Randomized Controlled Trial to Improve Care for Urban Children With Asthma

Halterman, Jill S.; Szilâgyi, Peter G.; Fisher, Susan G.; Fagnano, Maria; Tremblay, Paul; Conn, Kelly M.; Wang, Hongyue; Borrelli, Belinda

doi:10.1001/archpediatrics.2011.1

Cited by 119 publications

(135 citation statements)

References 44 publications

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“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] The trials were published between 1994 and 2013. A flowchart describing the identification process is presented in Fig 1. Study characteristics of included trials are presented in Tables 1 and 2. …”

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confidence: 99%

“…21,28,29,32,[85][86][87]90,[92][93][94]96 Fidelity Seven studies reported high fidelity, with at least 80% of participants receiving the full intervention 23,24,27,84,88,93,96 ; 6 studies had moderate fidelity, with 50% to 79% of participants receiving the intervention 25,[29][30][31][32][33] ; and the remaining 17 studies did not report fidelity. [20][21][22]26,28,34,83,[85][86][87][89][90][91][92]94,95,97 Intervention Effects …”

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confidence: 99%

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Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Rosen¹,

Myers²,

Hovell

et al. 2014

Pediatrics

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BACKGROUND AND OBJECTIVE: Worldwide, roughly 40% of children are exposed to the damaging and sometimes deadly effects of tobacco smoke. Interventions aimed at reducing child tobacco smoke exposure (TSE) have shown mixed results. The objective of this study was to perform a systematic review and meta-analysis to quantify effects of interventions aimed at decreasing child TSE.METHODS: Data sources included Medline, PubMed, Web of Science, PsycNet, and Embase. Controlled trials that included parents of young children were selected. Two reviewers extracted TSE data, as assessed by parentally-reported exposure or protection (PREP) and biomarkers. Risk ratios and differences were calculated by using the DerSimonian and Laird random-effects model. Exploratory subgroup analyses were performed.RESULTS: Thirty studies were included. Improvements were observed from baseline to follow-up for parentally-reported and biomarker data in most intervention and control groups. Interventions demonstrated evidence of small benefit to intervention participants at follow-up (PREP: 17 studies, n = 6820, relative risk 1.12, confidence interval [CI] 1.07 to 1.18], P , .0001). Seven percent more children were protected in intervention groups relative to control groups. Intervention parents smoked fewer cigarettes around children at follow-up than did control parents (P = .03). Biomarkers (13 studies, n = 2601) at follow-up suggested lower child exposure among intervention participants (RD 20.05, CI 20.13 to 0.03, P = .20).CONCLUSIONS: Interventions to prevent child TSE are moderately beneficial at the individual level. Widespread child TSE suggests potential for significant population impact. More research is needed to improve intervention effectiveness and child TSE measurement. KEY WORDS secondhand smoke exposure, tobacco smoke exposure, metaanalysis, systematic review, child ABBREVIATIONS CCR-cotinine/creatinine ratio CI-confidence interval CT-controlled trial PREP-parentally reported exposure or protection RCT-randomized controlled trial RD-relative difference RR-relative risk SHS-secondhand smoke THS-thirdhand smoke TSE-tobacco smoke exposure Dr Rosen conceptualized and designed the study, oversaw all aspects of the research, performed the systematic review of the literature, extracted data from the original studies, contributed to the statistical analysis, wrote sections of the manuscript, and edited the entire manuscript; Ms Myers contributed to systematically reviewing the literature, extracted data from the original articles, contributed to the data analysis, and contributed to the writing of the manuscript; Dr Hovell contributed to the design of the meta-analysis and interpretation of the data and edited the manuscript for scientific content; Dr Zucker assisted with various statistical issues in the analysis of the manuscript and edited the manuscript; Ms Ben Noach contributed to the design of the study, the systematic review of the literature, data extraction, data analysis, data interpretation, and writing of the m...

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confidence: 99%

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confidence: 99%

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Rosen¹,

Myers²,

Hovell

et al. 2014

Pediatrics

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“…14,15 The school system can also be supportive in reinforcing key messages in the medical treatment plan and in notifying the asthma care provider if poor adherence to the treatment plan is noted. Overall, a population health approach could also be useful to identify overuse of urgent care settings for periodic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…14, 15 We must take steps to standardize communication, especially the school asthma treatment plan. It would also be useful for the school, particularly the school nurse, to see the full medical treatment plan.…”

Section: Potential Support Systems For Inner City Children With Asthmamentioning

confidence: 99%

“…In certain situations, directly observed therapy is needed to assure adherence to the treatment schedule. 15 An important feature of all school-centered asthma programs is an effort to sustain such programs, e.g., through reorganization of school staffing or some unique mechanisms of payment to supplement schools. It is our hope that national medical and nursing societies will support these efforts and make them ongoing features of their continuing education and maintenance of certification programs as community engagement and quality improvement efforts.…”

Section: Potential Support Systems For Inner City Children With Asthmamentioning

confidence: 99%

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Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies

Szefler

2016

allergy asthma proc

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Asthma in the inner city contributes to high morbidity and mortality, and, in school children, reduced school attendance and alteration in academic performance. There is a need to improve asthma care in the inner city by reducing asthma exacerbations. Methods are currently available to predict and prevent seasonal exacerbations of asthma. In addition, new medications are being developed that will be effective in improving pulmonary function and reducing asthma exacerbations. School-centered asthma programs can also be helpful to assist children and clinicians in applying asthma treatment plans and assuring optimal adherence to these plans.

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Astoria Revisited

Lear¹

2011

Arch Pediatr Adolesc Med

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Randomized Controlled Trial to Improve Care for Urban Children With Asthma

Abstract: To evaluate the impact of the School-Based Asthma Therapy trial on asthma symptoms among urban children with persistent asthma.Design: Randomized trial, with children stratified by smoke exposure in the home and randomized to a schoolbased care group or a usual care control group.

Cited by 119 publications

References 44 publications

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Meta-analysis of Parental Protection of Children From Tobacco Smoke Exposure

Examining causes of the urban (inner city) asthma epidemic: Implementing new management strategies

Astoria Revisited

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