Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Peer Counselor Motivational Interviewing PROVIDER/PRACTICE Nurse/Nurse Practitioner CAREGIVER Motivational Interviewing/Counseling

Intervention Description: Premature infants are at high risk for respiratory disease, and secondhand smoke (SHS) exposure further increases their risk for developing respiratory illness and asthma. Yet, SHS exposure remains problematic in this vulnerable population. Our objective was to evaluate the effects of brief asthma education plus motivational interviewing counseling on reducing SHS exposure and improving respiratory outcomes in premature infants compared to asthma education alone.

Intervention Results: Caregivers in the treatment group reported significantly more home smoking bans (96% vs 84%, P = .03) and reduced infant contact with smokers after the intervention (40% vs 58%, P = .03), but these differences did not persist long term. At study end (8 months after neonatal intensive care unit discharge), treatment group infants showed significantly greater reduction in salivary cotinine versus comparison (−1.32 ng/mL vs −1.08 ng/mL, P = .04), but no significant differences in other clinical outcomes.

Conclusion: A community-based intervention incorporating motivational interviewing and asthma education may be helpful in reducing SHS exposure of premature infants in the short term. Further efforts are needed to support sustained protections for this high-risk group and ultimately, prevent acute and chronic respiratory morbidity. Strategies for successfully engaging families during this stressful period warrant attention.

Study Design: RCT

Setting: Community (home)

Population of Focus: Pre-term infants and SHSe

Data Source: Golisano Children’s Hospital. Rochester, NY

Sample Size: 165 caregivers and their infants born at ≤ 32 weeks’ gestational age, within 6 weeks of discharge from the NICU

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Home Visits Other Person-to-Person Education CAREGIVER Education/Training (caregiver) PROVIDER/PRACTICE Nurse/Nurse Practitioner Motivational Interviewing Motivational Interviewing/Counseling

Intervention Description: Intervention (INT) was a home-based asthma follow-up after ED visit and two visits for an environmental control educational program delivered by trained nurses and nurse practitioners to the child and caregiver. For caregivers of children with positive cotinine results, brief motivational interviewing sessions were conducted to implement total home smoking ban.

Intervention Results: Over half of children in the study tested positive for SHS. Targeting SHS exposure was major component of the intervention [but] no significant reduction in cotinine exposures was associated with the intervention at 12 months.

Conclusion: In this study, a home-based EC intervention was not successful in reducing asthma ED revisits in children with poorly controlled asthma with SHS exposure. Allergic sensitization, young age, and increased controller medication use were important predictors of asthma ED visits.

Study Design: Prospective randomized controlled trial

Setting: Home-based (following ED visit)

Population of Focus: Children with physician diagnosed persistent asthma, having two or more ED asthma visits or more than one hospitalization over the past 12 months and residing in the Baltimore metropolitan area

Data Source: For SHS exposure, child saliva samples collected during the ED visit and at 6- and 12-month follow up visits.

Sample Size: 222 inner city children ages 3-12

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 Peer Counselor PROVIDER/PRACTICE Nurse/Nurse Practitioner CAREGIVER Motivational Interviewing/Counseling

Intervention Description: To test an air cleaner and health coach intervention to reduce secondhand smoke exposure compared with air cleaners alone or no air cleaners in reducing particulate matter (PM), air nicotine, and urine cotinine concentrations and increasing symptom-free days in children with asthma residing with a smoker.

Intervention Results: The overall follow-up rate was high (91.3%). Changes in mean fine and coarse particulate matter (PM) concentrations (baseline to 6 months) were significantly lower in both air cleaner groups compared with the control group. No differences were noted in air nicotine or urine cotinine concentrations. The health coach provided no additional reduction in PM concentrations. Symptom-free days were significantly increased in both air cleaner groups compared with the control group.

Conclusion: Although the use of air cleaners can result in a significant reduction in indoor PM concentrations and a significant increase in symptom-free days, it is not enough to prevent exposure to secondhand smoke.

Study Design: 3-arm RCT

Setting: Hospital and home

Population of Focus: Inner-city children with asthma and SHSe

Data Source: Caregiver self-report, urine cotinine levels, and air nicotine concentrations

Sample Size: 126 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER Motivational Interviewing/Counseling PATIENT/CONSUMER Motivational Interviewing Educational Material Pharmacotherapy (Nicotine) Educational Material (caregiver) Telephone Support

Intervention Description: In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention.

Intervention Results: Intervention group showed a larger increase in self-reported smoking abstinence over time than the control group. For cotinine, the intervention group showed a decrease from baseline and then maintenance through year 4, whereas the control group showed increases from baseline.

Conclusion: This study provides evidence that tailored cessation offered to Ps/Cs in their children’s schools during their children’s enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.

Study Design: 2-group RCT with repeated measures

Setting: Elementary school-based recruitment; Face-to-face or telephone motivational interviewing sessions

Population of Focus: Elementary schools with high enrollment percentages of African American children in fourth grade across 5 counties in a Southeastern state

Data Source: Parent and caregiver self-report, biochemical measures (saliva cotinine and exhaled carbon monoxide)

Sample Size: 453 parents and or caregivers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Telephone Support Motivational Interviewing CAREGIVER Motivational Interviewing/Counseling

Intervention Description: Individualized motivational intervention for 30 minutes with nurse counsellor; appropriate stage-matched intervention used to “increase motivation and lower resistance to quit”; telephone reminder 1 week after the intervention.

Intervention Results: Preliminary results showed that the quit rate in the intervention group was 7.5% (95% CI, 0–21) versus 2.5% (95% CI, 0–7) in the control group. A total of 15% of the intervention group versus 10% of the control group reduced smoking consumption by half; 20.0% of the intervention group versus 7.5% of the control group reported quit attempts in the past 30 days; and 17.5% of the intervention group versus 10% of the control group moved up the stage of readiness to quit. The results were not statistically significant because of the small sample size.

Conclusion: Preliminary results indicated that the IMI provided by nurses seemed to be effective in helping resistant parents of sick children stop smoking. They also suggested that it was acceptable and feasible to implement such intervention in a pediatric outpatient clinic/ward in Hong Kong.

Study Design: RCT

Setting: Hospital (pediatric ward/outpatient setting)

Population of Focus: Parents of sick children who smoked

Data Source: Parental self-report

Sample Size: 80 parents of sick children presenting to a clinic or admitted to a children’s ward of a major Hong Kong hospital

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material Peer Counselor CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling

Intervention Description: The aim of the "Don't smoke in our home" trial was to evaluate a counseling intervention focused on promoting totally smoke-free homes and cars (TSFHC) delivered to women with children resident in four Tuscan towns.

Intervention Results: Outcomes were: Reported smoking restrictions in home and car and change in smoking status reported. All participants independently of the study arm recorded significant increases of 12 and 15 percentage points in TSFH and TSFC, respectively. Few smokers quit smoking (7%), stopped smoking indoors (5%), and stopped smoking in cars (7%), with no differences between the intervention and control groups.

Conclusion: Adding brief counseling to written materials did not significantly increase TSFHC. However, delivering written materials only may produce modest but noteworthy TSFHC increases at the population level, even though the participants in the study did not represent a population-based sample, given the high proportion of highly educated women. Further studies are required to confirm these results.

