Overall this investigation will contribute to the NHLBI goal to reduce tobacco-related morbidity of under-served low SES Latino children with asthma. Our primary specific aims are: 1) to determine the differential effectiveness of behavioral counseling for reduction of ETS exposure in asthmatic Latino children compared to children who receive only general asthma management education; 2) to validate Latino parent-reported smoke exposure measures using CDC's repeated urine cotinine biological assay; 3) to determine the change in asthma management knowledge, and change in reported home asthma management procedures compared to pre-education. Secondary aims are: 4) to determine the degree to which smoking parents reduce or quit smoking as a result of ETS reduction counseling; 5) to explore the correlates of change in ETS exposure; 6) to develop a satisfactory field measure of asthma severity; and 7) to explore the differences in asthma severity between groups and to explore possible predictors of asthma severity. Two hundred families will be recruited from four large community medical clinics in San Diego County, each located in the most densely populated Latino neighborhoods. Families will receive asthma management education after which they will be assigned at random (stratified by clinic) to two groups: control or behavioral counseling to reduce ETS exposure. Counseling will include contingency contracting and problem solving negotiations. Bicultural, bilingual, Latina counselors and research staff will tailor the intervention and measurement procedures to be compatible with the Latino culture and to provide counseling and interviews in Spanish or English, as requested by the families. Measures will be obtained repeatedly over 13 months at pre- intervention and 4 times post-intervention. Measures will include a biological estimate of ETS exposure and parent-reported measures of ETS exposure. Both biological and parent report measures will be used as dependent variables. The repeated biological measure will estimate validity for the parent-reported exposure. Repeated measures statistical models will be used to determine significant differences within and between groups for both ETS exposure measures and parent smoking rates. Changes in knowledge and asthma management practices will be assessed using paired t-tests. Hierarchial multiple regression analyses will be used to explore correlates of ETS exposure, asthma severity, and general health. This study will provide a model for delivering preventive medical care to an under-served low SES minority population, which will contribute to the prevention and control of tobacco related morbidity. If successful, this study will set the stage for clinical trials needed to determine the possible reduction in asthma morbidity to be derived from reduced ETS exposure. This proposal is a revision based on feedback from all study sections.
| Wahlgren, D R; Hovell, M F; Matt, G E et al. (1997) Toward a simplified measure of asthma severity for applied research. J Asthma 34:291-303 |
