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J Clin Nurs. 2010 Feb;19(3-4):507-16. doi: 10.1111/j.1365-2702.2009.02847.x. Epub 2009 Jul 20.

Child health nurses' roles and attitudes in reducing children's tobacco smoke exposure.

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Division of Paediatrics, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.



To investigate and analyse the attitudes to tobacco prevention among child healthcare nurses, to study how tobacco preventive work is carried out at child healthcare centres today. To evaluate how the tobacco preventive work had changed in child health care since the Swedish National Board of Health and Welfare's national evaluation in 1997.


Exposure to environmental tobacco smoke has adverse health effects. Interventions aiming at minimising environmental tobacco smoke have been developed and implemented at child healthcare centres in Sweden but the long-term effects of the interventions have not been studied.




In 2004, a postal questionnaire was sent to all nurses (n = 196) working at 92 child healthcare centres in two counties in south-eastern Sweden. The questionnaire was based on questions used by the National Board of Health and Welfare in their national evaluation in 1997 and individual semi-structured interviews performed for this study.


Almost all the nurses considered it very important to ask parents about their smoking habits (median 9.5, range 5.1-10.0). Collaboration with antenatal care had decreased since 1997. Nearly all the nurses mentioned difficulties in reaching fathers (70%), groups such as immigrant families (87%) and socially vulnerable families (94%) with the tobacco preventive programme. No nurses reported having special strategies to reach these groups.


Improvement of methods for tobacco prevention at child healthcare centres is called for, especially for vulnerable groups in society. However, the positive attitude among nurses found in this study forms a promising basis for successful interventions.


This study shows that launching national programmes for tobacco prevention is not sufficient to achieve sustainable work. Nurses working in child healthcare centres have an overall positive attitude to tobacco prevention but need continuous education and training in communication skills especially to reach social vulnerable groups. Regular feedback from systematic follow-ups might increase motivation for this work.

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