title: Effect of a family-centered, secondhand smoke intervention to reduce respiratory illness in indigenous infants in Australia and New Zealand: a randomized controlled trial.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Indigenous mothers/infants from homes with ≥ 1 smoker were randomized to a SHS intervention involving 3 home visits in the first 3 months of the infants' lives (plus usual care) or usual care. The primary outcome was number of ARI-related visits to a health provider in the first year of life. Secondary outcomes, assessed at 4 and 12 months of age, included ARI hospitalization rates and mothers' report of infants' SHS exposure (validated by urinary cotinine/creatinine ratios [CCRs]), smoking restrictions, and smoking cessation.
  
  
  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].
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand; n.walker@nihi.auckland.ac.nz.
authors.forename: Natalie
authors.initials: N
authors.lastname: Walker
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia;
authors.forename: Vanessa
authors.initials: V
authors.lastname: Johnston
authors.affiliation: Centre for Tobacco Control Research, Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand;
authors.forename: Marewa
authors.initials: M
authors.lastname: Glover
authors.affiliation: National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;
authors.forename: Christopher
authors.initials: C
authors.lastname: Bullen
authors.affiliation: Kidz First and Women's Health Division, Counties Manukau District Health Board, Auckland, New Zealand;
authors.forename: Adrian
authors.initials: A
authors.lastname: Trenholme
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia; Queensland Children's Respiratory Centre and Queensland Children's Medical Research Institute, Royal Children's Hospital, Brisbane, Queensland, Australia;
authors.forename: Anne
authors.initials: A
authors.lastname: Chang
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia;
authors.forename: Peter
authors.initials: P
authors.lastname: Morris
authors.affiliation: Centre for Health Policy, Programs and Economics, University of Melbourne, Victoria, Australia;
authors.forename: Catherine
authors.initials: C
authors.lastname: Segan
authors.affiliation: Department of Medicine, University of Wollongong, Wollongong, Australia;
authors.forename: Ngiare
authors.initials: N
authors.lastname: Brown
authors.affiliation: Kidz First and Women's Health Division, Counties Manukau District Health Board, Auckland, New Zealand;
authors.forename: Debra
authors.initials: D
authors.lastname: Fenton
authors.affiliation: Danila Dilba Aboriginal Health Service, Darwin, Australia;
authors.forename: Eyvette
authors.initials: E
authors.lastname: Hawthorne
authors.affiliation: VicHealth Center for Tobacco Control, Cancer Council Victoria, Victoria, Australia;
authors.forename: Ron
authors.initials: R
authors.lastname: Borland
authors.affiliation: National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;
authors.forename: Varsha
authors.initials: V
authors.lastname: Parag
authors.affiliation: National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand;
authors.forename: Taina
authors.initials: T
authors.lastname: Von Blaramberg
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia;
authors.forename: Darren
authors.initials: D
authors.lastname: Westphal
authors.affiliation: Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, Darwin, Australia; Lowitja Institute, Charles Darwin University, Darwin, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Thomas
mesh_terms: D000328:Adult; D001315:Australia; D005190:Family; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D033261:Maternal-Fetal Relations; D009520:New Zealand; D044382:Population Groups; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care; D012141:Respiratory Tract Infections / Q000517:prevention & control*; D016037:Single-Blind Method; D016540:Smoking Cessation / Q000379:methods*; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D014028:Tobacco Smoke Pollution