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3 questions may provide good clues to smoke exposure


Every day, in thousands of busy pediatric medical offices, doctors and nurses routinely use a variety of questions to determine which of their young patients are at risk for exposure to second-hand smoke in their homes.

But these don’t always provide a clear enough picture of a young child’s environment. Questions can be ambiguous or misunderstood by the child’s caregiver, or the caregiver may be consciously or unconsciously less than accurate with their answers.

A report, however, in the May 2 issue of JAMA’s Archives of Pediatric & Adolescent Medicine says that three significant but simple questions can provide an accurate prediction of environmental tobacco smoke (ETS) exposure.

Asking a child’s primary caregiver – usually the mother -- the seemingly straightforward yes/no question “Do you smoke?” does not capture all of the information health care professionals need to gauge risk to the child, according to Judith A. Groner, a clinical professor in the department of pediatrics at The Ohio State University College of Medicine and Public Health.

The study was conducted at Columbus Children’s Hospital where 291 mothers or primary caregivers, both self-reported smokers (120) and nonsmokers (171), completed questionnaires that provided answers on demographics and smoking habits. If applicable, the surveys also indicated the location (inside/outside) where smoking occurred, the smoking status of other household members or visitors to the home, and the location in the home where their smoking occurred.

In addition, researchers collected hair samples from 291 children, age 3 or younger, whose primary caregiver completed the survey. The hair samples were used to determine the amount of cotinine in the child’s body. Cotinine is a chemical transformed in the body from nicotine, which enters the body through inhaled cigarette smoke. Hair cotinine has been used in research to determine child ETS exposure, but the test is expensive and not widely available.

By comparing the questionnaire information to the analysis of hair cotinine levels, it was possible to develop a three-question model that determines the child’s ETS exposure risk category. “Many patients state that they smoke outdoors and/or smoke only a few cigarettes per day. We found that parental report of these factors did not impact on the child’s actual exposure as measured by hair cotinine,” said Groner, who is on the medical staff at Columbus Children’s Hospital.

“Our interpretation of this finding is that parents tell pediatricians what they perceive is the ‘socially desirable’ response – that they are not heavy smokers and that they do not expose their children.”

Although further research is needed and the study can be expanded, Groner says data from the study can be a helpful tool for health care practitioners assessing ETS risk in children younger than 3 years of age, the period most pediatricians acknowledge that children are most vulnerable.

In addition to asking “Do you smoke?” the study says following up with “Do others who live or frequently visit with you smoke?” and “Do they smoke indoors?” can provide added insight into the child’s environment.

The risk to children living in an environment with smokers is well documented. Tobacco smoke exposure is linked to an increased incidence of ear infections, pneumonia, asthma and other upper respiratory infections in children.

Additional authors are Robert Castile and Stacy Hoshaw-Woodward of The Ohio State University College of Medicine and Public Health and Columbus Children’s Hospital, and Julia Klein and Gideon Korean of the Hospital for Sick Children in Toronto.

The study was funded by the American Lung Association and Columbus Children’s Hospital Research Institute.

David Crawford | EurekAlert!
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