A review of interventions for reduction of residential environmental tobacco smoke exposures among children.
OBJECTIVE
To describe individual-level interventions to reduce residential environmental tobacco smoke (ETS) exposure among children and to summarize the evidence of the effectiveness of the interventions.


METHODS
A search of electronic databases (from 1987 to 1998) was conducted for studies designed to reduce ETS exposure of children through the use of interventions that included strategies other than parental smoking cessation. Twelve articles that presented nine unique interventions (six interventions were designed for well children and three interventions targeted children with asthma) were found. Information about location, target population, design, sample size, tested intervention and results were summarized for each study.


RESULTS
Only one of the six interventions designed for well children produced significant reductions in ETS exposure, while all three of the interventions that targeted children with asthma reported small to moderate reductions in ETS exposure or respiratory symptoms.


CONCLUSIONS
The number of interventions for ETS reduction published to date is miniscule relative to the magnitude of the associated health problems. Some ETS reduction interventions for children have shown significant reductions in exposure, but most interventions, especially those designed for well children, have had little effect. Little is known about which specific intervention components may be effective. Parental characteristics that may predict positive response to intervention efforts have not been identified. More research is needed to develop effective interventions that can be integrated with physician visits in the perinatal and early childhood periods. Adapting standard guidelines on counselling for parental smoking cessation may be a promising approach if the barriers identified by health professionals can be addressed adequately.
Adair
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Child Health Research Unit, Alberta Children's Hospital and Department of Community Health Sciences, University of Calgary;
Patten
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