Prevention of passive smoking exposure in children with a high risk of asthma.

Exposure to passive smoking is a huge problem world-wide. The WHO estimates that about 50% of children are exposed to passive smoking globally. The health effects of passive smoking in children are huge: on average, they have 30-40% more respiratory infections, a higher chance on asthma-like symptoms and more severe asthma, more episodes of acute bronchitis, a two times higher risk on ‘Sudden Infant Death syndrome (SIDS)’, and even more meningococcal septic shock syndrome. From earlier studies in the Netherlands (PIAMA, PREVASC, RAKKER) it is evident that even 30% of children at high risk for asthma are exposed to passive smoking. We recently found that children aged 0-2 years with a first degree family member with asthma and passive smoke exposure had a 6 to 7 times higher risk on ‘wheezing ever’ or ‘attacks of wheezing’ than children without asthma in the first degree. This underlines the importance of effective prevention of passive smoking at home in this group of vulnerable children. The purpose of this study is to test the effectiveness of a new intervention. The intervention is an individualized, subject-tailored program with repeated contacts, including motivational interviewing, attention for barriers and needs of parents, and feedback on the children’s urine cotinine levels and lung functions. Such an innovative approach is a further development of existing knowledge in the literature and has a high chance on being effective.

An effective intervention towards stopping passive smoke exposure in children is possible by means of an individualized program with repeated counseling, education, motivational interviewing, and by promoting parental awareness with feedback about the lung function of the children and their urine cotinine levels.

Lung function and cotinine measurements will be done at time points 0, 3, 6, 9 and 12 months.

The intervention group will receive the intervention during 6 months; from time point 1 month until 6 months.

Two hundred families (1child per family) are randomized into two groups: a control group, and an active intervention group. Stratification for ‘age’ will occur. The control group receives ‘usual care’ with no extra visits or extra information about health effects of smoking, other than standard usual care according to the standards of the Dutch Society of General Practitioners (NHG). The active intervention group receives an intervention strategy given by two trained practice nurses at home. The intervention consists of 6 counseling sessions during six months, each lasting about 1hour. The intervention consists of motivational interviewing and feedback on the children’s' lung function and urine cotinine measurements.