This project is designed to test the effectiveness of an education program conducted by public health nurses to reduce passive smoking by infants who are part of a geographically defined population in a non-metropolitan North Carolina county. The immediate goal is to reduce the frequency and severity of lung disease in infants by reducing their exposure to cigarette smoke. The second goal is to develop a community laboratory for testing other intervention strategies designed to prevent lung disease and its sequelae in children. The families of all children born in Chatham County during a 24-month period will be recruited for the study. These families will be randomly assigned to an intervention or to a control group. The intervention group will receive a passive smoking reduction program as well as a general respiratory hygiene education package. Emphasis will be placed on the avoidance of smoking by family members and others in the presence of the child. The control group will be given the respiratory hygiene education package only, with no discussion of the role of smoking in respiratory disease prevention. Families in both the intervention and control groups will be visited by a nurse prior to the birth, at the time of delivery, and at one, two, three, and six months post-partum. All families will be visited by a data collector before birth and at one, two, three, six, nine, and twelve months. Data will be collected on variables known to influence the incidence of respiratory disease. The occurrence of respiratory illness will be measured by questionnaire data, a parent-kept diary of respiratory illness, and review of health records. Urinary cotinine will be used as a measure of passive smoking by infants. Expired carbon monoxide levels will be determined to evaluate the parents' active smoking. The principal hypotheses to be tested are: (1) passive smoking by infants will be reduced in the intervention group because of a decrease in parental smoking in the presence of their infants, motivated by parental concern for the child; (2) infant respiratory illnesses will be fewer in non-smoking household and in those households with reduced levels of passive smoking; and (3) the reduction of infant respiratory illness in non-smoking families will be greatest in families where other risk factors for lung disease are present. In addition, data will be obtained on the relative importance of other risk factors for the occurrence of respiratory illness in infants.
