title: Evaluation of systematic assessment of asthma-like symptoms and tobacco smoke exposure in early childhood by well-child professionals: a randomised trial.
abstract: OBJECTIVE
  This study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure during regular preventive well-child visits between age 1 and 4 years by well-child professionals.
  
  
  METHODS
  Sixteen well-child centres in Rotterdam, the Netherlands, were randomised into 8 centres where the brief assessment form regarding asthma-like symptoms and ETS exposure was used and 8 centres that applied usual care. 3596 and 4179 children (born between April 2002 and January 2006) and their parents visited the intervention and control centres, respectively. At child's age 6 years, physician-diagnosed asthma ever, wheezing, fractional exhaled nitric oxide (FeNO), airway resistance (Rint), health-related quality of life (HRQOL) and ETS exposure at home ever were measured. Linear mixed models were applied.
  
  
  RESULTS
  No differences in asthma, wheezing, FeNO, Rint or HRQOL measurements between intervention and control group were found using multilevel regression in an intention-to-treat analysis (p>0.05). Children of whom the parents were interviewed by using the brief assessment form at the intervention well-child centres had a decreased risk on ETS exposure at home ever, compared to children who visited the control well-child centres, in an explorative per-protocol analysis (aOR = 0.71, 95% CI:0.59-0.87).
  
  
  CONCLUSIONS
  Systematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by well-child care professionals using a brief assessment form was not effective in reducing the prevalence of physician-diagnosed asthma ever and wheezing, and did not improve FeNO, Rint or HRQOL at age 6 years. Our results hold some promise for interviewing parents and using information leaflets at well-child centres to reduce ETS exposure at home in preschool children.
  
  
  BACKGROUND
  Controlled-Trials.com ISRCTN15790308.
authors.affiliation: The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Esther
authors.initials: E
authors.lastname: Hafkamp-de Groen
authors.affiliation: The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Paediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Ralf J P
authors.initials: RJ
authors.lastname: van der Valk
authors.affiliation: TNO, Netherlands Organisation for Applied Scientific Research, Department of Child Health, Leiden, The Netherlands.
authors.forename: Ashna D
authors.initials: AD
authors.lastname: Mohangoo
authors.affiliation: Department of General Practice and Elderly Care Medicine, EMGO, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.affiliation: Department of Paediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Paediatrics, Division of Neonatology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Liesbeth
authors.initials: L
authors.lastname: Duijts
authors.affiliation: The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Vincent W
authors.initials: VW
authors.lastname: Jaddoe
authors.affiliation: Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.affiliation: Department of Paediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Johan C
authors.initials: JC
authors.lastname: de Jongste
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
mesh_terms: D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016014:Linear Models; D008297:Male; D009426:Netherlands; D009569:Nitric Oxide / Q000737:chemistry; D011446:Prospective Studies; D011788:Quality of Life; D012044:Regression Analysis; D012135:Respiratory Sounds; D012306:Risk; D016540:Smoking Cessation; D000074606:Smoking Prevention; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
chemical_list: D014028:Tobacco Smoke Pollution; D009569:Nitric Oxide