Child health care provider interventions to prevent secondhand smoke exposure in children

Background: Secondhand smoke exposure is associated with significant morbidity and mortality among children. The prevalence of child secondhand smoke exposure in some high income countries remains high and understanding of its prevalence amongst Australian children is limited. Additionally, although child health care settings present an opportunity to prevent such exposure, limited evidence exists regarding the effectiveness of interventions delivered routinely by child health care providers in doing so. This thesis aimed to determine: the prevalence of, and factors associated with secondhand smoke exposure amongst Australian infants less than 12 months of age; the effectiveness of child health care provider delivered interventions in decreasing infant exposure ; and the prevalence of care delivered in Australian child health care services to address this risk. Methods: The following studies were undertaken: a cross-sectional survey of parents of infants attending child health clinics in New South Wales, Australia to determine the objectively measured prevalence of infant exposure to second hand smoke; a cluster randomised controlled trial to determine the effectiveness of a child health nurse delivered intervention in reducing infant secondhand smoke exposure; a systematic review of the effectiveness of interventions delivered by child health care providers to reduce child exposure to secondhand smoke; and a cross sectional survey of managers of all public child health facilities in New South Wales to determine the prevalence of secondhand smoke exposure care provision. Results: The survey found 27% of infants were exposed to secondhand smoke, and that despite the presence of household smoking bans, infants remained at risk if parents were smokers. The trial found the interventions were not successful in decreasing infant exposure to secondhand smoke, parental smoking or in increasing the prevalence of households smoking bans. The systematic review found no intervention effect for either child secondhand smoke exposure or parental smoking cessation, however an effect was demonstrated for maternal smoking relapse. The survey of child health services found that assessment of child secondhand smoke exposure risk and parental smoking was low, as was the provision of parental smoking cessation support. Conclusions: Further research is required to monitor and improve the effectiveness of child secondhand smoke exposure interventions when delivered by child health providers in the context of routine care. Intervention research should focus on parental smoking cessation, incorporate best practice smoking cessation intervention elements, and include strategies to facilitate intervention delivery.