***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal , family planning , and pediatric services in 12 public health clinics .  Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits . METHODS The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline ( all clinics prior to the start of the intervention ) and an experimental period ( matchedpair r and om assignment of clinics to intervention or control conditions ) . Subjects were 683 ( baseline ) and 1,064 ( experimental ) smokers with measurements of smoking outcomes at both times . Mixed-effects regressions analyzed individual outcomes clustered within clinics and services . RESULTS Control and intervention clinics had similar outcomes in the baseline period . In the experiment , outcomes improved in the intervention but not in the control clinics . Compared to controls , smokers exposed to the intervention were more likely to have quit ( 14.5 versus 7.7 % ) or take actions toward quitting and had higher mean action , stage of readiness , and motivation to quit scores . These positive effects persisted when clustering within clinics and services was controlled . CONCLUSIONS This intervention , implemented by clinic personnel as part of routine medical visits , was effective under these natural conditions across different types of clinic service BACKGROUND Pediatric well-care visits provide a clinical opportunity to counsel new mothers about their smoking and the deleterious effects of environmental tobacco smoke ( ETS ) on infant health . METHODS Forty-nine Oregon pediatric offices enrolled 2,901 women who were currently smoking or had quit for pregnancy , using a brief survey at the newborn 's first office visit . R and omly assigned offices provided advice and material s to mothers at each well-care visit during the first 6 months postpartum to promote quitting or relapse prevention . RESULTS The intervention reduced smoking ( 5.9 % vs 2.7 % ) and relapse ( 55 % vs 45 % ) at 6-month follow-up , but logistic regression analysis at 12 months revealed no significant treatment effect . The intervention had a positive effect on secondary outcome variables , such as readiness to quit and attitude toward and knowledge of ETS . Multiple logistic regression analysis indicated that husb and /partner smoking was the strongest predictor of maternal quitting or relapse . CONCLUSIONS A pediatric office-based intervention can significantly affect smoking and relapse prevention for mothers of newborns , but the effect decreases with time . Consistent prompting of the provider to give brief advice and material s at well-care visits could provide a low-cost intervention to reduce infant ETS exposure BACKGROUND Since most smoker parents of children with asthma are unable to quit , an alternative measure that would reduce their children 's exposure to environmental tobacco smoke ( ETS ) is to ban smoking in the home . METHODS Compared with 136 usual-care controls , 128 intervention-group parents recruited from South Australian pediatric hospital outpatient waiting rooms were given written and verbal feedback about their 1- to 11-year-old child 's urinary cotinine-to-creatinine level , information booklets , and two telephone calls encouraging a ban on smoking at home . RESULTS At 6 months , 49.2 % of the intervention group reported having banned smoking in the home compared with 41.9 % of controls , but the differential rate of change from baseline was not significant ( P = 0.40 ) . At follow-up , there were no significant differences between groups in the percentage reporting bans on smoking in the car , the mean reduction from baseline in total daily consumption or consumption in front of the child , children 's urinary cotinine level , or parental smoking cessation . CONCLUSIONS The intervention did not change parents ' propensity to create or maintain bans on smoking in their homes or otherwise change smoking habits to reduce their children 's exposure to ETS . More intensive interventions may be required to achieve change among low-income smoker parents of children with asthma OBJECTIVE To examine the effects of environmental tobacco smoke ( ETS ) on health services use in Chinese infants with nonsmoking mothers . DESIGN Prospect i ve , population -based birth cohort . SETTING General population of Hong Kong in 1997 - 1998 . PARTICIPANTS A total of 8327 parent-infant pairs who were followed up for 18 months . MAIN OUTCOME MEASURES Doctor consultations and hospitalizations . Results . After adjusting for the age , education level , and employment status of mothers-as well as infants ' birth weight , method of delivery , breastfeeding status , and birth order-ETS exposure through the mother in utero was positively associated with higher consultation ( adjusted odds ratio [ OR ] : 1.26 ; 95 % confidence interval [ CI ] : 1.14 , 1.39 ) and hospitalization ( OR : 1.18 ; 95 % CI : 1.05 , 1.31 ) use in infants with nonsmoking mothers attributable to any illness . In addition , postnatal exposure to ETS at home was linked to higher rates of hospitalizations for any illness compared with nonexposed infants ( OR : 1.12 ; 95 % CI : 1.00 , 1.25 ) , although the relationship did not hold for outpatient consultation visits . The OR for higher hospital use in infants exposed to 2 or more smokers at home was 1.30 ( 95 % CI : 1.08 , 1.58 ) . CONCLUSIONS The use of tobacco products by household members , even among nonsmoking mothers , has an enormous adverse impact on the health of children , as well as increases health services use and cost . The present data support the revision of public policy to reflect an evidence -based approach to the promotion of smoking cessation in all household members during and after pregnancy . environmental tobacco smoke , health services , infants Abstract Objective : To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke . Design : R and omised controlled trial . Setting : Tayside and Fife , Scotl and . Participants : 501 families with an asthmatic child aged 2 - 12 years living with a parent who smoked . Intervention : Parents were told about the impact of passive smoking on asthma and were advised to stop smoking or change their smoking habits to protect their child 's health . Main outcome measures : Salivary cotinine concentrations in children , and changes in reported smoking habits of the parents 1 year after the intervention . Results : At the second visit , about 1 year after the baseline visit , a small decrease in salivary cotinine concentrations was found in both groups of children : the mean decrease in the intervention group ( 0.70 ng/ml ) was slightly smaller than that of the control group ( 0.88 ng/ml ) , but the net difference of 0.19 ng/ml had a wide 95 % confidence interval ( −0.86 to 0.48 ) . Overall , 98 % of parents in both groups still smoked at follow up . However , there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking . Conclusions : A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children 's exposure to environmental tobacco smoke . The intervention may have made some parents less inclined to stop smoking . If a clinician believes that a child 's health is