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Passive Smoking in Children: The Importance of Parents’ Smoking and Use of Protective Measures
Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
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 [en]
ETS, infant, child, cotinine, smoking behaviour, protective measures, parents, home, tobacco, child health care, ABIS
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-5174ISBN: 91-7373-801-8 (print)OAI: oai:DiVA.org:liu-5174DiVA: diva2:21077
Public defence
2004-02-13, Victoriasalen, Campus US, Linköpings universitet, Linköping, 09:00 (English)
Opponent
Supervisors
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
List of papers
1. Indoor and outdoor smoking: Impact on children’s health
Open this publication in new window or tab >>Indoor and outdoor smoking: Impact on children’s health
2003 (English)In: European Journal of Public Health, ISSN 1101-1262, Vol. 13, no 1, 61-66 p.Article in journal (Refereed) Published
Abstract [en]

Background: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children.

Methods: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12–24 months old.

Results: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers.

Conclusion: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.

Keyword
children, environmental tobacco smoke, health effects, smoking behaviour
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13622 (URN)10.1093/eurpub/13.1.61 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
2. Does having children affect adult smoking and behaviours at home?
Open this publication in new window or tab >>Does having children affect adult smoking and behaviours at home?
2003 (English)In: Tobacco Induced Diseases, ISSN 1617-9625, Vol. 1, no 3, 175-183 p.Article in journal (Refereed) Published
Abstract [en]

Background

Smoking prevalence and smoking behaviours have changed in society and an increased awareness of the importance of protecting children from environmental tobacco smoke (ETS) is reported. The aim of this study was to find out if smoking prevalence and smoking behaviours were influenced by parenthood, and if differences in health-related quality of life differed between smoking and non-smoking parents.

Methods

Questionnaires were sent to a randomly selected sample, including 1735 men and women (20–44 years old), residing in the south-east of Sweden. Participation rate was 78%. Analyses were done to show differences between groups, and variables of importance for being a smoker and an indoor smoker.

Results

Parenthood did not seem to be associated with lower smoking prevalence. Logistic regression models showed that smoking prevalence was significantly associated with education, gender and mental health. Smoking behaviour, as well as attitudes to passive smoking, seemed to be influenced by parenthood. Parents of dependent children (0–19 years old) smoked outdoors significantly more than adults without children (p < 0.01). Logistic regression showed that factors negatively associated with outdoor smoking included having immigrant status, and not having preschool children. Parents of preschool children found it significantly more important to keep the indoor environment smoke free than both parents with schoolchildren (p = 0.02) and adults without children (p < 0.001). Significant differences in self-perceived health-related quality of life indexes (SF-36) were seen between smokers and non-smokers.

Conclusion

As smoking behaviour, but not smoking prevalence, seems to be influenced by parenthood, it is important to consider the effectiveness of commonly used precautions when children's risk for ETS exposure is estimated.

Keyword
smoking prevalence, children, protection, parents, SF-36
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13623 (URN)10.1186/1617-9625-1-3-175 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
3. Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
Open this publication in new window or tab >>Assessment of Smoking Behaviors in the Home and Their Influence on Children's Passive Smoking: Development of a Questionnaire
2005 (English)In: Annals of Epidemiology, ISSN 1047-2797, Vol. 15, no 6, 453-459 p.Article in journal (Refereed) Published
Abstract [en]

Purpose

To construct and validate a questionnaire aiming to measure children's exposure to environmental tobacco smoke (ETS) in the home.

Methods

The development of the instrument included epidemiological studies, qualitative interviews, pilot studies, and validation with biomarkers and is described in seven consecutive steps. Parents of preschool children, from different population-based samples in south-east Sweden, have participated in the studies.

Results

Content and face validity was tested by an expert panel and core elements for the purpose of the instrument identified. Reliability was shown with test-retest of the first version. The validation with biomarkers indicated that the sensitivity of the instrument was high enough to discriminate between children's ETS exposure levels. Cotinine/creatinine levels were related to parents' described smoking behaviors. Differences were shown between children from non-smoking homes, and all groups with smoking parents, independent of their smoking behavior (p < 0.01), as well as between parents smoking strictly outdoors and parents reporting indoor smoking (p < 0.001).

