Young children can be protected from much of the harm from tobacco smoke exposure if their parents quit smoking. Some researchers encourage parents to quit for their children's benefit, but the evidence for effectiveness of such approaches is mixed.
To perform a systematic review and meta-analysis to quantify the effects of interventions that encourage parental cessation.
We searched PubMed, the Cochrane Library, Web of Science, and PsycINFO. Controlled trials published before April 2011 that targeted smoking parents of infants or young children, encouraged parents to quit smoking for their children's benefit, and measured parental quit rates were included. Study quality was assessed. Relative risks and risk differences were calculated by using the DerSimonian and Laird random-effects model.
Eighteen trials were included. Interventions took place in hospitals, pediatric clinical settings, well-baby clinics, and family homes. Quit rates averaged 23.1% in the intervention group and 18.4% in the control group. The interventions successfully increased the parental quit rate. Subgroups with significant intervention benefits were children aged 4 to 17 years, interventions whose primary goal was cessation, interventions that offered medications, and interventions with high follow-up rates (>80%).
Interventions to achieve cessation among parents, for the sake of the children, provide a worthwhile addition to the arsenal of cessation approaches, and can help protect vulnerable children from harm due to tobacco smoke exposure. However, most parents do not quit, and additional strategies to protect children are needed.
Comments
Revised tables
Errors appeared in this article by Rosen et al (doi: 10.1542/peds.2010-3209. Epub 2011 Dec 26). In May 2013, the author of one of the articles included in this review informed us that her data had been mishandled. We checked her data, found her concerns to be justified, and then re-extracted all data from all included studies. Each data point was re-extracted at least twice. Five of the original 18 studies did not present quit rates and were erroneously included in the original meta-analysis. A number of other data extraction errors were detected. The meta-analysis was re-run using the corrected data. It appears that, as originally reported, interventions to promote parental cessation in order to protect children from tobacco smoke exposure are beneficial (RR=1.47 [CI: 0.97,2.23], p=0.07; RD =0.05 [CI:0.01,0.08], p=.0.02.) Results from the revised subgroup analyses showed that studies with a primary aim of parental cessation, and studies which included 2-4 sessions, were beneficial. Revised tables are available from the corresponding author upon request.
Laura J. Rosen, PhD
Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University
rosenl@post.tau.ac.il