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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.
Chest. 2011 Mar; 139(3):581-590.Chest

Abstract

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.

TRIAL REGISTRY

ClinicialTrials.gov; No.: NCT00217958; URL: clinicaltrials.gov.

Authors+Show Affiliations

Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA. Electronic address: Wilsons@pamfri.org.Section of Pediatric Pulmonology, Baylor College of Medicine, Houston, TX.Department of Health Services Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA.Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20864611

Citation

Wilson, Sandra R., et al. "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." Chest, vol. 139, no. 3, 2011, pp. 581-590.
Wilson SR, Farber HJ, Knowles SB, et al. 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. Chest. 2011;139(3):581-590.
Wilson, S. R., Farber, H. J., Knowles, S. B., & Lavori, P. W. (2011). 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. Chest, 139(3), 581-590. https://doi.org/10.1378/chest.10-0772
Wilson SR, et al. 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. Chest. 2011;139(3):581-590. PubMed PMID: 20864611.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Wilson,Sandra R, AU - Farber,Harold J, AU - Knowles,Sarah B, AU - Lavori,Philip W, Y1 - 2010/09/23/ PY - 2010/9/25/entrez PY - 2010/9/25/pubmed PY - 2011/4/22/medline SP - 581 EP - 590 JF - Chest JO - Chest VL - 139 IS - 3 N2 - 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. TRIAL REGISTRY: ClinicialTrials.gov; No.: NCT00217958; URL: clinicaltrials.gov. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/20864611/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_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(11)60126-8 DB - PRIME DP - Unbound Medicine ER -