Determinants of children's exposure to environmental tobacco smoke (ETS): a study in Southern Germany

J Expo Anal Environ Epidemiol. 2004 Jul;14(4):284-92. doi: 10.1038/sj.jea.7500323.


Maternal smoking has been repeatedly found to be the most important determinant of children's exposure to environmental tobacco smoke (ETS). Here, we further investigated predictors for the urinary cotinine/creatinine ratio (CCR, ng/mg) in 1220 preschool children for the year 1996. Children from smoking homes (35.1%) had significantly higher CCR than children from nonsmoking homes (mean: 55.5 vs. 14.9 ng/mg). The level of education of the parents was a strong predictor for CCRs even after adjusting for number of cigarettes smoked, maternal smoking and dwelling space. Additionally, dwelling space was inversely related to children's urinary cotinine level. The CCR- levels in children investigated in 1996 and 1998 were significantly correlated (Pearson's r=0.67). The parents of 806 children agreed for a visit to their homes. In 79 of the 536 (14.7%) of the self-reported, nonsmoking households, smoking was admitted during the visit. The mean urinary CCR of these children was 25.2 ng/mg. We conclude that in addition to parental smoking behaviour, other variables such as dwelling space and social and educational status predict the children's exposure to ETS. Our data also revealed that a considerable percentage of parents denied the ETS exposure of their children at home.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cotinine / analysis
  • Cotinine / urine*
  • Creatinine / analysis
  • Creatinine / urine*
  • Environmental Exposure / analysis*
  • Female
  • Germany
  • Humans
  • Male
  • Surveys and Questionnaires
  • Tobacco Smoke Pollution / adverse effects*
  • Tobacco Smoke Pollution / analysis*


  • Tobacco Smoke Pollution
  • Creatinine
  • Cotinine