Chest
Volume 139, Issue 3, March 2011, Pages 581-590
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Original Research
Tobacco Cessation & Prevention
A Randomized Trial of Parental Behavioral Counseling and Cotinine Feedback for Lowering Environmental Tobacco Smoke Exposure in Children With Asthma: Results of the LET'S Manage Asthma Trial

https://doi.org/10.1378/chest.10-0772Get rights and content

Background

Secondhand tobacco smoke exposure impairs the control of pediatric asthma. Evidence of the efficacy of interventions to reduce children's exposure and improve disease outcomes has been inconclusive.

Methods

Caregivers of 519 children aged 3 to 12 years with asthma and reported smoke exposure attended two baseline assessment visits, which involved a parent interview, sampling of the children's urine (for cotinine assay), and spirometry (children ≥ 5 years). The caregivers and children (n = 352) with significant documented exposure (cotinine ≥ 10 ng/mL) attended a basic asthma education session, provided a third urine sample, and were randomized to the Lowering Environmental Tobacco Smoke: LET'S Manage Asthma (LET'S) intervention (n = 178) or usual care (n = 174). LET'S included three in-person, stage-of-change-based counseling sessions plus three follow-up phone calls. Cotinine feedback was given at each in-person session. Follow-up visits at 6 and 12 months postrandomization repeated the baseline data collection. Multivariate regression analyses estimated the intervention effect on the natural logarithm of the cotinine to creatinine ratio (lnCCR), use of health-care services, and other outcomes.

Results

In the sample overall, the children in the LET'S intervention had lower follow-up lnCCR values compared with the children in usual care, but the group difference was not significant (β coefficient = −0.307, P = .064), and there was no group difference in the odds of having > one asthma-related medical visit (β coefficient = 0.035, P = .78). However, children with high-risk asthma had statistically lower follow-up lnCCR values compared with children in usual care (β coefficient = −1.068, P = .006).

Conclusions

The LET'S intervention was not associated with a statistically significant reduction in tobacco smoke exposure or use of health-care services in the sample as a whole. However, it appeared effective in reducing exposure in children at high risk for subsequent exacerbations.

Section snippets

Materials and Methods

Study methods were approved by the Institutional Review Board of the Kaiser Foundation Research Institute (No. CN-01HFarb-01-H). Additional methods and results information is available in e-Appendix 1.

Results

Recruitment occurred from April 2003 to September 2005. Three hundred eighty-four families met all eligibility criteria for participation, and 352 were randomized (Fig 1). Three hundred thirty-four (94.9%) provided questionnaire data and/or a urine sample at the 6-month follow-up visit, and 336 (95.5%) at the 12-month follow-up visit. Baseline and follow-up data on the use of health-care services and pharmacy dispensing were available for all participants.

Discussion

In the overall sample, the LET'S intervention did not have a statistically or clinically significant effect on any of the primary or secondary outcomes. This is a disappointing outcome, but one that is not unusual in the history of the development of what have subsequently become effective tobacco control interventions.

However, in children who were at high risk for subsequent exacerbations, the intervention was associated with substantially (∼ 90%) and significantly lower secondhand smoke

Conclusions

The study did not demonstrate an effect of the LET'S intervention on secondhand tobacco smoke exposure in the reference population of children with asthma. However, it did provide some evidence, short of conventional statistical proof, of an effect in children whose use of health-care services and overuse of rescue medication would classify them as having high-risk asthma.

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    Funding/Support: This research was supported by the National Institutes of Health [Grant NIH RO1 HL70012; Sandra R. Wilson, PhD, principal investigator].

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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