Summary of findings 2. Summary of findings: interventions in the ill‐child setting for reducing children's exposure to environmental tobacco smoke.

Interventions in the ill‐child setting for reducing children's exposure to environmental tobacco smoke (ETS)
Patient or population: people who smoke and are involved in the care of young children (birth to 12 years of age) Settings: healthcare ‐ ill‐child setting Intervention: behavioural interventions Comparison: usual care or minimal intervention
Intervention type and outcomes1	Impact	No. of participants2 (studies)	Quality of the evidence (GRADE)	Comments
Multi‐component, counselling‐based interventions assessed with biochemical validation of ETS exposure and self‐report length of follow‐up: 5 to 12 months	Three studies found no significant differences between intervention and control groups.	746 (3 studies)	+‐‐‐ VERY LOW3
Multi‐component, education‐based interventions assessed with biochemical validation of ETS exposure and self‐report length of follow‐up: 6 to 13 months	One study reported significantly lower child's ETS exposure at home by any smoker at 12 months' follow‐up (52% vs 58%; P = 0.03). Six studies found no significant differences between intervention and control groups.	2936 (7 studies)	+‐‐‐ VERY LOW4
In‐person counselling (no additional components) assessed with biochemical validation of ETS exposure, self‐report length of follow‐up: 3 to 18 months	Eight studies appeared to show intervention benefits based on self‐reported ETS exposures but no significant differences between intervention and control groups in objective measures of exposure (e.g. cotinine).	1835 (8 studies)	+‐‐‐ VERY LOW5
Telephone counselling	No studies examined telephone counselling delivered in the ill‐child setting and measured ETS exposure.
Brief interventions Assessed with presence of home and car smoking ban length of follow‐up: 24 weeks	One study showed no significant differences between intervention and control groups in changed smoking policy: OR 2.0 (95% CI 0.166 to 24.069).	100 (1 study)	+‐‐‐ VERY LOW6
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.

¹ Not all studies reported length of follow‐up; length given based on those that reported.

² Not all studies reported numbers of participants; number provided based on those that reported.

³ Downgraded one level due to risk of bias: two studies at unclear risk of bias. Downgraded one level due to imprecision. Downgraded one level due to indirectness: all studies were set in the USA and cannot be generalised to low income countries where smoking is more prevalent.

⁴ Downgraded two levels due to risk of bias: five of seven studies at high or unclear risk of bias. Downgraded one level due to inconsistency: interventions and populations were clinically heterogeneous.

⁵ Downgraded two levels due to risk of bias: all eight studies at high or unclear risk of bias. Downgraded one level due to inconsistency: interventions and populations were clinically heterogeneous.

⁶ Downgraded two levels due to risk of bias: only study was at high risk of bias. Downgraded one level due to imprecision: small study with a small number of events and wide confidence interval.