Non-smoking Households Research Articles

Environmental Tobacco Smoke and Respirable Suspended Particle Exposures for Non-Smokers in Beijing

The study was centred in Beijing, People’s Republic of China, and comprised housewives in one group, primarily for assessing exposures in the home, and office workers in a second group to assess the contribution of the workplace to overall exposure. Two hundred and fifty-three randomly selected non-smoking subjects collected air samples near to their breathing zone by wearing personal monitors for 24 h. Samples collected were analysed for respirable suspended particles (RSP), nicotine, 3-ethenylpyridine and environmental tobacco smoke (ETS) particles using ultraviolet absorbing particulate matter (UVPM), fluorescing particulate matter (FPM) and solanesol-related particulate matter (SolPM) measurements. Saliva cotinine analyses were also undertaken to confirm the non-smoking status of the subjects, and a misclassification rate of between 3.4 and 3.8% was estimated. RSP levels were the highest reported to date by these authors, with median 24-hour time-weighted average concentrations varying between 70 µg·m^–3 for housewives living in non-smoking households and 114 µg·m^–3 for office workers both living and working in smoking environments. High background levels of unidentified airborne fluorescing compounds in Beijing resulted in abnormally high FPM estimates and precluded the use of this marker in the assessment of ETS exposure. The highest exposures to ETS particles (SolPM) and nicotine were estimated for office workers living and working in smoking environments. These subjects would potentially inhale between 5 and 11 cigarette equivalents per year (CEs/y), based upon median exposures, with the workplace contributing approximately 40% of this exposure. The most highly exposed subjects in this study, based upon 90th percentile exposures, would potentially inhale between 32 and 46 CEs/y.

Assessment of environmental tobacco smoke and respirable suspended particle exposures for nonsmokers in Prague using personal monitoring.

Exposures to respirable suspended particles (RSP) and environmental tobacco smoke (ETS) were assessed in Prague, Czech Republic, to determine the range and degree of personal exposure by means of personal monitoring over a 24-h period. Self-reported nonsmokers were randomly selected from a representative sample of the population of Prague. Housewives were recruited into one group, primarily for assessment exposures in the home, and office workers were recruited into a second group for assessment of the contribution from the workplace. A total of 238 randomly selected nonsmoking subjects collected air samples near their breathing zone by wearing personal monitors for 24 h. Samples collected were analyzed for RSP, nicotine, 3-ethenylpyridine, and ETS particles (using ultraviolet absorbance, fluorescence, and solanesol measurements). Saliva cotinine analyses were also undertaken to confirm the nonsmoking status of the subjects. The most highly exposed subjects in this study were office workers both living and working with smokers. Median time-weighted average exposure concentrations of 60 microg m(-3)RSP, 16 microg m(-3)ETS particles, and 1.6 microg m(-3) nicotine were determined for these subjects, who also had the highest median saliva cotinine level of 2.4 ng ml(-1). Housewives living in nonsmoking households were the least exposed subjects in this study, showing levels of 32 microg m(-3) RSP, 0.17 microg m(-3) ETS particles, and 0.15 microg m(-3) nicotine. As based upon median levels of ETS particles and nicotine, no group would potentially inhale or be exposed to more than 10 cigarette equivalents per year (CE/y) and the least exposed would inhale less than 1 CE/y. The most highly exposed (90th percentile levels) nonsmokers in this study, who both worked and lived with smokers, would potentially inhale up to 29 CE/y. Overall, the workplace was estimated to contribute between 45% and 49% of the annual exposure to nicotine and ETS particles, respectively. On the basis of determined saliva cotinine concentrations, a misclassification rate of between 1.7% and 2.5% was calculated. Highest exposures were apparent for office workers both working and living in smoking environments. and our findings suggest a significant contribution to overall ETS particle and nicotine levels from the workplace where smoking takes place. Overall, the rates at which subjects were determined to have misclassified their smoking status in this study were the lowest observed in any of the European cities investigated to date. Clearly, a more sensitive method of analysis for cotinine in body fluids is needed for more accurate determination of the levels expected for nonsmokers.

