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Table 1 Summary of included studies

From: Behaviour change interventions to reduce second-hand smoke exposure at home in pregnant women – a systematic review and intervention appraisal

Author (year)

Study Design and Setting

Participants

Intervention

Outcomes

Findings

El-Mohandes (2010) [22]

RCT

USA

African American women at 6 prenatal care sites

I = 335; C = 356

Integrated Behavioural Intervention using role play and skills practice to build negotiation skills with partner and other smoking family members and to enhance knowledge of SHS harm.

Self-reported environmental tobacco smoke exposure (ETSE), birth weight and gestational age at delivery

Sub group with <20 ng/ml saliva cotinine used to represent median number with no. cigarettes smoked

Logistic regression analysis: ETSE OR 0.5 (0.35,0.71); <20 ng/ml: 0.57(0.38,0.84).

LBW: I = 9.5%, C = 13.5%, p = 0.11; VLBW: I = 0.4%, C = 3.1%, p = 0.02; Pre-term birth:

I = 11.6%, C = 13.5%, p = 0.49;

Very pre-term: I = 1.4%, C = 5.6%, p = 0.01

Karatay (2010) [26]

Before-after study

Turkey

Educated smoking pregnant women selected from ANC. N = 45; 38 completed

Motivational interviews based on TTM. Eight weekly visits at home with data on baseline smoking habits, raising awareness, motivation to quilt, asking all smokers not to smoke at home and evaluation of self-efficacy score.

Self-reported smoking and reduction in SHS exposure

Reduction in SHS 86.8% at first visit to 47.7% at final visit (p < 0.05)

Measured CO and urine cotinine to verify quitting smoking but did not report if SHS reduction had any impact on these levels

Huang (2013) [24]

RCT

Taiwan

Pregnant women from Urban Taiwan I = 65; C = 70

Intervention based on TTM.

DVD informing about effects of SHS and strategies to avoid SHS; a booklet about the stages of change, quizzes, and exercises to reinforce the information; accessory tools such as stickers, bibs, door hangers with no smoking signs.

Stages of change

i) pre-contemplation

ii) contemplation/preparation

iii) action/maintenance

Determinants of Change

i) Knowledge

ii) Experiential process

iii) Behavioural process

Decisional Balance

i) Pros

ii) Cons

Self-efficacy

I vs C

Stages of change

i) 3 (4.6%) vs 8 (11.4%)

ii) 4 (6.2%) vs 12 (17.1%)

iii) 58 (89.2%) vs 50(71.4%)

Determinants of Change

i) 15.04 SD 0.18 vs 12.46 SD 0.24

ii) 44.32 SD 0.43 vs 40.39 SD 0.51* (p = 0.025)

iii) 38.86 SD 0.74 vs 31.83 SD 0.78

Decisional Balance

i)19.27 SD 0.18 vs 18.27 SD 0.21

ii) 12.02 SD 0.51 vs 13.23 SD 0.46

Self-efficacy

16.28 SD 0.8 vs 13.29 SD 0.43

*denotes statistically significant

Kazemi (2012) [23]

RCT

Iran

Pregnant women recruited from 10 health centres. 91/130 completed study; I = 47; C = 44

5 sessions with 4-week interval of education package informed by HBM. This comprised a pictorial booklet and face to face verbal session.

Perceived susceptibility

Perceived severity

Perceived benefits of avoiding SHS

Perceived barriers to avoiding SHS

Weekly ETSE exposure defined as mean number of cigarettes smoked close to pregnant woman each week by husband

Scores at final visit

Perceived susceptibility I 17.93 SD2.23; C 16.29 SD 3.27

Perceived severity I 17.85 SD2.24; C 16.83 SD 2.76

Perceived benefits I 22.8 SD2.1; C 21.14 SD 2.94

Perceived barriers I 6.57 SD1.75; C 6.93 SD 1.47

Weekly ETSE: I 12.28 SD 15.1 C 25.39 SD 13.2 F-stat 8.68, p < 0.0001 for diff b/w groups on t-test; mean ETSE exposure difference at baseline and last week in I and C: −19.49

Loke and Lam (2005) [25]

RCT

China

758 Literate pregnant women attending ANC

Intervention informed by the Theory of Reasoned Action.

Standardised advice from obstetrician and an education booklet which described simple strategies helping husbands to quit smoking.

Attempt to quit in past 7 days

Change in number of cigarettes per day in last month

Quit smoking completely in last 7 days; quit for last 30 days or more

Attempted and actual quitting.

Post-intervention questionnaire was administered around 36 weeks of pregnancy.

Number of quit attempts

None: I 266 (70%) vs C 294 (78%)

≥1: I 114 (30%) vs C 84 (22%);

p = 0.02.

Changes in number of cigarettes smoked I : 151 (39.7%) vs C 67 (17.7%)

No change I 193 (50.8%) vs C 267 (70.7%)

Increase I 36 (9.5) vs C 44 (11.6%) (p < 0.0001)

Quit smoking in last 7 days

I 32 (8.4%) vs C 18 (4.8%) (p = 0.04)

Quit smoking for last 30 days or more: I 23(6.1%) vs C 16 (4.2%) (p = 0.26)

Lee (2008) [17]

Before-after study

China

Non-smoking pregnant women with husband smokers recruited from antenatal clinics of 3 hospitals for 6 focus groups; N = 55

128 women recruited to pilot study.

Intervention informed by HBM with reference to Social Cognitive Theory.

Advice from the doctor (noted in the clinical records for clinicians to reinforce the message), hot telephone line for counselling and advice delivered bi-weekly over the telephone by the researcher.

Round up meeting with all to share their experiences and a resource booklet.

Knowledge about harmful components of SHS

Disease due to SHS

Harm to pregnancy

Dislike SHS

Assertive action against husband's smoking

Assertive action against family member smoking

Change from before to after

Knowledge of harmful components 32% to 92% (p < 0.01)

Knowledge of disease 19.5% to 74.2% (p < 0.01)

Knowledge of harm 38% to 73% (p < 0.01)

Dislike SHS 51% to 83% (p < 0.01)

Assertive action against husband 92% to 98% (p < 0.05)

Assertive action against family member 56% to 87% (p < 0.01)