Study Design: Two-group randomized controlled trial

Setting: Pediatric well visit

Population of Focus: Children exposed to SHS

Data Source: The trial staff recruited women aged 30-49 years with children in the waiting rooms of public health facilities, hospitals and outside of supermarkets

Sample Size: 218 women 30 to 49 years of age with children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing/Counseling

Intervention Description: The Shared Decision-Making Model for Adolescent Smoking Cessation integrates shared decision-making principles into smoking cessation interventions for adolescent smokers. It consists of three steps: "team talk," "option talk," and "decision talk." The model aims to engage adolescents in the decision-making process, clarify their preferences, and reach concordant goals with educators before taking action. It incorporates motivational interviews, brief counseling, and decision aids to support informed decision making and potentially improve smoking cessation outcomes.

Intervention Results: The primary outcome shows positive effects by both increasing the cessation rate (a 25% point abstinence rate at 3 month follow up) and decreasing the number of cigarettes smoked per day (60% of the participants at 3 month follow up) among 20 senior high school participants (mean age, 17.5 years; 95% male).

Conclusion: The results also show that the model can achieve the goal of SDM and optimal informed decision making, based on the positive SURE test and the satisfaction survey regarding the cessation model. The SDM cessation model can be further applied to different fields of adolescent substance cessation, yielding beneficial effects regarding reducing potential health hazards. The dissemination of the model may help more adolescent smokers to cease smoking worldwide.

Study Design: Pilot cohort study

Setting: National medical center in Taiwan

Population of Focus: Researchers, public health professionals, policymakers

Sample Size: 20 high school students

Age Range: ages 15-18

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing/Counseling

Intervention Description: The brief motivational intervention for adolescent smokers in the study followed the motivational interviewing (MI) style, focusing on exploring pros and cons of smoking, providing personalized feedback, setting goals, and enhancing self-efficacy for change. Patients received guidance on envisioning their future with and without smoking, creating action plans, and overcoming barriers. The intervention aimed to increase motivation to quit and support smoking cessation efforts

Intervention Results: Self-report data indicated that 7-day abstinence rates at 6-month follow-up were significantly higher in the MI group than in the BA group, but this difference was not confirmed biochemically. Self-reported smoking rate (average cigarettes per day) was significantly lower at 1, 3, and 6 months follow-up than it was at baseline. Cotinine levels indicated reduced smoking for both groups at 6 months, but not at 1 month. At 3-month follow-up, only those in MI showed cotinine levels that were significantly reduced compared to baseline.

Conclusion: Findings offer some support for MI for smoking reduction among non-treatment-seeking adolescents, but overall changes in smoking were small.

Study Design: Randomized two group comparison

Setting: ED in an urban hospital in the Northeasth US

Population of Focus: Adolescent patients in the outpatient clinic or ED

Sample Size: 85 youth

Age Range: ages 14-19

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Peer Counselor Intensive Therapy CAREGIVER Motivational Interviewing/Counseling

Intervention Description: We tested the efficacy of a behavioral counseling approach with underserved maternal smokers to reduce infant’s and preschooler’s secondhand smoke exposure.

Intervention Results: Participation in Philadelphia Family Rules for Establishing Smokefree Homes (FRESH) behavioral counseling was associated with lower child cotinine (β=-0.18, p=0.03) and reported tobacco smoke exposure (β=-0.57, p=0.03) at the end of treatment. Mothers in behavioral counseling smoked fewer cigarettes/day (β=-1.84, p=0.03) and had higher bioverified quit rates compared with controls (13.8% vs 1.9%, χ(2)=10.56, p<0.01). There was no moderating effect of other smokers living at home.

Conclusion: FRESH behavioral counseling reduces child secondhand smoke exposure and promotes smoking quit rates in a highly distressed and vulnerable population.

Study Design: Two-arm randomized trial

Setting: Community (home and telephone)

Population of Focus: Underserved children’s exposure to tobacco smoke

Data Source: Participants were recruited from lowincome neighborhoods in North and West Philadelphia

Sample Size: 300 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Education on Disease/Condition Motivational Interviewing/Counseling

Intervention Description: The study evaluated the impact of a public health strategy to counteract an 'epidemic panic' that occurred in the district of Palermo following four cases of meningococcal disease in the summer of 2016. The strategy included effective communication strategies to provide timely and effective information on appropriate prevention measures and regulated access for the population to receive vaccination services. Healthcare workers of the vaccination services targeted counseling to adolescents and young adults in order to promote greater confidence in vaccination

Intervention Results: The study found a significant increase in the anti-meningococcal vaccination coverage in each local health unit and at a regional level. Concurrent catch-up of other recommended vaccinations for age (diphtheria-tetanus-pertussis-poliomyelitis and papillomavirus) resulted in a further increase of administered doses.

Conclusion: The study concluded that a public health strategy that includes effective communication strategies and measures provided by public health authorities can lead to an increase in vaccination coverage in the target population and positive effects on vaccine compliance in the general population.

Study Design: The study used a retrospective observational design.

Setting: The study was conducted in the district of Palermo, Sicily, Italy.

Population of Focus: Adolescents and young adults.

Sample Size: The study included a total of 10,735 individuals.

Age Range: The target population included individuals aged 14-30 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material Motivational Interviewing Telephone Support CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling

Intervention Description: Evaluate a smoking cessation intervention for women.

Intervention Results: The main outcome measure was self-reported abstinence from smoking 12 months after enrollment in the study, defined as not smoking, even a puff, during the 7 days prior to assessment. At both follow-ups, abstinence rates were twice as great in the intervention group as in the control group. The 12-month difference was statistically significant.

Conclusion: A pediatric clinic smoking cessation intervention has long-term effects in a socioeconomically disadvantaged sample of women smokers. The results encourage implementation of evidence-based clinical guidelines for smoking cessation in pediatric practice.

Study Design: Two-arm randomized trial (usual care vs. intervention)

Setting: Pediatric clinics serving ethnically diverse population of low-income families

Population of Focus: Self-identified women smokers whose children received care at participating clinics

Data Source: Women smokers whose children received care at participating clinics self-report.

Sample Size: 303 women smokers

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): CAREGIVER Motivational Interviewing/Counseling SCHOOL Head Start Participation

Intervention Description: To evaluate the effectiveness of motivational interviewing (MI) delivered in the context of a SHS education reduction initiative within Head Start to reduce preschool children’s SHS exposure.

Intervention Results: The primary outcome measure was household air nicotine levels measured by passive dosimeters. Secondary outcomes included child salivary cotinine, self-report of home smoking ban (HSB), and smoking status. Participants in the MI + education group had significantly lower air nicotine levels (0.29 vs. 0.40 mg), 17% increase in prevalence of caregiver-reported HSBs, and a 13% decrease in caregiver smokers compared with education-alone group (all P values < 0.05). Although group differences in salivary cotinine were not significant, among all families who reported having an HSB, salivary cotinine and air nicotine levels declined in both groups (P < 0.05).

Conclusion: MI may be effective in community settings to reduce child SHSe. More research is needed to identify ways to tailor interventions to directly impact child SHSe and to engage more families to make behavioral change.

Study Design: Randomized trial with two implementation groups, no controls

Setting: Head Start Program

Population of Focus: Children aged 6 months to 6 years whose caregivers reported a smoker living in the household and who spoke English

Data Source: Data collected by project staff

Sample Size: 350 children were recruited

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): Motivational Interviewing/Counseling

Intervention Description: Anonymous Internet-based cross-sectional survey of postpartum women to gather information on various topics, including prenatal/postpartum care and family planning. The study used multivariable logistic regression to determine associations between the quantity of provider counseling (indexed as the number of family planning topics discussed with a healthcare provider) and women’s decisions regarding contraception and pregnancy spacing

Intervention Results: Receipt of high-quality postpartum contraceptive counseling was reported by 26%. At 3-months postpartum 70% of participants reported the same contraceptive preferences by category of effectiveness that they expressed at the time of delivery. Spanish-speaking, Hispanic foreign-born, and lower socioeconomic status women were less likely to receive high-quality counseling than their counterparts. High-quality counseling was associated with lower odds of preferring a less effective method (OR: 0.31, 95% CI: 0.18-0.52) and changing preference from an IUD or implant (OR: 0.34, 95% CI: 0.17-0.68).

