A randomised controlled trial of a family-based, second-hand smoke intervention has failed to reduce the occurrence of acute respiratory illness in indigenous infants in Australia and New Zealand, despite previous research suggesting that such an intervention could be effective.
University of Auckland clinical trialist, Dr Natalie Walker, led the New Zealand arm of the international study, which delivered an intensive three-month programme involving behavioral “coaching” about the dangers of second-hand smoke to children, commitment to smoking restrictions in the home/car, positive role modeling, and strategies for overcoming obstacles to making smoke-free changes. Family members who smoked were also given smoking cessation support.
Senior indigenous researchers Dr Marewa Glover (University of Auckland) in New Zealand and Professor Ngiare Brown in Australia guided founding the programme on Māori and Aboriginal holistic models of health, which was then delivered by indigenous community health workers.
The findings, which have just been published in the journal Nicotine & Tobacco Research 2014 (Oxford University Press), show that while parents’ who received the intervention reported that exposure of their infants to second-hand smoke was low (about 95 per cent reported having smoke-free homes and cars), the mean urinary cotinine/creatinine ratios (CCRs) in the infants at baseline and at four months were consistent with exposure to second-hand smoke.
The authors found that over 12 months the programme had no effect on the rate of health care presentations for acute respiratory illness, second-hand smoke exposure for the infants, or parental smoking.
Dr Walker says the results show that emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal. Furthermore, breast feeding should continue to be encouraged, but smoking while breast feeding should be discouraged.
The report concludes that: “These findings suggest that simply having smoke-free homes and cars is not sufficient to protect children from exposure to second-hand smoke.”
This study is funded by the Health Research Council of New Zealand and the National Health and Medical Research Council of Australia, via the International Investment Opportunities Fund (IIOF) Trans-Tasman Clinical Trials Collaboration Initiative. Additional funding support was provided by Cure Kids New Zealand and the James Russell Lewis Trust.