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The Termination of a Randomized Clinical Trial for Poor Hispanic Children FREE

Mary Ann Lewis, DrPH, RN; Gary Rachelefsky, MD; Charles E. Lewis, MD, ScD; Barbara Leake, PhD; Warren Richards, MD
Arch Pediatr Adolesc Med. 1994;148(4):364-367. doi:10.1001/archpedi.1994.02170040030005.
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Objective:  To conduct a randomized clinical trial of the Spanish version of an educational program designed to be an adjuvant to adequate medical care of children with asthma.

Design:  Randomized, clinical trial.

Setting:  Los Angeles County, Calif.

Participants:  One hundred thirty-eight Hispanic children, ages 7 to 12 years, from disadvantaged families. All had used emergency facilities of major local hospitals in the previous year.

Measurement/Main Results:  As the study proceeded, it became apparent that subjects were receiving inadequate medical and nursing care and had numerous barriers to applying knowledge and self-care skills gained from the program. Realizing this, we considered it unethical to allow the control children to suffer for the duration of the trial (1 year). Therefore, all children received "adequate" care from the research staff, and the randomized clinical trial, as originally designed, was ended. The emergency department/hospital use by both groups was significantly reduced compared with previous experience.

Conclusion:  Those researchers conducting randomized trials involving poor children should be aware of the potential ethical problems inherent in such ventures.(Arch Pediatr Adolesc Med. 1994;148:364-367)

REFERENCES

Evans R, Mullally DI, Wilson RW, et al.  National trends in the morbidity and mortality of asthma in the US: prevalence, hospitalization, and death from asthma over two decades: 1965-1984 . Chest . 1987;;91( (suppl) ):65S-74S.
Gergen PJ, Mullally DI, Evans R.  National survey of prevalence of asthma among children in the United States: 1976-1980 . Pediatrics . 1988;;81:1-7.
Wing JS, Weiss KB. Asthma among children in minority populations in the United States: working towards the year 2000 objectives. In: Program and Abstracts of the 119th annual meeting of the American Public Health Association; 1992; Washington, DC. 199:238. Abstract.
Weitzman M, Gortmaker SL, Sobol AM, Perrin JM.  Recent trends in the prevalence and severity of childhood asthma . JAMA . 1992;;268:2673-2677.
Taylor WR, Newacheck PW.  Impact of childhood asthma on health . Pediatrics . 1990;;90:657-662.
Cooperative Projects (R01's) on Minority Health . Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; October 1992;. RFA 93-HL-01.
National Cooperative Inner City Asthma Study . Bethesda, Md: National Institute of Allergy and Infectious Disease, National Institutes of Health; 1990;. RFA 90-A1-02.
Fisher RA, Mackenzie WA.  Studies in crop variation, II: the manorial response to different potato varieties . J Agricul Sci . 1923;;13:315.
Hill AB.  Observation and experiment . N Engl J Med . 1953;;248:955-1001.
Lewis CE, Rachelefsky GS, Lewis MA, de la Sota A, Kaplan MS.  A randomized trial of ACT (asthma care training) for kids . Pediatrics . 1984;;74:478-486.
Klingelhofer EL, Gershwin ME.  Asthma self-management programs: premises, not promises . J Asthma . 1988;;25:89-101.
Evans D, Mullins RB.  Educational programs for children with asthma . Pediatrician . 1991;;18:317-323.
Lewis MA, de la Sota, A, Rachelefsky GC, Lewis CE, Quiones H, Richards R.  ACT-asma control y tratamiento para ninos: a progress report . Health Educ Q . 1987;;14:281-290.
SAS/STATUser's Guide, Version 6 .4th ed. Cary, NC: SAS Institute Inc; 1989;;1.
Feinstein AR.  Clinical biostatistics XII on exorcising the ghost of gases and the curse of kelvin . Clin Pharmacol Ther . 1971;;12:1003-1016.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

Evans R, Mullally DI, Wilson RW, et al.  National trends in the morbidity and mortality of asthma in the US: prevalence, hospitalization, and death from asthma over two decades: 1965-1984 . Chest . 1987;;91( (suppl) ):65S-74S.
Gergen PJ, Mullally DI, Evans R.  National survey of prevalence of asthma among children in the United States: 1976-1980 . Pediatrics . 1988;;81:1-7.
Wing JS, Weiss KB. Asthma among children in minority populations in the United States: working towards the year 2000 objectives. In: Program and Abstracts of the 119th annual meeting of the American Public Health Association; 1992; Washington, DC. 199:238. Abstract.
Weitzman M, Gortmaker SL, Sobol AM, Perrin JM.  Recent trends in the prevalence and severity of childhood asthma . JAMA . 1992;;268:2673-2677.
Taylor WR, Newacheck PW.  Impact of childhood asthma on health . Pediatrics . 1990;;90:657-662.
Cooperative Projects (R01's) on Minority Health . Bethesda, Md: National Heart, Lung, and Blood Institute, National Institutes of Health; October 1992;. RFA 93-HL-01.
National Cooperative Inner City Asthma Study . Bethesda, Md: National Institute of Allergy and Infectious Disease, National Institutes of Health; 1990;. RFA 90-A1-02.
Fisher RA, Mackenzie WA.  Studies in crop variation, II: the manorial response to different potato varieties . J Agricul Sci . 1923;;13:315.
Hill AB.  Observation and experiment . N Engl J Med . 1953;;248:955-1001.
Lewis CE, Rachelefsky GS, Lewis MA, de la Sota A, Kaplan MS.  A randomized trial of ACT (asthma care training) for kids . Pediatrics . 1984;;74:478-486.
Klingelhofer EL, Gershwin ME.  Asthma self-management programs: premises, not promises . J Asthma . 1988;;25:89-101.
Evans D, Mullins RB.  Educational programs for children with asthma . Pediatrician . 1991;;18:317-323.
Lewis MA, de la Sota, A, Rachelefsky GC, Lewis CE, Quiones H, Richards R.  ACT-asma control y tratamiento para ninos: a progress report . Health Educ Q . 1987;;14:281-290.
SAS/STATUser's Guide, Version 6 .4th ed. Cary, NC: SAS Institute Inc; 1989;;1.
Feinstein AR.  Clinical biostatistics XII on exorcising the ghost of gases and the curse of kelvin . Clin Pharmacol Ther . 1971;;12:1003-1016.

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