BMJ 1999;318:1456-1459 ( 29 May )

General Practice

Advising parents of asthmatic children on passive smoking: randomised controlled trial

Linda Irvine, research nurse, ^a Iain K Crombie, reader, ^b Roland A Clark, consultant respiratory physician, ^c Peter W Slane, general practitioner, ^d Colin Feyerabend, senior biochemist, ^e Kirsty E Goodman, research nurse, ^a John I Cater, senior lecturer. ^a

^a Department of Child Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, ^b Department of Epidemiology and Public Health, Ninewells Hospital and Medical School, ^c Department of Medicine, Ninewells Hospital and Medical School, ^d Wallacetown Health Centre, Dundee DD4 6RB, ^e Nicotine Laboratory, Wardalls Grove, London SE14 5ER

Correspondence to: L Irvine lirvine{at}eph.dundee.ac.uk

Objective: To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke.
Design: Randomised controlled trial.
Setting: Tayside and Fife, Scotland.
Participants: 501 families with an asthmatic child aged 2-12 years living with a parent who smoked.
Intervention: Parents were told about the impact of passive smoking on asthma and were advised to stop smoking or change their smoking habits to protect their child's health.
Main outcome measures: Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention.
Results: At the second visit, about 1 year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children: the mean decrease in the intervention group (0.70 ng/ml) was slightly smaller than that of the control group (0.88 ng/ml), but the net difference of 0.19 ng/ml had a wide 95% confidence interval (0.86 to 0.48). Overall, 98% of parents in both groups still smoked at follow up. However, there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking.
Conclusions: A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children's exposure to environmental tobacco smoke. The intervention may have made some parents less inclined to stop smoking. If a clinician believes that a child's health is being affected by parental smoking, the parent's smoking needs to be addressed as a separate issue from the child's health.

Key messages Many asthmatic children are exposed to high levels of environmental tobacco smoke A brief intervention informing parents of asthmatic children on the harmful effects of passive smoking did not lead to a reduction in exposure of their children to tobacco smoke Low rates of smoking cessation were found in both the intervention group and the control group Some parents may have been less inclined to stop smoking after the intervention Brief interventions requesting smokers to stop for another person's health seem ineffective

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© BMJ 1999
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Rapid Responses:

Read all Rapid Responses

Doctors are ethically bound to inform parents about risks

Will Carroll
bmj.com, 6 Jun 1999 [Full text]

Sensitive counselling still may be worth while

John Kemm
bmj.com, 8 Jun 1999 [Full text]

Re: Doctors are ethically bound to inform parents about risks

Carl Henshall, et al.
bmj.com, 10 Jun 1999 [Full text]

Concerns from Newcastle

E Browne, et al.
bmj.com, 24 Jun 1999 [Full text]

Authors' response

Linda Irvine, et al.
bmj.com, 18 Jul 1999 [Full text]