3 questions identify children at risk of passive smoking

May 2 2005

Pediatricians can reliably identify children at risk for environmental tobacco smoke (ETS) exposure (secondhand smoke) by asking parents just three questions, according to an article in the May issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.

Exposure to tobacco smoke impairs children's respiratory health, putting them at increased risk of pneumonia, bronchiolitis, asthma and ear infections with greater rates of hospitalization and longer recovery periods from these conditions than unexposed children, according to background information in the article. The American Academy of Pediatrics recommends that pediatricians assess children's exposure to tobacco smoke beginning with their first doctor's visit. A simple, quick method for determining the child's risk is needed to facilitate that assessment in busy pediatric practices, the authors suggest.

Judith A. Groner, M.D., of The Ohio State University College of Medicine & Public Health, Columbus, and colleagues, compared answers to a series of easily administered screening questions about home secondhand smoke exposure to child hair cotinine levels. Hair cotinine is not derived directly from environmental tobacco smoke exposure but from absorbed nicotine, which is metabolized to cotinine and then deposited in growing hair. The researchers considered cotinine levels as a "gold standard" for measuring tobacco smoke exposure because it correlates well with nicotine levels in the blood, measures exposure over several months and is not influenced by short-term exposure.

Hair samples were collected from 291 healthy children, two weeks to three years of age, at a primary care clinic and the children were divided into three groups based on level of cotinine: low, medium and high exposure. The child's level of exposure was then compared to caregiver's answers to questions about smoking factors in the home. The questions included whether the mother (or primary caregiver) smoked; whether the father smoked; whether other family members or visitors smoked in the home; whether people smoked in the house or only outside; as well as questions on the social characteristics of the parents including education, marital status, type of health insurance and race. Homes where no one smoked inside were said to have a smoking ban.

Maternal, but not paternal, smoking was associated with higher cotinine levels, the researchers found, regardless of how many cigarettes per day the mother reported smoking or whether she reported smoking only outside. Living in a home where others smoke, where others smoke inside or with no smoking ban were all associated with higher cotinine levels. "Based on our data, our practical clinical recommendations are as follows: health care professionals can obtain an ETS risk assessment for a child younger than three years by asking the mother 'Do you smoke?'" the authors report. "If the mother reports that she is a nonsmoker, then two more questions can be asked at that point: 'do others who live or frequently visit with you smoke?' and 'Do they smoke indoors?'"

"In conclusion, it was possible to develop a simple screening tool to be used in the office setting to define children at highest risk for ETS exposure," the authors write. "Although in clinical practice, mothers frequently report smoking few cigarettes per day and smoking outside, these factors did not prove to be significant determinants of their child's exposure. Further research is needed to test and refine this tool in the practice setting."

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