Child health-centre-based promotion of a tobacco-free environment - a Swedish case study

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.