Assessment of air quality in Paris by personal monitoring of nonsmokers for respirable suspended particles and environmental tobacco smoke

Exposure to respirable suspended particles (RSP), environmental tobacco smoke (ETS) particles, nicotine, and 3-ethenylpyridine (3-EP) was assessed in Paris for 222 subjects during March and April 1995. Personal monitors were worn over a 24-h period, each subject providing a saliva sample for cotinine analysis both prior to and following the monitoring period. Comprehensive lifestyle questionnaires were also completed before and after the monitoring period. The study comprised housewives in one group, primarily for assessing exposures in the home, and office workers in a second group to assess exposures in the workplace. A single personal monitor was worn by each housewife, while employed subjects wore one monitor at work and a separate monitor at home and elsewhere. Based on median 24-h time-weighted average exposures, the most highly exposed subjects to RSP, ETS particles, nicotine, and 3-EP were office workers living with smokers. Additionally, based upon nicotine exposures, subjects who were also employed in locations where smoking was allowed were the most exposed. Based upon median levels, housewives living in nonsmoking households would be exposed to 1 cigarette equivalent per y or less, compared with between 1.2 and 3 cigarette equivalents per y for housewives living in smoking households. Subjects living and working with smokers had the highest median saliva cotinine level of 1.6 ng mL −1. Using a cut off level of 25 ng mL −1 to indicate active smoking, up to 4.7% of the subjects were found to have misreported themselves as nonsmokers.

URINARY PROSTACYCLIN IN NONSMOKERS LIVING WITH SMOKERS

This study tested the hypothesis that environmental tobacco smoke (ETS) exposure increases platelet activation. The concentration of the stable urinary metabolites of thromboxane (Tx-M) and prostacyclin (PGI-M) was measured in 3 groups of subjects: 27 nonsmokers who did not live with a smoker, 21 nonsmokers who lived with at least 1 smoker, and 10 cigarette smokers who served as a positive control group. Urinary concentrations of the stable metabolites Tx-M and PGI-M did not differ between the nonsmokers living with at least one smoker and the nonsmokers not living with a smoker (p = .39 for Tx-M; p = .42 for PGI-M). There was a statistically significant increase in the urinary concentration of PGI-M in the cigarette smokers when compared with either the nonsmokers living with at least one smoker (p < .05) or the nonsmokers not living with a smoker (p < .05). There was no significant difference in Tx-M excretion in the cigarette smokers relative to either nonsmokers living with a smoker (p = .99) or to nonsmokers in nonsmoking households (p = .53). In the 21 nonsmokers living with smokers, ETS exposure did not result in platelet activation as measured by either thromboxane or prostacyclin release.

Anti-Smoking Socialization: Relationship to Parent and Child Smoking Status

Anti-smoking socialization is defined as the transmission of knowledge, attitudes, and skills that prepare children to resist smoking. Three types of anti-smoking socialization are studied: parents' communication with children regarding no-smoking rules at home, health risks associated with smoking, and the disciplinary consequences of smoking. Results from a survey of children in 3rd through 8th grades (N = 937) indicate that (a) children from households where one or both parents smoke perceive less anti-smoking socialization than their peers from nonsmoking households; (b) anti-smoking socialization is positively associated with authoritative parenting; (c) children have significantly lower rates of smoking intention and initiation when parents engage in anti-smoking socialization, even if parents currently smoke. The findings offer an encouraging message to all parents Communicating anti-smoking messages may effectively discourage children from smoking

5651276 Dry-cleaning of garments using gas-jet agitation : Purer Edna; Wilkerson Angela Y; Townsend Carl W; Chao Sidney Los Angeles, CA, United States assigned to Hughes Aircraft Company

Community and environmental exposure to volatile organic compounds (VOCs) has been associated with a number of emission sources and activities, e.g., environmental tobacco smoke and pumping gasoline. Such factors have been identified from mostly small studies with relatively limited information regarding influences on VOC levels. This study uses data from the Relationship of Indoor Outdoor and Personal Air (RIOPA) study to investigate environmental, individual and social determinants of VOC concentrations. RIOPA included outdoor, indoor and personal measurements of 18 VOCs from 310 non-smoking households and adults in three cities and two seasons, and collected a wide range of information pertaining to participants, family members, households, and neighborhoods. Exposure determinants were identified using stepwise regressions and linear mixed-effect models. Most VOC exposure (66 to 78% of the total exposure, depending on VOC) occurred indoors, and outdoor VOC sources accounted for 5 (d-limonene) to 81% (carbon tetrachloride) of the total exposure. Personal exposure and indoor measurements had similar determinants, which depended on the VOC. Gasoline-related VOCs (e.g., benzene, methyl tertiary butyl ether) were associated with city, residences with attached garages, self-pumping of gas, wind speed, and house air exchange rate (AER). Odorant and cleaning-related VOCs (e.g., 1,4-dichlorobenzene and chloroform) also were associated with city and AER, and with house size and family members showering. Dry-cleaning and industry-related VOCs (e.g., tetrachloroethylene and trichloroethylene) were associated with city, residence water supply type, and dry-cleaner visits. These and other relationships were significant, explained from 10 to 40% of the variation, and are consistent with known emission sources and the literature. Outdoor concentrations had only two common determinants: city and wind speed. Overall, personal exposure was dominated by the home setting, although a large fraction of VOC concentrations were due to outdoor sources. City, personal activities, household characteristics and meteorology were significant determinants.

