Systematic Review of Behaviour Change Techniques within Interventions to Reduce Environmental Tobacco Smoke Exposure for Children.

Tracey J Brown,Paul Clarke,Wendy Hardeman,Sarah Gentry,Elaine M Boyle,Felix Naughton,Michael Ussher,Linda Bauld,Sophie Orton,Richard Holland,Caitlin Notley

doi:10.3390/ijerph17217731

Abstract

Children are particularly vulnerable to environmental tobacco smoke (ETS). There is no routine support to reduce ETS in the home. We systematically reviewed trials to reduce ETS in children in order to identify intervention characteristics and behaviour change techniques (BCTs) to inform future interventions. We searched Medline, EMBASE, CINAHL, PsycINFO, ERIC, Cochrane Central Register of Controlled Trials, and Cochrane Tobacco Addiction Group Specialised Register from January 2017 to June 2020 to update an existing systematic review. We included controlled trials to reduce parent/caregiver smoking or ETS in children <12 years that demonstrated a statistically significant benefit, in comparison to less intensive interventions or usual care. We extracted trial characteristics; and BCTs using Behaviour Change Technique Taxonomy v1. We defined “promising” BCTs as those present in at least 25% of effective interventions. Data synthesis was narrative. We included 16 trials, of which eight were at low risk of bias. All trials used counselling in combination with self-help or other supporting materials. We identified 13 “promising” BCTs centred on education, setting goals and planning, or support to reach goals. Interventions to reduce ETS in children should incorporate effective BCTs and consider counselling and self-help as mechanisms of delivery.

Highlights

Smoking has a severe detrimental impact on parental and child health [1]
Children exposed to tobacco smoke in utero or in early life are more likely to be admitted to paediatric care, or to a neonatal intensive care unit (NICU) [8,9], resulting in significant economic burden [10,11,12,13]
We identified a wide range of behaviour change techniques (BCTs) targeting smoking cessation, smoking relapse, or behaviours relating to a reduction of environmental tobacco smoke (ETS) as summarised in Table 1 and detailed

Summary

Introduction

Smoking has a severe detrimental impact on parental and child health [1]. Exposure to environmental tobacco smoke (ETS) from parents or caregivers increases rates of sudden infant death syndrome, respiratory conditions, and other infections [2]. Children are more susceptible to second-hand smoke than adults are [3,4], vulnerable children, such as premature infants [5]. Exposure to smoke in early life results in increased morbidity throughout childhood and into adulthood [2,6,7]. Children exposed to tobacco smoke in utero or in early life are more likely to be admitted to paediatric care, or to a neonatal intensive care unit (NICU) [8,9], resulting in significant economic burden [10,11,12,13]. In the U.K., the annual cost of smoking in pregnancy is estimated to be

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