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Original Research: TOBACCO CESSATION & PREVENTION |

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

Sandra R. Wilson, PhD; Harold J. Farber, MD, FCCP; Sarah B. Knowles, PhD; Philip W. Lavori, PhD
Author and Funding Information

From the Department of Health Services Research (Drs Wilson and Knowles), Palo Alto Medical Foundation Research Institute, Palo Alto, CA; the Section of Pediatric Pulmonology (Dr Farber), Baylor College of Medicine, Houston, TX; and the Department of Health Research and Policy (Dr Lavori), Stanford University School of Medicine, Stanford, CA.

Correspondence to: Sandra R. Wilson, PhD, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Bldg, Palo Alto, CA 94301; e-mail: Wilsons@pamfri.org


Funding/Support: This research was supported by the National Institutes of Health [Grant NIH RO1 HL70012; Sandra R. Wilson, PhD, principal investigator].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(3):581-590. doi:10.1378/chest.10-0772
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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

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