Better asthma outcomes: lowering tobacco smoke exposure.

更好的哮喘结果：减少烟草烟雾暴露。

• 批准号: 6464469
• 负责人: Sandra R Wilson
• 金额: $ 69.13万
• 依托单位: PALO ALTO MEDICAL FOUNDATION RES INST
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-05-03 至 2006-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6464469
• 关键词: African American; Hispanic Americans; asthma; behavioral /social science research tag; child (0-11); environmental exposure; health behavior; health care service utilization; health education; health services research tag; human subject; nicotine; outcomes research; parent offspring interaction; passive smoking; patient care management; patient oriented research; socioeconomics

DESCRIPTION (provided by applicant) Chronic environmental tobacco smoke (ETS) exposure, particularly from parental smoking, is associated with more severe asthma - increased incidence of emergnecy department visits, life-threatening attacks, asthma symptoms, and prolonged time to recovery from asthma exacerbations requiring hospitalization. Daily ETS exposure has been reported in as many as one-third of low socioeconomic status children with asthma in U.S. samples. We recently reported a preliminary randomized control trial of an ETS reduction intervention based on social cognitive learning theory and including ongoing objective feedback on ETS exposure in a low-income, predominantly Latino and African American sample of 87 children with asthma, which was associated with a statistically significant reduction in health care utilization for acute athma and a reduction in ETS exposure of comparable effect size as measured by parental report and the child's urine cotinine level. Replication and extension are needed to improve the intervention, validate the exposure reduction, and better understand the mechanism(s) linking the intervention to clinical outcome. We propose an 18-month randomized control trial of this intervention, tailored to parental stage of change with regard to smoking practices, in 500 ETS-exposed children with persistent asthma, 3-12 years of age, receiving care from Kaiser Permanente in Northern California. All children will be on an adequate medication regimen and receive equivalent asthma education prior to randomization. Primary outcomes will be asthma acute care utilization and urine cotinine/creatinine ratio; secondary outcomes will be caregiver readiness to change smoking behavior (stage of change), asthma functional severity, non-appearance on the Kaiser Permanente list of "high risk" asthma patients, reported prohibition of smoking within the home and other indoor/enclosed areas, reported parental smoking cessation, and reported school absences. Changes in controller medication adherence will be evaluated using a pharmacy-based dispensing index. We hypothesize that this intervention will be associated with decreased asthma crisis care utilization, lower ETS exposure, and improvements in secondary disease outcomes at follow- up when compared with usual medical care. Further, we hypothesize that decreases in urine cotinine/creatinine ratio, but not changes in controller medication adherence, will be found to be instrumental in the intervention- associated improvements in asthma crisis care utilization. Special measures will be taken to enhance the reliability of cotinine as an indicator of chronic personal exposure.

描述（由申请人提供） 慢性环境烟草烟雾（ETS）暴露，特别是来自父母 吸烟，与更严重的哮喘有关-增加的发病率 急诊室就诊、危及生命的发作、哮喘症状，以及 从哮喘急性发作恢复的时间延长，需要 住院 据报道，多达三分之一的人每天接触ETS， 低社会经济地位的哮喘儿童的数据。 我们最近 报道了一项关于减少ETS的初步随机对照试验， 基于社会认知学习理论的干预措施， 低收入人群中ETS暴露的客观反馈，主要是拉丁美洲人， 非裔美国人样本的87名儿童哮喘，这是与 在统计学上显著减少了急性 athma和ETS暴露的减少具有可比的效应量， 家长报告和孩子的尿液可替宁水平 复制和 需要扩展以改进干预措施，验证暴露 更好地了解将干预措施与 临床结果。 我们建议进行一项为期18个月的随机对照试验， 针对父母在吸烟方面的变化阶段采取干预措施 在500名暴露于ETS的持续性哮喘儿童中， 年龄，接受照顾凯撒永久在北方加州。 所有 儿童将接受适当的药物治疗， 随机分组前接受哮喘教育。 主要结局为哮喘 急性护理利用和尿可替宁/肌酸酐比率;次要结局 将是护理人员准备改变吸烟行为（改变阶段）， 哮喘功能严重程度，未出现在Kaiser Permanente的 “高危”哮喘患者，报告禁止在家中吸烟 和其他室内/封闭区域，报告父母戒烟，以及 报告的学校缺席。 控制药物依从性的变化将 使用基于药房的配药指数进行评估。 我们假设这 干预将与哮喘危机护理利用率降低相关， 降低ETS暴露，并改善随访时的继发性疾病结局- 与常规医疗相比， 此外，我们假设， 尿可替宁/肌酐比值降低，但对照组无变化 药物依从性，将被发现是在干预工具- 哮喘危机护理利用率的相关改善。 特别措施 将采取提高可替宁作为指标的可靠性 慢性个人接触。