Assessment of air quality in barcelona by personal monitoring of nonsmokers for respirable suspended particles and environmental tobacco smoke

Personal monitoring over a 24-h period was performed using over 190 subjects divided into two distinct groups, one for housewives and one for office workers. Questionnaire surveys were conducted in addition to determinations for respirable suspended particles (RSP), environmental tobacco smoke (ETS) particles, nicotine, 3-ethenylpyridine, and saliva cotinine. The highest median levels of RSP, ETS particles, and nicotine were measured for subjects working in smoking workplaces. However, workers living in smoking households were more exposed outside working hours since more time was spent outside the workplace. These subjects, based upon median levels (90th percentile in parentheses), would be exposed each year to between 5.2 and 8.4 (26 and 40) cigarette equivalents (CE) outside the workplace compared with approximately 3.5 (13) CE at work. The lowest median levels were recorded for housewives living in nonsmoking households, equivalent to an exposure of approximately 1 CE per y. Subjective assessments of ETS exposure over the monitoring periods made by subjects on two separate occasions were considered to be consistent with measured concentrations. Subjects were not considered to have taken the length of time spent in any one environment into consideration, the ETS concentration rather than “overall exposure” having been assessed. Saliva cotinine measurements were used during the course of this investigation as a tool for determining misclassification of smoking status rather than a marker for ETS exposure. Using a cutoff level of 25 ng mL −1, between 10.5% and 17.8% of the subjects were found to have misclassified themselves as nonsmokers, depending upon the criteria used.

SUDDEN INFANT DEATH SYNDROME IN CROSS-CULTURAL PERSPECTIVE: Is Infant-Parent Cosleeping Protective?

▪ Abstract This chapter reviews what is presently known about the sudden infant death syndrome (SIDS) and examines the role that infant sleeping arrangements may play in reducing SIDS risks. Alongside sleep laboratory-based experimental evidence comparing bedsharing and solitary sleeping mother-infant pairs, an evolutionary and cross-cultural framework is used to argue that infant-parent cosleeping is biologically, psychologically, and socially the most appropriate context for the development of healthy infant sleep physiology. It is also the context within which potentially more optimal breastfeeding activities for both the mother and infant are most likely to emerge. A survey of cross-cultural data and laboratory findings suggest that where infant-parent cosleeping and breastfeeding are practiced in tandem in nonsmoking households, and are practiced by parents specifically to promote infant health, the chances of an infant dying from SIDS should be reduced.

Contribution of tobacco smoke to environmental benzene exposure in Germany

The concentrations of environmental tobacco smoke (ETS) constituents including benzene were measured in the living rooms of 10 nonsmoking households and 20 households with at least one smoker situated in the city and suburbs of Munich. In the city, the median benzene levels during the evening, when all household members were at home, were 8.1 and 10.4 μg/m 3 in nonsmoking and smoking homes, respectively. The corresponding levels of 3.5 and 4.6 μg/m 3 were considerably lower in the suburbs. Median time-integrated 1-week benzene concentrations in the city were 10.6 μg/m 3 in nonsmoking homes and 13.1 μg/m 3 in smoking homes. In the suburbs, the corresponding values were 3.2 and 5.6 μg/m 3. While the benzene concentrations in nonsmoking homes located in the city were significantly higher (p < 0.05) than in suburban nonsmoking households, no difference was found between smoking and nonsmoking households located either in the city or in the suburbs. Individual exposures to benzene and to specific markers for tobacco smoke of all household members (82 nonsmokers and 32 smokers) were determined by questionnaire, personal monitoring, and biomonitoring. Within the city, the benzene exposure determined by personal samplers was 11.8 μg/m 3 for nonsmokers living in nonsmoking homes and 13.3 μg/m 3 for nonsmokers in smoking homes. The corresponding values for nonsmokers living in the suburbs were 5.9 and 6.9 μg/m 3, respectively. Neither difference was statistically significant. Nonsmokers living in nonsmoking households in the city had significantly higher exposure to benzene compared to their counterparts living in the suburbs (personal samplers: 11.8 vs 5.9 μg/m 3, p < 0.001; benzene in exhalate: 2.4 vs. 1.1 μg/m 3, p < 0.05; trans,trans-muconic acid excretion in urine: 92 vs. 54 μg/g creatinine, p < 0.05). Nonsmokers from all households with smokers were significantly more exposed to benzene than nonsmokers living in the nonsmoking households (personal samplers: 13.2 vs. 7.0 μg/m 3, p < 0.05; benzene in exhalate: 2.6 vs. 1.8 μg/m 3, p < 0.01; trans,trans-muconic acid excretion in urine: 73 vs. 62 μg/g creatinine), but the contribution of ETS to the total benzene exposure was relatively low compared to that from other sources. Analysis of variance showed that at most 15% of the benzene exposure of nonsmokers living in smoking homes was attributable to ETS. For nonsmokers living in nonsmoking households benzene exposure from ETS was insignificant.

