Study objectives: To determine the effectiveness of a
cotinine-feedback, behaviorally based education intervention in
reducing environmental tobacco smoke (ETS) exposure and health-care
utilization of children with asthma.
Randomized controlled trial of educational intervention vs usual
Setting: The pediatric pulmonary service of a
regional pediatric hospital.
ETS-exposed, Medicaid/Medi-Cal-eligible, predominantly minority
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 strategies and basic asthma education and
that incorporated repeated feedback on the child’s urinary cotinine
Measurements: The primary measurements were the
urinary cotinine/creatinine ratio (CCR) and the number of acute asthma
medical visits. The secondary measurements were number of
hospitalizations, smoking restrictions in home, amount smoked, reported
exposures of children, and asthma control.
The intervention was associated with a significantly lower odds ratio
(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 hospitalization (OR, 0.34; p = 0.14). The follow-up CCR
measurement and the determination 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 smoking],
0.24; p = 0.11; n = 60).
intervention significantly reduced asthma health-care utilization in
ETS-exposed, low-income, minority children. Effects sizes for urine
cotinine and proportion prohibiting smoking were moderate to large but
not statistically significant, possibly the result of reduced precision
due to the loss of patients to active follow-up. Improving ETS
reduction interventions and understanding their mechanism of action on
asthma outcomes requires further controlled trials that measure ETS
exposure and behavioral and disease outcomes