A Program to Protect Young Children From Tobacco Smoke Exposure

• Child exposure to tobacco smoke - hair nicotine [ Time Frame: Baseline, 3 months, post-intervention, 6 months post-intervention ] [ Designated as safety issue: No ]
  Child exposure to tobacco smoke as assessed by hair nicotine level
  
  

• Child exposure to tobacco smoke - parental report [ Time Frame: 6 months post-intervention ] [ Designated as safety issue: No ]
  Child exposure to tobacco smoke as measured by parental report
  
  
• Child health status [ Time Frame: 6 months post-intervention (continuous) ] [ Designated as safety issue: No ]
  Incidence of respiratory events as reported by parents
  
  
• Respirable Small Particle (RSP) level in home [ Time Frame: Baseline, 1 month, 3 months ] [ Designated as safety issue: No ]
  Measurement of RSPs in the home over a 24-hour period
  
  

Goals The primary goal of this research is to develop and test a theory-based intervention which will reduce tobacco smoke exposure (TSE) of young children. A secondary goal is to increase knowledge of measurement of TSE in young children, and explore the relationship between early TSE, illness, and health care utilization. The study is being conducted in several stages: Developmental (Phase I), Pilot (Phase II), and Trial (Phase III).

Developmental Stage (Phase I)

This stage includes the following: Systematic reviews of the literature on the topics of encouraging parental cessation and reducing child tobacco smoke exposure; consultations with experts worldwide; conduct of interviews and focus groups with parents and professionals to understand parental perceptions of tobacco smoke exposure, and barriers to protection of children from TSE; development of an initial intervention program; and conduct of design workshops. This stage draws on a social marketing approach and employs in-depth interviews and focus groups in order to identify barriers for behavior change and relevant behavior-change recommendations, tailored to the intervention population, and to test the acceptability of program components.

Intervention Program

The planned intervention consists of: motivational interviews (in-person and by phone), biochemical feedback on child exposure to tobacco smoke and measurement of RSP levels in the home; and an interactive website.

Pilot (Phase II) A pilot of the planned intervention will be conducted with 50-100 families. A before - and - after design will be used, without a control group. The main endpoint is child exposure to tobacco smoke.

Randomized Controlled Trial (Phase III) The investigators plan to implement and evaluate the intervention using a randomized controlled trial with an estimated 240 participants. The primary response variable will be child tobacco smoke exposure. The control group will be offered the intervention at the end of the study (eg, a randomize-to-wait-list design). Child TSE will be measured using hair (nicotine or cotinine) or urinary cotinine , and parental report.

An effective program could be implemented nationally and sustainably in Israel and serve as a prototype for reducing child tobacco smoke exposure.