Study: Strategies to Reduce ETS Exposure to Infants [08/05/03]

Excerpts from: Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey

For Complete Study: BMJ.COM [08/02/03]

Banning smoking in the home is associated with a small but significant reduction in urinary cotinine to creatinine ratios in infants, whereas less strict measures compared with no measures to reduce tobacco smoke in the home had no effect on exposure of infants. Our study is the first to report, in detail, parents' knowledge and use of measures to reduce the exposure of their infants to tobacco smoke in the home. Our sample was more socially disadvantaged than all UK households with infants, consistent with the known association between smoking and social disadvantage.22

Only a small proportion of respondents reported not knowing of any harm reduction measures or knowing of measures but not using them. This suggests that health promotion messages urging parents to protect their children from tobacco smoke may have had some success. However, we found that parents would benefit from more information on what measures actually work. Many of the harm reduction strategies used by the parents, such as opening windows when smoking and using fans and ionisers, were ineffective. The parents frequently used a combination of measures, making it difficult to determine the extent to which individual practices affect exposure.

The strengths of our study were that we sampled a representative population of smoking households with infants, we assessed the cotinine to creatinine ratio, which corrects for dilution of urine,22 and we studied a narrow age range of infants thus reducing the variation associated with differential speed of metabolism and excretion of nicotine. Previous observational studies were based on selected populations (hospital outpatients and children with asthma), parental reporting of cigarette consumption, and wide age ranges.3 19 20

The group we studied was chosen to coincide with the peak age for sudden infant death syndrome. Reducing the exposure of infants to tobacco smoke is likely to be important in preventing sudden infant death as there is a close association between the two. Our results suggest that, independent of major confounding variables, banning smoking in the home significantly reduces infant exposure to environmental tobacco smoke but, as there are no data directly relating cotinine levels to risk of death, it is not possible to predict the likely effect of a reduction of this magnitude on the risk of sudden infant death. Our results also suggest that harm reduction measures short of a total ban on smoking in the home are likely to have little effect on the exposure of infants to tobacco smoke, but this requires verification with a larger sample.

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