Environmental tobacco smoke exposure in children: household and community determinants.

To determine the most important sources of environmental tobacco smoke exposure to young children, the authors studied the associations among urinary cotinine, reported household smoking habits, and socioeconomic variables in 575 schoolchildren aged 6-11 y. The school children were among a population of prodigious smokers in Cape Town, South Africa. Eighty percent of the children were exposed to environmental tobacco smoke. Maternal smoking, which was adjusted for creatinine, accounted for 21.8% of the variation in urinary cotinine--more than all other sources combined. The male parent and other household smokers accounted for 12.7% of the variation, and socioeconomic indicators explained an additional 4.8%. By defining the ecological variable of smoking prevalence per school, the authors estimated a "community" contribution of 3.3%. The relative importance of different sources of smoke should be taken into account in the prevention of environmental tobacco smoke exposure in young children. Most importantly, of all the sources of environmental tobacco smoke, mothers' smoking habits had the greatest impact on exposure to children.