Environmental tobacco smoke, low birth weight, and hospitalization for respiratory disease.

The author examined the effect of exposure to environmental tobacco smoke (ETS) on hospitalization for respiratory illness in low-birth-weight (LBW, less than 2,500 g) infants. This analysis was performed on the combined data of 3,285 infants from the Jing-An and Chang-Ning epidemiologic studies of children's health in Shanghai. Infants were classified into three ETS groups according to the total number of cigarettes smoked daily by household members: none, light (one to 19 cigarettes/d) and heavy (20+ cigarettes/d). There were no mothers who were smokers. Infants might have been hospitalized more than once during their first 18 mo of life. Risk and incidence density of hospitalization for respiratory disease increased with increasing smoking by household members among the LBW infants more rapidly than among the normal-birth-weight (NBW) infants. Compared with the NBW infants who were living in nonsmoking households, the odds ratios for the first episode of hospitalization for respiratory disease were 1.40 in the NBW infants who were living in light smoking households and 1.61 in those who were living in heavy smoking households. In the LBW infants, the odds ratios were 2.91 and 4.48 in light and heavy smoking households respectively, after adjustment for study area, sex, and feeding by simple logistic regression analysis. Ordinal logistic regression analysis for all episodes of respiratory hospitalization showed similar results.

Effects of passive smoking on respiratory illness from birth to age eighteen months, in Shanghai, People's Republic of China

The objective of this study was to evaluate the effects of exposure to nonmaternal, passive household cigarette smoke on the incidence of respiratory illness (bronchitis and pneumonia) among children from birth through age 18 months in the Lu-Wan District, Shanghai City, People's Republic of China. A secondary objective was to evaluate the effects of other environmental factors, such as the fuel used for cooking and whether the child was breast fed, on the incidence of respiratory illness. The total daily cigarette consumption of family members was used to estimate exposure to passive smoke. The relative risks of exposure to passive cigarette smoke on the incidence of respiratory illness were 1.3, 1.7, and 2.0 for children living in households with members who smoked 1 to 9, 10 to 19, and 20 to 39 cigarettes per day, respectively, compared with the risks for children living in nonsmoking households (p for trend = 0.0002). These effects did not change materially when potential confounding factors were controlled. Children who were not fed human milk had a 1.8-fold increased risk of respiratory disease at each level of exposure to passive cigarette smoke evaluated, in comparison with children who were fed human milk for at least 1 month.

Relation of passive smoking as assessed by salivary cotinine concentration and questionnaire to spirometric indices in children.

