Interventions by Health Care Professionals Who Provide Routine Child Health Care to Reduce Tobacco Smoke Exposure in Children A Review and Meta-analysis
Interventions by Health Care Professionals Who Provide Routine Child Health Care to Reduce Tobacco Smoke Exposure in Children A Review and Meta-analysis
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DOI：
10.1001/jamapediatrics.2015.3342
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发表时间：
2016-02-01
期刊：
影响因子：
26.1
通讯作者：
Wiggers, John H.
中科院分区：
文献类型：
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作者：
Daly, Justine B.;Mackenzie, Lisa J.;Wiggers, John H.
减少儿童接触烟草烟雾是一项公共卫生优先事项。指南建议，儿童卫生机构的卫生保健专业人员应处理儿童的烟草烟雾暴露问题。目的确定提供常规儿童保健的卫生保健专业人员提供的干预措施在减少儿童TSE中的有效性。资料来源对2014年Cochrane综述中纳入的57项试验进行了二次分析，并进行了随后的扩展检索。确定了以减少儿童TSE为重点的干预措施的对照试验（发表至2015年6月），对实施干预措施的人员没有限制。2015年8月进行二次数据提取。研究选择：由卫生保健专业人员（医生、护士、医疗助理、健康教育工作者和营养师）提供的常规儿童卫生保健的对照试验，涉及感兴趣的结果（儿童TSE减少和父母吸烟行为），符合纳入本综述和荟萃分析的条件。研究细节和质量特征由2位作者独立提取。如果结果测量足够相似，则使用DerSimonian和Laird的随机效应模型进行meta分析。否则，结果被叙述。主要结局和测量主要结局测量是儿童TSE的减少。次要结局是父母戒烟、父母减少吸烟和母亲产后吸烟复发预防。结果16项研究符合入选标准。对测量儿童TSE的6项试验的叙述性分析表明，与对照组相比，没有干预效果。同样，对9项测量父母戒烟情况的试验的荟萃分析显示，总体上没有干预效果（n = 6399）（风险比1.05;95% CI, 0.74-1.50; P = 0.78）。对3项测量产妇产后吸烟复发预防的试验进行meta分析，结果显示总体干预效果显著（n = 1293）（风险比1.53;95% CI, 1.10-2.14; P = 0.01）。高水平的研究异质性可能是由于结果测量、随访时间、干预策略和未知的干预保真度的可变性所致。结论和相关性：提供常规儿童保健的卫生保健专业人员提供的干预措施可能有效预防产妇吸烟复发。需要进一步研究以提高此类干预措施在减少儿童TSE和促进父母戒烟方面的有效性。本荟萃分析的结果对常规儿科卫生保健专业人员旨在减少儿童接触烟草烟雾的干预措施具有政策和实践意义。
IMPORTANCE Reducing child exposure to tobacco smoke is a public health priority. Guidelines recommend that health care professionals in child health settings should address tobacco smoke exposure (TSE) in children.OBJECTIVE To determine the effectiveness of interventions delivered by health care professionals who provide routine child health care in reducing TSE in children.DATA SOURCES A secondary analysis of 57 trials included in a 2014 Cochrane review and a subsequent extended search was performed. Controlled trials (published through June 2015) of interventions that focused on reducing child TSE, with no restrictions placed on who delivered the interventions, were identified. Secondary data extraction was performed in August 2015.STUDY SELECTION Controlled trials of routine child health care delivered by health care professionals (physicians, nurses, medical assistants, health educators, and dieticians) that addressed the outcomes of interest (TSE reduction in children and parental smoking behaviors) were eligible for inclusion in this review and meta-analysis.DATA EXTRACTION AND SYNTHESIS Study details and quality characteristics were independently extracted by 2 authors. If outcome measures were sufficiently similar, meta-analysis was performed using the random-effects model by DerSimonian and Laird. Otherwise, the results were described narratively.MAIN OUTCOMES AND MEASURES The primary outcome measure was reduction in child TSE. Secondary outcomes of interest were parental smoking cessation, parental smoking reduction, and maternal postpartum smoking relapse prevention.RESULTS Sixteen studies met the selection criteria. Narrative analysis of the 6 trials that measured child TSE indicated no intervention effects relative to comparison groups. Similarly, meta-analysis of 9 trials that measured parental smoking cessation demonstrated no overall intervention effect (n = 6399) (risk ratio 1.05; 95% CI, 0.74-1.50; P =.78). Meta-analysis of the 3 trials that measured maternal postpartum smoking relapse prevention demonstrated a significant overall intervention effect (n = 1293) (risk ratio 1.53; 95% CI, 1.10-2.14; P =.01). High levels of study heterogeneity likely resulted from variability in outcome measures, length of follow up, intervention strategies, and unknown intervention fidelity.CONCLUSIONS AND RELEVANCE Interventions delivered by health care professionals who provide routine child health care may be effective in preventing maternal smoking relapse. Further research is required to improve the effectiveness of such interventions in reducing child TSE and increasing parental smoking cessation. The findings of this meta-analysis have policy and practice implications relating to interventions by routine pediatric health care professionals that aim to reduce child exposure to tobacco smoke.