Journal of Immigrant and Minority Health

, Volume 16, Issue 2, pp 256–264 | Cite as

Can a Minimal Intervention Reduce Secondhand Smoke Exposure Among Children with Asthma from Low Income Minority Families? Results of a Randomized Trial

  • Leanne Streja
  • Catherine M. Crespi
  • Roshan Bastani
  • Glenn C. Wong
  • Craig A. Jones
  • John T. Bernert
  • Donald Tashkin
  • S. Katharine Hammond
  • Barbara A. Berman
Original Paper


We report on the results of a low-intensity behavioral intervention to reduce second hand smoke (SHS) exposure of children with asthma from low income minority households in Los Angeles, California. In this study, 242 child/adult dyads were randomized to a behavioral intervention (video, workbook, minimal counseling) or control condition (brochure). Main outcome measures included child’s urine cotinine and parental reports of child’s hours of SHS exposure and number of household cigarettes smoked. Implementation of household bans was also considered. No differences in outcomes were detected between intervention and control groups at follow-up. Limitations included high attrition and low rates of collection of objective measures (few children with urine cotinine samples). There continues to be a need for effective culturally and linguistically appropriate strategies that support reduction of household SHS exposure among children with asthma in low income, minority households.


SHS exposure Behavioral modification Environmental tobacco smoke Childhood asthma Household smoking restrictions 



Support for this work was provided by National Institutes of Health grants HL53957 from the National Heart, Lung and Blood Institute, Division of Lung Diseases, and CA16042 from the National Cancer Institute. Approval was obtained from the UCLA Office for Protection of Research Subjects, UCLA IRB #G94-09-1000-34. We wish to thank the adults and children who participated in the research, and the administrative and clinical staffs at our recruitment sites. We also express appreciation to Ms. Connie Sosnoff, Mr. Alberto Febo, Mr. Charles Perrino, Tuyen Hoang, Ph.D., Darlene Goldstein, Ph.D., Ms. Guadelupe Escobar, Ms. Claudia Huezo, Ms. Yanscy Flores, Ms. Melissa Aguayo, and Ms. Laura Hoyos for assistance in data collection and analysis; K. Michael Cummings, Ph.D., Mary Ann Lewis, R.N., Dr.P.H., F.A.A.N., Maria Hayes-Bautista, R.N., M.P.H., Lesa Walden, M.D. (VitalSigns, Inc. Santa Monica, CA), and Antronette K.Yancey, M.D., M.P.H. for assistance in developing the intervention materials and survey instruments.