Previous studies of the effects of passive exposure to smoke on spirometric indices in children have largely relied on questionnaire measures of exposure. This may have resulted in underestimation of the true effect of passive smoking. Biochemical measures offer the opportunity to estimate recent exposure directly. The relation between spirometric indices and passive exposure to tobacco smoke was examined in a large population sample of 5-7 year old children from 10 towns in England and Wales. The effects of passive exposure to smoke on lung function were assessed by means of both salivary cotinine concentration and questionnaire measurements of exposure. Analyses of the relation between spirometric values and cotinine concentrations were based on 2511 children and of the relation between spirometric values and questionnaire measures on 2000 children. Cotinine concentration was negatively associated with all spirometric indices after adjustment for confounding variables, which included age, sex, body size, and social class. The strongest association was with mid expiratory flow rate (FEF50), the fall between the bottom and top fifths of the cotinine distribution being 6%, equivalent to a reduction of 14.3 (95% confidence limits (CL) 8.6, 20.0) ml/s per ng/ml cotinine. Salivary cotinine concentrations were strongly related to exposure to cigarette smoke at home but 88% of children who were from non-smoking households and not looked after by a smoker had detectable cotinine concentrations, 5% being in the top two fifths of the cotinine distribution. A composite questionnaire score based on the number of regular sources of exposure was as strongly related to mid and end expiratory flow rates as the single cotinine measure. The fall in FEF50 per smoker to whom the child was exposed was 51.0 (26.5, 75.5) ml/s. The relationships between the questionnaire score and forced vital capacity (FVC) or forced expiratory volume in one second (FEV1) were not statistically significant. These effects of passive smoking on respiratory function are consistent with the results of previous studies and, although small in absolute magnitude, may be important if the effects of exposure are cumulative. In children aged 5-7 years the use of a single salivary cotinine concentration as a marker of passive exposure to smoke resulted in clear relationships between exposure and FVC and FEV1, whereas the associations were much weaker and not significant when based on the questionnaire score. The associations between exposure and mid or end expiratory flow rates were of similar magnitude for cotinine concentration and the questionnaire score. The use of salivary cotinine concentration in longitudinal studies may help to determine the extent to which these effects are cumulative or reversible.

Lifestyle differences between smokers, ex-smokers and non-smokers, and implications for their health

Abstract Much evidence has been published in order to demonstrate that smoking cessation leads to a decrease in morbidity and mortality. Using data from the Health and Lifestyle Survey respondents were divided into three groups: smokers, ex-smokers and non-smokers and lifestyle characteristics such as diet and exercise were compared. Smokers were more likely to eat chips (French fries), fried food, butter and less likely to eat fresh fruit in winter, green vegetables and margarine high in polyunsaturated fats. Non-smokers were more likely than smokers and ex-smokers to take part in keepfit, jogging and swimming. Non-smokers in smoking households were more likely than non-smokers in non-smoking households to eat fried food, chips and butter and less likely to eat fruit in winter or margarine high in polyunsaturated fats. Results suggest that part of the assumed health benefits of smoking cessation are due to ex-smokers having a healthier diet than that of smokers.

Cognitive and Social Influences on Smoking Behaviour During Pregnancy

A random sample of 292 women attending a hospital antenatal clinic for routine care was surveyed concerning smoking behaviour and beliefs about smoking in pregnancy. Among women who continued to smoke during their pregnancy, most had cut down. Many expressed a desire to quit, felt guilty about not being able to do so, but reported that smoking offered important benefits relating to relaxation and mood control. Forty (27.8%) of the 144 women who were smokers at the time they became pregnant had quit during pregnancy. In a multivariate analysis, a nonsmoking household, and being more convinced about the health effects of maternal smoking, were most strongly associated with successful cessation. These 2 variables alone were able to correctly classify 83.8% of women as quitters or continuing smokers. Implications for health promotion programmes and messages are discussed.

The Relationship of Salivary Cotinine to Respiratory Symptoms, Spirometry, and Exercise-induced Bronchospasm in Seven-Year-Old Children

The effects of passive tobacco smoke exposure upon respiratory symptoms and lung function were assessed in a cross-sectional survey of 770 children 7 yr of age, using cotinine as a quantitative biochemical marker of exposure. Salivary cotinine levels were strongly related to the number of smokers in the home, but three-quarters of children from nonsmoking households had detectable salivary cotinine, and 10% of this group were in the upper two-fifths of the distribution of measured tobacco smoke exposure. Smoking by persons other than members of the household may deserve greater attention in future studies of young children. After adjustment for housing tenure, most respiratory symptoms were unrelated to salivary cotinine, but a "tendency for colds to go to the chest" was twice as prevalent in the upper two-fifths as in the lower two-fifths of the cotinine distribution. No association was found between salivary cotinine and reports of wheeze or measured reduction in FEV1 after 6 min of free running. After adjustment for sex, height, test conditions, and housing tenure, all baseline spirometric indices except FVC were inversely associated with salivary cotinine. Only FEF75-85 and FEF75 were significantly reduced, the difference for each index between the top and bottom quintiles of the cotinine distribution being about 7%, equivalent to a reduction of 1.1% (95% CL, 0.1 to 2.1%) per doubling of cotinine concentration. These changes may be evidence of small airways damage, which could later progress to more severe respiratory impairment.

