1. Smoke-Free Homes and Asthma Asthma Advisory Committee Meeting Connie Wong Program Coordinator, The Lung Association cwong@on.lung.ca February 24, 2011

2. 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.

3. 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.

4. 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.

5. 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.

6. 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).

7. 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.

8. 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.

9. 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).

10. 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.

11. 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 3 rd hand smoke exposure in addition to SHSe).

12. 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

13. 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.