哮喘联盟

   摘要

   背景：家庭环境中细颗粒物主要来源为吸烟，烹饪和清洁卫生，而这些颗粒物质会对家庭人员，尤其是儿童健康造成损害。一项自2011年至2016年的随机临床研究就实时反馈联合家长或监护人的教育是否降低家庭细颗粒物水平进行探讨。

   研究设计：干预组和对照组的随机研究；
   受试者：298名来自以低收入家庭为主的受试者，家中有成人吸烟者，儿童年龄＜14岁。2012~2015年之间，受试者经圣地亚哥地区多种途径进行招募，主要是妇女、婴幼儿和儿童项目场所。
   干预：多种干预措施内容如下：根据实时细颗粒物浓度进行持续亮灯和短暂报警提示，通过细颗粒浓度相关图示和鼓励性谈话进行4个短暂的培训。鼓励性谈话主要集中在降低颗粒物浓度对于儿童和其他受试者的损害，特别是吸烟环境。
   主要研究终点：室内颗粒物浓度通过激光颗粒计数方法持续测定。两个结果为每日平均颗粒物计数和高颗粒物浓度时间百分比（>15,000颗粒物/0.01 ft3）。线性混合方法用于分析两组2016-2017年的变化情况。
   结果: 家庭干预措施可以显著降低每日平均颗粒物浓度（干预组和对照组：18.8% vs 6.5%, p<0.001）。干预组平均高颗粒物浓度时间百分比也显著下降（干预组和对照组：45.1% vs 4.2%, p<0.001）。
   结论：实时反馈联合短期教育有助于降低吸烟者及儿童家庭细颗粒物水平。这一研究结果也为再次定义降低烟草相关颗粒物的反馈机制和可能的增强干预效应奠定了基础。

（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）

（Am J Prev Med. 2018 Jan 2. pii: S0749-3797(17)30640-2. doi: 10.1016/j.amepre.2017.10.017. [Epub ahead of print]）

Randomized Trial to Reduce Air Particle Levels in Homes of Smokers and Children.

Am J Prev Med. 2018 Jan 2. pii: S0749-3797(17)30640-2. doi: 10.1016/j.amepre.2017.10.017. [Epub ahead of print]

Hughes SC et al.
 
Abstract
INTRODUCTION: Exposure to fine particulate matter in the home from sources such as smoking, cooking, and cleaning may put residents, especially children, at risk for detrimental health effects. A randomized clinical trial was conducted from 2011 to 2016 to determine whether real-time feedback in the home plus brief coaching of parents or guardians could reduce fine particle levels in homes with smokers and children.
DESIGN:A randomized trial with two groups-intervention and control.
SETTING/PARTICIPANTS:A total of 298 participants from predominantly low-income households with an adult smoker and a child aged <14 years. Participants were recruited during 2012-2015 from multiple sources in San Diego, mainly Women, Infants and Children Program sites.
INTERVENTION:The multicomponent intervention consisted of continuous lights and brief sound alerts based on fine particle levels in real time and four brief coaching sessions using particle level graphs and motivational interviewing techniques. Motivational interviewing coaching focused on particle reduction to protect children and other occupants from elevated particle levels, especially from tobacco-related sources.
MAIN OUTCOME MEASURES:In-home air particle levels were measured by laser particle counters continuously in both study groups. The two outcomes were daily mean particle counts and percentage time with high particle concentrations (>15,000 particles/0.01 ft3). Linear mixed models were used to analyze the differential change in the outcomes over time by group, during 2016-2017.
RESULTS:Intervention homes had significantly larger reductions than controls in daily geometric mean particle concentrations (18.8% reduction vs 6.5% reduction, p<0.001). Intervention homes' average percentage time with high particle concentrations decreased 45.1% compared with a 4.2% increase among controls (difference between groups p<0.001).
CONCLUSIONS:Real-time feedback for air particle levels and brief coaching can reduce fine particle levels in homes with smokers and young children. Results set the stage for refining feedback and possible reinforcing consequences for not generating smoke-related particles.