A randomised controlled trial of a brief multi strategic child health nurse intervention to reduce infant secondhand smoke exposure

Experimental conditions This is a three armed trial. A brief multi-strategic intervention will be provided to parents during their clinic visit in each of two treatment conditions by existing clinic staff as part of routine care. Treatment condition 1 Computer delivered care: prior to the clinic consultation parent/carers will complete a touch screen survey (approximately 20 minutes duration) in the clinic waiting room and will receive tailored on-screen and printed feedback regarding their infant’s risk of secondhand smoke(SHS) exposure, and tips on implementing household smoking bans. Parent/carers who are smokers will be provided advice to quit and contact details for the Quitline counselling service. Child health nurse delivered care: during the consultation, nurses will provide a brief SHS intervention (approximately 15 minutes duration) modelled on the 5 A’s framework. Specifically nurses will Ask about parental smoking and infant SHS exposure, Advise on strategies to protect the infant from SHS exposure and the benefits of quitting smoking, Assess willingness to change and arrange Assistance to do so. Parent/carers interested in quitting smoking will be advised to use nicotine replacement therapy (NRT) and provided with the Quitline contact details. Treatment Condition 2 Treatment condition 2 will include the same strategies as Treatment condition 1 plus two additional components. During the consultation a urine sample will be obtained from all infants by a cotton wool pad placed in the diaper of each infant. Results will be mailed to the parent/carer, the child health nurse and the parent/carer’s general practitioner. Parents will also receive a booklet "Clearing the air for your baby". This guide provides information about preventing infant SHS exposure and strategies for quitting smoking . Clinical practice change strategies The following strategies will be implemented to support intervention delivery by nurses in treatment conditions 1 and 2 clinics. Training: nurses will attend a training session that addresses the health risks associated with infant exposure to SHS and skills in supporting parent/carers to quit smoking and implement household smoking bans. Prompts: the computer will generate a tailored checklist to support intervention delivery by the nurses. In addition medical record labels will be provided to facilitate recording of infant SHS exposure and parental smoking status and to prompt follow up care. Resources: nurses will be provided with resource packs including SHS fact sheets, a 5 A’s flip chart, pamphlets and quit smoking fact sheets. Cotinine feedback (Treatment condition 2): cotinine results of each infant, a results interpretation guide, and tips for discussion with parents will be provided to nurses.