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Second Hand Tobacco Smoke in Children with Asthma: Sources of and Parental Perceptions about Children's Exposure, and Parental Readiness to Change

a. Section of Pediatric Pulmonology, Baylor College of Medicine, Houston, TX; b. Palo Alto Medical Foundation Research Institute, Palo Alto, CA; c. Department of Pediatrics, Kaiser Permanente Vallejo Medical Center, Vallejo, CA; d. Stanford University School of Medicine, Palo Alto, CA

hjfarber{at}texaschildrenshospital.org

Abstract

BACKGROUND: Secondhand smoke triggers childhood asthma. Understanding sources, parental beliefs about, and readiness to change that exposure are important for designing smoke exposure reduction interventions.

METHODS: As part of screening for a clinical trial of a smoke exposure reduction intervention, 519 smoke-exposed children 3-12 years with asthma provided urine specimens for cotinine testing and their primary caregivers completed questionnaires.

RESULTS: The urine cotinine to creatinine ratio (CCR) was lowest if neither the primary caregiver nor day care provider smoked (mean CCR (standard deviation)=14.0 (14.4)), greater if either smoked (mean CCR (SD)=22.2 (21.3) and 26.3 (22.2) respectively), and greatest if both smoked (mean CCR (SD)=39.6 (27.5), p<0.01). Parental perception of their child's exposure was weakly associated with the child's CCR (r-square=0.11, p < 0.001). Most parents (58.3%) reported tobacco smoke exposure had small/no negative effect on their child's asthma. Substantial proportions of those for whom a specific exposure reduction action was relevant were classified as contemplating, preparing or had recently taken action to reduce their child's exposure, including smoking cessation (61.3%), keeping the child out of smoke-exposed places (72.7%), and making the child's home (49.2%) and non-home areas smoke-free (66.9%).

CONCLUSIONS: Smoking by the primary caregiver and day care provider are important sources of exposure for children with asthma. Parental assessment of their child's exposure is associated with biologically confirmed exposure, but cannot be relied upon to assess that exposure. Although the harm of smoke exposure was frequently underestimated, many parents appeared receptive to considering action to reduce their child's exposure.

Clinical trial registered as NCT00217958 at clinicaltrials.gov.

Key Words: Asthma • Childhood • Secondhand tobacco smoke • Day Care • Stages of Change • Cotinine