--- title: "Parent counseling & smoking exposure to children. | Sutter Health" description: "Evidence of the efficacy of interventions to reduce children's exposure and improve disease outcomes has been inconclusive." url: "https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Parent counseling & smoking exposure to children. # A randomized trial of parental behavioral counseling and cotinine feedback for Lowering Environmental Tobacco Smoke exposure of children with asthma: results of the LET'S Manage Asthma trial Wilson SR, Farber HJ, Knowles SB, & Lavori PW _Chest. 139(3):581-90. doi: 10.1378/chest.10-0772. Epub 2010 Sep 23._ 2010-09-23 ## Abstract ****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. [PubMed abstract](http://www.ncbi.nlm.nih.gov/pubmed/?term=A+randomized+trial+of+parental+behavioral+counseling+and+co) ## Research topics - [Child and Adolescent Health](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Child+and+Adolescent+Health%5C%22%22) - [Lung Diseases](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Lung+Diseases%5C%22%22) - [Smoking](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Smoking%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [New recommendation and coverage of low-dose computed tomography for lung cancer screening: uptake has increased but is still low.](https://www.sutterhealth.org/research/publications/ldct-lung-ca-screening-low-uptake-1055312362) Li J, Chung S, Wei EK, Luft HS. BMC Health Serv Res. 18(1):525. doi: 10.1186/s12913-018-3338-9. 2018 Jul 05 - Publication ### [Common measures, better outcomes (COMBO): a field test of brief health behavior measures in primary care.](https://www.sutterhealth.org/research/publications/brief-health-beh-measures-primary-care-1055312525) Fernald DH, Froshaug DB, Dickinson LM, Balasubramanian BA, Dodoo MS, Holtrop JS, Hung DY, Glasgow RE, Niebauer LJ, Green LA. Am J Prev Med. 35(5 Suppl):S414-22. doi: 10.1016/j.amepre.2008.08.006. 2008 Nov 01 - Publication ### [Precision lifestyle medicine: a new frontier in the science of behavior change and population health.](https://www.sutterhealth.org/research/publications/precision-lifestyle-medicine-1055312346) Ma J, Rosas LG, Lv N. Am J Prev Med. pii: S0749-3797(15)00638-8. doi: 10.1016/j.amepre.2015.09.035. \[Epub ahead of print\] 2015 Dec 01 - Publication ### [Patient dose simulations for scanning-beam digital x-ray tomosynthesis of the lungs.](https://www.sutterhealth.org/research/publications/pt-dose-simulations-sbdx-lung-tomosynthesis-1055312925) Nelson G, Yoon S, Krishna G, Wilfley B, Fahrig R. Med Phys. 40(11):111917. doi: 10.1118/1.4826159. 2013 Nov 01 - Publication ### [Development of the ATAQ-IPF: A tool to assess quality of life in IPF](https://www.sutterhealth.org/research/publications/development-of-the-ataq-ipf-quality-of-life-1055312581) Swigris JJ, Wilson SR, Green KE, Sprunger DB, Brown KK, Wamboldt FS Health Qual Life Outcomes. 8:77. doi: 10.1186/1477-7525-8-77. 2010 Jul 31 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Parent counseling & smoking exposure to children."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576#medicalscholarlyarticle","name":"A randomized trial of parental behavioral counseling and cotinine feedback for Lowering Environmental Tobacco Smoke exposure of children with asthma: results of the LET'S Manage Asthma trial","headline":"Parent counseling & smoking exposure to children.","abstract":"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.","description":"Evidence of the efficacy of interventions to reduce children's exposure and improve disease outcomes has been inconclusive.","keywords":["Child and Adolescent Health","Lung Diseases","Smoking"],"datePublished":"2010-09-23","url":"https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576","inLanguage":"en-US","identifier":[{"@type":"PropertyValue","propertyID":"DOI","value":"10.1378/chest.10-0772"}],"sameAs":["https://doi.org/10.1378/chest.10-0772"],"isPartOf":{"@type":"Periodical","name":"Chest"},"author":[{"@type":"Person","name":"Wilson SR"},{"@type":"Person","name":"Farber HJ"},{"@type":"Person","name":"Knowles SB"},{"@type":"Person","name":"Lavori PW"}],"sourceOrganization":{"@type":"MedicalOrganization","name":"Palo Alto Medical Foundation Research Institute"},"about":[{"@type":"DefinedTerm","name":"Child and Adolescent Health","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Child+and+Adolescent+Health%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Lung Diseases","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Lung+Diseases%22%5D%7D%5D&verticalKey=research_publication"},{"@type":"DefinedTerm","name":"Smoking","url":"https://www.sutterhealth.org/research-search-results?facets=%5B%7B%22i%22%3A%22c_researchTopics.name%22%2C%22v%22%3A%5B%22Smoking%22%5D%7D%5D&verticalKey=research_publication"}],"mainEntityOfPage":{"@type":"WebPage","@id":"https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576","breadcrumb":{"@id":"https://www.sutterhealth.org/research/publications/behavioral-counseling-tobacco-smoke-exposure-child-1055312576#breadcrumblist"}}} ```