Assessment of environmental tobacco smoke exposure in children with asthmatic symptoms by questionnaire and cotinine concentrations in plasma, saliva, and urine

J Clin Epidemiol. 2000 Jul;53(7):715-21. doi: 10.1016/s0895-4356(99)00212-7.


To validate a detailed questionnaire for assessment of environmental tobacco smoke (ETS) exposure by the biomarker cotinine in various media, a population-based study in the urban area of Malmö, Sweden was performed in children aged 8-13 years with and without asthmatic symptoms. There were strong correlations between urinary and saliva cotinine concentrations and also, though to a lesser extent, between these media and plasma. Even a detailed questionnaire gave only a rough picture of the ETS exposure, as indicated by the biomarkers. In a multivariate model, the most significant questionnaire-derived predictor of the cotinine levels was the maternal smoking habits; other questionnaire variables gave only a minimal explained variance. Children with a history of asthmatic symptoms had statistically significantly lower median cotinine levels in urine and saliva compared to referent children, most likely because of the antismoking information to their parents. This should be considered in epidemiological studies of ETS risks.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Asthma / epidemiology*
  • Asthma / etiology
  • Asthma / metabolism*
  • Child
  • Cotinine / analysis*
  • Cotinine / blood
  • Cotinine / urine
  • Educational Status
  • Female
  • Humans
  • Male
  • Regression Analysis
  • Risk Factors
  • Saliva / chemistry
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution*


  • Tobacco Smoke Pollution
  • Cotinine