Norway, Scotland, Finland, Italy and Australia with no clear indication of the number of studies from each country.

How were the study findings combined?
Data extraction was carried out by two named authors; differences were resolved through discussion. Statistical analyses and meta-analyses were carried out using RevMan 5.0.24 and the DerSimonian and Laird random effects method. Primary analyses are reported as risk ratios and risk differences, and subgroup analyses as risk ratios. Pooled quit rates were calculated for each group .

Findings of the review

The most widely used intervention components were self-help materials and face-to-face counselling. Telephone counselling, the provision of cessation medication, and cotinine feedback were used less often. The majority of studies included two or more components and provided between three and five sessions. The most common intervention providers were nurses or research assistants.

All eighteen studies with a total of 7,053 participants were included in a meta-analysis of the effects of interventions on parental smoking cessation. Quit rates in individual studies varied from 0.9% to 83.6% in the intervention group, mean 23.1%, compared to 0.8% to 72.1%, mean 18.4% in the control group. Four studies reported a statistically significant reduction in cessation rates with intervention. Relative risks ranged from 0.14 to 29.3. The overall relative risk related to intervention was 1.34, indicating a modest improvement compared to controls.

Subgroup analyses revealed that interventions were beneficial: in parents whose children were four years old and over; when cessation medication was used; in studies whose primary aim was cessation, rather than reduction of child exposure, and; when follow-up was 81% or higher.  

Authors' conclusions

‘Some parents will quit smoking to benefit their children. Policy makers should recommend effective interventions that counsel parents to quit for the benefit of their children, and recommend training of clinicians in this area.’

Implications for policy or practice

None are discussed.


Subject terms:
intervention, parents, smoking, children;
Content type:
systematic review
Link:
Journal home page
ISSN online:
1098-4275
ISSN print:
0031-4005

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