Chest
Volume 111, Issue 1, January 1997, Pages 81-88
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Clinical Investigations: Asthma
Reduction of Environmental Tobacco Smoke Exposure in Asthmatic Children: A 2-Year Follow-up

https://doi.org/10.1378/chest.111.1.81Get rights and content

Study objective

To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic children's exposure to environmental tobacco smoke (ETS).

Participants

Families of asthmatic children (6 to 17 years), including at least one parent who smoked in the home, recruited from four pediatric allergy clinics.

Design

Participants were randomized to one of three groups: behavioral counseling to reduce ETS exposure, self-monitoring control, and usual medical care control. Counseling concluded at month 6, and the original trial ended at month 12. Two follow-up interviews occurred at months 20 and 30.

Measurements and results

The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure. The 2-year follow-up period was analyzed similarly. Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up. Further exploratory analyses suggested that printed counseling materials given to all participants at month 12 (conclusion of the original study) were associated with decreased exposure in the control groups. Conclusion: Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature, let alone for addictive behaviors. We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit.

Section snippets

Design

Original Study: A three-group repeated measures design was employed in the initial study. Ninety-one families with at least one parent who smoked cigarettes and a child (6 to 17 years) with asthma who was exposed to at least one of the parent's cigarettes per day were recruited from among patients at four of the largest pediatric allergy medical centers in San Diego. Screening forms obtained from the medical centers were reviewed and eligible families were invited to participate in a study of

RESULTS

The counseling group included an outlying data point at baseline (25 cigarettes per day), and the control group included two outliers at baseline (30 and 40 cigarettes per day). Distributions of the exposure variables were moderately skewed at most measurement points. Outlying cases were retained in the data set, and dependent variables for all analyses were transformed using natural logarithms (after adding a value of 1 to all scores to remove zero values). Means of these logs of target

DISCUSSION

These ETS data demonstrate an initial reactivity among participants in all groups, followed by a greater decrease in exposure in the counseling group. This was followed by stabilization or slight increase for the control subjects and sustained or slightly decreased exposure for the counseling group, but general stability during the 6- to 12-month initial follow-up period. The overall effect was maintained throughout the entire 30-month period even in the context of the observed change

REFERENCES (9)

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This research was supported in part by grants from the Cigarette and Tobacco Surtax Fund of the State of California through the Tobacco-Related Disease Research Program of the University of California, grant 4RT-0092, and from the National Heart, Lung, and Blood Institute, National Institutes of Health, grant 1 R18 HL52835 01A1, and from San Diego State University.

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