Skip to main content
PMC home page
Tobacco Control logoLink to Tobacco Control
. 2000 Jun;9(Suppl 2):ii40–ii47. doi: 10.1136/tc.9.suppl_2.ii40

Reducing children's exposure to environmental tobacco smoke: the empirical evidence and directions for future research

M Hovell, J Zakarian, D Wahlgren, G Matt
PMCID: PMC1766288  PMID: 10841590

Abstract

OBJECTIVE—To summarise the issues and empirical evidence for reduction of children's residential environmental tobacco smoke (ETS) exposure.
DATA SOURCES—Literature was obtained by computer search, with emphasis on studies that included quantitative measures of ETS exposure in children's residences and interventions based on social learning theory.
STUDY SELECTION—Review and empirical articles concerning ETS exposure were included and inferences were drawn based on a synthesis of these studies as contrasted with a quantitative meta-analysis.
DATA SYNTHESIS—Interventions designed for residential/child ETS exposure control have included policy/legal regulations, minimal clinical services, and counselling services. Divorce court and adoption services have limited custody to protect children from ETS exposure. Controlled trials of clinicians' one time counselling services have shown null results. One controlled trial found that repeated physician ETS counselling increased parent cessation. Three trials found that repeated counselling/shaping procedures reduced quantitative estimates of ETS exposure in asthmatic children.
CONCLUSIONS—Insufficient controlled studies of repeated session counselling procedures have been completed to determine efficacy for ETS exposure reduction, but evidence is promising. One time minimal interventions appear ineffective, but large scale studies may be warranted. No studies have been conducted to assess court or adoption agency regulations; no community ordinances for regulating residential ETS exposure have been invoked. Ethical and enforcement issues are discussed.


Keywords: environmental tobacco smoke; passive smoking; interventions; counselling

