Daly Justine B, Freund Megan, Burrows Sally, Considine Robyn, Bowman Jennifer A, Wiggers John H
Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, NSW, 2289, Australia.
Faculty of Health, School of Medicine and Population Health, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.
Matern Child Health J. 2017 Jan;21(1):108-117. doi: 10.1007/s10995-016-2099-5.
Background Exposure to secondhand smoke (SHS) is a significant contributor to ill health in children. A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans. Methods This study was a 3 arm, cluster randomised controlled trial. Clusters were 39 community based well child health clinics in one local area health service. Clinics were stratified according to annual number of client appointments and then randomly assigned in a 1:1:1 ratio, (Intervention 1: Intervention 2: Control), with 13 clinics in each cluster. Parents/carers of infants in the intervention groups received a brief multi-strategic intervention from child health nurses during clinic consultations. Treatment condition 1 included computer delivered risk assessment and feedback and nurse brief advice. Treatment condition 2 included all elements of Treatment condition 1 with the addition of biochemical feedback of infant SHS exposure. Results When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 (OR 1.16, 95 % CI 0.73-1.85, p = 0.53) or Treatment condition 2 (OR 1.30, 95 % CI 0.88-1.92, p = 0.19) Similarly, no significant differences were detected in the proportion of parent/carers who reported that they were smokers (T1:OR 0.95, 95 % CI 0.78-1.15, p = 0.58 and T2:OR 0.97, 95 % CI 0.80-1.18, p = 0.77), or in the proportion of households reported to have a complete smoking ban (T1:OR 1.21, 95 % CI 0.89-1.64, p = 0.23 and T2:OR 1.06, 95 % CI 0.79-1.43, p = 0.68). Conclusions Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.
背景 接触二手烟（SHS）是导致儿童健康不良的一个重要因素。开展了一项研究，以确定由儿童健康护士实施的两种简短的多策略干预措施在以下方面的有效性：降低接触二手烟的婴儿的比例；降低婴儿父母/照顾者的吸烟率；提高家庭实施全面禁烟的比例。方法 本研究为一项三臂整群随机对照试验。整群为一个当地卫生服务机构中的39个社区儿童健康诊所。诊所根据每年的客户预约数量进行分层，然后以1:1:1的比例随机分配（干预1组：干预2组：对照组），每组13个诊所。干预组中婴儿的父母/照顾者在诊所咨询期间接受了儿童健康护士的简短多策略干预。治疗条件1包括计算机提供的风险评估和反馈以及护士的简短建议。治疗条件2包括治疗条件1的所有内容，并增加了婴儿接触二手烟的生化反馈。结果 与对照组在12个月时相比，治疗条件1（比值比1.16，95%可信区间0.73 - 1.85，p = 0.53）或治疗条件2（比值比1.30，95%可信区间0.88 - 1.92，p = 0.19）从基线到随访期间，接触二手烟的婴儿比例没有显著差异。同样，在报告自己是吸烟者的父母/照顾者比例方面（T1：比值比0.95，95%可信区间0.78 - 1.15，p = 0.58；T2：比值比0.97，95%可信区间0.80 - 1.18，p = 0.77），或在报告实施全面禁烟的家庭比例方面（T1：比值比1.21，95%可信区间0.89 - 1.64，p = 0.23；T2：比值比1.06，95%可信区间0.79 - 1.43，p = 0.68），均未检测到显著差异。结论 如果要实现此类场所对减少儿童接触二手烟的潜在作用，需要进一步研究以确定儿童健康护士能够持续提供的有效干预措施。
