Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure

Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Journal of Clinical Nursing (Impact Factor: 1.26). 08/2009; 19(3-4):507-16. DOI: 10.1111/j.1365-2702.2009.02847.x
Source: PubMed


To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfare's national evaluation in 1997.
Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied.
In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study.
Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups.
Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions.
This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.

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    • "The health promotion includes tobacco prevention [8]. Previous research indicates that CHC nurses had a positive attitude to tobacco prevention [9]. However, results indicated that parents were not satisfied with tobacco prevention in CHC and expressed a wish to have a dialogue with the CHC nurse about how they could protect their child from ETS exposure [10]. "
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    ABSTRACT: Child health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents' experiences from participating in a nursebased tobacco prevention intervention. Eleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process. The analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents' smoking. The clinical implication is that CHC is an important arena for preventive work aiming to minimize children's tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.
    BMC Pediatrics 03/2014; 14(1):69. DOI:10.1186/1471-2431-14-69 · 1.93 Impact Factor
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    • "The intervention was carried out with an interactive approach where the researcher was given access to an understanding based on the participants’ own perspectives, both from the CHC nurses and the parents [30]. The results from the two earlier studies [20,21] formed the basis for the intervention which was designed to reduce children’s ETS exposure in their homes in “high risk areas”. In order to successfully communicate with parents with different backgrounds, the dialogue between nurses and parents needed to be improved, and in order to make this improvement, different evidence based components were combined in an “intervention bundle”. "
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    ABSTRACT: Background Despite the low prevalence of daily smokers in Sweden, children are still being exposed to environmental tobacco smoke (ETS), primarily by their smoking parents. A prospective intervention study using methods from Quality Improvement was performed in Child Health Care (CHC). The aim was to provide nurses with new methods for motivating and supporting parents in their efforts to protect children from ETS exposure. Method Collaborative learning was used to implement and test an intervention bundle. Twenty-two CHC nurses recruited 86 families with small children which had at least one smoking parent. Using a bundle of interventions, nurses met and had dialogues with the parents over a one-year period. A detailed questionnaire on cigarette consumption and smoking policies in the home was answered by the parents at the beginning and at the end of the intervention, when children also took urine tests to determine cotinine levels. Results Seventy-two families completed the study. Ten parents (11%) quit smoking. Thirty-two families (44%) decreased their cigarette consumption. Forty-five families (63%) were outdoor smokers at follow up. The proportion of children with urinary cotinine values of >6 ng/ml had decreased. Conclusion The intensified tobacco prevention in CHC improved smoking parents’ ability to protect their children from ETS exposure.
    BMC Pediatrics 05/2013; 13(1):76. DOI:10.1186/1471-2431-13-76 · 1.93 Impact Factor
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    • "In reviewing CH nurses' roles to encourage parents to reduce or stop smoking, Carlsson et al. (2010) mailed a questionnaire to all of the CH nurses (N = 196) in two Swedish counties. The CH nurses stated that it was difficult to reach fathers, immigrant families, and socially vulnerable groups. "
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    ABSTRACT: By reviewing the literature, we looked at how parental leave policies in Sweden have influenced two well-defined areas of early father involvement: participating in parental leave and at visits/activities at the Child Health Centers. Sweden has one of the most comprehensive and egalitarian parental leave policies in the world, permitting parents to take 480days off of work, receive 80% of their pay for the first 15months, and divide their leave however they see fit, barring that both parents receive 2months of parental leave that is exclusive to them. Additionally, fathers are permitted to take the first ten working days off to be at home with his family. Most parents, especially mothers, use parental leave throughout their infant’s first year. During the parents’ time off from work, nearly all Swedish parents (95–99%) utilize the Child Health Centers between 11 and 13 times during the infant’s first year of life. The Child Health Centers help to monitor a child’s growth and development, provide parenting support, immunizations, health education, health screenings, and provide referral sources if the child has any special needs. However, fathers only use 22% of all parental leave days. Studies have pointed out that fathers may not use parental leave because of corporate, maternal, and financial attitudes. Despite the Child Health Centers’ policy of including both parents, fathers do not utilize the Child Health Centers to the same extent as mothers. Research has shown that fathers may not use Child Health Centers as they are mainly only open during normal working hours, they are dominated by females (staff and mothers), and many conversations during the child’s first year are directed towards mothers. Barriers for why father involvement is lower than mothers are discussed. KeywordsSweden–Parental leave–Child health centers–Fathers–Public policy
    Journal of Child and Family Studies 02/2012; 21(1):25-31. DOI:10.1007/s10826-011-9487-7 · 1.42 Impact Factor
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