Conclusion: High-quality postpartum contraceptive counseling is relatively rare and occurs less often among low SES and immigrant women. High-quality counseling appears to reinforce preferences for effective contraception.

Study Design: Cross-sectional survey

Setting: Respondents were at least 18 years old and has an infant between 3-9 months of age

Sample Size: 2850 women

Age Range: Respondents were at least 18 years old and has an infant between 3-9 months of age

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling Motivational Interviewing Patient Reminder/Invitation PROVIDER/PRACTICE Nurse/Nurse Practitioner

Intervention Description: To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group.

Intervention Results: Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects.

Conclusion: Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.

Study Design: RCT

Setting: Primary care center in a large urban children’s hospital

Population of Focus: Female caregivers (16 years and older) who accompanied a child (under 12 years) to the Primary Care Center of Columbus Children’s Hospital for a health care visit for any chief complaint or well-child examination

Data Source: Baseline data on demographics and smoking topics collected by questionnaire; and 1- and 6-month follow-ups.

Sample Size: 479 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH Adult-led Support/Counseling/Remediation CAREGIVER Home Visit (caregiver) Motivational Interviewing/Counseling PROVIDER/PRACTICE Nurse/Nurse Practitioner

Intervention Description: To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma.

Intervention Results: The primary outcome was the number of symptom-free days during 2 weeks averaged across the pea asthma season (November-February). Children in the treatment group experienced more symptom-free days and better results on several other asthma-related measures. Full-year outcomes also showed a significant treatment effect. When comparing outcomes separately for children without and with smoke exposure in the home, results suggest an effect of the intervention for both groups of children. Primary findings were independent of any change in the child’s cotinine level, suggesting that the school-based care component alone is effective in reducing symptoms.

Conclusion: The School-Based Asthma Therapy intervention significantly improved symptoms among urban children with persistent asthma. This program could serve as a model for improved asthma care in urban communities.

Study Design: Randomized trial, with children stratified by smoke exposure in the home and randomized to a school-base care group or a usual care group

Setting: School, with intervention in the home

Population of Focus: Children aged 3 to 10 years with persistent, physician-diagnosed asthma in the Rochester City School District, with consent of the child’s primary care provider to participate in the study

Data Source: All families were given diaries to track their child’s symptoms, and outcomes were assessed by monthly telephone interviews. Saliva samples were collected from the child at the beginning and end of the study to determine the child’s level of cotinine. Medical records were reviewed for 10% of the sample to confirm office and emergency department visits and hospitalizations.

Sample Size: 530 children from 67 schools and preschools

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy Motivational Interviewing/Counseling Feedback

Intervention Description: Contraception consultation combined with in-person brief interventions and motivational interviewing with support from community participants

Intervention Results: The study has shown preliminary success in changing behaviors and impacting how the community views the prevention of alcohol-exposed pregnancies. The CHOICES intervention was found to be acceptable and welcomed by the tribal community, indicating its potential for implementation with other interested populations. The program has demonstrated success in reducing the risk for alcohol-exposed pregnancies among participants, with the majority showing a reduction in risk through behavior changes such as increased use of birth control, reduced alcohol consumption, or a combination of both.

Conclusion: By incorporating community input and making appropriate modifications to the intervention materials, the program has been successful in addressing the issue of alcohol-exposed pregnancies within the American Indian community. The study highlights the importance of community-based participatory research (CBPR) in developing and implementing effective prevention programs. The researchers suggest that future implementation efforts can benefit from the methods and results discussed in the study to sustain and expand this important alcohol-exposed pregnancy prevention program. Overall, the study underscores the significance of primary prevention efforts, such as increasing the utilization of birth control, in reducing the risk of alcohol-exposed pregnancies, particularly among at-risk populations like American Indians

Study Design: The study design involves the modification and implementation of an existing alcohol-exposed pregnancy prevention program, Project CHOICES, to fit the needs and norms of the American Indian community, specifically the Oglala Sioux Tribe.

Setting: Oglala Sioux Tribe community,

Population of Focus: Non-pregnant American Indian women, particularly within the Oglala Sioux Tribe community

Sample Size: Not specified

Age Range: Reproductive age

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy Motivational Interviewing/Counseling Feedback

Intervention Description: The intervention included MI counseling techniques, such as reflective listening and open questioning, to encourage participants to decrease binge drinking and/or increase birth control use to reduce the risk of alcohol-exposed pregnancies. The interventionists provided either two or four CHOICES sessions, held approximately 1-2 weeks apart, depending on the site's preference. Participants were given gift card incentives for participating in the intervention sessions and completing follow-up data collection. Additionally, referrals to local health care providers for birth control were provided, and participants were encouraged to make appointments to discuss their birth control options

Intervention Results: The results of the study showed a significant decrease in the risk of alcohol-exposed pregnancies (AEP) among American Indian women enrolled in the program

Conclusion: Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail, we found a significant impact in reducing AEP risk. This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of settings and populations

Study Design: Pre-post intervention design

Setting: Three sites, two located on a reservation and a third that serves American Indian women in an urban setting

Population of Focus: Non-pregnant American Indian women at-risk for alcohol-exposed pregnancies due to binge drinking and being at-risk for unintended pregnancy

Sample Size: 193 women

Age Range: 18-46

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material Intensive Therapy Peer Counselor Motivational Interviewing Telephone Support CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling

Intervention Description: To develop and test an intervention to reduce children’s exposure to secondhand smoke (SHS) at homes in Yerevan, Armenia.

Intervention Results: Hair nicotine concentration in the child was 17% lower in the intervention group. The follow-up survey revealed an increased proportion of households with smoking restrictions and decreased exposure of children to SHS in both groups. The adjusted odds of children’s less-than-daily exposure to SHS was 1.87 times higher in the intervention group and the geometric mean of mothers’ knowledge scores at follow-up was 10% higher in that group.

Conclusion: Intensive intervention is effective in decreasing children’s exposure to SHS through educating mothers and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s exposure was not statistically significant.

Study Design: RCT

Setting: Home visits

Population of Focus: Households with a nonsmoking mother and at least 1 child 2-6 years of age residing with at least 1 daily smoker

Data Source: Measures of air quality and child hair nicotine; parent self-report.

Sample Size: 250 households

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Presentation/Meeting/Information Session/Event Training (Parent/Family) CAREGIVER Home Visit (caregiver) Education/Training (caregiver) Motivational Interviewing/Counseling

Intervention Description: This study tested the efficacy of coaching to reduce environmental tobacco smoke ETS exposure among asthmatic Latino children.

Intervention Results: Intervention parents reported their children exposed to significantly fewer cigarettes than control parents by 4 months (post-coaching). Reported prevalence of exposed children decreased to 52% for intervention families but only 69% for controls. By month 4, cotinine levels decreased from 54% to 40% among intervention and increased from 43% to 49% among control children. However, cotinine levels decreased among controls to same level achieved by intervention families by the 13-month follow-up.

Conclusion: Asthma management education plus coaching can reduce ETS exposure more than expected from education alone, and decreases in the coached condition may be sustained for about a year. The delayed decrease in cotinine among controls is discussed.

