Air Quality Committee of the Central Environment Council. 2009. (accessed 28 April 2017)

Becquemin MH, Swift DL, Bouchikhi A, Roy M, Teillac A Particle deposition and resistance in the noses of adults and children. Eur Respir J. 1991; 4:(6)694-702

Bernert JT, McGuffey JE, Morrison MA, Pirkle JL Comparison of serum and salivary cotinine measurements by a sensitive high-performance liquid chromatography-tandem mass spectrometry method as an indicator of exposure to tobacco smoke among smokers and nonsmokers. J Anal Toxicol. 2000; 24:(5)333-9

Daly JB, Wiggers JH, Considine RJ Infant exposure to environmental tobacco smoke: a prevalence study in Australia. Aus N Z J Public Health. 2001; 25:(2)132-7

Daly JB, Wiggers JH, Burrows S, Freund M Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?. Aus N Z J Public Health. 2010; 34:(3)269-73

Dempsey D, Jacob P, Benowitz NL Nicotine metabolism and elimination kinetics in newborns. Clin Pharmacol Ther. 2000; 67:(5)458-65

DiFranza JR, Aligne CA, Weitzman M Prenatal and postnatal environmental tobacco smoke exposure and children's health. Pediatrics. 2004; 113:(4)1007-1015

International Union Against Cancer. 2008. (accessed 28 April 2017)

Jarvis MJ, Russell M A, Benowitz NL, Feyerabend C Elimination of cotinine from body fluids: implications for noninvasive measurement of tobacco smoke exposure. Am J Public Health. 1988; 78:(6)696-8

Katsumata M, Hirata K, Inagaki H, Hirata S, Kawata T Evaluation of New Saliva Collection Device for Determination of Salivary Cotinine, Cortisol, Dehydroepiandrosterone and Testosterone Concentrations. Nihon Eiseigaku Zasshi. 2009; 64:(4)811-6

Kubo S, Adachi K, Nagasaka K, Komagata K, Okubo S Effect of Passive Smoking Maternal and Neonatal Salivary Cotinine Measurements. Nurs Res. 2012; 61:(2)140-4

Ministry of Foreign Affairs of Japan. 2011. (accessed 28 April 2017)

Ministry of Health, Labour and Welfare. 2012. (accessed 28 April 2017)

Ministry of Health, Labour and Welfare. 2013. (accessed 28 April 2017)

Nishida H, 4th edn. Tokyo: Igaku-Shoin; 2012

Seifert JA, Ross CA, Norris JM Validation of a five-question survey to assess a child's exposure to environmental tobacco smoke. Ann Epidemio. 2002; 12:(4)273-7

Seong MW, Hwang JH, Moon JS Neonatal hair nicotine levels and fetal exposure to paternal smoking at home. Am J Epidemiol. 2008; 168:(10)1140-4

United States Department of Health and Human Services. 2006. (accessed 28 April 2017)

Geneva: WHO; 1999

Geneva: WHO; 2007

World Health Organization. 2012. (accessed 28 April 2017)

Geneva: WHO; 2015

Evaluation of infants' exposure to environmental tobacco smoke using salivary cotinine measurements

02 June 2017
12 min read
Volume 25 · Issue 6


This study aimed to determine longitudinal variations in exposure to environmental tobacco smoke (ETS) in the home among infants in Japan, and the association between infants' exposure to ETS and their living environment using salivary cotinine measurements. Data collected from 71 pairs of infants and their mothers at a general hospital over 10 months, starting 1 month after birth, were analysed using McNemer's test and Cochran's Q test as well as risk rates and 95% confidence intervals. The results showed that cotinine levels, where detected, were significantly higher in infants than in mothers living in the same household (P=0.022). The cotinine detection rates in infants who lived with smokers were significantly higher than in those who did not (risk rate=1.890) as early as 1 month after birth. These findings should therefore be communicated to smoking households to prevent ETS exposure among infants.

Many studies have elucidated the relationship between exposure to environmental tobacco smoke (ETS) and damage to health in children. The World Health Organization (WHO) (1999) performed a large-scale systematic review concerning the effects of exposure to ETS on infant health, and indicated that the risk of diseases of the lower respiratory tract increased 1.7 times in children with mothers who smoked, and was 1.3 times higher in children living with smoking fathers than in children not exposed to ETS. Furthermore, the risk of acute or chronic otorhinological diseases increased by 1.2%–1.4% in children living with two smoking parents compared to children living with non-smoking parents, and the risk of sudden infant death syndrome was five times greater in children whose mothers smoked than in children whose mothers did not. Furthermore, childhood exposure to ETS is associated with learning disabilities, behavioural problems, and speech disorders. DiFranza et al (2004) reported that living with two smoking parents increased the risk of paediatric asthma associated with exposure to ETS by 1.37%, and that exposure to ETS was associated with behavioural problems, cognitive impairment, and increased likelihood of smoking during adolescence. The WHO (2007) claims that ‘smoke-free policies protect health; where they are introduced, exposure to second-hand smoke falls and health improves’. Therefore, promoting smoke-free environments is essential to protect infant health.

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