Intervention: The ETS exposure-reduction intervention consisted of three behaviorally based counseling sessions spaced over approximately 5 weeks. Each session (outlined in the “Appendix”) followed a written protocol for a nurse-educator to instruct the caregiver(s). This protocol included instruction about asthma and its treatment, including environmental controls, and was designed to ensure a basic understanding of the inflammatory nature of the disease and the role of ETS in exacerbating and sustaining that inflammation. A variety of behavior-changing strategies were used, which were adaptable to the circumstances of the individual family. These strategies included monitoring of the time and circumstances of the child’s ETS exposure, role modeling and role-playing of interactions with (other) smokers to secure their cooperation in reducing the child’s exposure, personal feedback on progress, and contingency contracting. Exposure recall covered the day of the session and each of the 3 days preceding the session, extending beyond the 16- to 19-h half-life of cotinine in the body and the somewhat longer half-life in children. When the cotinine results were presented to the parent at the next session, the caregiver and interventionist reviewed the 4-day ETS exposure recall taken the same day as the urine sample. To help caregivers, especially nonsmokers, address exposure reduction with other (smoking) family members, the caregiver was asked whether those persons could be invited to the third session and whether the invitation should be issued by the caregiver or the nurse. To the extent that the children were developmentally able, they also were involved in learning about asthma and the problems of ETS exposure and played an asthma “Jeopardy”-like game along with the caregiver to demonstrate what they had learned. amaryl 2mg
Usual Care: Subsequent to the initial medication adjustment, control group children received usual medical care in the Pediatric Pulmonary Clinic. Caregivers were given basic information about asthma and their medication regimen by a regular clinic nurse who was not otherwise involved in the study. Inflammation and bronchoconstriction were described, and questions about asthma and its treatment were answered. Enrollment cotinine-testing results were not volunteered, and there was no specific focus on ETS reduction except for the statement (which is a part of the usual care in this clinic) that the exposure of children to ETS is to be avoided, especially children with asthma. If cotinine test results were specifically requested, the parent was told whether cotinine had been detected but not its concentration.
As is usual in this hospital-based clinic, the parents of children in both the treatment and control groups were informed about the three-session small group Wee Wheezers asthma education classes being offered at VCH and were encouraged to attend. At the 12-month follow-up, six parents of children in the control group and two parents of children in the treatment group reported having attended such classes.