Who in this day and age would claim that environmental
tobacco smoke (ETS) — commonly called "secondhand
smoke" — is a real and substantial threat to the
health of our children? Well, the World Health Organization,
for one, made that very assertion. Because ETS exposure
clearly causes a wide array of adverse health effects
in children, including pneumonia, bronchitis, ear infections,
not to mention the worsening of asthma symptoms, the American
Academy of Pediatrics recommends that doctors assess children's
exposure to secondhand smoke at their very first visit.
But there's one glaring flaw in the execution of this
plan — no one quite knows what specific questions
will most likely identify kids with high ETS exposure.
A study published in the May issue
of the Archives of Pediatric and Adolescent Medicine
set out to rectify this problem. The authors suggest
that MDs can reliably spot youngsters who are at risk
of ETS exposure by asking three simple questions. The
primary caregiver (often the mother) should be asked:
"Do you smoke?" If the answer is "no," two more questions
should follow: "Do others who live or frequently visit
with you smoke?" and "Do they smoke indoors?"
Skeptical that this might actually
work in practice? Granted the questions seem a little
obvious but the researchers objectively tested the validity
of their questionnaire using a novel technique to gauge
nicotine exposure in kids. Testing the level of cotinine,
a nicotine metabolite, in hair samples proved to be
a reliable biomarker for exposure. This tool virtually
cut through reporting bias in the study.
MOTHER
OF PREDICTION
"We found that the main predictor of children's exposure
to tobacco smoke was having a mother who's a smoker.
Whether or not the mother stated she smoked outside,
and the number of cigarettes she smoked per day were
not significant factors," says Dr Judith Groner, the
study's lead author. She speculates that this is because
parents feel it's socially desirable to say that they
'smoke only a few cigarettes outside' when tobacco issues
are discussed.
The researchers looked at 291 healthy
children between 2 weeks and 3 years of age at the Columbus
(Ohio) Children's Hospital Primary Care Centre. By comparing
questionnaire information to the analysis of cotinine
levels in hair, they developed the simple three-question
model to determine a child's ETS exposure.
So what do you do if the questionnaire
shows that your pint-sized patients are at risk? "I
think that it's important to state that the best solution
for parental smokers is to consider quitting," says
Dr Groner. "Family doctors are uniquely positioned for
this since they can actually prescribe medications for
the parents to help them quit."
Arch Pediatr Adolesc Med May
2005;159:450-5
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