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Behavioral counseling for reducing children's ETS exposure: implementation in community clinics
Joy M Zakarian1, Melbourne F Hovell, Rachel D Sandweiss
1Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, CA 92123, USA. jzakarian@projects.sdsu.edu
Summary
This study found that behavioral counseling for mothers did not significantly reduce children's environmental tobacco smoke (ETS) exposure, despite reported decreases in maternal smoking. Implementation challenges in the clinic setting may have limited the intervention's effectiveness.
Area of Science:
- Public Health
- Behavioral Science
- Pediatrics
Background:
- Environmental tobacco smoke (ETS) exposure poses significant health risks to children.
- Behavioral counseling is a potential strategy to reduce parental smoking and subsequent child ETS exposure.
- Community clinic settings offer opportunities for integrating health interventions into routine pediatric care.
Purpose of the Study:
- To evaluate the effectiveness of a behavioral counseling program aimed at reducing children's exposure to environmental tobacco smoke (ETS).
- To assess the impact of counseling on maternal smoking cessation and children's ETS exposure levels within a community clinic setting.
Main Methods:
- A randomized controlled trial involving 150 mothers and their children (aged 4 years or younger).
- Intervention group received seven behavioral counseling sessions over 6 months, including behavioral contracting and problem-solving.
- Exposure was measured using parent reports and children's urinary cotinine levels at baseline, 3, 6, and 12 months.
Main Results:
- Parent-reported measures showed declines in children's ETS exposure and maternal smoking in both intervention and control groups.
- Children's urinary cotinine levels did not significantly change over time in either group.
- Implementation fidelity was compromised by clinic system factors like funding, staff turnover, and training.
Conclusions:
- The behavioral counseling program, as implemented in this community clinic, did not significantly reduce children's ETS exposure based on objective measures.
- Challenges in the healthcare system's structure and operations may have hindered the intervention's efficacy.
- Future effectiveness trials require careful consideration of implementation context and support for clinic staff.