The Healthy Starts Program is an international randomised controlled trial of a family-centred tobacco control program to reduce respiratory illness in Indigenous infants in Australia and New Zealand.

Over 60% of Indigenous children live in households with one or more regular smokers, where they are exposed to high levels of environmental tobacco smoke (ETS). ETS is a significant and preventable cause of respiratory illness. Currently, more young Indigenous children die from acute respiratory illness (ARI) than any other cause. ARI is also the leading cause of hospitalisations in this population, and recurrent ARI is associated with an increased risk of chronic respiratory disease. The aim of this research project is to test whether a family-based program about ETS smoke will reduce the number of clinic presentations of infants for respiratory illness. If successful, it has the potential to improve the health of Indigenous children across Australia and New Zealand
 
This is an international trial collaboration between Menzies School of Health Research and University of Auckland in New Zealand. Recruitment will take place in Darwin and Greater Darwin as well as Auckland. In both locations of this study mothers must be current smokers or live, with the infant, in a household with another smoker to be eligible to participate. Mothers with their infants will be randomly allocated to one of two study arms: the ‘intervention’ group who will receive the tobacco control program about ETS exposure and the control group who will receive ‘usual care.’
 
The program will be delivered at three face-to-face home visits conducted over the first three months of the infant’s life. It will be delivered by Aboriginal Health Workers (AHWs), who are specifically trained and supported. The primary outcome measure is rate of health provider presentations for new primary episodes of documented respiratory illness in the first year of life. Secondary outcomes include measures of the infant’s ETS exposure and this will include collecting urine samples from infants to test for urinary cotinine, a metabolite of nicotine.
 
Outcomes of the program will include interventions aimed at encouraging smoking cessation as well as reducing exposure of Indigenous children to ETS have the potential for significant benefits for Indigenous communities. There is a currently a dearth of evidence for the effect of tobacco control interventions. This study will provide high-level evidence of the efficacy to reduce respiratory illness of a family-centred tobacco control program about ETS. This study utilises a novel RCT design, based on our research finding that one of the most common reasons Indigenous adults want to quit smoking is to protect their children from the harmful effects of ETS. Outcomes of our study will be important and significant for Indigenous tobacco control and prevention of respiratory illness in children.