Introduction: Second-hand smoke exposure (SHS) in children remains as a major pollution problem, with important consequences for children's health. This study aimed to identify the sources of exposure to SHS among 4-year-old children, comparing self-reports to a urinary biomarker of exposure, and characterize the most important variables related to SHS exposure in this population.
Methods: 4-year-old children's exposure to SHS was assessed by a parental-reported questionnaire and by urinary cotinine (UC) measurements in 1757 participants from 4 different areas of the Spanish INMA Project. The questionnaire about SHS included information about smoking habits at home by household members, and about exposure to SHS in other places including other homes, bars, restaurants or transportation. The association between quantified UC levels (44 ng/ml) and sociodemographic variables and the different sources of SHS exposure was examined using logistic regression.
Results: Based on parental reports, 21.6% of the children were exposed to SHS at home and 47.1% elsewhere; making a total 55.9% of the children exposed to SHS. In addition, 28.2% of the children whose parents reported being not regularly exposed to SHS had quantified UC values. Children from younger mothers had a higher odds of exposure to SHS, as well as from families with a lower educational level. The odds of quantifiable UC in children dropped after the smoking ban in public places. Regarding the sources of SHS exposure we observed that quantifiable UC odds was increased in children whose parents smoked at home in their presence or in children attending other confined places, mainly other houses where people smoked.
Conclusions: Children's SHS exposure is nowadays an unresolved major public health problem in Spain. After the ban of smoking in public places health care professionals should put more emphasis to the parents on the importance of controlling the exposure of their children in private spaces.

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Keywords Biological monitoring, Cotinine, Passive smoking, Preschool children, SHS
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Journal Environmental Research
Aurrekoetxea, J.J, Murcia, M, Rebagliato, M, Guxens Junyent, M, Fernández-Somoano, A, López, M.J, … Santa-Marina, L. (2016). Second-hand smoke exposure in 4-year-old children in Spain: Sources, associated factors and urinary cotinine. Environmental Research, 145, 116–125. doi:10.1016/j.envres.2015.11.028