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Children With Asthma: Interventions to Reduce ETS Exposure in Children

Legal, regulatory, and taxation changes, antismoking education programs, and smoking cessation assistance that incorporates nicotine replacement therapy have been associated with a reduction in the overall smoking rates in the United States, but reductions in the rates among young women, especially those with less education, have lagged behind those of men. Attempts to encourage nonvolunteer female smokers of childbearing age, including pregnant women and new mothers, to quit smoking or to modify household smoking habits to reduce infant and early childhood exposure have had very mixed results. However, even women who abstain during pregnancy do not cease permanently, because approximately two thirds resume smoking. Efforts to decrease relapses have had limited suc-cess.
Several controlled trials of ETS reduction interventions have been reported that have specifically targeted families of children with asthma. The success of these interventions has been mixed, and ETS exposure has been assessed in a variety of ways, Although one study measured ETS concentration in the home environment, most have failed to confirm parental self-report with objective measures of the child’s exposure and/or have failed to measure asthma outcomes, making it difficult to assess the clinical significance of any changes that may have occurred in the child’s exposure. Both the use of feedback to the caregiver on the child’s exposure (via urine cotinine measurement) and behaviorally base d counseling have shown promise, but these techniques have not been used in combination. www.canadian-familypharmacy.com

The present study reports the results of a controlled trial comparing a behaviorally based, nurse-administered, individual feedback and counseling intervention to reduce the ETS exposure of children with asthma who were 3 to 12 years of age and were from low-income, predominantly minority families. All of the children were at risk, having been seen for acute asthma in an urgent-care setting, hospital ED, or inpatient hospital setting in the previous year. A key feature of the intervention was repeated feedback to the parents, over a period of approximately 5 weeks, on the results of four successive urine cotin-ine measurements to inform them of the initial level of exposure of the child and the success of their efforts to reduce this exposure. The primary outcomes investigated were emergency/urgent healthcare utilization for asthma and ETS exposure as indexed by the child’s urine cotinine/creatinine ratio (CCR). Asthma hospitalization, parental reporting on whether smoking was allowed in the home and on the child’s exposure, and several indicators of asthma control also were examined on an exploratory basis.