Reducing children's exposure to environmental tobacco smoke: the empiricalevidence and directions for future research

Objective-To summarise the issues and empirical evidence for reduction of c hildren's residential environmental tobacco smoke (ETS) exposure. Data sources-literature was obtained by computer search, with emphasis on s tudies that included quantitative measures of ETS exposure in children's re sidences and interventions based on social learning theory. Study selection-Review and empirical articles concerning ETS exposure were included and inferences were drawn based on a synthesis of these studies as contrasted with a quantitative metaanalysis. Data synthesis-Interventions designed for residential/child ETS exposure co ntrol have included policy/legal regulations, minimal clinical services, an d counselling services. Divorce court and adoption services have limited cu stody to protect children from ETS exposure. Controlled trials of clinician s' one time counselling services have shown null results. One controlled tr ial found that repeated physician ETS counselling increased parent cessatio n. Three trials found that repeated counselling/shaping procedures reduced quantitative estimates of ETS exposure in asthmatic children. Conclusions-Insufficient controlled studies of repeated session counselling procedures have been completed to determine efficacy for ETS exposure redu ction, but evidence is promising. One time minimal interventions appear ine ffective, but large scale studies may be warranted. No studies have been co nducted to assess court or adoption agency regulations; no community ordina nces for regulating residential ETS exposure have been invoked. Ethical and enforcement issues are discussed.