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When does exposure of children to tobacco smoke become child abuse?
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
2003 (English)In: The Lancet, ISSN 0140-6736, Vol. 361, no 9371, 1828-1828 p.Article in journal (Refereed) Published
Abstract [en]

We report an instance of a child aged 2.5 years, who is exposed to tobacco smoke in the home. The child is a participant in a prospective cohort study (ABIS; all babies in southeast Sweden) we are undertaking, on environmental factors affecting development of immune-mediated diseases in children.1

Exposure to environmental tobacco smoke, known to affect present and future health of children,2 is one of the environmental factors being studied. Parents are asked, in questionnaires, if and how much they smoke. A subsample of smoking parents of 2–3 year-old children has been asked about their smoking behaviour at home—ie, what precautions they use to protect their child from tobacco smoke. To validate this questionnaire, we have analysed urine cotinine concentrations (the major urinary metabolite of nicotine) in specimens provided by children of this age. We recorded that the smoking behaviour of parents at home was significantly associated with cotinine concentrations of their child. Cotinine concentrations were adjusted for creatinine.3

The child we report here had a cotinine/creatinine ratio of 800 μg cotinine/1 g creatinine, corresponding to active smoking of 3–5 cigarettes a day.4 The parents reported a joint consumption of 41–60 cigarettes a day. They said they smoke in the kitchen and living room, whereas bedrooms were reported to be smoke-free. The parents reported smoking at the dinner table once a day and in front of the television set several times a day. They also said they smoke near the kitchen fan several times a day and near an open door at least once a week. These comments from the parents indicate that, in their opinion, their child was well protected from exposure to environmental tobacco smoke, since they did not smoke in bedrooms and the windows were almost always open.

Though nicotine and cotinine metabolism is independent probably due to genetic differences,5 the cotinine concentration of this child is remarkably high. If active smoking in adults causes lung cancer and other serious diseases, passive smoking from the age of 2.5 years (and probably younger) must be even more deleterious. Since a child at this age cannot, by his or her own will, avoid a smoky environment, we ask ourselves when exposure to tobacco smoke should be regarded as child abuse?

We want to stress the fact that, although most parents are aware of the importance of protecting their children from tobacco smoke, and try in different ways, children can still be massively exposed to this toxic drug. Since to just forbid smoking might be ineffective, nurses and doctors should pay attention to smoking behaviour of smoking parents they meet. Until we know more about effective measures of protection, the recommendation should be never to smoke indoors in homes with children.

Place, publisher, year, edition, pages
2003. Vol. 361, no 9371, 1828-1828 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13625DOI: 10.1016/S0140-6736(03)13431-9OAI: oai:DiVA.org:liu-13625DiVA: diva2:21074
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
In thesis
1. Passive Smoking in Children: The Importance of Parents’ Smoking and Use of Protective Measures
Open this publication in new window or tab >>Passive Smoking in Children: The Importance of Parents’ Smoking and Use of Protective Measures
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Passive smoking has been recognised as a health hazard, and chidren are especially vulnerable. The general aim of this thesis was to describe and analyse the importance of parents’ smoking and smoking behaviour for children’s tobacco smoke exposure. The studies were conducted in the South-East part of Sweden and pre-school children and their parents constituted the study samples. Five studies are described in six papers. Smoking prevalence among parents (14%) and commonly used measures of protection were surveyed. An instrument designed to measure children’s tobacco smoke exposure in the home was developed and validated. It was used on 687 families with a smoking parent and a child 2½-3 years old, included in a prospective cohort study on environmental variables of importance for immun-mediated diseases ABIS (All Babies in South-East Sweden). Almost 60% of the parents stated that they always smoked outdoors with the door closed, 14% mixed this with smoking near the kitchen fan, 12% near an open door, 7% mixed all these behaviours and 8 % smoked indoors without precautions. The smoking behaviours were related to the children’s creatinine adjusted urine cotinine. All groups had significantly higher values than had children from non-smoking homes, controls. Outdoor smoking with the door closed seemed to be the best, though not a total, measure for tobacco smoke protection in the home.

Most parents were aware of the importance of protecting children from tobacco smoke exposure but all were not convinced of the increased risk for disease for exposed children. The majority of parents were not satisfied with the smoking prevention in health-care and 50% did not think that their smoking was of any concern to the child health care nurse.

Further research is warranted to describe if the difference in exposure score related to smoking behaviours is related to different prevalence of disease. Efforts are needed to convince those who still smoke indoors that tobacco smoke exposure influence children’s health and that consequent outdoor smoking with the door closed seemed to give the best protection.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2004. 80 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 831
Keyword
ETS, infant, child, cotinine, smoking behaviour, protective measures, parents, home, tobacco, child health care, ABIS
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-5174 (URN)91-7373-801-8 (ISBN)
Public defence
2004-02-13, Victoriasalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
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Note
Article I: copyright (2003), with permission from Oxford University Press. On the day of the public defence the status of article III was: Submitted and the status of article VI was: Revised and resubmitted and the original title was: Attitudes to children’s tobacco smoke exposure among smoking and non-smoking parents and their opinions on how the issue is handled in health care.Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2012-01-25Bibliographically approved

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Johansson, AnnaKarinHermansson, GöranLudvigsson, Johnny

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