***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: A large body of epidemiologic data has been accrued on the health effects of exposure of infants to environmental  tobacco smoke ( ETS ) . Household members , particularly mothers , are the major source of postnatal ETS exposure , ~ perhaps because infants are commonly held much closer to the direct source of ETS than adults . Because the epidemiologic data implicate ETS as a postnatal risk factor for infants ~ and suggest that maternal smoking is the major source of ETS , encouraging mothers of newborns to quit smoking can benefit the health of both mother and child . Although many mothers quit or reduce smoking during pregnancy , most relapse and /or return to smoking at their usual rates after delivery . TM Thus , reinforcing the absence of smoking is also an important behavioral target . The regularly scheduled , pediatric well-care visits provide an opportunity to deliver cessation advice to the mother in the context of protecting the baby from ETS . While pediatricians view the child as their patient , it is common practice to recommend a wide range of preventive behaviors ( e.g. , child seats , poison control , etc . ) that involve parental behavior to reduce the risk of injury to the child . The relationship between smoke exposure and child health provides a unique avenue for discussing parental smoking AIM To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children 's exposure to tobacco smoke . METHODS In 1990 , 1062 healthy infants were recruited to a r and omized , ongoing atherosclerosis prevention trial ( STRIP ) . Intervention families received at least twice a year individualized nutrition and lifestyle counselling . By 1999 , 652 8-y-old children continued participation . Exposure to tobacco smoke was evaluated using serum cotinine concentration . Parents ' smoking was also assessed using question naires and interviews . RESULTS Parents ' smoking decreased during the study similarly in the intervention and control groups . Of the 8-y-old children , 46 % had detectable serum cotinine concentration , suggesting exposure to tobacco smoke during the past few days . All children were non-smokers . Serum cotinine concentrations did not differ between the intervention and control children . Children 's cotinine values were highest in the families where either father or both parents were smokers . CONCLUSION Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents . However , counselling led to no differences in parental smoking between the two groups , or in exposure of the intervention and control children to tobacco smoke . This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children 's tobacco smoke exposure This study examined control of environmental tobacco smoke ( ETS ) exposure in the home by new mothers and identified factors related to the establishment of home smoking control rules . Pregnant women who , at 28 weeks gestation , reported they had not smoked in the past 28 days were enrolled in a r and omized smoking cessation study .  Telephone interviews were conducted at 6 weeks , 3 months , 6 months , and 12 months postpartum . A Home Smoking Control Index , composed of four items ( whether the mother smokes in the home , the partner smokes in the home , other household smokers are asked to smoke outside , and visitors who smoke are asked to smoke outside ) , was used to classify homes as having a home smoking policy in effect , no policy or an incomplete policy , or no policy needed . Sociodemographic variables and maternal self-efficacy were examined in relation to the index data among 325 women who had need to exercise control of smoking in the home : 63 % had a home smoking policy in effect at 3 months , 60 % at 6 months , and 64 % at 12 months postpartum . Predictors of policy at 6 and 12 months included ( a ) having a policy in effect at the previous assessment , ( b ) confidence in limiting infant ETS exposure in the home , and ( c ) perceived difficulty in preventing exposure . Early establishment of a policy appears to be important for ensuring sustained infant ETS avoidance over time . The index measures key actions that influence infant exposure and warrants further testing for use in intervention trials 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 % The American Academy of Pediatrics recently removed nicotine from the list of drugs contraindicated during breastfeeding . The objective of this study was to evaluate the feasibility of determining the effect of a smoking hygiene intervention on infants of breastfeeding mothers who smoke cigarettes . An experimental design with repeated measures was used . A convenience sample of 35 mother-infant dyads from seven sites was recruited and r and omly assigned to the intervention or control group . Of the 27 dyads completing the study , 16 were in the experimental group and 11 were in the control group . Smoking hygiene was introduced when infants were 2 weeks old and reinforced when they were 3 and 5 weeks old . At these three data points , infant health and urinary nicotine and cotinine levels were measured , as well as the mothers ' breast-milk nicotine and cotinine levels and smoking hygiene behaviors . Recruiting and retaining a sample of breastfeeding mothers who smoke proved difficult . Only 27 % of women in the intervention group implemented all aspects of the smoking hygiene intervention behaviors . Repeated- measures ANOVA revealed no difference in a ) infant urinary nicotine and cotinine levels or b ) breast-milk nicotine and cotinine levels between the two groups . The McNemar test for related sample s revealed no difference between frequency of respiratory symptoms in either the control or intervention groups when Week 2 levels were compared with levels at Weeks 3 and 5 . Mothers were not successful in adhering to the smoking hygiene intervention . To adequately test interventions , strategies must be developed to help women incorporate health-promoting behaviors into their lives BACKGROUND While trends in smoking prevalence during pregnancy are known , little is known about trends in quitting during pregnancy and resuming smoking after pregnancy . OBJECTIVES This study examined the trends in and correlates of quitting during pregnancy and resuming smoking after pregnancy . METHODS We used population -based r and om surveys of recent mothers in ten U.S. states ( total of 115,000 women ) conducted between 1993 and 1999 . RESULTS Although the prevalence of smoking 3 months before pregnancy was stable at around 26 % , quitting during pregnancy rose from 37 % to 46 % between 1993 and 1999 . Adjusted for maternal and state characteristics , the odds of quitting during pregnancy increased 51 % between 1993 and 1999 ( odds ratio [OR]=1.51 ; 95 % confidence