Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), PROFESSIONAL_CAREGIVER, PARENT_FAMILY, Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: To evaluate formative evaluation, a pedagogic method that sensitizes mothers to sudden infant death syndrome (SIDS), as a new way to improve prevention of SIDS.

Intervention Results: At follow-up, 91.9% and 86.8% of the mothers reported practicing supine sleep position in the intervention and control group respectively (p=0.16; OR=1.7, 95% CI: 0.7-4.0).

Conclusion: Formative evaluation using an educative questionnaire could improve maternal awareness on SIDS risk factors and their compliance with recommendations about SIDS prevention.

Study Design: RCT

Setting: Maternity department of the Rennes University Hospital

Population of Focus: Mothers hospitalized during the immediate postpartum period between Jun 19 and Aug 28, 2005 who were not hospitalized for abnormal or high-risk pregnancies and did not have newborns hospitalized in neonatology

Data Source: Mother report

Sample Size: Baseline (n=320) Follow-up (n=292)  Intervention (n=148)  Control (n=144)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, CAREGIVER, Motivational Interviewing/Counseling, Assessment (caregiver), PATIENT/CONSUMER, Educational Material, Online Material/Education/Blogging, Motivational Interviewing, PARENT/FAMILY, Consultation (Parent/Family), Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans.

Intervention Results: When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 or Treatment condition 2. Similarly, no significant differences were detected in the proportion of parent/care givers who reported that they were smokers, or in the proportion of households reported to have a complete smoking ban.

Conclusion: Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Study Design: Cluster randomized controlled trial

Setting: Community well-child health clinics

Population of Focus: s Infants exposed to second hand smoke

Data Source: Data was collected via computer during the visit, child health clinic records

Sample Size: 1424 parents of children aged 0 to 4 years attending well-child health checks

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, CAREGIVER, Outreach (caregiver), Assessment, SCHOOL, Reporting & Response System

Intervention Description: The goals of this study were to determine the self-reported environmental tobacco smoke exposure status (ETS) of primary school students in grades 3 to 5, to verify self-reported exposure levels with data provided from a biomarker of exposure, and to develop methods for preventing school children from passive smoking.

Intervention Results: According to questionnaire data, 59.9% of the study group (208 of 347) were exposed to ETS. Urinary cotinine measurements of children were highly consistent with the self-reported exposure levels (P < 0.001). Two different intervention methods were applied to parents of the exposed children. Control tests suggested a remarkable reduction in the proportion of those children demonstrating a recent exposure to ETS in both groups. Proportions of children with urinary cotinine concentrations 10 ng/ml or lower were 79.5% in Group I and 74.2% in Group II (P > 0.05).

Conclusion: Self-reported ETS exposure was found to be pretty accurate in the 9–11 age group when checked with urinary cotinine tests. Only informing parents that their childrens' ETS exposure were confirmed by a laboratory test seems to be very promising in preventing children from ETS.

Study Design: Comparison of two groups with different interventions

Setting: Private school primary grades 3-5

Population of Focus: Primary school students

Data Source: Data collected by project staff

Sample Size: 347 students

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Assessment (caregiver)

Intervention Description: An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested

Intervention Results: There was no significant difference between the groups with respect to change in smoking behavior. None of the families had contacted the smoking cessation resources provided to the intervention group.

Conclusion: We found no significant differences between the groups with respect to change in smoking behaviour.

Study Design: Randomized, parallel group, clinical trial

Setting: Clinic based well-child intervention

Population of Focus: Families bringing their children to the participating health centers for 6-week, 2 or 4 year well-child visits

Data Source: Self-report by parents

Sample Size: 443 families initially, 80 families dropped out

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing

Intervention Description: The aim of this study is to evaluate effects of the counseling method “Smoke-free children” that focuses on protection of infants.

Intervention Results: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine.

