A controlled trial of an environmental tobacco smoke reduction intervention in low-income children with asthma

Study objectives: To determine the effectiveness of a cotinine-feedback, be haviorally based education intervention in reducing environmental tobacco s moke (ETS) exposure and health-care utilization of children with asthma. Design: Randomized controlled trial of educational intervention vs usual ca re. Setting: The pediatric pulmonary service of a regional pediatric hospital. Participants: ETS-exposed, Medicaid/Niedi-Cal-eligible, predominantly minor ity children who were 3 to 12 years old and who were seen for asthma in the hospital's emergency, inpatient, and outpatient services departments (n = 87). Intervention: Three nurse-led sessions employing behavior-changing strategi es and basic asthma education and that incorporated repeated feedback on th e child's urinary cotinine level. Measurements: The primary measurements were the urinary cotinine/creatinine ratio (CCR) and the number of acute asthma medical visits. The secondary m easurements were number of hospitalizations, smoking restrictions in home, amount smoked, reported exposures of children, and asthma control. Results: The intervention was associated with a significantly lower odds ra tio (OR) for more than one acute asthma medical visit in the follow-up year , after adjusting for baseline visits (total visits, 87; OR, 0.32; p = 0.03 ), and a comparably sized but nonsignificant OR for one or more hospitaliza tion (OR, 0.34; p = 0.14). The follow-up CCR measurement and the determinat ion of whether smoking was prohibited inside the home strongly favored the intervention group (n = 51) (mean difference in CCR adjusted for baseline, -0.38; p = 0.26; n = 51) (60; OR [for proportion of subjects prohibiting sm oking], 0.24; p = 0.11; n = 60). Conclusions: This intervention significantly reduced asthma health-care uti lization in ETS-exposed, low-income, minority children. Effects sizes for u rine cotinine and proportion prohibiting smoking were moderate to large but not statistically significant, possibly the result of reduced precision du e to the loss of patients to active follow-up. Improving ETS reduction inte rventions and understanding their mechanism of action on asthma outcomes re quires further controlled trials that measure ETS exposure and behavioral a nd disease outcomes concurrently.