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Restrictions on smoking at home and urinary cotinine levels among children with asthma

      Abstract

      Objectives: The purpose of this study was to determine the extent to which various levels of restrictions on smoking in the home may be associated with children’s exposure to environmental tobacco smoke (ETS).
      Methods: The methodology consisted of a cross-sectional survey involving 249 children with asthma aged 1 to 11 attending hospital outpatient clinics, with at least one parent who smoked, linked to the child’s urinary cotinine to creatinine ratios (CCR).
      Results: After adjustment for child’s age, mother’s smoking status, and total parental daily cigarette consumption, a total ban was associated with significantly lower urinary CCR levels (7.6 nmol/mmol) than bans with exceptions or limited smoking in the home. Where exceptions to bans were made (14.9 nmol/mmol), children’s urinary CCR levels were no different from homes in which smoking was allowed in rooms the child rarely frequented (14.1 nmol/mmol). These two intermediate levels of restriction were in turn associated with significantly lower CCR levels than unrestricted smoking in the home (26.0 nmol/mmol).
      Conclusions: Making exceptions to bans on smoking at home measurably undermines the protective effect of a ban. However, making some exceptions to a ban and limiting smoking to rooms where the child rarely goes may result in reduced exposure to ETS, compared with unrestricted smoking.

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      References

        • Cook D.G
        • Strachan D.P
        Summary of effects of parental smoking on the respiratory health of children and implications for research.
        Thorax. 1999; 54: 357-366
        • Evans D
        • Levison M.J
        • Fledman C.H
        • et al.
        The impact of passive smoking on emergency room visits of urban children with asthma.
        Am Rev Resp Dis. 1987; 135: 567-572
        • Abulhosn R.S
        • Morray B.H
        • Llewellyn C.E
        • Redding G.J
        Passive smoke exposure impairs recovery after hospitalization for acute asthma.
        Arch Pediatr Adolesc Med. 1997; 151: 135-139
        • Irvine L
        • Crombie I.K
        • Clark R.A
        • et al.
        Advising parents of asthmatic children on passive smoking.
        Br Med J. 1999; 318: 1456-1459
        • Ashley M.J
        • Ferrence R
        Reducing children’s exposure to environmental tobacco smoke in homes.
        Tobacco Control. 1998; 7: 61-65
        • Benowitz N.L
        Cotinine as a biomarker of environmental tobacco smoke exposure.
        Epidemiol Rev. 1996; 18: 188-204
        • Benowitz N.L
        Biomarkers of environmental tobacco smoke.
        Environ Health Perspect. 1999; 107: 349-355
        • Jaakola M.S
        • Jaakola J.J.K
        Assessment of exposure to environmental tobacco smoke.
        Eur Respir J. 1997; 10: 2384-2397
        • Thompson S.G
        • Barlow R.D
        • Wald N.J
        • Van Vunakis H
        How should urinary cotinine concentrations be adjusted for urinary creatinine concentration?.
        Clin Chem Acta. 1990; 187: 289-296
        • Fried P.A
        • Perkins S.L
        • Watkinson B
        • McCartney J.L
        Association between creatinine-adjusted and unadjusted urine cotinine values in children and the mother’s report of exposure to environmental tobacco smoke.
        Clin Biochem. 1995; 28: 415-420
        • Bakoula C.G
        • Kafritsa Y.J
        • Kavadias G.D
        • Haley N.J
        • Matsaniotis N.S
        Factors modifying exposure to environmental tobacco smoke in children (Athens, Greece).
        Cancer Causes Control. 1997; 8: 73-76
        • Winkelstein M.L
        • Tarzian A
        • Wood R.A
        Parental smoking behavior and passive smoke exposure in children with asthma.
        Ann Allergy Asthma Immunol. 1997; 78: 419-423
        • McBride S.J
        • Ferro A.R
        • Ott W.R
        • Switzer P
        • Hildemann L.M
        Investigations of the proximity effect for pollutants in the indoor environment.
        J Expo Anal Environ Epidemiol. 1999; 9: 602-621
        • Lofroth G
        Environmental tobacco smoke.
        Tobacco Control. 1993; 2: 222-225
        • Henschen M
        • Frischer T
        • Pracht T
        • et al.
        The internal dose of passive smoking at home depends on the size of the dwelling.
        Environ Res. 1997; 72: 65-71
        • Ott W.R
        Mathematical models for predicting indoor air quality from smoking activity.
        Environ Health Perspect. 1999; 107: 375-381
        • Rosier M.J
        • Bishop J
        • Nolan T
        • Robertson C.F
        • Carlin J.B
        • Phelan P.D
        Measurement of functional severity of asthma in children.
        Am J Resp Crit Care Med. 1994; 149: 1434-1441
        • Dell’Orco V
        • Forastiere F
        • Agabiti N
        • et al.
        Household and community determinants of exposure to involuntary smoking.
        Am J Epidemiol. 1995; 142: 419-427
        • Ronchetti R
        • Bonci E
        • De Castro G
        • et al.
        Relationship between cotinine levels, household and personal smoking habit and season in 9–14 year old children.
        Eur Respir J. 1994; 7: 472-476
        • Greenland S
        Modeling and variable selection in epidemiological analysis.
        Am J Public Health. 1989; 79: 340-349
        • Tabachnick B.G
        • Fidell L.S
        Using multivariate statistics, 3rd ed. Harper Collins, New York1996
        • Coultas D.B
        • Samet J.S
        • McCarthy J.F
        • Spengler J.D
        Variability of measures of exposure to environmental tobacco smoke in the home.
        Am Rev Respir Dis. 1990; 142: 602-606
        • Cook D.G
        • Whincup P.H
        • Jarvis M.J
        • et al.
        Passive exposure to tobacco smoke in children aged 5–7 years.
        Br Med J. 1994; 308: 384-389
        • Oddoze C
        • Dubus J.C
        • Badier M
        • et al.
        Urinary cotinine and exposure to parental smoking in a population of children with asthma.
        Clin Chem. 1999; 45: 505-509
      1. Wakefield M, Roberts L, Miller C, Banham D. Parental perceptions of the pros and cons of banning smoking at home. Health Prom J Aust. In press.

        • Strecher V.J
        • Bauman K.E
        • Boat B
        • et al.
        The development and formative evaluation of a home-based intervention to reduce passive smoking by infants.
        Health Educ Res. 1989; 4: 225-232
        • Farkas A
        • Gilpin E.A
        • Distefan J.M
        • Pierce J.P
        The effects of household and workplace smoking restrictions on quitting behaviors.
        Tobacco Control. 1999; 8: 261-265
        • Emerson J.A
        • Wahlgren D.R
        • Hovell M.F
        • et al.
        Parent smoking and asthmatic children’s exposure patterns.
        Addict Behav. 1994; 19: 677-689