E. Arborelius et S. Bremberg, Child health-centre-based promotion of a tobacco-free environment - a Swedish case study, HEALTH PR I, 16(3), 2001, pp. 245-254
Environmental tobacco smoke exposure is an important health risk for small
children. The development, spread and evaluation of a national child health
-centre-based counselling method targeting environmental tobacco smoke is d
escribed. The work progressed in six steps. In a first step, accomplished i
n 1994, it was found that child health nurses used a limited repertoire of
techniques and were dissatisfied with their discussion on tobacco smoke. In
a second step, routine recording of parental smoking status was introduced
at all child health centres. In a third step, a counselling method based o
n Bandura's self-efficacy concept was developed, 'smoke-free children', In
a fourth step, smoke-free children was tested by 28 nurses in 128 families.
At follow-up discussions, all parents said that they now smoked outdoors a
nd that they had cut down on their smoking. In a fifth step, the national d
issemination of smoke-free children was studied. A manual and a videotape w
ere launched in 1995, supported by a newsletter and 10 regional conferences
in the following years. In January 1997, 36 % of the child health nurses i
n Sweden (three counties excluded) stated that they used the method. Traini
ng of county instructors did not seem to have improved dissemination. In a
sixth step, routinely collected information on parental smoking in Stockhol
m county on infants born 1995-1997 was used to study the effect. Little cha
nge in smoking rates between two consecutive years was found before the int
roduction of smoke-free children. Yet, after training of the child health n
urses, the annual decrease was 1.7% in a pilot area and later, in remaining
parts of the county, 2.7%. Thus, answers to two crucial questions were giv
en: first, that the method seemed to affect parental behaviour; and secondl
y, that the training of county instructors might not have affected the diss
emination of smoke-free children.