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- Carlsson, Noomi
(författare)
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A Zero-vision for Children’s Tobacco Smoke Exposure : Tobacco prevention in Child Health Care
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Adverse health effects in children caused by environmental tobacco smoke (ETS) are well known. Children are primarily exposed by their parents’ smoking in their homes. A comprehensive evidence base shows that parental smoking during pregnancy and ETS exposure in early childhood are associated with an increased risk for a range of adverse health problems. Child Health Care nurses, who meet nearly all families in Sweden with children aged 0-6 years, have thus an important role in tobacco preventive work in order to support parents in their ambitions to protect their children from ETS exposure.The overall aim of this thesis was to develop, test and evaluate a new model for tobacco preventive work in Child Health Care (CHC) with special focus on areas with a high prevalence of parental smoking. In a first step CHC nurses’ and parents’ views on tobacco preventive work were analysed in two studies based on questionnaires.The intervention was performed during the second step, based on the results from nurses’ and parents’ experience of the tobacco preventive work in CHC, and with methods from Quality Improvement. An “intervention bundle” was developed which included evidence based methods for prevention of ETS exposure, and four learning sessions for the nurses. The instrument “Smoking in Children’s Environment Test” (SiCET) included in the bundle was evaluated with focus group interviews with the CHC nurses who participated in the intervention. Two urine samples were analysed to measure cotinine levels in children which provide an estimate for ETS exposure. Parents’ answers from the SiCET questionnaire, measurements of cotinine, and data from the nurses’ log-books were used in the evaluation of the effects of the intervention. In areas with a high prevalence of parental smoking 22 nurses recruited 86 families of whom 72 took part for the entire one-year period of the intervention.The results showed that parents wanted to have information on the harmful effects tobacco smoke have on their children and how they can protect their children from ETS exposure. The nurses saw tobacco preventive work as important but they experienced difficulties to reach certain groups such as fathers, foreign-born parents, and those who are socio-economically disadvantaged. The SiCET instrument provided a basis for dialogue with parents. The main results from the intervention showed that ten parents (11%) quit smoking, thirty-two families (44%) decreased their cigarette consumption in the home, and fewer children were exposed to tobacco smoke. Consequently, more children showed levels of urinary cotinine less than 6 ng/ml (base-line n=43, follow up n=54; p=0.05). The total number of outdoor smokers did not change. Seven of the nurses (30%) had successful results in their areas with a decrease of smokers in families with a child of 8 months, from 20% in 2009 to 12% in 2011. The corresponding figures for the whole county as well as the country did not decrease during the same period.The sustainability of the intervention has to be followed and thus measures should be followed prospectively over time. The SiCET instrument was found useful and might be applicable in other arenas where children’s ETS exposure is discussed. The development of an instant cotinine test using dipsticks would make it possible to give parents immediate feedback on the effectiveness of taken protective actions. This could work as a pedagogic resource in the dialogue with parents.
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| 2. |
- Rosén, Anders, Dr, et al.
(författare)
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Experiences from Applying the CDIO Standard for Sustainable Development in Institution-Wide Program Evaluations
- 2021
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Ingår i: Proceedings 17th International CDIO Conference, CDIO 2021. - : Chalmers University of Technology.
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Konferensbidrag (refereegranskat)abstract
- In the CDIO standards 3.0, the original “core” CDIO standards have been updated regarding sustainable development. In addition, one of the new, so called “optional”, CDIO standards addresses sustainable development. This paper puts the new CDIO standard for sustainable development to test, in an institution-wide evaluation of engineering education programs at the KTH Royal Institute of Technology. First, the standard is operationalized by establishing a set of indicators and slightly modifying the standard rubrics. Then, it is used in the evaluation of a large number of programs on bachelor and master level. Examples are given of the evaluation outcomes, and the character of the integration of sustainable development in programs on different rubric levels are discussed. With the proposed indicators and rubric modifications, the new standard is concluded to be a useful tool for evaluating, promoting, and guiding, integration of sustainable development, not only in programs with particularly high ambitions regarding sustainable development, but in basically any engineering program. It is recommended that the new standard, with the here proposed modifications, is used for setting university-wide goals and for providing teachers and program directors with a framework for enhancing the future relevance of engineering education programs.
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