  1. 1.
    Akinbami LJ, Moorman JE, Garbe PL, Sondik EJ. Status of childhood asthma in the United States, 1980–2007. Pediatrics. 2009;123(Suppl 3):S131–45.PubMedCrossRefGoogle Scholar
  2. 2.
    Canino G, McQuaid EL, Rand CS. Addressing asthma health disparities: a multilevel challenge. J Allergy Clin Immunol. 2009;123(6):1209–17.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Bryant-Stephens T. Asthma disparities in urban environments. J Allergy Clin Immunol. 2009;123(6):1199–206.PubMedCrossRefGoogle Scholar
  4. 4.
    Koinis-Mitchell D, McQuaid EL, Kopel SJ, Esteban CA, Ortega AN, Seifer R, et al. Cultural-related, contextual, and asthma-specific risks associated with asthma morbidity in urban children. J Clin Psychol Med Settings. 2010;17(1):38–48.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    U.S. Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the surgeon general. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006.Google Scholar
  6. 6.
    Gerald LB, Gerald JK, Gibson L, Patel K, Zhang S, McClure LA. Changes in environmental tobacco smoke exposure and asthma morbidity among urban school children. Chest. 2009;135(4):911–6.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    U.S. Environmental Protection Agency. Fact sheet: national survey on environmental management of asthma and children’s exposure to ETS. Retrieved 10 Dec 2011, from, (2011).
  8. 8.
    Halterman JS, Fagnano M, Conn KM, Szilagyi PG. Do parents of urban children with persistent asthma ban smoking in their homes and cars? Ambul Pediatr. 2006;6(2):115–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Hovell MF, Zakarian JM, Matt GE, Hofstetter CR, Bernert JT, Pirkle J. Effect of counselling mothers on their children’s exposure to environmental tobacco smoke: randomised controlled trial. BMJ. 2000;321(7257):337–42.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Greenberg RA, Strecher VJ, Bauman KE, et al. Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness. J Behav Med. 1994;17(3):273–90.PubMedCrossRefGoogle Scholar
  11. 11.
    Emmons KM, Hammond SK, Fava JL, Velicer WF, Evans JL, Monroe AD. A randomized trial to reduce passive smoke exposure in low-income households with young children. Pediatrics. 2001;108(1):18–24.PubMedCrossRefGoogle Scholar
  12. 12.
    Hovell MF, Meltzer SB, Zakarian JM, et al. Reduction of environmental tobacco smoke exposure among asthmatic children: a controlled trial. Chest. 1994;106(2):440–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Hovell MF, Meltzer SB, Wahlgren DR, et al. Asthma management and environmental tobacco smoke exposure reduction in Latino children: a controlled trial. Pediatrics. 2002;110(5):946–56.PubMedCrossRefGoogle Scholar
  14. 14.
    Wahlgren DR, Hovell MF, Meltzer SB, Hofstetter CR, Zakarian JM. Reduction of environmental tobacco smoke exposure in asthmatic children. A 2-year follow-up. Chest. 1997;111(1):81–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Wilson SR, Yamada EG, Sudhakar R, et al. A controlled trial of an environmental tobacco smoke reduction intervention in low-income children with asthma. Chest. 2001;120(5):1709–22.PubMedCrossRefGoogle Scholar
  16. 16.
    Hughes DM, McLeod M, Garner B, Goldbloom RB. Controlled trial of a home and ambulatory program for asthmatic children. Pediatrics. 1991;87(1):54–61.PubMedGoogle Scholar
  17. 17.
    Conway TL, Woodruff SI, Edwards CC, Hovell MF, Klein J. Intervention to reduce environmental tobacco smoke exposure in Latino children: null effects on hair biomarkers and parent reports. Tob Control. 2004;13(1):90–2.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Krieger JW, Takaro TK, Song L, Weaver M. The Seattle-King County Healthy Homes Project: a randomized, controlled trial of a community health worker intervention to decrease exposure to indoor asthma triggers. Am J Public Health. 2005;95(4):652–9.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Chan S, Lam TH. Protecting sick children from exposure to passive smoking through mothers’ actions: a randomized controlled trial of a nursing intervention. J Adv Nurs. 2006;54(4):440–9.PubMedCrossRefGoogle Scholar
  20. 20.
    Irvine L, Crombie IK, Clark RA, et al. Advising parents of asthmatic children on passive smoking: randomised controlled trial. BMJ. 1999;318(7196):1456–9.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Priest N, Roseby R, Waters E, et al. Family and carer smoking control programmes for reducing children’s exposure to environmental tobacco smoke. Cochrane Database Syst Rev. 2008;(4):CD001746. doi: 10.1002/14651858.CD001746.pub2.
  22. 22.
    Wakefield M, Banham D, McCaul K, et al. Effect of feedback regarding urinary cotinine and brief tailored advice on home smoking restrictions among low-income parents of children with asthma: a controlled trial. Prev Med. 2002;34:58–65.PubMedCrossRefGoogle Scholar
  23. 23.
    Curry SJ, Emmons KM. Theoretical models for predicting and improving compliance with breast cancer screening. Ann Behav Med. 1994;16(4):302–16.Google Scholar
  24. 24.
    Bastani R, Glenn BA, Taylor VM, et al. Integrating theory into community interventions to reduce liver cancer disparities. The Health Behavior Framework. Prev Med. 2010;501(1–2):63–7.CrossRefGoogle Scholar
  25. 25.
    Bastani R, Glenn BA, Tsui J, et al. Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiol Biomarkers Prev. 2011;20:1463–72.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Lozano P, Finkelstein JA, Carey VJ, et al. A multisite randomized trial of the effects of physician education and organizational change in chronic-asthma care—health outcomes of the Pediatric Asthma Care Patient Outcomes Research Team II Study. Arch Pediatr Adolesc Med. 2004;158(9):875–83.PubMedCrossRefGoogle Scholar
  27. 27.