Conclusion

The results indicate that the presented instrument can be used to discriminate between different levels of ETS exposure and when children's level of tobacco smoke exposure is to be assessed.

Keyword
Cotinine; ETS; Parents; Outdoor Smoking
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13624 (URN)10.1016/j.annepidem.2004.09.012 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-05-20
4. When does exposure of children to tobacco smoke become child abuse?
Open this publication in new window or tab >>When does exposure of children to tobacco smoke become child abuse?
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.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13625 (URN)10.1016/S0140-6736(03)13431-9 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
5. How should parents protect their children from environmental tobacco-smoke exposure in the home?
Open this publication in new window or tab >>How should parents protect their children from environmental tobacco-smoke exposure in the home?
2004 (English)In: Pediatrics, ISSN 1098-4275, Vol. 113, no 4, 291-295 p.Article in journal (Refereed) Published
Abstract [en]

Background. Children’s exposure to tobacco smoke is known to have adverse health effects, and most parents try to protect their children.

Objective. To examine the effectiveness of parents’ precautions for limiting their children’s tobacco-smoke exposure and to identify variables associated to parents’ smoking behavior.

Design and participants. Children, 2.5 to 3 years old, participating in All Babies in Southeast Sweden, a prospective study on environmental factors affecting development of immune-mediated diseases. Smoking parents of 366 children answered a questionnaire on their smoking behavior. Cotinine analyses were made on urine specimen from these children and 433 age-matched controls from nonsmoking homes.

Results. Smoking behavior had a significant impact on cotinine levels. Exclusively outdoor smoking with the door closed gave lower urine cotinine levels of children than when mixing smoking near the kitchen fan and near an open door or indoors but higher levels than controls.

Variables of importance for smoking behavior were not living in a nuclear family (odds ratio: 2.1; 95% confidence interval: 1.1–4.1) and high cigarette consumption (odds ratio: 1.6; 95% confidence interval: 1.2-2.1).

An exposure score with controls as the reference group (1.0) gave an exposure score for outdoor smoking with the door closed of 2.0, for standing near an open door + outdoors of 2.4, for standing near the kitchen fan + outdoors of 3.2, for mixing near an open door, kitchen fan, and outdoors of 10.3, and for indoor smoking of 15.2.

Conclusion. Smoking outdoors with the door closed was not a total but the most effective way to protect children from environmental tobacco-smoke exposure. Other modes of action had a minor effect.

Keyword
ETS, cotinine, children, smoking behavior, measures of precaution
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13626 (URN)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19
6. Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
Open this publication in new window or tab >>Parents' attitudes to children's tobacco smoke exposure and how the issue is handled in health care
2004 (English)In: Journal of Pediatric Health Care, ISSN 0891-5245, Vol. 18, no 5, 228-235 p.Article in journal (Refereed) Published
Abstract [en]

Introduction

The objective of the study was to understand the opinions and attitudes among parents of preschool children towards children's passive smoking, to show how attitudes influenced smoking and smoking behavior, and how the parents had experienced the handling of the tobacco issue in antenatal and child health care.

Method

A subsample of smoking and nonsmoking parents (n = 300) with 4- to 6-year-old children participating in All Babies in Southeast Sweden (ABIS), a prospective study on environmental factors affecting development of immune-mediated diseases, answered a questionnaire on their opinions and attitudes to children's passive smoking.

Results

Indoor smokers were more positive regarding smoking, less aware of the adverse health effects from passive smoking, and more negative regarding the handling of tobacco prevention in health care than both outdoor smokers and nonsmokers. Indoor smokers' idea of how children should be protected from tobacco smoke exposure was significantly different from the idea of nonsmokers and outdoor smokers.

Discussion

Results indicate that further intense efforts are needed to convince the remaining indoor smokers about the adverse health effects related to tobacco smoke exposure. Pediatric nurses meet these parents in their daily work and should be aware of the need to focus this group and their use of protective measures.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-13627 (URN)10.1016/j.pedhc.2004.03.006 (DOI)
Available from: 2004-03-12 Created: 2004-03-12 Last updated: 2009-08-19

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