Evaluation of a counseling method for the prevention of child exposure to tobacco smoke: An example of client-centered communication

Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Karolinska Hospital, Norrbacka, SE-171 76 Stockholm, Sweden.
Preventive Medicine (Impact Factor: 3.09). 04/2004; 38(3):295-301. DOI: 10.1016/j.ypmed.2003.10.008
Source: PubMed


Environmental tobacco smoke (ETS) is an important risk factor. The aim of this study is to evaluate effects of the counseling method "Smoke-free children" that focuses on protection of infants.
The counseling method, "Smoke-free children", has been developed and implemented at Swedish child health centers. The counseling method's point of departure is based upon a client-centered approach. Saliva cotinine samples from the mothers were collected when the child was 1-4 weeks and 3 months of age. Interviews regarding mothers' smoking habits and self-reported maternal smoking were also carried out.
Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine.
The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

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    • "“Smoke-free children”, a national intervention in Sweden in the 1990s, stressed that the first step always was to ask what the parents knew about the effects of smoking on children [23]. Several studies have shown a positive relationship between low educational level and low awareness of ETS risks on children [24,25], and this might explain our findings since only three parents had an academic background. "
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    • "For example, research links social support [14], coping skills [15], and self-efficacy [16] to smoking behavior change. The KiSS interventions have elements shown to be associated with improved social support [17], coping skills [18], and self-efficacy [19]. Other non-program factors, such as psychological symptoms [20], nicotine dependence [21], and presence of other smokers in home [22], are known predictors of smoking outcomes and might moderate intervention efficacy. "
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    • "Chan 2006a used Ajzen's theory of planned behavior in the development of their educational intervention. Greenberg 1994, Elder 1996, Conway 2004 and Fossum 2004 employed the social learning model. "
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