Study Design: RCT

Setting: Community (home)

Population of Focus: Latino or Hispanic families with an asthmatic child who lived in a home with a smoker and was exposed to at least 6 cigarettes in the past week

Data Source: Reported ETS exposure, children’s urine cotinine, air nicotine monitors, and parent’s saliva cotinine were measured

Sample Size: 204 Latino children ages 3-17 years with asthma

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Training (Parent/Family) CAREGIVER Education/Training (caregiver) Motivational Interviewing/Counseling

Intervention Description: To test the efficacy of behavioural counselling for smoking mothers in reducing young children's exposure to environmental tobacco smoke.

Intervention Results: Mothers’ reports of children’s exposure to their smoke in the home declined in the counseled group from 27.30 cigarettes/week at baseline to 3.66 at 12 months and in the controls from 24.56 to 8.38; the differences were significant. Most of the change in exposure was during the first three months. Children’s cotinine levels in both groups increased from baseline to three months but then declined slightly in the counselled group whereas it continued to climb in the control group; the same pattern occurred in the mothers.

Conclusion: Counselling was effective in reducing children's exposure to environmental tobacco smoke. Similar counselling in medical and social services might protect millions of children from environmental tobacco smoke in their homes.

Study Design: Randomized double blind controlled trial

Setting: Low income homes in San Diego county, California

Population of Focus: English and Spanish speaking mothers who smoked at least two cigarettes a day and exposed their child aged under 4 years to the smoke from at least one cigarette a day

Data Source: Mothers’ self-report and child urine cotinine measure. Mothers’ saliva was collected at each interview; those who reported stopping smoking were tested and cessation confirmed by cotinine concentration. One week before the three month interview nicotine monitors were placed in the homes of a randomly selected half of the families.

Sample Size: 108 mothers smoking at least 2 CPD with children under 4 years, using a supplemental nutrition program

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Presentation/Meeting/Information Session/Event Training (Parent/Family) CAREGIVER Home Visit (caregiver) Education/Training (caregiver) Educational Material (caregiver) Motivational Interviewing/Counseling Notification/Information Materials (Online Resources, Information Guide) PATIENT/CONSUMER Pharmacotherapy (Nicotine) Home Visits Educational Material Motivational Interviewing Peer Counselor Telephone Support

Intervention Description: We tested a combined intervention to reduce children's secondhand smoke exposure (SHSe) and help parents quit smoking.

Intervention Results: Parents’ reports of their smoking and children’s exposure showed moderate and significant correlation with children’s urine cotinine levels and home air nicotine. 13 intervention group mothers and 4 controls reported quitting smoking for 7 days prior to 1 or more study measurements without biochemical contradiction. Results of generalized estimating equations showed significantly greater decrease in reported SHSe and mothers’ smoking in the counseled group compared with controls. Reported indoor smoking and children’s urine cotinine decreased, yet group differences for changes were not significant.

Conclusion: Nicotine contamination of the home and resulting thirdhand exposure may have contributed to the failure to obtain a differential decrease in cotinine concentration. Partial exposure to counseling due to dropouts and lack of full participation from all family members and measurement reactivity in both conditions may have constrained intervention effects. Secondhand smoke exposure counseling may have been less powerful when combined with smoking cessation.

Study Design: Two-group, repeated measures RCT

Setting: Community (home)

Population of Focus: WIC clients in San Diego, California

Data Source: 3 weekly baseline child urine cotinine measures collected before trial randomization then reported and urine cotinine measures at 3 (midintervention), 6 (post-intervention), 12, and 18 months

Sample Size: 150 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Motivational Interviewing Peer Counselor CAREGIVER Motivational Interviewing/Counseling

Intervention Description: Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children.

Intervention Results: Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p<0.001). Intervention homes’ average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p<0.001).

Conclusion: Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles.

Study Design: A randomized trial with two groups—intervention and control

Setting: Home-based

Population of Focus: Participants from predominantly low-income households with an adult smoker and a child under 14 years of age

Data Source: Real-time lights and sounds (programmed to emit a blinking yellow LED light and brief aversive auditory alert when levels of indoor particles reached a threshold as measured by a Dylos air monitor. Delayed particle feedback charts

Sample Size: 298 homes

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Presentation/Meeting/Information Session/Event Training (Parent/Family) CAREGIVER Home Visit (caregiver) Motivational Interviewing/Counseling

Intervention Description: We tested the effectiveness of a program consisting of motivational interviewing (MI) and feedback of urine cotinine to stop passive smoking (PS) in children at risk for asthma.

Intervention Results: After 6 months, a significant group difference was observed for the unverified parental report of stopping PS in children: 27% of parents in the intervention group versus 7% in the control group. For the verified parental report, the difference was similar (23% versus 7%) but was not statistically significant.

Conclusion: Despite a limited sample size, the results suggest that the intervention program is probably an effective strategy to stop PS in children. A program longer than 6 months might be necessary for a longer lasting intervention effect.

Study Design: RCT

Setting: Home-based (6 sessions)

Population of Focus: Families with children ages 0-13 with a high risk of asthma and passive smoking exposure

Data Source: Parental self-report, urine cotinine in children

Sample Size: 58 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH Adult-led Support/Counseling/Remediation PARENT/FAMILY CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling Consultation/Counseling (Parent/Family) Counseling (Parent/Family)

Intervention Description: To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke.

Intervention Results: Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8-y-old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non-smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers.

Conclusion: Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.

Study Design: Randomized prospective intervention trial

Setting: Pediatric well-child visits

Population of Focus: Families presenting at a well-baby clinic with a child 5 months old.

Data Source: Cotinine measurements of mothers, fathers, and children; Reported smoking of parents during annual office visit to pediatrician (via questionnaires and interviews)

Sample Size: 1062 families (Intervention= 540; Control = 522)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Multicomponent Approach Quality Improvement/Practice-Wide Intervention Motivational Interviewing/Counseling

Intervention Description: From 2015 to 2018 we convened 2 learning collaboratives, named the Quality Improvement Network for Contraceptive Access, with 17 teams (representing 40 sites) from New York City-based hospitals and health centers using an adaptation of the Institute for Healthcare Improvement's Breakthrough Series Learning Collaborative model. Participating teams sought to implement evidence-informed recommendations to increase access.

Intervention Results: Learning collaborative teams successfully implemented all 4 of the recommendations in 95% of the participating sites. Patients who chose and received a most or moderately effective method increased from 22% to 38% in primary care, and from 0% to 17% in the immediate postpartum period. Patients who chose and received a long-acting-reversible contraceptive increased from 5% to 11% in primary care, and from 0% to 3% in immediate postpartum. Facilitating factors included the involvement of interdisciplinary teams, consideration of costs, utilization of peers to demonstrate change, and champions to drive change.

Conclusion: The application of evidence-informed recommendations using a structured quality improvement initiative increases contraceptive access.

Study Design: Pre-post intervention

Setting: New York City, NY

Sample Size: 17 organization representing 40 care delivery sites

Age Range: NA

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver) Motivational Interviewing/Counseling Provider Training/Education

Intervention Description: Identified in this article are 5 pillars for implementing CBPPC care in cases involving ethical considerations: (1) identification of biases, (2) utilization of a culturally safe approach, (3) communication, (4) assessment and support, and (5) knowledge of community resources.