being affected by parental smoking , the parent 's smoking needs to be addressed as a separate issue from the child 's health . Key messages Many asthmatic children are exposed to high levels of environmental tobacco smoke A brief intervention informing parents of asthmatic children on the harmful effects of passive smoking did not lead to a reduction in exposure of their children to tobacco smoke Low rates of smoking cessation were found in both the intervention group and the control group Some parents may have been less inclined to stop smoking after the intervention Brief interventions requesting smokers to stop for another person 's health seem We conducted a r and omized controlled trial to determine whether a home-based intervention program could reduce  infant passive smoking and lower respiratory illness . The intervention consisted of four nurse home visits during the first 6 months of life , design ed to assist families to reduce the infant 's exposure to tobacco smoke . Among the 121 infants of smoking mothers who completed the study , there was a significant difference in trend over the year between the intervention and the control groups in the amount of exposure to tobacco smoke ; infants in the intervention group were exposed to 5.9 fewer cigarettes per day at 12 months . There was no group difference in infant urine cotinine excretion . The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school : intervention group , 14.6 % ; and controls , 34.0 % Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences . An experimental design was used to evaluate a minimal-contact intervention aim ed at modifying parents ' smoking behavior in their homes . All subjects received counseling on the health effects of passive smoking and advice to quit smoking inside the home . Treatment subjects were also mailed the results of a  urine cotinine test on their child and a self-help manual . More treatment ( 35 % ) than control ( 17 % ) subjects reported smoking outside their homes at posttest ( and their children 's cotinine levels were lower ) , but this difference was not statistically significant STUDY OBJECTIVE To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic children 's exposure to environmental tobacco smoke ( ETS ) . PARTICIPANTS Families of asthmatic children ( 6 to 17 years ) , including at least one parent who smoked in the home , recruited from four pediatric allergy clinics . DESIGN Participants were r and omized to one of three groups : behavioral counseling to reduce ETS exposure , self-monitoring control , and usual medical care control . Counseling concluded at month 6 , and the original trial ended at month 12 . Two follow-up interviews occurred at months 20 and 30 . MEASUREMENTS AND RESULTS The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure . The 2-year follow-up period was analyzed similarly . Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up . Further exploratory analyses suggested that printed counseling material s given to all participants at month 12 ( conclusion of the original study ) were associated with decreased exposure in the control groups . CONCLUSION Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature , let alone for addictive behaviors . We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit An information programme on measures to prevent passive smoking by children , design ed for use during well‐child visits , was tested . A total of 443 consecutive families with one or two smoking parents , attending mother and child health centres in Oslo , Norway , were r and omly allocated to an intervention group ( n= 221 ) and a control group ( n= 222 ) . Eighty families ( 18 % ) dropped out during the study period . For the intervention group , the communication between the health visitor and the family was prolonged at one well‐child visit with a brief session on smoking , and the parents were given three brochures . The families in the control group received no information on smoking . Changes in practical measures to prevent passive smoking by the children ( e.g. no smoking indoors ) as well as changes in daily smoking and smoking quantity were assessed by parental reports . We found no significant differences between the groups with respect to change in smoking behaviour BACKGROUND The Child and Adolescent Trial for Cardiovascular Health ( CATCH ) is a multistate field trial examining the effects of school environment , classroom curricula , and family intervention components in promoting the cardiovascular health of elementary school students . The purpose of this paper is to describe the CATCH tobacco use intervention and measurement , including the adoption of tobacco-free school policies . METHODS In this study , changes in school tobacco use policies and smoking experimentation among students were assessed . Smoking experimentation was measured in all CATCH schools when the students were in their fifth- grade year . A total of 6,527 subjects in 96 schools in California , Louisiana , Minnesota , and Texas answered questions about behaviors and potential correlates of smoking as part of the CATCH health behavior question naire in Spring 1994 . School tobacco use policy , an important complement to classroom- and home-based prevention efforts , was promoted as part of the CATCH intervention . The degree to which such policy was implemented was measured using surveys of school officials . RESULTS At the end of fifth grade , only 4.8 % of the subjects indicated that they had experimented with tobacco . School intervention condition was not a factor in the prediction of experimentation . Those whose best friend or sibling smoked , or who had ready access to cigarettes in the home , were more likely to have experimented with smoking . In the 3 years of the study , the percentages of tobacco-free schools went up from 49.7 to 76.8 % . Though differences in the rate of policy adoption could not be directly attributed to the CATCH intervention , the implementation of the tobacco-free schools ' policies did vary substantially from state to state . Minnesota and Texas , with stronger state laws supporting local policy , had nearly completely smoke-free schools . In spite of a statewide tobacco control initiative , California was slower to implement school policies . Louisiana , which allows local decision making regarding smoking policy , had the most difficulty establishing a policy for all districts . CONCLUSION Future studies should examine the impact of parallel policy interventions that are ongoing at both school and state levels . Tobacco-free policies appear to be a crucial part of school-based interventions 
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REVIEW ER 'S CONCLUSIONS Brief counselling interventions , successful in the adult health setting when coming from physicians , can not be extrapolated to adults in the setting of child health .
There is limited support for more intensive counselling interventions .
There is no clear evidence for differences between the respiratory , non-respiratory ill child , well child and peripartum setting s as context s for reduction of children 's ETS exposure