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SLM Babies Living in Smokefree Homes

Note: This SLM has been revised as of 31 October 2018. Refer to SLM Babies Living in Smokefree Homes (OLD) for the previous version.


Healthy Start (refer to the intervention logic on the Nationwide Service Framework Library)


Babies living in a smokefree household at six weeks post natal (up to 56 days of age).


System Level Measure
Well Child Tamariki Ora Quality Indicator

Relationship(s) to other frameworks

There are three measures which relate to reduced rates of infant exposure to tobacco smoke:

  • Well Child Tamariki Ora (WCTO) Quality Improvement Framework:
    - Quality Indicator 3: Infants receive all WCTO core contacts due in their first year
    - Quality Indicator 19: Mothers smokefree at two weeks postnatal
    - Quality Indicator 20: Children live in smokefree homes aged four years old
    ((Ministry of Health. 2015. Indicators for the Well Child/Tamariki Ora Quality Improvement Framework – March 2015. Wellington: Ministry of Health Framework available at: http://www.health.govt.nz).
  • 2013 NZ Maternity Clinical Indicators
    - Indicator 1: Registration with an LMC in the first trimester of pregnancy
    - Indicator 16: Maternal tobacco use during postnatal period
    (Ministry of Health. 2015. New Zealand Maternity Clinical Indicators 2013. Wellington: Ministry of Health. Document available at: http://www.health.govt.nz)


This measure is important because it aims to reduce the rate of infant exposure to tobacco smoke by focusing attention beyond maternal smoking to the home and family/whānau environment and will encourage an integrated approach between maternity, community and primary care. It emphasises the need to focus on the collective environment that an infant will be exposed to - from pregnancy, to birth, to the home environment within which they will initially be raised.

The patient benefit in this measure is a smokefree outcome for the baby's home and therefore no exposure of baby to smoke. This includes benefit for whoever is smoking in the house becoming an ex-smoker.

The benefit for the health system is the integration of childhood health services provided that include midwives, WCTO nurses, primary care nurses, staff screening services in the first 6 weeks, and general practice. (Note: If the measure does not focus at the six week check, it is unlikely that integration will occur as the six week check is the point at which all the prior requirements can be checked)

This measure also promotes the roles which collectively, service providers play in the infants life and the many opportuntites for smoking interventions to occur. Implementation of this measure will enable the sector to engage the wider population of infants, that may not be enrolled in a PHO, but are registered with the WCTO. It will also engage mothers who are not enrolled with a LMC.

The measure has a strong correlation to smoking rates at first registration with LMC and at the two weeks post natal assessment (Ref – NZ child & youth epidemiology service report Mar 2016 – the determinants of health for children and young people in NZ, table 64).

This measure is already routinely collected by WCTO providers.

Population measure


Eligible population

All registered newborn babies that are 56 days old (excluding stillbirth/death in neonatal period: < 56 days)

Measure status


Measure definition


Number of new babies, up to 56 days of age, with ‘No’ recorded for their WCTO contact question: ‘Is there anyone living in the house who is a tobacco smoker?’ (source: WCTO data set)


Number of registered births by DHB of domicile (source: Ministry of Health NHI register)

National target


Local target

Improvement milestone (from DHB baseline) set by district alliance in their System Level Measure improvement plan

Data Sources

  • Well Child Tamariki Ora reports
  • NHI register

Data extracted from data sources

Refer to data standard and reporting template on the Nationwide Service Framework Library

Data availability

Data is released by the Ministry of Health six monthly. DHB aggregate level data is available on the Nationwide Service Framework Library website.
NHI level data is available on request and this will be shared through secure means.

Measure calculation process

  1. Extract the data according to the data standard for the reporting period by provider or DHB.
  2. Identify each baby with ‘Smokefree home’ status ie the measure numerator
  3. Identify which babies are before 56 days of age at date of visit
  4. Identify number of registered births by DHB of domicile, which is babies born 56 days before the start of a reporting period to 56 days before the end of the reporting period eg for reporting period 1 Jan 2019 to 30 June 2019, date of birth range will be from 6 Nov 2018 to 5 May 2019
  5. Divide the babies with ‘Smokefree home’ status by total number of registered births
  6. Multiply by 100 for percentage

Relationship(s) to other measures

Contributory measures under the System Level Measure framework in the online Measures Library
WCTO Quality Improvement Framework
Maternity Clinical Indicators
Other smoking indicators reported by DHBs and PHOs

Measure development notes

Technical notes:

  • The definition of a smokefree household is one where no person ordinarily resident in the home is a current smoker.
  • The definition of a current smoker is someone who has smoked more than 100 cigarettes (including hand rolled cigarettes, cigars, cigarillos etc.) in their lifetime and has smoked in the last 28 days.
  • Where a baby is living in more than one household (for example, with its mother for one week and with its father alternate weeks) then the household where the baby is present and receiving WCTO services is to be assessed (for smoking).
  • The registered birth range is calculated to ensure the measure captures all the babies likely to be assessed for first core contact in the reporting period.
  • Frequently Asked Questions on the Nationwide Service Framework Library

Reporting frequency: Six monthly

Measure champion: Dr Peter Jones (TBC)

Template: System Level Measure Template