Intervention Results: successful intervention

Conclusion: By facilitating the communication of patient and family needs and goals and by connecting patients and families with community resources to improve quality of life, CBPPC and hospice nurses play an essential role in decreasing stressors and suffering. The implementation of palliative care improves patient outcomes, enhances interprofessional and family communication, and reduces end-of-life cost burdens both to families and to health care systems; however, the time it takes a nurse to develop trusting relationships, consider family-centered education needs, connect families with accessible specialists, and address their own needs and possible biases is not easily coded for compensation in the current health care system. Without substantial CBPPC nurse involvement in this case, the outcome might have been far less satisfactory for the family. It is recommended that nurses and interprofessional teams implement the 5 crucial pillars discussed for providing ethical and safe palliative care.

Study Design: case review

Setting: CMC: community-based palliative care - a case study involving a family with a child who has a life-limiting genetic disease and the community-based pediatric palliative care (CBPPC) team that provided care in the family's home.

Population of Focus: CMC - healthcare professionals, particularly those involved in community-based pediatric palliative care.

Sample Size: 1 family

Age Range: children

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE Community Health Workers (CHWs) PATIENT/CONSUMER Home Visits Educational Material Other Person-to-Person Education Peer Counselor Motivational Interviewing CAREGIVER Home Visit (caregiver) Education/Training (caregiver) Educational Material (caregiver) Motivational Interviewing/Counseling

Intervention Description: We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers.

Intervention Results: The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721.

Conclusion: Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.

Study Design: RCT

Setting: Community (home)

Population of Focus: Families in low-income households with children with asthma

Data Source: In-home interviewing, dust sample and standardized home inspection

Sample Size: 274 randomized participants

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material Peer Counselor Telephone Support Other Education Motivational Interviewing CAREGIVER Education/Training (caregiver) Educational Material (caregiver) Motivational Interviewing/Counseling PARENT/FAMILY Notification/Information Materials (Online Resources, Information Guide) Consultation/Counseling (Parent/Family) Counseling (Parent/Family)

Intervention Description: We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone.

Intervention Results: Child TSE (urine cotinine) declined significantly in both intervention and control groups from baseline to 12-months with no between-group differences. There was s statistically significant effect on 12-month bioverified quit status-intervention group participants were 2.47 times more likely to quit smoking than those in the control group.

Conclusion: Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation.

Study Design: RCT

Setting: Telephone counseling

Population of Focus: Parents/caregivers

Data Source: Self-reported interview data

Sample Size: 327 were randomized (164-control and 163-intervention)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider) Motivational Interviewing/Counseling

Intervention Description: Screening, Brief Intervention, and Referral to Treatment (SBIRT) delivered either electronically or by a clinician.

Intervention Results: The study found that Screening, Brief Intervention, and Referral to Treatment (SBIRT) significantly decreased the number of days of primary substance use, including alcohol consumption, among women in reproductive healthcare centers. Pregnant women reported substance use, on average, about 17% fewer days per month than did non-pregnant women.

Conclusion: Screening, Brief Intervention, and Referral to Treatment (SBIRT) significantly reduced the number of days of primary substance use among women in reproductive healthcare centers. Both the electronic and clinician-delivered interventions were more effective in reducing substance use compared to enhanced usual care. However, there was no significant difference in treatment utilization between the intervention groups and the enhanced usual care group.

Study Design: Randomized controlled trial

Setting: Two urban academic hospital based clinics

Population of Focus: Nonpreganant and pregnant women who screened positive for substance use

Sample Size: 439 women

Age Range: ≥18

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

Intervention Description: Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences. An experimental design was used to evaluate a minimal-contact intervention aimed at modifying parents' smoking behavior in their homes.

Intervention Results: More treatment (35%) than control (17%) subjects reported smoking outside their homes at posttest (and their children’s cotinine levels were lower), but this difference was not statistically significant.

Conclusion: difference was not statistically significant.

Study Design: Experimental design

Setting: Pediatric pulmonary clinics in U of MI

Population of Focus: Parents of children with asthma

Data Source: Parent questionnaire on smoking status and child urine sample.

Sample Size: 92 families randomly assigned

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling Attestation (caregiver)

Intervention Description: The current study examined home and full (i.e., home plus car) smoking ban adoption as secondary outcomes to a randomized controlled trial targeting reduced secondhand smoke exposure (SHSe) for children under treatment for cancer.

Intervention Results: Regardless of group assignment, there was an increase in home (odds ration [OR] = 1.16, p = .074) and full (OR = 1.37, p = .001) smoking ban adoption across time. Families in the intervention group were more likely to adopt a full ban by 3 months, but this difference was nonsignificant by 12 months.

Conclusion: Smoking bans are in-line with Healthy People 2020’s tobacco objectives and may be more feasible for parents with medically compromised children for immediate SHSe reduction. Furthermore, interventions targeting full smoking bans may be a more effective for comprehensive elimination of SHSe.

Study Design: RCT

Setting: Pediatric oncology hospital setting

Population of Focus: Parents (at least 1 adult smoker in home) of children under treatment for cancer

Data Source: Parent self-report on household and car smoking behavior, demographic, psychosocial, and medical/treatmentrelated information.

Sample Size: 119 families randomized

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) PATIENT/CONSUMER Motivational Interviewing CAREGIVER Motivational Interviewing/Counseling

Intervention Description: Our objectives were to determine the effectiveness of a brief primary care intervention directed at parents who smoke in reducing babies’ TSP exposure, and to establish variables related to greater exposure.

Intervention Results: During follow-up, TSP-avoidance strategies improved more in the IG than in the CG: 35.4% and 26.9% ( p=0.006) at home, and 62.2% and 53.1% in cars (p=0.008). Logistic regression showed adjusted ORs for appropriate measures in the IG versus CG of 1.59 (95% CI 1.21 to 2.09) at home and 1.30 (95% CI 0.97 to 1.75) in cars. Hair samples showed that 78.7% of the babies tested were exposed. Reduced nicotine concentration was associated with improved implementation of effective strategies reported by parents at home (p=0.029) and in cars (p=0.014).

Conclusion: The intervention produced behavioural changes to avoid TSP exposure in babies. The proportion of babies with nicotine (>=1ng/mg) in hair samples at baseline is a concern.

Study Design: RCT

Setting: Primary care well-child visit

Population of Focus: Babies whose parents were smokers

Data Source: Outcomes were measured by parents’ reported strategies to avoid TSP exposure. Baseline clinical data and characteristics of each baby’s TSP exposure were collected, along with infant hair samples and parents’ tobacco use and related attitudes/ behaviors.

Sample Size: 1101 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material Pharmacotherapy (Nicotine) PARENT/FAMILY Notification/Information Materials (Online Resources, Information Guide) Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling Motivational Interviewing

Intervention Description: Although many Latinos in the US smoke, they receive assistance to quit less often than non-Latinos. To address this disparity, we recruited Latino couples into a randomized controlled trial and provided a smoking cessation program during a teachable moment, when men’s partners were pregnant.

Intervention Results: We found high rates of cessation but no arm differences in smoking rates at the end of pregnancy (0.31 vs. 0.30, materials only vs. counseling, respectively) and 12 months after randomization (postpartum: 0.39 vs. 0.38). We found high quit rates among nondaily smokers but no arm differences (0.43 vs. 0.46 in pregnancy and 0.52 vs. 0.48 postpartum). Among daily smokers, we found lower quit rates with no arm differences but effects favoring the intervention arm (0.13 vs. 0.16 in pregnancy and 0.17 vs. 0.24 postpartum).

Conclusion: A less intensive intervention promoted cessation equal to more intensive counseling. Postpartum might be a more powerful time to promote cessation among Latino men. Impact Less intensive interventions when delivered during teachable moments for Latino men could result in a high smoking cessation rate and could reduce disparities.