Conclusion: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

Study Design: RCT

Setting: Child health centers

Population of Focus: Swedish mothers who had given birth to a healthy child

Data Source: Self-reporting of smoking; cotinine levels of mothers’ saliva

Sample Size: 26 mothers in the intervention group and 15 in the control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Telephone Support, CAREGIVER, Home Visit (caregiver), Assessment (caregiver), Attestation (caregiver), Motivational Interviewing/Counseling

Intervention Description: This pilot study evaluated the effectiveness of a nurse-delivered home-visiting program during the postpartum period that included a low-intensity smoking relapse-prevention intervention.

Intervention Results: Although both groups showed significant relapse from being smoke free, the intervention group was twice as likely to be smoke free at 3 and 6 months, and three times as likely to be smoke free at both times. The cotinine verification revealed a misclassification rate of 37% at the 6-month follow-up (i.e., participants self-reported as abstinent but shown by cotinine not to be abstinent).

Conclusion: The effectiveness of this brief, low-cost, and potentially replicable intervention in improving the rate of persistent postpartum smoke-free status for women who quit smoking during pregnancy is encouraging. A randomized trial of the approach is warranted.

Study Design: Pilot study; Prospective two-group design

Setting: Birthing hospital plus home visit

Population of Focus: English-speaking women who delivered healthy babies, resided in Franklin County, Ohio, and reported quitting smoking during pregnancy and at least 7 days before delivery

Data Source: Questionnaire that included smoking history and attitudes and intent to stay smoke free administered at baseline. Saliva sample for maternal cotinine analysis collected at baseline and 3 and 6 months for all participants who self-reported abstinence (defined as no smoking for the previous 7 days)

Sample Size: 97 in the baseline group and 122 in the intervention group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, CAREGIVER, Education/Training (caregiver), Assessment (caregiver), Educational Material (caregiver)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.

Intervention Results: Audit data showed that there was a significant increase in the rate of supine positioning from 39% at baseline to 83% at follow-up (p<0.001). Parental surveys showed that there was a significant increase in the rate of supine position from 73% at baseline to 93% at follow-up (p<0.05).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Study Design: QE: pretest-posttest

Setting: Children’s Memorial Hermann Hospital NICU in Houston, TX

Population of Focus: Infants in open cribs eligible for safe sleep practices; Parents of infants after discharge

Data Source: Crib audit/infant observation; Parent report

Sample Size: Baseline (n=62) Follow-up (n=79); Baseline (n=66) Follow-up (n=98)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: This study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure during regular preventive well-child visits between age 1 and 4 years by well-child professionals.

Intervention Results: No differences were found in asthma, wheezing and other measures between intervention and control group. Children whose parents received the intervention had a decreased risk of ETS at home ever at age 2 and 3 years, but not at age 6.

Conclusion: Systematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by well-child care professionals using a brief assessment form was not effective in reducing the prevalence of physician-diagnosed asthma ever and wheezing, and did not improve FeNO, Rint or HRQOL at age 6 years. Our results hold some promise for interviewing parents and using information leaflets at well-child centres to reduce ETS exposure at home in preschool children.

Study Design: RCT

Setting: Well-child care centers in Rotterdam

Population of Focus: Children born between April 2002 and January 2006 attending wellcare visits at 16 well-care centers. The centers were randomized into 8 intervention and 8 control centers

Data Source: Parent self-report

Sample Size: 7775 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), Counseling (Parent/Family)

Intervention Description: To investigate whether a biomarker screening approach for tobacco smoke exposure (TSE) conducted concurrently with lead screening at well-child visits would increase parental smoking cessation and implementation of home smoking restrictions.

Intervention Results: Eighty-four percent of eligible parents agreed to have their child tested for TSE along with lead testing. Measurable cotinine was identified in 93% of children. More parents in the intervention group received tobacco treatment than in the comparison group (74% vs. 0%) and more parents reported 7-day point-prevalent abstinence from smoking at 8 weeks (29% vs. 3%).

Conclusion: These data demonstrate the feasibility of adding cotinine measurement to routine well-child lead screening to document TSE in small children. Data suggest providing this information to parents increases engagement in tobacco treatment and prompts smoking cessation.