Full Text

The Full Text of this article is available as a PDF (132.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abernathy T., O'Grady B., Dukeshire S. Changes in ETS following anti-smoking legislation. Can J Public Health. 1998 Jan-Feb;89(1):33–34. doi: 10.1007/BF03405791. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Anda R. F., Croft J. B., Felitti V. J., Nordenberg D., Giles W. H., Williamson D. F., Giovino G. A. Adverse childhood experiences and smoking during adolescence and adulthood. JAMA. 1999 Nov 3;282(17):1652–1658. doi: 10.1001/jama.282.17.1652. [DOI] [PubMed] [Google Scholar]
  3. Ashley M. J., Ferrence R. Reducing children's exposure to environmental tobacco smoke in homes: issues and strategies. Tob Control. 1998 Spring;7(1):61–65. doi: 10.1136/tc.7.1.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bahçeciler N. N., Barlan I. B., Nuhoğlu Y., Başaran M. M. Parental smoking behavior and the urinary cotinine levels of asthmatic children. J Asthma. 1999;36(2):171–175. doi: 10.3109/02770909909056314. [DOI] [PubMed] [Google Scholar]
  5. Bernert J. T., Jr, Turner W. E., Pirkle J. L., Sosnoff C. S., Akins J. R., Waldrep M. K., Ann Q., Covey T. R., Whitfield W. E., Gunter E. W. Development and validation of sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clin Chem. 1997 Dec;43(12):2281–2291. [PubMed] [Google Scholar]
  6. Borland R., Mullins R., Trotter L., White V. Trends in environmental tobacco smoke restrictions in the home in Victoria, Australia. Tob Control. 1999 Autumn;8(3):266–271. doi: 10.1136/tc.8.3.266. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Brauer M., Hirtle R. D., Hall A. C., Yip T. R. Monitoring personal fine particle exposure with a particle counter. J Expo Anal Environ Epidemiol. 1999 May-Jun;9(3):228–236. doi: 10.1038/sj.jea.7500040. [DOI] [PubMed] [Google Scholar]
  8. Butz A. M., Rosenstein B. J. Passive smoking among children with chronic respiratory disease. J Asthma. 1992;29(4):265–272. doi: 10.3109/02770909209048941. [DOI] [PubMed] [Google Scholar]
  9. Chilmonczyk B. A., Palomaki G. E., Knight G. J., Williams J., Haddow J. E. An unsuccessful cotinine-assisted intervention strategy to reduce environmental tobacco smoke exposure during infancy. Am J Dis Child. 1992 Mar;146(3):357–360. doi: 10.1001/archpedi.1992.02160150097031. [DOI] [PubMed] [Google Scholar]
  10. Cook D. G., Strachan D. P. Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999 Apr;54(4):357–366. doi: 10.1136/thx.54.4.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Eisner M. D., Smith A. K., Blanc P. D. Bartenders' respiratory health after establishment of smoke-free bars and taverns. JAMA. 1998 Dec 9;280(22):1909–1914. doi: 10.1001/jama.280.22.1909. [DOI] [PubMed] [Google Scholar]
  12. Emerson J. A., Hovell M. F., Meltzer S. B., Zakarian J. M., Hofstetter C. R., Wahlgren D. R., Leaderer B. P., Meltzer E. O. The accuracy of environmental tobacco smoke exposure measures among asthmatic children. J Clin Epidemiol. 1995 Oct;48(10):1251–1259. doi: 10.1016/0895-4356(95)00021-u. [DOI] [PubMed] [Google Scholar]
  13. Eriksen W., Sørum K., Bruusgaard D. Effects of information on smoking behaviour in families with preschool children. Acta Paediatr. 1996 Feb;85(2):209–212. doi: 10.1111/j.1651-2227.1996.tb13994.x. [DOI] [PubMed] [Google Scholar]
  14. Farkas A. J., Gilpin E. A., Distefan J. M., Pierce J. P. The effects of household and workplace smoking restrictions on quitting behaviours. Tob Control. 1999 Autumn;8(3):261–265. doi: 10.1136/tc.8.3.261. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Farrelly M. C., Evans W. N., Sfekas A. E. The impact of workplace smoking bans: results from a national survey. Tob Control. 1999 Autumn;8(3):272–277. doi: 10.1136/tc.8.3.272. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Gergen P. J., Fowler J. A., Maurer K. R., Davis W. W., Overpeck M. D. The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988 to 1994. Pediatrics. 1998 Feb;101(2):E8–E8. doi: 10.1542/peds.101.2.e8. [DOI] [PubMed] [Google Scholar]
  17. Glantz S. A., Parmley W. W. Passive smoking and heart disease. Epidemiology, physiology, and biochemistry. Circulation. 1991 Jan;83(1):1–12. doi: 10.1161/01.cir.83.1.1. [DOI] [PubMed] [Google Scholar]
  18. Greenberg R. A., Strecher V. J., Bauman K. E., Boat B. W., Fowler M. G., Keyes L. L., Denny F. W., Chapman R. S., Stedman H. C., LaVange L. M. Evaluation of a home-based intervention program to reduce infant passive smoking and lower respiratory illness. J Behav Med. 1994 Jun;17(3):273–290. doi: 10.1007/BF01857953. [DOI] [PubMed] [Google Scholar]
  19. Hovell M. F., Meltzer S. B., Zakarian J. M., Wahlgren D. R., Emerson J. A., Hofstetter C. R., Leaderer B. P., Meltzer E. O., Zeiger R. S., O'Connor R. D. Reduction of environmental tobacco smoke exposure among asthmatic children: a controlled trial. Chest. 1994 Aug;106(2):440–446. doi: 10.1378/chest.106.2.440. [DOI] [PubMed] [Google Scholar]
  20. Huss K., Rand C. S., Butz A. M., Eggleston P. A., Murigande C., Thompson L. C., Schneider S., Weeks K., Malveaux F. J. Home environmental risk factors in urban minority asthmatic children. Ann Allergy. 1994 Feb;72(2):173–177. [PubMed] [Google Scholar]
  21. Hymowitz N. A survey of pediatric office-based interventions on smoking. N J Med. 1995 Oct;92(10):657–660. [PubMed] [Google Scholar]