Study Design: RCT

Setting: Community (home)

Population of Focus: Pregnant Latinas and their partners who smoked from 10 county health departments

Data Source: Surveys at end of pregnancy, 3-mo postpartum and 12-mo postpartum; also saliva samples for cotinine analysis.

Sample Size: 348 randomized couples

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) Counseling (Parent/Family) CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling

Intervention Description: Smoking caregivers of children hospitalized for respiratory illness at the University of New Mexico were offered a smoking cessation intervention during the child's hospitalization.

Intervention Results: Fourteen percent of participants in the counseling group and 5% in the brief message group were self-reported quitters at 6 months. A significant percentage of smoking parents of children hospitalized for respiratory illness are willing to receive smoking cessation counseling while their child is in the hospital. Abstinence rates appear similar to other pediatric office-based interventions. Child hospitalization should be considered an important opportunity to provide parents with smoking cessation services, particularly since many smoking parents will not have access to these services elsewhere.

Conclusion: Child hospitalization should be considered an important opportunity to provide parents with smoking cessation services, particularly since many smoking parents will not have access to these services elsewhere.

Study Design: RCT

Setting: Community (hospitalization for Respiratory Illness)

Population of Focus: Parents of children hospitalized for respiratory illness

Data Source: Validated questionnaires and Fagerstrom test for nicotine dependence (self-report) All participants were followed by phone at 3 and 6 months posthospitalization for quit attempts.

Sample Size: 42 randomly assigned parents

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing/Counseling Notification/Information Materials (Online Resources, Information Guide) Text Messaging

Intervention Description: At half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum.

Intervention Results: 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG.

Conclusion: Our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy.

Study Design: Randomized controlled trial

Setting: Primary care clinic in National Health Care System, Catalonia, Spain

Sample Size: 975 women (482 in control group; 493 in intervention group)

Age Range: At least 18 years old, no maximum age provided

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

Intervention Description: This study tested a behavioral intervention to increase dental attendance among rural Oregonian low-income women and their children.

Intervention Results: Compared to statewide PRAMS, attendance was higher during pregnancy for study mothers (45% statewide; 95% CI = 40-50%) and for their children by 24 months (36% statewide; 95% CI = 27-44%).

Conclusion: Prenatal or postpartum motivational interviewing/counseling (MI) did not lead to greater attendance when compared to HE alone and cost more to implement. High attendance may be attributable to the counselors' patient navigator function.

Study Design: RCT

Setting: Four rural counties in OR

Population of Focus: Children of pregnant women aged ≥15 years in their first or second trimester eligible for Medicaid

Data Source: Medicaid claims; maternal self-report

Sample Size: Prenatal MI/Postpartum MI (n=121) Prenatal MI/Postpartum HE (n=50) Prenatal HE/Postpartum MI (n=134) Prenatal HE/Postpartum HE (n=44)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH Assessment PARENT/FAMILY Counseling (Parent/Family) PATIENT/CONSUMER Motivational Interviewing CAREGIVER Motivational Interviewing/Counseling

Intervention Description: Tobacco smoke exposure (TSE) harms children, who are often “captive smokers” in their own homes. Project Zero Exposure is a parent-oriented, theory-based intervention designed to reduce child TSE. This paper reports on findings from the pilot study, which was conducted in Israel from 2013 to 2014

Intervention Results: Twenty-six of the 29 recruited families completed the study. The intervention was feasible to implement and acceptable to participants. Among the 17 children with reliable hair samples at baseline and follow-up, log hair nicotine dropped significantly after the intervention (P = .04), hair nicotine levels decreased in 64.7% of children, and reductions to levels of nonexposed children were observed in 35.3% of children. The number of cigarettes smoked by parents (P = .001) and parent-reported child TSE declined (P = .01). Logistical issues arose with measurement of all objective measures, including air nicotine, which did not decline; home air particulate matter; and hair nicotine.

Conclusion: A program based on motivational interviewing and demonstrating TSE and contamination to parents in a concrete and easily understandable way is a promising approach to protect children from TSE. Further research is needed to enhance current methods of measurement and assess promising interventions.

Study Design: Single group pre- and post-test design

Setting: Home-based with child biomarker and home air quality feedback

Population of Focus: Parents from families in which smoking occurred were recruited from areas adjacent to NA’AMAT child day care centers by using the snowball technique

Data Source: Baseline questionnaire (reported exposure, child health, demographics). Objective assessments of child TSE via biomarkers (hair nicotine) and measurement of home air quality (air nicotine, particulate matter). Motivational interviewing action plan. Follow-up questionnaire (reported exposure).

Sample Size: 26 of the 29 recruited families completed the study

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing/Counseling

Intervention Description: Preconception consultations focusing on behavioral change

Intervention Results: Of the 259 included participants, paired analyses were available in 177 participants for self-reported outcomes and in 82 for biomarker outcomes. Baseline self-reported prevalence of no folic acid use was 36%, smoking 12%, weekly alcohol use 22%, and binge drinking 17%. Significant changes in prevalence toward better lifestyle during follow-up were seen for folic acid use (both self-reported, P < .001; and biomarker confirmed, P ¼ .008) and for self-reported binge drinking (P ¼ .007)

Conclusion: This study suggests that PCC contributes to initiation of folic acid supplementation and cessation of binge drinking in women who intend to become pregnant. Although based on a small sample, the study adds to the limited body of evidence regarding the benefits of PCC in improving periconception health

Study Design: Prospective cohort study

Setting: Deprived neighborhoods in 14 Dutch municipalities

Population of Focus: Women who intend to become pregnant

Sample Size: 259 women

Age Range: 18-41

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) Counseling (Parent/Family) Peer Counselor Motivational Interviewing/Counseling

Intervention Description: We report on a randomized controlled trial conducted between 1996 and 2001 to evaluate a minimal contact behavioral counseling intervention to decrease household SHS exposure among children with asthma from low-income, predominantly ethnic minority families.

Intervention Results: The intervention was unsuccessful with respect to reduction of household smoking and household SHS exposure of these children. In addition, while most households that remained in the study reported full household smoking bans by the end of the study, the study team found no difference in control/intervention households citing a ban on smoking.

Conclusion: Despite these results, our study provided several important insights. The “null” results of our trial suggest that a minimal intervention with limited contact may not suffice to achieve a reduction in household tobacco exposure among low income minority families that have children with asthma. However, although no intervention/control group differences were found, our study suggests that it is possible to implement household restrictions that were not previously in place, including among low-income and minority families, since most households reported implementing full smoking bans by the end of the study (136 of the original 242 at baseline, 56%). This is significant in light of the implications of such restrictions for reduced exposure [43] and the association of bans with smoking cessation and decreased cigarette consumption. Our research also points to the need for further study of the process by which change occurs, i.e., what changes families believe they are making and actually achieve.

Study Design: RCT

Setting: Community (home)

Population of Focus: Children 2-14 years of age with asthma and a parent or guardian from each child’s household

Data Source: Parental survey (baseline data); urine cotinine; air nicotine monitor readings; and in-person follow-up.

Sample Size: 242 child/adult dyads

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Motivational Interviewing/Counseling

Intervention Description: We enrolled patients in a single-blinded, one-to-one, randomized, controlled trial to assess the impact of enhanced family planning counseling immediately after a viable preterm birth in the inpatient setting. Participants received either structured counseling with an emphasis on LARC by a family planning specialist (intervention) or routine postpartum care (control). We followed participants to the primary outcome of LARC use 3 months postpartum.

