Eligibility: Eligible children had the following characteristics: (1) age between 3 and 12 years; (2) had been examined because of acute asthma within the preceding year in the ED or urgent-care (Peds Plus) clinics and/or had been admitted to the inpatient service of the Valley Children’s Hospital (VCH) (VCH had been located in Fresno County, CA, until its new facility [in-patient services, ED, and specialty clinics] opened just across the Fresno-Madera County line in September 1998; the Peds Plus outpatient clinics remained in their original community locations); (3) were Medi-Cal (California’s Medicaid program)-eligible; (4) were exposed to ETS, per the caregiver report; and (5) had caregivers who spoke either English or Spanish.
VCH electronic records were searched to identify children who were 3 to 12 years of age who had been seen for acute asthma between January 1996 and June 1997. Of the 867 families contacted, 25 (3%) were not Medi-Cal-eligible and 568 (66%) had no reported ETS exposure. Eight-seven families (31% of those who were eligible) agreed to participate and were enrolled. The study was reviewed annually and approved by the Institutional Review Board (IRB) of the VCH and the Committee for the Protection of Human Subjects of the California State Health and Welfare Agency. The consent process informed parents of the following: (1) that the study was directed at children who had emergency or other unscheduled visits for acute asthma exacerbations and were regularly exposed to ETS; and (2) samples of the child’s urine would be taken periodically and “analyzed for cotinine, a substance found in the urine of a person who has breathed tobacco smoke.”
Instruments: At baseline and at the 6-month and 12-month follow-up visits, the primary caregiver provided data by personal interview on family demographic characteristics, the child’s asthma history, current symptoms, activity limitations, environmental factors, and medication regimen (ie, a complete listing of asthma medications, dosages, and schedules). The caregiver reports included the following: (1) the types of tobacco products smoked, the amount smoked, and the relationship of the child to each smoker who lived in or regularly visited the home; (2) the degree to which the child was exposed to ETS; and (3) any restrictions on smoking in the home (eg, smoking not allowed inside the home, only allowed in certain locations inside the home, or not restricted). Families received $10 each time that they completed the scheduled data collection at baseline, 6 months, and 12 months, and the child received a small bag of inexpensive, age-appropriate toys.