Transcript Asthma Action Program - The Ontario Lung Association

Smoke-Free Homes and Asthma
Asthma Advisory Committee Meeting
Connie Wong
Program Coordinator,
The Lung Association
[email protected]
February 24, 2011
Program Overview
•
Second-Hand Smoke (SHS) affects respiratory health and
is considered a health and social policy concern in
Canada.
•
SHS exposure is associated with:
– increased frequency and severity of exacerbations of
asthma
– development of asthma in infants and young children.
Pilot Study Objectives
•
To evaluate the preliminary effectiveness of a pilot
intervention in reducing children’s exposure to SHS
through the establishment of smoke-free homes.
•
To evaluate the preliminary effectiveness of the pilot
intervention in reducing asthma symptoms and hospital
emergency visits.
•
To determine the feasibility of having Certified
Asthma/Respiratory Educators of Primary Care Asthma
Programs (PCAPs) and similar settings deliver the pilot
intervention.
Current Participant Eligibility Criteria
•
Adult aged 18 and over residing in a home (now including
multi-unit dwellings – noted in participants’ file).
•
One or more residents in the home has asthma (with a
particular interest in children under 12 with asthma).
•
One or more smokers reside in the home. (Smoker defined
as having smoked 6 or more cigarettes in the past 7 days.
Hovell, Meltzer et al 2002).
•
One or more children reside in the home. At least one of the
children is below the age of 12.
•
The child(ren) is exposed to SHS in the home.
Pilot Study Protocol
•
Focus: Eliminating SHS exposure from the home, not
Cessation (guidance is provided).
•
17 or 9 week intervention conducted by CAE/CREs:
– 2 in-person counseling sessions (1 involving physician).
– 2 follow-up telephone calls.
•
Pre and Post intervention questionnaires administered, with
findings analyzed to address research questions.
•
Sessions use Motivational Interviewing (MI) and Coaching
approaches.
Pilot Study Protocol (Continued)
•
Nicotine monitoring conducted in interested sample homes:
5 days prior to start of intervention, repeated 5 days after the
intervention is complete.
•
Participants receive an honorarium (between $50-$100).
•
Smoke-Free Homes Kit provided to each participant during
first in-person session (contains information and resources
including Cessation support for those hoping to quit).
Current Status of Pilot Project
•
Hotel Dieu Grace Hospital – Windsor-Essex
– 17 week intervention started in January 2010.
– 6 CREs, 12 sites.
– Due to low enrollment, amendments submitted to UofT
Research Ethics Board to:
• Broaden age range of participants from under age 5 to
under age 12.
• Enable staff to utilize existing database of patients to
identify/recruit those meeting eligibility criteria.
• Increase honorariums from $20 to $50-$100.
Current Status of Pilot Project (Continued)
•
Orillia Soldiers’ Memorial Hospital - Orillia
– Dr. Gary Smith – Regional Paediatric Asthma Centre.
– 17 week intervention, 1 CRE working out of OSMH.
– Separate ethics application submitted and approved.
– Protocol and MI training session conducted January 28,
2011.
– Potential participants identified; recruitment underway.
Current Status of Pilot Project (Continued)
•
Royal Victoria Hospital - Barrie
– Dr. Brian Kuzik – Paediatrician, Asthma Clinic.
– 9 week intervention, 1 CRE working out of RVH.
– Separate ethics application to be submitted for approval.
– Protocol and MI training session to be scheduled for
March 2011.
– Suggested revised eligibility criteria questions to
increase enrollment success and provide clear definitions
on a number of terms (identify “asthma” in children).
Current Status of Pilot Project (Continued)
•
Somerset West Community Health Centre (Ottawa)
– Laurie Taylor – Lung Health Coordinator.
– 9 week intervention, 4 CRE’s, 6 sites.
– No separate ethics application required.
– Protocol and MI training session scheduled for March
11, 2011.
– Able to begin recruitment after training session.
Next Steps for 2011-2012
•
Continue working with 3 new sites and provide ongoing
support and resources as needed.
•
Monitor feedback and analyze results obtained at 3 sites.
•
Expand training opportunities for CAEs/CREs regarding
Motivational Interviewing techniques.
•
Seek partnership opportunities to develop a larger
controlled study based on findings of pilot study (include
3rd hand smoke exposure in addition to SHSe).
References
Allison, K. (2008). Smoke-Free Homes and Asthma: Research
Synthesis. Toronto, Ontario Lung Association.
Canadian Tobacco Use Monitoring Survey, Household component, Feb.
– Dec. 2008
Institute for Clinical and Evaluative Sciences. Asthma Prevalence Rates,
Ontario 1997-2005. http://intool.ices.on.ca/
Liu AH et al, Development and cross-sectional validation of the
Childhood Asthma Control Test, J Allergy Clin Immunol 2007
119:817-25
Murphy KR et al. Test for Respiratory and Asthma Control in Kids
(TRACK): A caregiver-completed questionnaire for preschool-aged
children. JACI 2009; 123:833-39
References (Continued)
Nathan RA et al. Development of the asthma control test: a survey for
assessing asthma control. J Allergy Clin Immunol 2004;113: 59-65)
Schatz M et al. The minimally important difference of the Asthma
Control Test. J Allergy Clin Immunol 2009:124: 719-23
To T, Gershon A, Tassoudji M, Guan J, Wang C, Estrabillo E, Cicutto L.
(2006). The Burden of Asthma in Ontario. ICES Investigative
Report. Toronto: Institute for Clinical Evaluative Sciences.
U.S. Environmental Protection Agency (2004). National Survey on
Environmental Management of Asthma and Children’s Exposure to
Environmental Tobacco Smoke.