Intervention Results: We followed 121 participants for 3 months. Primary outcome data were available for 119 participants (61 intervention, 58 control). We found no demographic differences between the groups. Participants in the intervention group were significantly more likely to use LARC at 3 months postpartum compared with controls (51% vs. 31%; p < .05). For every six women who received the counseling intervention, one additional woman was using a LARC method at 3 months.

Conclusion: After a preterm birth, brief LARC-focused, structured counseling before hospital discharge significantly increased LARC method use at 3 months postpartum.

Study Design: Singe blinded, randomized controlled trial

Setting: University of Utah Hospital, Salt Lake City, Utah

Sample Size: 150 women separated into control and intervention groups

Age Range: 18-45 women who delivered a viable prematurei nfant

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling

Intervention Description: This randomized controlled trial tested the efficacy of parent-based behavioral counseling for reducing secondhand smoke exposure (SHSe) among children with cancer. It also examined predictors of smoking and SHSe outcomes.

Intervention Results: Reductions in parent-reported smoking and exposure were observed in both the intervention and control conditions. There was a significantly greater reduction in parent-reported smoking and child SHSe at 3 months for the intervention group compared with the control group. Child SHSe was significantly lower at 12 months relative to baseline in both groups. Children's cotinine levels did not show significant change over time in either group. Exposure outcomes were influenced by the number of smokers at home, smoking status of the parent participating in the trial, and the child's environment (home versus hospital) the day before the assessment.

Conclusion: Children's SHSe can be reduced by advising parents to protect their child from SHSe, combined with routine reporting of their child's exposure and cotinine testing, when delivered in the context of the pediatric cancer setting. More intensive interventions may be required to achieve greater reductions in SHSe.

Study Design: RCT

Setting: Ill-child healthcare setting (hospital)

Population of Focus: Parents or guardians of nonsmoking children with cancer, <18 years, at least 30 days post diagnosis, and living with at least one adult smoker

Data Source: Parent reports (child SHS exposure and smoking), child urine cotinine assays, parent satisfaction survey.

Sample Size: 135 parents or guardians

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling

Intervention Description: To explore the reach of a German population-based household sample using proactive recruitment and to test the efficacy of a behavioral change counseling intervention including feedback about children's urine cotinine level (CUCL).

Intervention Results: CUCL below the detection limit in the IG was found in 43.2% at baseline and 44.6% at follow-up and in 44.8% of the CG at baseline and 47.2% at follow-up. The CUCL difference between follow-up and baseline was smaller in the CG than in the IG. The effect was not significant.

Conclusion: Data revealed a high reach of the target population but failed to identify an intervention effect.

Study Design: RCT

Setting: Community (home and telephone)

Population of Focus: Households with at least one child aged below 4 and at last one current smoker

Data Source: Baseline assessment, biomarkers with urine cotinine.

Sample Size: 852 household completed the study protocol: n=428 intervention group; n=424 control group

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 PARENT/FAMILY Notification/Information Materials (Online Resources, Information Guide) Counseling (Parent/Family) PATIENT/CONSUMER Educational Material CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling Motivational Interviewing Peer Counselor

Intervention Description: We conducted a population-based trial to evaluate the efficacy of an intervention aimed at preventing exposure of young children to parental tobacco smoke.

Intervention Results: A strong association was found between social class and smoking behavior, in particular smoking during meals at home. The intervention itself had limited effectiveness in decreasing the number of smokers. The effect was stronger in mothers and in higher social groups. Among the "white-collar" families belonging to the intervention group, the proportion of mothers who stopped smoking was 3 times higher than in the control group (not statistically significant).

Conclusion: Educational interventions against smoking should be planned taking into account the difference in efficacy according to social class.

Study Design: Control trial with nonrandom assignment

Setting: Community (population based survey) and well-child health care visit

Population of Focus: Parents of newborn babies living in the town of Rivoli before 3 month compulsory vaccination

Data Source: Baseline (pre-intervention) and followup (2 and 4 years post-intervention) questionnaires

Sample Size: 1015 parents with 402 in the intervention group and 613 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 Educational Material Motivational Interviewing Other Education PARENT/FAMILY Notification/Information Materials (Online Resources, Information Guide) Counseling (Parent/Family) CAREGIVER Educational Material (caregiver) Motivational Interviewing/Counseling Education/Training (caregiver)

Intervention Description: To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic children's exposure to environmental tobacco smoke (ETS).

Intervention Results: The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure. The 2-year follow-up period was analyzed similarly. Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up. Further exploratory analyses suggested that printed counseling materials given to all participants at month 12 (conclusion of the original study) were associated with decreased exposure in the control groups.

Conclusion: Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature, let alone for addictive behaviors. We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit.

Study Design: Three-group RCT

Setting: Ill-child healthcare setting (pediatric allergy clinic)

Population of Focus: Families of children with asthma (6 to 17 years) including at least one parent who smoked in the home

Data Source: Interview data, pulmonary function testing, daily peak flow measures, symptom diary recordings, urinary cotinine, environmental air sampling, and permanent product (e.g., cigarette butt counts).

Sample Size: 91 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling Home Visit (caregiver) PATIENT/CONSUMER Home Visits Motivational Interviewing

Intervention Description: Secondhand smoke (SHS) is a significant cause of acute respiratory illness (ARI) and 5 times more common in indigenous children. A single-blind randomized trial was undertaken to determine the efficacy of a family centered SHS intervention to reduce ARI in indigenous infants in Australia and New Zealand.

Intervention Results: Two hundred and ninety-three mother/infant dyads were randomized and followed up. Three quarters of mothers smoked during pregnancy and two thirds were smoking at baseline (as were their partners), with no change for more than 12 months. Reported infant exposure to SHS was low (≥95% had smoke-free homes/cars). Infant CCRs were higher if one or both parents were smokers and if mothers breast fed their infants. There was no effect of the intervention on ARI events [471 intervention vs. 438 usual care (reference); incidence rate ratio = 1.10, 95% confidence intervals (CI) = 0.88–1.37, p = .40].

Conclusion: Despite reporting smoke-free homes/cars, mothers and their partners continue to smoke in the first year of infants’ lives, exposing them to SHS. Emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal.

Study Design: Single-blind randomized trial

Setting: Community (homes)

Population of Focus: Indigenous mothers/infants from homes with more than one smoker

Data Source: Baseline data at home visit; Baseline, 2 month, and 3 month quantitative and qualitative process evaluation indicators; outcome data from face-toface home visits and urine samples

Sample Size: 293 mother/infant dyads

Age Range: Not specified

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

Intervention Description: To assess counseling to caregivers and classroom health education interventions to reduce environmental tobacco smoke exposure of children aged 5–6 years in China.

Intervention Results: At the 6-month follow-up, children’s urinary cotinine was significantly lower (Z = –3.136; p = 0.002) and caregivers’ 7-day quit rate was significantly higher (34.4% versus 0%) (p < 0.001; adjusted OR = 1.13; 95% CI: 1.02–1.26) in the intervention than control group.

Conclusion: Helping caregivers quitting smoke combined with classroom-based health education was effective in reducing children’s environmental tobacco smoke exposure. Larger-scale trials are warranted.

Study Design: RCT

Setting: Community (preschools)

Population of Focus: Children ages 5-6 and their caregivers from six districts and one county in Changsha in families where one or more parent/caregiver smoked

Data Source: Caregiver interviews; child urine cotinine feedback

Sample Size: 65 smoker caregivers and their children with 33 in the intervention group and 32 in the control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling

Intervention Description: Secondhand tobacco smoke exposure impairs the control of pediatric asthma. Evidence of the efficacy of interventions to reduce children’s exposure and improve disease outcomes has been inconclusive.

