REFERENCE: Hovell, M.F., Wahlgren, D. R., Meltzer, S. B., Zakarian, J. M., & Matt, G. E., & Hofstetter, C. R. (1997). Project Zephyr: Reduction of passive smoking in asthmatic children. Presented at the Annual Investigators Meeting of the Tobacco Related Disease Research Program, San Francisco, CA, December 2, 1997.
Project Zephyr was a randomized clinical trial designed to test whether behavioral counseling can decrease asthmatic children's exposure to their parents' environmental tobacco smoke (ETS). Ninety-one families were recruited from pediatric allergy clinics in San Diego, and assigned at random to one of three groups: behavioral counseling, self-monitoring, or usual medical care. Measures were obtained six times during the first year of study, and again at 20 and 30 months.
Study findings have been presented at meetings of numerous and diverse scientific societies and published in a variety of scientific journals. Behavioral counseling achieved an average reduction in ETS exposure of 75%, a significantly greater reduction to that observed in the self-monitoring (25%) and usual care (33%) control groups. The reduction was sustained throughout the entire 30 month follow-up period. Asthma symptoms decreased in severity in the counseling group and increased in the control groups, demonstrating that even relatively short-term interventions to reduce ETS exposure can begin to reverse the detrimental health effects of several years of exposure.
The validity of self- or parent-reported child ETS exposure was upheld by comparing results with those obtained from urine metabolite analyses, ambient air nicotine measurement, and other measures. Residential parental smoking and child ETS exposure patterns were examined and it was found that the locations, times, and activities during which the most smoking occurred were not the same as those during which most ETS exposure took place, suggesting that interventions to reduce exposure should focus directly on exposure patterns rather than on parents' smoking patterns.
Further, this study has provided data for the development of a new asthma severity rating measure which is more suitable for epidemiological studies and for nonspecialist physician clinical use than previous measures. Other analyses examined patient characteristics that predict whether his or her physician will advise the parent to not smoke around the child, prevalence of pets in the homes of asthmatic children exposed to ETS, and predictors of ETS exposure in the home.
Overall, Project Zephyr has provided a diverse collection of findings on a relatively unstudied population, asthmatic children exposed to ETS, and presented these findings broadly across the disciplines of behavioral science, public health, and medicine. Current studies are extending the methodology and findings from Project Zephyr to low income and minority asthmatic and well children and infants. Improvements in identifying, measuring, and reducing ETS exposure among children will play an important role in future public health policy and intervention to reduce the effects of tobacco-related disease among non-smokers.