Monoclonal antibody ELISA for cotinine in saliva and urine of active and passive smokers

The value of a monoclonal antibody-based ELISA for measuring cotinine in saliva and urine of active and passive smokers was assessed. Cotinine (mean ± SEM) was detected in all 26 saliva (392 ± 74 ng/ml) and 27 urine (4264 ± 508 ng/mg creatinine; 2566 ± 364 ng/ml) samples from smoking parents, but in only two of 36 salivas and one of 37 urines from nonsmokers ( P < 0.001). Similarly, mean cotinine levels in 30 salivas (4.67 ± 1.10 ng/ml) and 33 urines (35.5 ± 8.8 ng/mg creatinine; 25.3 ± 8.1 ng/ml) from passively exposed children were significantly higher ( P < 0.001) than in fluids of 36 unexposed children. Children's levels showed a strong correlation ( P < 0.001) with the number of cigarrettes smoked in the home, but only when data from nonsmoking households were included in the analysis. In adult smokers there was positive correlation between salivary and urinary cotinine ( P = 0.002) and a close relationship between urinary cotinine and cigarettes smoked per day ( P = 0.066). The ELISA gives a reliable quantitative measure of cotinine as an indicator of active and passive exposure to tobacco smoke. However, correlations with cotinine can be overestimated if large numbers of nonsmokers are included in the comparison.

Medical costs of nonsmoking women and children in a town of Miyagi.

To know the differences in utilization of medical care and medical costs among children and nonsmoking women depending on the states of smoking of other household members, the records of a health survey conducted in a town of Miyagi in 1987 were linked to the medical insurance records. The rates of medical care use and medical costs among nonsmoking women in nonsmoking households were almost the same as those in smoking households. Children in smoking households had medical care more often than those in nonsmoking households (74.1% vs. 56.4%) and the difference in the medical costs was also observed (Y33,713 vs. Y26,558). The costs were almost correlated with the number of cigarettes smoked in the home.

The impact of passive smoking on emergency room visits of urban children with asthma.

Baseline data obtained from a study of 276 children with asthma from 259 low income families were analyzed to test the hypothesis that passive smoking is associated with frequency of emergency room (ER) visits, hospitalizations, and impaired pulmonary function. The data were analyzed using multiple regression techniques. We controlled for other variables that might affect the frequency of ER visits, including smoking by the children themselves and the presence of other irritants or allergens in the child's home. Passive smoking was positively associated with ER visits (p less than 0.01), but not with hospitalizations or abnormalities in pulmonary function. The frequency of days with symptoms of asthma per month was also directly associated with ER visits (p less than 0.02). The estimated mean annual increase in ER visits attributable to the presence of one or more smokers in the household was 1.34 +/- 0.50, an increase of 63% over nonsmoking households. The estimated annual health care cost for emergency care of children with asthma that can be attributed to passive smoking is 92 dollars (95% confidence interval from 24 to 160 dollars) for families with 1 or more smokers.

Effects of parental smoking on medical care utilization by children.

A household interview survey of 2,582 adult members of the Kaiser-Permanente Medical Care Program of Oregon conducted in 1970-71 contained detailed questions about cigarette smoking patterns. Detailed, computerized medical records were maintained for all inpatient and outpatient care rendered between 1967 and 1974 to the 1,761 children of the interviewed sample. Adjusted for age, family size, socioeconomic status, and duration of Health Plan membership, children in non-smoking households used significantly more outpatient services than did children in smoking households, a relationship largely accounted for by their use of more preventive medical services than by children in smoking households. There were no significant differences in inpatient medical care use and outpatient care use for respiratory illness by children of smoking and non-smoking households.

Tobacco smoke xenobiotic compound appearance in mothers' milk after involuntary smoke exposures I. Nicotine and cotinine

In the development of the extraction procedure for the analysis of nicotine and cotinine from a single breast milk sample, nicotine and cotinine were detected in 3 of 10 nonsmoking mothers' milk samples. Interviews of these women revealed the presence of nonsmoking husbands and households but of tobacco smoke exposures during the working day. Clinically these levels may be considered inconsequential in regard to the threat to the mother and nursing infant but may be important in studies designed to monitor tobacco smoke xenobiotic compound appearance in breast milk.