Protecting young children from tobacco smoke exposure: A pilot study of Project Zero Exposure

Laura Rosen*, Nurit Guttman, Vicki Myers, Nili Brown, Amit Ram, Mel Hovell, Patrick Breysse, Ana Rule, Mati Berkovitch, David Zucker

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Background: Tobacco smoke exposure (TSE) harms children, who are often "captive smokers" in their own homes. Project Zero Exposure is a parent-oriented, theory-based intervention designed to reduce child TSE. This paper reports on findings from the pilot study, which was conducted in Israel from 2013 to 2014. Methods: The intervention consisted of motivational interviews, child biomarker and home air quality feedback, a Web site, a video, and self-help materials. The primary outcome was child TSE as measured by hair nicotine. Secondary outcome measures were air nicotine and particulate matter, parental reports of TSE, parental smoking behavior, and TSE child protection. A single-group pre- and posttest design was used. Results: Twenty-six of the 29 recruited families completed the study. The intervention was feasible to implement and acceptable to participants. Among the 17 children with reliable hair samples at baseline and follow-up, log hair nicotine dropped significantly after the intervention (P = .04), hair nicotine levels decreased in 64.7% of children, and reductions to levels of nonexposed children were observed in 35.3% of children. The number of cigarettes smoked by parents (P = .001) and parent-reported child TSE declined (P = .01). Logistical issues arose with measurement of all objective measures, including air nicotine, which did not decline; home air particulate matter; and hair nicotine. Conclusions: A program based on motivational interviewing and demonstrating TSE and contamination to parents in a concrete and easily understandable way is a promising approach to protect children from TSE. Further research is needed to enhance current methods of measurement and assess promising interventions.

Original languageAmerican English
Pages (from-to)S107-S117
StatePublished - Jan 2018

Bibliographical note

Funding Information:
Approval for the trial was received from the Tel Aviv University Ethics Committee, the Ministry of Health, and the Asaf HaRofeh Hospital Helsinki Committee. Approval for recruitment from areas adjacent to NA’AMAT day care centers was received from the national educational supervisor of the NA’AMAT day care center network. Written informed consent was obtained from all participants during the first home visit. The trial is registered in the National Institutes of Health Clinical Trials Registry (identifier NCT01335178).

Funding Information:
FUNDING: Funded by the Flight Attendant Medical Research Institute (Award 072086_YCSA) and the Sackler Faculty of Medicine at Tel Aviv University.

Funding Information:
aDepartment of Health Promotion, School of Public Health, Sackler Faculty of Medicine, bDepartment of Communications, Faculty of Social Sciences, and fAssaf Harofeh Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; cCenter for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, California; dDepartment of Environmental Health and Engineering, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; eNational Center for Environmental Health, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia; and gDepartment of Statistics, Hebrew University, Jerusalem, Israel

Publisher Copyright:
Copyright © 2018 by the American Academy of Pediatrics.


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