Effectiveness of a brief primary care intervention to reduce passive smoking in babies: a cluster randomised clinical trial.
BACKGROUND
Tobacco smoke pollution (TSP) has major negative effects on infant health. 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.


METHODS
A multicentre, open, cluster-randomised clinical trial in Catalonia. The 83 participating primary health paediatric teams of the Catalan Health Service recruited 1101 babies whose parents were smokers. The intervention group (IG) received a brief TSP intervention; the control group (CG) received the usual care. 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/behaviours. At 3-month and 6-month follow-up, behavioural changes to avoid TSP exposure were recorded; the association between reported parental behaviours and nicotine concentration in infant hair samples was tested in a random sample of 253 babies at baseline and 6 months.


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).


CONCLUSIONS
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.


BACKGROUND
Clinical Trials.gov Identifier: NCT00788996.
Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain Fundació Atenció Primària de la CAMFiC, Barcelona, Spain.
Guadalupe
G
Ortega Cuelva
Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
Carmen
C
Cabezas Peña
Unitat de Suport a la Recerca Costa de Ponent, IDIAP Jordi Gol, Institut Català de la Salut (ICS), Cornellà de Llobregat, Barcelona, Spain CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Catalunya, Spain.
Jesús
J
Almeda Ortega
CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Catalunya, Spain Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain.
Marc
M
Saez Zafra
EAP Florida Nord, Direcció d'Atenció Primària Costa de Ponent, ICS, L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain.
Jose L
JL
Ballvé Moreno
Bioanalysis and Analytical Services Research Group, Program of Neurosciences, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain Department of Experimental & Health Sciences, University Pompeu Fabra, Barcelona, Spain.
Jose A
JA
Pascual Esteban
EAP Lloret Centre, Corporació De Salut del Maresme i la Selva, Lloret de Mar, Girona, Spain.
Cristina
C
Castellà Cuesta
EAP Barcelona, Passeig Sant Joan, Àmbit d'Atenció Primària de Barcelona, ICS, Barcelona, Spain Departament de Medicina, Universitat Autònoma de Barcelona and Unitat de Suport a la Recerca Barcelona-Ciutat, Institut d'Investigació i Recerca en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.
Carlos
C
Martín-Cantera
Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
Esteve
E
Saltó Cerezuela
EAP Sant Gervasi, Unitat de pediatria, Àmbit d'Atenció Primària de Barcelona, ICS, Barcelona, Spain.
Rosa M
RM
Casademont Pou
Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
Estela
E
Díaz Alvarez
Fundació Atenció Primària de la CAMFiC, Barcelona, Spain.
Joan
J
Lozano Fernandez
Àrea de Coneixement Clínic-Avaluació, Direcció d'Atenció Primària de Girona, ICS, Girona, Spain.
Concepció
C
Morera Jordán
Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
Araceli
A
Valverde Trillo
Bioanalysis and Analytical Services Research Group, Program of Neurosciences, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
Raúl
R
Pérez-Ortuño
Hospital Universitari de Sant Joan de Reus, Reus, Spain.
Lourdes
L
Rofes Ponce
Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain.
Mireia
M
Jané Checa
D005260:Female; D006197:Hair / Q000737:chemistry / Q000187:drug effects*; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009538:Nicotine / Q000032:analysis*; D010290:Parents / Q000193:education*; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D012907:Smoking / Q000009:adverse effects*; D000074606:Smoking Prevention; D013030:Spain; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000517:prevention & control*
D014028:Tobacco Smoke Pollution; D009538:Nicotine
ENVIRONMENTAL HEALTH; HEALTH EDUCATION SA; HEALTH PROMOTION; PAEDIATRIC; Tobacco