Effectiveness of a Parental Smoking Reduction Intervention in Reducing Children’s Sick Visits, RTI Symptoms and Improving Spirometry Results

Background: Environmental tobacco smoke (ETS) exposure is among the most important health threats and the most preventable causes of death in paediatric population. Parental smoking is the major source of children’s ETS exposure, thus contact with parents during their children’s health care visits or hospitalisation serves as a golden opportunity to screen for ETS exposure and to provide intervention. The current analyses aimed to examine the effectiveness of one parental smoking reduction intervention in reducing children’s sick visits, respiratory tract infection (RTI) symptoms and improving spirometry result.

Methods: This is a randomized controlled trial, in which smoking parents were recruited from the paediatric inpatient and out-patient units of Prince of Wales Hospital in Hong Kong. Parents and their children were allocated randomly into the intervention or control group at a 1:1 ratio. Our intervention included motivational interviews on smoking reduction with emphasis on health hazards related to children’s ETS exposure, and provision of free nicotine patches. Data were collected with face-to-face interviews and spirometric measurements at the study baseline and endline visit, including demographic characteristics, parental smoking conditions, children’s sick visits and RTI symptoms during the study period, and children’s pre- and post-intervention spirometry results.

Results: 196 paediatric patients (mean age: 4.96±4.1 yrs.; female; 44.4 %) and their smoking parents (mean age: 37.6±7.6 yrs.; female: 18.1%) were included in this RCT study. The was no significant difference regarding the children’s and parental demographic and clinical characteristics between the two groups. Most of the participating children had chronic medical conditions, and about one third of them had chronic respiratory tract disease. As for smoking parents, most of them were daily smokers (mean tobacco consumption was 15.1 ± 7.5 cigarettes/day) with moderate nicotine dependence level. When comparing the two groups, no significant difference in terms of children’s respiratory symptoms, sick visits and hospitalisations was identified (Table 1), though there were less episodes of all-cause hospitalisation in the intervention children (58.8%) than the control (66.7%). Only 19 children in the intervention and 15 children in the control were able to perform spirometry at both baseline and end-line visits, and no significant difference in the spirometry results between the two groups was found (Table 2).

Conclusion: Children’s health outcomes such as sick visits, RTI symptoms and spirometry results are unlikely to be changed with a half-year intervention. Further trials with long follow-up period and larger sample size would be needed to evaluate the longer-term effectiveness of the smoking reduction intervention on children’s ETS exposure and health outcomes. Nonetheless, our trial has provided valuable information on effectiveness of such intervention in paediatric clinical settings.