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Effectiveness of a brief primary care intervention to reduce passive smoking in babies: a cluster randomised clinical trial
  1. Guadalupe Ortega Cuelva1,2,
  2. Carmen Cabezas Peña1,
  3. Jesús Almeda Ortega3,4,
  4. Marc Saez Zafra4,5,
  5. Jose L Ballvé Moreno6,
  6. Jose A Pascual Esteban7,8,
  7. Cristina Castellà Cuesta9,
  8. Carlos Martín-Cantera10,11,
  9. Esteve Saltó Cerezuela1,
  10. Rosa M Casademont Pou12,
  11. Estela Díaz Alvarez1,
  12. Joan Lozano Fernandez2,
  13. Concepció Morera Jordán13,
  14. Araceli Valverde Trillo1,
  15. Raúl Pérez-Ortuño7,
  16. Lourdes Rofes Ponce14,
  17. Mireia Jané Checa1,
  18. The BIBE study group15
  1. 1Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
  2. 2Fundació Atenció Primària de la CAMFiC, Barcelona, Spain
  3. 3Unitat de Suport a la Recerca Costa de Ponent, IDIAP Jordi Gol, Institut Català de la Salut (ICS), Cornellà de Llobregat, Barcelona, Spain
  4. 4CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Catalunya, Spain
  5. 5Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
  6. 6EAP Florida Nord, Direcció d'Atenció Primària Costa de Ponent, ICS, L'Hospitalet de Llobregat, Barcelona, Catalunya, Spain
  7. 7Bioanalysis and Analytical Services Research Group, Program of Neurosciences, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
  8. 8Department of Experimental & Health Sciences, University Pompeu Fabra, Barcelona, Spain
  9. 9EAP Lloret Centre, Corporació De Salut del Maresme i la Selva, Lloret de Mar, Girona, Spain
  10. 10EAP Barcelona, Passeig Sant Joan, Àmbit d'Atenció Primària de Barcelona, ICS, Barcelona, Spain
  11. 11Departament 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
  12. 12EAP Sant Gervasi, Unitat de pediatria, Àmbit d'Atenció Primària de Barcelona, ICS, Barcelona, Spain
  13. 13Àrea de Coneixement Clínic—Avaluació, Direcció d'Atenció Primària de Girona, ICS, Girona, Spain
  14. 14Hospital Universitari de Sant Joan de Reus, Reus, Spain
  15. 15Members of the BIBE study group are listed in Collaborators
  1. Correspondence to Guadalupe Ortega Cuelva, Agència de Salut Pública de Catalunya (ASPCAT), Departament de Salut. Generalitat de Catalunya, Barcelona, Spain and Fundació Atenció Primària de la CAMFiC, Roc Boronat 81–95, Barcelona 08005, Spain; guadalupe.ortega{at}gencat.cat

Abstract

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.

Method 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.

Trial registration number Clinical Trials.gov Identifier: NCT00788996.

  • ENVIRONMENTAL HEALTH
  • HEALTH EDUCATION SA
  • HEALTH PROMOTION
  • PAEDIATRIC
  • Tobacco

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