Project Zero Exposure, an Intervention to Protect Children from Tobacco Smoke Exposure: Results from a Randomized Controlled Trial -

LJ Rosen ¹ David Zucker ² Nurit Guttman ³ Nili Braun ¹ Michal Bitan ^1,4 Ana Rule ⁵ Mati Berkovitch ^6,7 Vicki Myers ¹

¹Dept. of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Israel
²Dept. of Statistics, Hebrew University, Israel
³Dept. of Communications, Tel Aviv University, Israel
⁴Dept. of Statistics, Tel Aviv University, Israel
⁵Dept. of Environmental Health and Engineering, Johns Hopkins University, USA
⁶Sackler Faculty of Medicine, Tel Aviv University, Israel
⁷Pediatrics, Asaf HaRofe Hospital, Israel

Background: Young children are especially vulnerable to the harms to tobacco smoke exposure (TSE), which is caused primarily by their own parents. This paper presents results from a randomized controlled trial of Project Zero Exposure, an intervention program designed to protect young children from TSE.

Methods: Parents of young children (< 8 years) in families living in Israel with one or two smoking parents were eligible. Participants were randomized to intervention group (IG) (N=69), regular control (RCG) (N=70), or enhanced control group (ECG) (N=20). The intervention included objective feedback on child exposure (hair nicotine), and home air quality (PM_2.5). We were primarily interested in comparing log hair nicotine (LHN) in intervention versus regular control groups at six months. Secondary outcomes were parentally-reported child TSE.

Results: 159 families entered the trial, and 155 (97.5%) families completed the trial. Parents were positive about the intervention, particularly hair nicotine feedback. LHN, which decreased significantly in both IG and RCG (p<.05), was numerically lower in the IG versus RCG at trial end, but without statistical significance (p>.05). Improvements were seen in parentally-reported outcomes in the intervention groups, but no significant differences between the IG and RCG were observed at end of trial.

Conclusions: Project Zero Exposure is a feasible, acceptable program which reduced child exposure during the trial in both intervention and control groups. The lack of statistically significant benefit to intervention group participants may have been due to trial participation, which included biomarker measurement in all groups. Biomarker testing with feedback should be explored as a method to change parental behavior and decrease child tobacco smoke exposure.