A later study recruited a convenience sample of 49 interested families with a smoking mother and a nonbreastfeeding infant between 2 and 12 months of age.4 Families were classified by smoking history into one of 3 groups: nonsmoking households, smoking households where efforts were made to limit smoke exposure, and smoking households where no efforts were made to limit exposure. Urine samples were obtained 3 times over 1 week. Urine cotinine levels in infants averaged 0.33 ng/mL in nonsmoking households, 2.47 ng/mL in smoking households with limited exposure, and 15.47 ng/mL in smoking households with unlimited exposure (P<.001 for all comparisons).
A case-control study that recruited families with asthmatic and nonasthmatic children assessed the effectiveness of parental behaviors to reduce second-hand smoke in 182 households with 1 smoking parent and a child between 6 and 12 years of age.5 Researchers measured room air nicotine and salivary cotinine concentrations.
The nicotine levels on children’s belts and in their bedrooms and the family room were approximately 3 log units lower in houses with strict smoking bans compared with households with any degree of indoor smoking (P<.0001). Similarly, salivary cotinine levels were approximately 4 log units lower in children of households with indoor smoking bans (P<.0001).
Recommendations
The United States Preventive Services Task Force (USPSTF) strongly recommends that physicians help all smoking adults to quit.6 The American Academy of Family Physicians endorses the USPSTF position and further advises that smoking parents be counseled about the health effects of environmental tobacco smoke on their children.7
The American Academy of Pediatrics8 and the Veterans Administration9 recommend urging parents to stop smoking to prevent serious health implications for their children; they further encourage pediatric clinicians to offer parents advice on quitting in order to limit children’s exposure to second-hand smoke.