Environmental tobacco smoke exposure among urban children

Background. Environmental tobacco smoke (ETS) exposure is a well-known health hazard for children. Poor urban children may be at increased risk of exposure from nonparental sources of tobacco smoke. The unique problems of ETS exposure in urban children have previously not been well-defined. Objectives. This study was conducted: 1) to identify the sources of ETS exposure for children attending a hospital-based pediatric resident practice; and 2) to examine caregivers' perceptions of the pediatrician's role and action in addressing ETS exposure. Design. Questionnaires were administered to a convenience sample of 174 caregivers of children visiting a children's hospital-based resident practice. A structured face-to-face interview was used. Results. All caregivers agreed to participate in the study. Most of the caregivers interviewed were mothers (87.9%). Although only 14% of caregivers were smokers, 49.4% reported caring for at least 1 smoke-exposed child. Most smoke exposure occurred in the home; smoking is allowed in the home of 75% of the children who live with a smoker (48/64). Thirty-four percent of the caregivers who reported no smoking in the home reported having a child who spends time in homes where other people smoke. Most exposure outside the home occurred at a grandparent's home. A ban on smoking in the home did not eliminate a child's risk of residential smoke exposure but did predict whether smoking occurred in the same room as the child. All caregivers reported believing that tobacco smoke is harmful. Approximately one half of caregivers who smoke (54.2%) would like smoking cessation advice from the child's pediatrician. Interest in receiving advice on helping others quit smoking was also high (51.3%) among nonsmoking caregivers who cared for a smoke-exposed child. Conclusions. Nonparental sources of ETS exposure are reported to be common in urban children. Children may be exposed to tobacco smoke even in homes where smoking is banned. Many caregivers would like help from pediatricians in reducing children's exposure to tobacco smoke.