  22. Irvine L., Crombie I. K., Clark R. A., Slane P. W., Feyerabend C., Goodman K. E., Cater J. I. Advising parents of asthmatic children on passive smoking: randomised controlled trial. BMJ. 1999 May 29;318(7196):1456–1459. doi: 10.1136/bmj.318.7196.1456. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Jaakkola M. S., Jaakkola J. J. Assessment of exposure to environmental tobacco smoke. Eur Respir J. 1997 Oct;10(10):2384–2397. doi: 10.1183/09031936.97.10102384. [DOI] [PubMed] [Google Scholar]
  24. Lister S. M., Jorm L. R. Parental smoking and respiratory illnesses in Australian children aged 0-4 years: ABS 1989-90 National Health Survey results. Aust N Z J Public Health. 1998 Dec;22(7):781–786. doi: 10.1111/j.1467-842x.1998.tb01493.x. [DOI] [PubMed] [Google Scholar]
  25. Matt G. E., Wahlgren D. R., Hovell M. F., Zakarian J. M., Bernert J. T., Meltzer S. B., Pirkle J. L., Caudill S. Measuring environmental tobacco smoke exposure in infants and young children through urine cotinine and memory-based parental reports: empirical findings and discussion. Tob Control. 1999 Autumn;8(3):282–289. doi: 10.1136/tc.8.3.282. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. McIntosh N. A., Clark N. M., Howatt W. F. Reducing tobacco smoke in the environment of the child with asthma: a cotinine-assisted, minimal-contact intervention. J Asthma. 1994;31(6):453–462. doi: 10.3109/02770909409089487. [DOI] [PubMed] [Google Scholar]
  27. Meltzer S. B., Hovell M. F., Meltzer E. O., Atkins C. J., de Peyster A. Reduction of secondary smoke exposure in asthmatic children: parent counseling. J Asthma. 1993;30(5):391–400. doi: 10.3109/02770909309056743. [DOI] [PubMed] [Google Scholar]
  28. Moskowitz J. M., Lin Z., Hudes E. S. The impact of California's smoking ordinances on worksite smoking policy and exposure to environmental tobacco smoke. Am J Health Promot. 1999 May-Jun;13(5):278-81, iii. doi: 10.4278/0890-1171-13.5.278. [DOI] [PubMed] [Google Scholar]
  29. Murray A. B., Morrison B. J. The decrease in severity of asthma in children of parents who smoke since the parents have been exposing them to less cigarette smoke. J Allergy Clin Immunol. 1993 Jan;91(1 Pt 1):102–110. doi: 10.1016/0091-6749(93)90302-v. [DOI] [PubMed] [Google Scholar]
  30. Narce-Valente S., Kligman E. W. Increasing physician screening and counseling for passive smoking. J Fam Pract. 1992 Jun;34(6):722–728. [PubMed] [Google Scholar]
  31. Pierce J. P., Gilpin E. How long will today's new adolescent smoker be addicted to cigarettes? Am J Public Health. 1996 Feb;86(2):253–256. doi: 10.2105/ajph.86.2.253. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Pirkle J. L., Flegal K. M., Bernert J. T., Brody D. J., Etzel R. A., Maurer K. R. Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA. 1996 Apr 24;275(16):1233–1240. [PubMed] [Google Scholar]
  33. Russos S., Keating K., Hovell M. F., Jones J. A., Slymen D. J., Hofstetter C. R., Rubin B., Morrison T. Counseling youth in tobacco-use prevention: determinants of clinician compliance. Prev Med. 1999 Jul;29(1):13–21. doi: 10.1006/pmed.1999.0495. [DOI] [PubMed] [Google Scholar]
  34. Slymen D. J., Hovell M. F. Cluster versus individual randomization in adolescent tobacco and alcohol studies: illustrations for design decisions. Int J Epidemiol. 1997 Aug;26(4):765–771. doi: 10.1093/ije/26.4.765. [DOI] [PubMed] [Google Scholar]
  35. Sweda E. L., Jr, Gottlieb M. A., Porfiri R. C. Protecting children from exposure to environmental tobacco smoke. Tob Control. 1998 Spring;7(1):1–2. doi: 10.1136/tc.7.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Thompson B., Emmons K., Abrams D., Ockene J. K., Feng Z. ETS exposure in the workplace. Perceptions and reactions by employees in 114 work sites. Working Well Research Group [corrected]. J Occup Environ Med. 1995 Sep;37(9):1086–1092. [PubMed] [Google Scholar]
  37. Vineis P., Ronco G., Ciccone G., Vernero E., Troia B., D'Incalci T., Gogliani F. Prevention of exposure of young children to parental tobacco smoke: effectiveness of an educational program. Tumori. 1993 Jun 30;79(3):183–186. doi: 10.1177/030089169307900304. [DOI] [PubMed] [Google Scholar]
  38. Wahlgren D. R., Hovell M. F., Meltzer S. B., Hofstetter C. R., Zakarian J. M. Reduction of environmental tobacco smoke exposure in asthmatic children. A 2-year follow-up. Chest. 1997 Jan;111(1):81–88. doi: 10.1378/chest.111.1.81. [DOI] [PubMed] [Google Scholar]
  39. Wahlgren D. R., Hovell M. F., Slymen D. J., Conway T. L., Hofstetter C. R., Jones J. A. Predictors of tobacco use initiation in adolescents: a two-year prospective study and theoretical discussion. Tob Control. 1997 Summer;6(2):95–103. doi: 10.1136/tc.6.2.95. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Wall M. A., Severson H. H., Andrews J. A., Lichtenstein E., Zoref L. Pediatric office-based smoking intervention: impact on maternal smoking and relapse. Pediatrics. 1995 Oct;96(4 Pt 1):622–628. [PubMed] [Google Scholar]
  41. Winkelstein M. L., Tarzian A., Wood R. A. Parental smoking behavior and passive smoke exposure in children with asthma. Ann Allergy Asthma Immunol. 1997 Apr;78(4):419–423. doi: 10.1016/S1081-1206(10)63206-1. [DOI] [PubMed] [Google Scholar]
  42. Woodward A., Owen N., Grgurinovich N., Griffith F., Linke H. Trial of an intervention to reduce passive smoking in infancy. Pediatr Pulmonol. 1987 May-Jun;3(3):173–178. doi: 10.1002/ppul.1950030311. [DOI] [PubMed] [Google Scholar]

Articles from Tobacco Control are provided here courtesy of BMJ Publishing Group

RESOURCES