title: Meta-analysis of parental protection of children from tobacco smoke exposure.
abstract: OBJECTIVE
  Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.
  
  
  METHODS
  Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.
  
  
  RESULTS
  Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P < .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD -0.05, CI -0.13 to 0.03, P = .20).
  
  
  CONCLUSIONS
  Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement.
authors.affiliation: Departments of Health Promotion.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Rosen
authors.forename: Vicki
authors.initials: V
authors.lastname: Myers
authors.forename: Melbourne
authors.initials: M
authors.lastname: Hovell
authors.forename: David
authors.initials: D
authors.lastname: Zucker
authors.forename: Michal
authors.initials: M
authors.lastname: Ben Noach
mesh_terms: D002648:Child; D006801:Humans; D010290:Parents; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
chemical_list: D014028:Tobacco Smoke Pollution
keywords: child; meta-analysis; secondhand smoke exposure; systematic review; tobacco smoke exposure