    Severson HH, Zoref L, Andrews J, Lichtenstein E, Wall M. Reducing environmental tobacco smoke (ETS) exposure for infants: a cessation intervention for mothers of newborns. Am J Health Promot. 1994;8(4):252–3.PubMedCrossRefGoogle Scholar
  28. 28.
    Berman BA, Wong GC, Bastani R, et al. Household smoking behavior and ETS exposure among children with asthma in low-income, minority households. Addict Behav. 2003;28(1):111–28.PubMedCrossRefGoogle Scholar
  29. 29.
    Wong GC, Berman BA, Hoang T, Bernaards C, Jones C, Bernert JT. Children’s exposure to environmental tobacco smoke in the home: comparison of urine cotinine and parental reports. Arch Environ Health. 2002;57(6):584–90.PubMedCrossRefGoogle Scholar
  30. 30.
    Wong GC, Bernaards CA, Berman BA, Jones C, Bernert JT. Do children with asthma and their parents agree on household ETS exposure? Implications for asthma management. Patient Educ Couns. 2004;53(1):19–25.PubMedCrossRefGoogle Scholar
  31. 31.
    Cuellar I, Harris LC, Jasso R. An acculturation scale for Mexican American normal and clinical populations. Hisp J Behav Sci. 1980;2(3):199–217.Google Scholar
  32. 32.
    Bernert JT Jr, Turner WE, Pirkle JL, et al. Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clin Chem. 1997;43(12):2281–91.PubMedGoogle Scholar
  33. 33.
    Emerson JA, Hovell MF, Meltzer SB, et al. The accuracy of environmental tobacco smoke exposure measures among asthmatic children. J Clin Epidemiol. 1995;48(10):1251–9.PubMedCrossRefGoogle Scholar
  34. 34.
    Gehring U, Leaderer BP, Heinrich J, et al. Comparison of parental reports of smoking and residential air nicotine concentrations in children. Occup Environ Med. 2006;63(1):766–72.PubMedCentralPubMedCrossRefGoogle Scholar
  35. 35.
    Glasgow RE, Foster LS, Lee ME, Hammond SK, Lichtenstein E, Andrews JA. Developing a brief measure of smoking in the home: description and preliminary evaluation. Addict Behav. 1998;23(4):567–71.PubMedCrossRefGoogle Scholar
  36. 36.
    Hammond SK, Leaderer BP. A diffusion monitor to measure exposure to passive smoking. Environ Sci Technol. 1987;21:494–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Martinez-Donate AP, Johnson-Kozlow M, Hovell MF, Gonzalez Perez GJ. Home smoking bans and SHSs exposure in Mexico and the US. Prev Med. 2009;48(3):207–12.PubMedCrossRefGoogle Scholar
  38. 38.
    Centers for Disease Control and Prevention (CDC). State-specific prevalence of smoke-free home rules—United States, 1992–2003. MMWR Morb Mortal Wkly Rep. 2007;56(20):501–504.Google Scholar
  39. 39.
    Marin B, Marin G. Research with hispanic populations. Thousand Oaks: Sage Publications; 1991.Google Scholar
  40. 40.
    Gergen PJ, Fowler JA, Maurer KR, Davis WW, Overpeck MD. The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988–1994. Pediatrics. 1998;101(2):E8. Retrieved 13 Nov 2011, from,
  41. 41.
    Flores G, Fuentes-Afflick E, Barbot O, et al. The health of Latino children: urgent priorities, unanswered questions, and a research agenda. JAMA. 2002;288:82–90.PubMedCrossRefGoogle Scholar
  42. 42.
    Chen X, Stanton B, Hopper J, Khankari N. Sources, locations, and predictors of environmental tobacco smoke exposure among young children from inner-city families. J Pediatr Health Care. 2011;25:365–72.PubMedCrossRefGoogle Scholar
  43. 43.
    Wamboldt FS, Balkissoon RC, Rankin AE, et al. Correlates of household smoking bans in low-income families of children with and without asthma. Fam Process. 2008;47(1):81–94.PubMedCrossRefGoogle Scholar
  44. 44.
    Ashley MJ, Cohen J, Ferrence R, et al. Smoking in the home: changing attitudes and current practices. Am J Public Health. 1998;88(5):797–800.PubMedCentralPubMedCrossRefGoogle Scholar
  45. 45.
    Mumford EA, Levy DT, Romano EO. Home smoking restrictions. Problems in classification. Am J Prev Med. 2004;27(2):126–31.PubMedCrossRefGoogle Scholar
  46. 46.
    Kegler MC, Escoffery C, Groff A, Butler S, Foreman A. A qualitative study of how families decide to adopt household smoking restrictions. Fam Community Health. 2007;30(4):328–41.PubMedCrossRefGoogle Scholar
  47. 47.
    Liem JJ, Kozyrskyj AL, Benoit CM, Becker AB. Asthma is not enough: continuation of smoking among parents with an asthmatic child. Can Respir J. 2007;14(6):349–53.PubMedCentralPubMedGoogle Scholar
  48. 48.
    Zakarian JM, Hovell MF, Sandweiss RD, et al. Behavioral counseling for reducing children’s ETS exposure: implementation in community clinics. Nicotine Tob Res. 2004;6(6):1061–74.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Leanne Streja
    • 1
    • 2
    • 3
    • 9
  • Catherine M. Crespi
    • 1
    • 2
  • Roshan Bastani
    • 1
    • 2
  • Glenn C. Wong
    • 4
  • Craig A. Jones
    • 5
  • John T. Bernert
    • 6
  • Donald Tashkin
    • 7
  • S. Katharine Hammond
    • 8
  • Barbara A. Berman
    • 1
    • 2
  1. 1.Division of Cancer Prevention and Control Research and Jonsson Comprehensive Cancer CenterUniversity of California, Los AngelesLos AngelesUSA
  2. 2.Jonathan and Karin Fielding School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  3. 3.Division of Biostatistics, Department of Information SciencesCity of HopeDuarteUSA
  4. 4.GW Graphic WorksLos AngelesUSA
  5. 5.Vermont Blueprint for HealthAgency of AdministrationMontpelierUSA
  6. 6.Emergency Response and Air Toxicants Branch, Division of Laboratory Science, National Center for Environmental HealthCenters for Disease Control and PreventionAtlantaUSA
  7. 7.Division of Pulmonary and Critical Care Medicine, David Geffen School of MedicineUniversity of California, Los AngelesLos AngelesUSA
  8. 8.Division of Environmental Health Sciences, School of Public HealthUniversity of CaliforniaBerkeleyUSA
  9. 9.Department of Information SciencesCity of HopeDuarteUSA

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