Environmental tobacco smoke exposure in school children: parent report and urine cotinine measures

Pediatr Int. 2006 Aug;48(4):382-9. doi: 10.1111/j.1442-200X.2006.02225.x.


Background: Environmental tobacco smoke (ETS) in the home continues to be a major health risk for children around the world. Measuring ETS is a central feature of clinical and epidemiological studies, with children's exposure often assessed through parental estimates. The authors examined the relationship between parent-reported estimates of children's exposure to ETS and children's urinary cotinine levels and evaluated the ETS exposure and its effect on respiratory health in children.

Methods: A total of 188 school children were included in the study. Parents were asked to complete a questionnaire about their smoking habits, their children's respiratory morbidity status and housing conditions. Urinary cotinine levels were measured in children.

Results: According to the responses, 72.3% of the children came from households with smokers, and 34.6% had daily exposure to ETS. When urine cotinine levels of >10 ng/mL were used as the yardstick of exposure, 76% of the children were identified as ETS exposed. No relation was detected between the symptoms of respiratory tract diseases and ETS exposure. To determine the amount of ETS exposure, the contribution of parental reports was low.

Conclusion: To evaluate the level of ETS exposure of children, the parents' reports were not reliable. The addition of a biological measure results in a more informative estimate of ETS exposure in children.

MeSH terms

  • Child
  • Child, Preschool
  • Cotinine / urine*
  • Cross-Sectional Studies
  • Data Collection / methods
  • Environmental Exposure / adverse effects*
  • Environmental Exposure / analysis*
  • Female
  • Humans
  • Male
  • Parents
  • Reproducibility of Results
  • Respiratory Tract Diseases / epidemiology*
  • Respiratory Tract Diseases / etiology
  • Sensitivity and Specificity
  • Smoking / epidemiology
  • Surveys and Questionnaires*
  • Tobacco Smoke Pollution / adverse effects*
  • Tobacco Smoke Pollution / analysis*
  • Turkey / epidemiology


  • Tobacco Smoke Pollution
  • Cotinine