rimary 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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Contact: David Crawford
614-293-3737
JAMA and Archives Journals
2-May-2005

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