This article is more than 5 years old. Information may no longer be current.

Health care provider smoking intervention not found to reduce pediatric tobacco exposure

No significant association between health care provider intervention and reduction in childhood tobacco exposure was found in a retrospective review published in JAMA Pediatrics.

However, the researchers believe study heterogeneity may have played a role in their results.

“Based on this review and meta-analysis, the effectiveness of interventions implemented by health care professionals who provide routine child health care in reducing child TSE or increasing parental smoking cessation remains to be established,” Justine B. Daly, MMedSci(HProm), from the Population Health and Hunter New England Local Health District in Wallsend, Australia, and colleagues wrote. “These null effects may relate to issues surrounding outcome measurement, appropriateness of the intervention content, or intervention fidelity. Interventions delivered by health care professionals who provide routine child health care seem to be effective in preventing maternal smoking relapse in the postpartum period, suggesting a need to strengthen these guidelines.”

Daly and colleagues evaluated 57 trials from a 2014 Cochrane review — as well as a subsequent extended search — involving pediatric patients and reducing the risk for tobacco exposure. Studies met inclusion criteria if they involved health care professionals such as physicians, nurses, medical assistants and health educators reducing the risk for tobacco smoke exposure, including through modifying parental smoking behaviors.

Sixteen studies met inclusion criteria and in six of those studies, there were no interventions that reduced tobacco exposure in children as measured by urinary cotinine, serum cotinine or nicotine in the hair, according to the abstract. Further, a meta-analysis of nine additional trials comprising 6,399 patients showed no intervention that proved effective compared with a control group (RR = 1.05; 95% CI, 0.74-1.50).

However, in three trials analyzing the effect of health care provider intervention on maternal smoking relapse prevention comprising 1,293 patients showed a significant association (RR = 1.53; 95% CI, 1.10-1.24).

“Variability in outcome measures, length of follow-up, intervention strategies, and unknown intervention fidelity most likely contributed to study heterogeneity,” Daly and colleagues wrote. – by Jeff Craven

Disclosure: The researchers report no relevant financial disclosures.