Screening for children's exposure to environmental tobacco smoke in a pediatric primary care setting

Abstract

Context The American Academy of Pediatrics has recommended that pediatricians assess their patients' environmental tobacco smoke (ETS) exposure, but the specific questions most likely to identify children with high ETS exposure are not known. Cotinine, a nicotine metabolite present in hair, can be used to quantify months of ETS exposure. Objective To develop a brief screening tool that will accurately predict ETS exposure as defined by a child's hair cotinine level. Setting Columbus Children's Hospital Primary Care Center. Participants A convenience sample of healthy children age 2 weeks to 3 years of both self-reported smokers and nonsmokers. Interventions Screening questions regarding home ETS exposure. Main Outcome Measure Performance of the screening questions compared with child hair cotinine levels. Results Hair samples and questionnaire data were obtained from 291 children. Based on clinical applicability and statistical significance, 3 questions (Does the mother smoke?, Do others smoke?, and Do others smoke inside?) were selected as a valid screening tool to determine children's ETS exposure risk. Maternal reports of smoking outside only or smoking only a few cigarettes per day had no impact on child hair cotinine levels. Conclusions It was possible to derive a simple, specific, and valid screening tool that can be used in pediatric offices to identify children at risk for ETS exposure. Further research is needed to test this tool prospectively.