Study Design: Observational, quasiexperimental

Setting: Pediatric clinic in Minneapolis, Minnesota

Population of Focus: Parents who smoked and their children presenting for well-child visits

Data Source: Parental self-report and child cotinine level.

Sample Size: 80 parents

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Assessment (Provider), Provider Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Crib Card, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital)

Intervention Description: This was a pre/post quality improvement study conducted at a single quaternary care medical center from 2015 to 2019. Infants <12 months were observed in their sleeping environment pre- and post-implementation of multiple hospital-wide interventions to improve the sleep safety of hospitalized infants. Following baseline data collection, a multidisciplinary team reviewed the hospital’s infant sleep practices and developed and implemented a care bundle that included the following: A new safe sleep hospital policy; online-learning modules for all hospital staff who interact with infants; educational updates to physicians; an educational handout for volunteers; infant safe sleep education in the nursing admission and/or discharge education for infants; infant safe sleep education in the electronic health record; and various forms of education for families/caregivers in English and Spanish. The primary outcome measure was adherence to the ABCs of safe sleep (Alone in the sleep environment, on their Back on a firm sleep surface, and in an empty Crib).

Intervention Results: Only 1.3% of 221 infants observed preintervention met all ABCs of safe sleep; 10.6% of 237 infants met the ABCs of safe sleep postintervention. Significant improvements in the post-intervention cohort included sleeping in a crib (94% versus 80% preintervention; P < 0.001), avoidance of co-sleeping (3% versus 15% preintervention; P < 0.001), absence of supplies in the crib (58% versus 15% preintervention; P < 0.001), and presence of an empty crib (13% versus 2% preintervention; P < 0.001).

Conclusion: Most infants hospitalized at our institution do not sleep in a safe environment. However, the implementation of a care bundle led to improvements in the sleep environment in the hospital. Further research is necessary to continue improving in-hospital safe sleep and to assess whether these practices impact the home sleep environment.

Setting: A single quaternary care medical center

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Assessment (provider), Provider Training/Education, Nurse/Nurse Practitioner, PARENT/FAMILY, Education/Training (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement

Intervention Description: The purpose of our safe sleep initiative was to improve parental and staff knowledge of safe sleep practices and to achieve increased compliance with infant safe sleep in the hospital setting. A multidisciplinary team of health professionals was created to address poor compliance with safe sleep guidelines, investigate barriers, and identify primary drivers for improvement. Subsequent interventions included parent education, staff education, and improvements in system processes. Members of the hospitals nurse residency program conducted multidisciplinary surveys before and after the quality improvement initiative to assess staff knowledge of safe sleep practices. The data were collected prospectively.

Intervention Results: Compliance with safe sleep improved to >80% in both units. Tracking of process measures revealed NICU parents received safe sleep education 98-100% of the time. No change was observed in the balancing measures. Transfers from the NN to the NICU for temperature instability did not increase. Parent satisfaction with discharge preparedness did not change (98.2% prior to and 99.6% after).

Conclusion: We achieved improved compliance with safe sleep practices in our NN and NICU through education of staff and parents and improved system processes. We believe this will translate to improved safe sleep practices used by parents at home.

Setting: Truman Medical Center in Kansas City

Population of Focus: Infants admitted to newborn nursery and NICU

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Sleep Environment Modification

Intervention Description: The dual aims of this project were to develop a safe sleep educational model for our neonatal intensive care unit (NICU), and to increase the percentage of eligible infants in a safe sleep environment.

Intervention Results: At baseline, 21% of eligible infants were in a safe sleep environment. After education and reported observation, safe sleep compliance increased to 88%.

Conclusion: With formal staff and family education, optional wearable blanket, and data sharing, safe sleep compliance increased and patient safety improved.

Study Design: QE: pretest-posttest

Setting: The Children’s Mercy Hospital NICU in MO

Population of Focus: Safe sleep eligible infants (medically stable and transitioned to open cribs)

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=28) Follow-up (n=26)

Age Range: Not specified