Reducing Infant Smoke Exposure (RISE): Evaluation of a Wildfire Smoke Intervention in Early Life - ABSTRACT The frequency and intensity of wildfire smoke (WFS) events are on the rise, posing an acute threat to the health of children nationwide. The prenatal and early life periods are critical windows for the influence of the environment on child development, and WFS exposure during these times can exert lifelong impacts on healthy airway development. We will deploy and evaluate an intervention for reducing smoke exposure to children, the Reducing Infant Smoke Exposure (RISE) intervention. The RISE intervention is low-burden, potentially scalable, and evidence-based, aimed at increasing maternal behaviors that reduce child WFS exposure by targeting known barriers to protective actions. The intervention has three components: 1) An online education module, consisting of our team’s existing multi-media materials in English and Spanish, instructing parents on WFS risks and methods for reducing their children’s exposure; 2) The RISE Pack, containing supplies for effectively decreasing WFS exposure (i.e., portable air cleaner with high-efficiency particle air [HEPA] filter and N95 masks), and links to support for mothers, as needed, to implement supplies (online videos, opportunities to contact environmental health specialists with questions, etc.); and 3) Text alerts at the start of WFS events, notifying mothers of a time- sensitive need to implement guidance, offering support to those who need it. For enhanced support, participants will be connected to the Northwest Pediatric Environmental Health Specialty Unit (PEHSU), directed by RISE leader, Dr. Karr. We will evaluate the effectiveness of the RISE intervention to improve child respiratory health and reduce smoke exposure during WFS season in a region of Washington state highly-impacted by fires, where parents report serious concerns about WFS and child health and actively request resources for preventing health impacts. We will recruit up to 250 mother-child dyads from an existing pregnancy cohort in which participants are very well engaged in high-touch research activities (e.g., completing 20-30 surveys per year) and expressing strong interest in additional research participation in WFS related research. Participants will be randomized 1:1 into intervention and control arms and followed for repeated assessments of exposure and health for a six-month wildfire smoke season. Several measures of exposure and child health, especially respiratory health, will be analyzed to determine the effectiveness of the intervention. We will also conduct surveys and focus groups with mothers who receive the intervention to study determinants and outcomes of intervention implementation, to guide revisions to the final RISE intervention protocol and future dissemination and scale up. Finally, collaborations with leaders of state health departments will inform potential implementation of the RISE intervention across other WFS-impacted regions, including other rural and low-resource settings. Ultimately, the RISE study aims to deliver the first-of-its-kind intervention to reduce early-life WFS exposure.
