BACKGROUND AND OBJECTIVE
Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.
Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.
Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20).
Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.
7 Figures and Tables
FIGURE 1 Flowchart for identification of studies.
TABLE 3 PREP, by Intervention Group and Time
FIGURE 3 Plots to assess presence of publication bias. A, PREP at study end. B, Change in PREP during study. C, Parentally reported number of cigarettes to which child was exposed, at study end. D, Biochemically assessed child exposure, at study end.
TABLE 4 Parental Report of Number of Cigarettes to Which Child was Exposed, by Intervention Group and Time
TABLE 5 Biomarkers of Child Exposure to Tobacco Smoke, by Intervention Group and Time
TABLE 6 Effects of Intervention Programs on PREP, by Subgroup
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