interval [CI]=1.08 - 2.12 ) . Approximately half of the women who quit smoking during pregnancy resumed smoking within 6 months postpartum . Primiparous , privately insured , college-educated women are more likely to quit and least likely to resume smoking after delivery , compared to multiparous , Medicaid-insured , and high school-educated women . Teenaged women are more likely to quit , but also more likely to resume smoking than older women . CONCLUSIONS The increase in quit rates during pregnancy is encouraging , but the lack of any change in smoking before pregnancy or in postpartum relapse rates suggests that permanent changes in maternal smoking will require additional focus OBJECTIVE To test a low-intensity physician 's office-based intervention strategy using infant urine cotinine measurements , aim ed at reducing infant exposure to environmental tobacco smoke . DESIGN A r and omized intervention trial . SETTING Offices of 28 physicians ( pediatricians and family practitioners ) and two hospital-based clinics in the Greater Portl and , Me , area . PARTICIPANTS Infants brought to the physician by a parent ( usually the mother ) for an initial well-child visit . A total of 518 of these infants and their mothers consented to provide information about household smoking habits and to provide a sample of the infant 's urine for biochemical analysis . SELECTION PROCEDURE From among the consecutive sample of 518 enrolled mother/infant pairs , 103 mothers reported that they smoked 10 or more cigarettes per day , and these were r and omized on an individual basis for intervention ( 52 pairs ) or control ( 51 pairs ) . R and omization took place at the study center when the infant 's urine sample and information about household smoking habits were received . INTERVENTION The physician telephoned the mother to report the urine cotinine result and to explain its meaning . The physician then signed and sent an individualized form letter to the mother , providing specific recommendations for changing household smoking habits . RESULTS Follow-up urine cotinine measurements were obtained in 27 ( 52 % ) of 52 infants from the intervention group and in 29 ( 57 % ) of the 51 controls 2 months later . The mean log ratio of the follow-up to initial urine cotinine measurements was 6 % lower in the intervention group than in the control group . This difference was not statistically significant . CONCLUSION The low-intensity intervention strategy did not significantly influence  infant exposure to environmental tobacco smoke in the household OBJECTIVE Passive smoke exposure among children is widespread in the United States ; estimates suggest that almost 40 % of children who are younger than 5 years live with a smoker . Few r and omized studies of passive smoke exposure reduction among children have been conducted , and the impact of interventions that have been evaluated has been limited . The objective of this study was to determine whether a motivational intervention for smoking parents of young children will lead to reduced household passive smoke exposure . METHODS Project KISS ( Keeping Infants Safe From Smoke ) , a theory-driven exposure reduction intervention targeting low-income families with young children , was a r and omized controlled study in which participants -smoking parents/caregivers ( N = 291 ) who had children who were younger than 3 years and who were recruited through primary care setting s-were r and omly assigned to either the motivational intervention ( MI ) or a self-help ( SH ) comparison condition was used . Follow-up assessment s were conducted at 3 and 6 months . The MI condition consisted of a 30- to 45-minute motivational interviewing session at the participant 's home with a trained health educator and 4 follow-up telephone counseling calls . Feedback from baseline household air nicotine assessment s and assessment of the participant 's carbon monoxide level was provided as part of the intervention . Participants in the SH group received a copy of the smoking cessation manual , the passive smoke reduction tip sheet , and the re source guide in the mail . Household nicotine levels were measured by a passive diffusion monitor . RESULTS The 6-month nicotine levels were significantly lower in MI households . Repeated measures analysis of variance across baseline , 3-month , and 6-month time points showed a significant time-by-treatment interaction , whereby nicotine levels for the MI group decreased significantly and nicotine levels for the SH group increased but were not significantly different from baseline . CONCLUSIONS This study targeted a large sample of racially and ethnically diverse low-income families , in whom both exposure and disease burden is likely to be significant . This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children . These findings have important implication s for pediatric health care providers , who play an important role in working with parents to protect children 's health . Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit INTRODUCTION Our objective was to examine the efficacy of physicians ' advice and referral to individual counseling in preventing relapse to smoking among women who were smokers early in pregnancy , but quit prior to their first prenatal visit . DESIGN A r and omized controlled trial of prompted physician 's advice and individual relapse prevention counseling during pregnancy compared to usual physician advice .  Smoking status was assessed by self-report , exhaled carbon monoxide , and urinary cotinine during pregnancy and by self-report 1 year postpartum . RESULTS There were no significant differences in relapse rates between the intervention and usual-care groups during pregnancy , nor at 1 year postpartum . Relapse rates were 23 % in both groups at the 36-week visit , and 32 % and 22 % , respectively , 1 year postpartum . Younger age , higher motivation to resume smoking , and higher levels of exhaled carbon monoxide at the first prenatal visit were predictive of relapse to smoking during pregnancy . With the conservative assumption that all those lost to follow-up relapsed , the combined 1-year postpartum relapse rate , 51 % , was 17 percentage points lower than we observed in an earlier relapse prevention trial , and 15 percentage points lower than that observed nationally a decade earlier . CONCLUSION Prompting physicians to provide supportive advice combined with 
    Output:
    
The findings suggest inconclusive evidence relating to these intervention types , with a range of outcome measures reported .
The review was limited by its very specific population ; however , it suggests that currently there is mixed evidence for the effectiveness of interventions to reduce parental environmental tobacco smoke in early infancy