Intervention Results: In the sample overall, the children in the LET’S intervention had lower follow-up lnCCR values compared with the children in usual care, but the group difference was not significant (β coefficient = −0.307, P = .064), and there was no group difference in the odds of having > one asthma-related medical visit (β coefficient = 0.035, P = .78). However, children with high-risk asthma had statistically lower follow-up lnCCR values compared with children in usual care (β coefficient = −1.068, P = .006).

Conclusion: The LET’S intervention was not associated with a statistically significant reduction in tobacco smoke exposure or use of health-care services in the sample as a whole. However, it appeared effective in reducing exposure in children at high risk for subsequent exacerbations.

Study Design: RCT

Setting: Ill-child healthcare setting (respiratory disorders)

Population of Focus: Caregivers of children aged 3 to 12 years with asthma and reported smoke exposure

Data Source: Caregiver interview, urine collection, and spirometry

Sample Size: 352 caregivers with 178 in the intervention group and 174 in the control

Age Range: Not specified

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

Intervention Description: To determine the effectiveness of a cotinine-feedback, behaviorally based education intervention in reducing environmental tobacco smoke (ETS) exposure and health-care utilization of children with asthma.

Intervention Results: The intervention was associated with a significantly lower odds ratio (OR) for more than one acute asthma medical visit in the follow-up year, after adjusting for baseline visits (total visits, 87; OR, 0.32; p = 0.03), and a comparably sized but nonsignificant OR for one or more hospitalization (OR, 0.34; p = 0.14). The follow-up CCR measurement and the determination of whether smoking was prohibited inside the home strongly favored the intervention group (n = 51) (mean difference in CCR adjusted for baseline, −0.38; p = 0.26; n = 51) (60; OR [for proportion of subjects prohibiting smoking], 0.24; p = 0.11; n = 60).

Conclusion: This intervention significantly reduced asthma health-care utilization in ETS-exposed, low-income, minority children. Effects sizes for urine cotinine and proportion prohibiting smoking were moderate to large but not statistically significant, possibly the result of reduced precision due to the loss of patients to active follow-up. Improving ETS reduction interventions and understanding their mechanism of action on asthma outcomes requires further controlled trials that measure ETS exposure and behavioral and disease outcomes concurrently.

Study Design: RCT

Setting: Community (pediatric pulmonary service of a pediatric hospital)

Population of Focus: Parents of children 3 to 12 years of age with asthma who were ETS exposed

Data Source: Interview data, pulmonary function, urine cotinine, asthma medications, health care utilization.

Sample Size: 87 parents

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling

Intervention Description: The objective of this study was to test the feasibility and acceptability of introducing an intervention to address mothers' and fathers' smoking during the postpartum hospitalization.

Intervention Results: Enrolling mothers and father into tobacco treatment services during the immediate postpartum hospital stay is feasible and seems to stimulate quit attempts. The birth of an infant presents a teachable moment to reach both parents and to provide cessation assistance. Results were not significant for self-reported 7-day abstinence or 24-hour quit attempts.

Conclusion: Enrolling mothers and fathers into tobacco treatment services during the immediate postpartum hospital stay is feasible and seems to stimulate quit attempts. The birth of an infant presents a teachable moment to reach both parents and to provide cessation assistance.

Study Design: Quasi-experimental RCT

Setting: Well-child healthcare setting (hospital and community child health checks)

Population of Focus: Mothers and fathers of newborns recruited on the postnatal ward who were current smokers or recent quitters

Data Source: Saliva cotinine measurements; SmokeFree Families Core Assessment Forms, HEDIS Measures Interview Survey.

Sample Size: 101 mothers and fathers with 48 in the intervention group and 53 in control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment (Provider) Motivational Interviewing/Counseling

Intervention Description: Electronically delivered screening, brief intervention, and referral to treatment (e-SBIRT); clinician delivered SBIRT, and enhanced usual care

Intervention Results: Both clinician-delivered SBIRT and electronically-delivered SBIRT produced modest and statistically significant effects in promoting abstinence from substances.

Conclusion: The study concluded that both clinician-delivered SBIRT and electronically-delivered SBIRT interventions were effective in promoting abstinence from substances among women in reproductive health settings. While abstinence from the primary substance was a rare outcome in the sample, both interventions showed modest and statistically significant effects. The ease of implementation and relatively low cost of the e-SBIRT intervention suggest its practicality for implementing brief interventions at scale for at-risk women. Further optimization efforts and large-scale implementations could be facilitated by the ease with which electronic interventions can be modified and disseminated.

Study Design: 3-group randomized controlled trial

Setting: Urban academic healthcare settings with a predominantly minority population

Population of Focus: Pregnant and nonpregnant women seeking reproductive health services who may be abusing substances

Sample Size: 439 women

Age Range: Mean age of 34.2 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER Educational Material Home Visits PARENT/FAMILY Notification/Information Materials (Online Resources, Information Guide) Counseling (Parent/Family) Telephone Support Motivational Interviewing CAREGIVER Motivational Interviewing/Counseling Outreach (caregiver) Home Visit (caregiver)

Intervention Description: The aim of this randomized-controlled trial was to evaluate the effectiveness of an intensive intervention to reduce children’s environmental tobacco smoke (ETS) exposure at their home compared with a minimal intervention.

Intervention Results: The levels of cotinine in the intensive intervention and minimal intervention groups in the final follow-up were significantly lower than the initial levels. The proportion of mothers reporting a complete smoking ban at home in the final follow-up was higher in the intensive intervention group than the minimal intervention group. This increase was statistically significant. The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children’s exposure to ETS at their home. The decrease in cotinine levels was higher in the intensive intervention group than the minimal intervention group but the difference was not statistically significant.

Conclusion: The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children’s exposure to ETS at their home.

Study Design: RCT

Setting: Community (home and hospital)

Population of Focus: Mothers of children aged 1-5 who lived in the Cengizhan district of Izmir in Turkey, who smoked and/or whose spouses smoked

Data Source: Urinary cotinine samples and forms

Sample Size: 80 mothers with 40 in the intensive intervention group and 40 in the minimal intervention group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY Counseling (Parent/Family) CAREGIVER Motivational Interviewing/Counseling

Intervention Description: The present randomized controlled trial tested the effectiveness of a behavioral counseling program for reducing children's exposure to environmental tobacco smoke (ETS). Counseling was delivered by clinic staff as part of well-child health care services in a community clinic setting.

Intervention Results: In both groups, children’s reported exposure to their mothers’ tobacco smoke in the home declined steeply from baseline to 6-months post-test and remained essentially level during follow-up. The sharpest decline occurred by 3 months. Children’s urinary cotinine concentrations did not show a significant chance over time in either the intervention or control group. Mothers’ self-reported 7-day quit status did not vary by experimental group at 3, 6, or 12 months. At 12 months, a significant group difference was found in SCN- verified 7-day quit status.

Conclusion: Findings on the fidelity of treatment implementation suggest that the structure and funding of the community clinic health care system and associated staff turnover and training issues resulted in participants receiving a less efficacious intervention than in our past efficacy trials. Implications for future effectiveness trials are discussed.

Study Design: RCT

Setting: Well-child healthcare setting (community clinic)

Population of Focus: English or Spanish-speaking smoking mothers with children aged 4 or younger

Data Source: Children’s urinary cotinine measures, saliva samples from mothers, parent report from interviews at baseline, 3, 6, and 12 months, and nicotine monitors.

Sample Size: 150 mothers with 76 in the intervention group and 74 in the control group

Age Range: Not specified