7 Month Old Baby Co Sleeping With Dad Who Had One Cigar
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Abstruse
This written report examines mothers' and fathers' smoking patterns in different kinds of smoking households, and assesses their relative contribution to infants' exposure to environmental tobacco smoke. It uses data from a cross-sectional survey of 314 smoking households (infants: mean age 10 weeks) in Coventry and Birmingham, England, examining reported tobacco consumption and objective measures of exposure: the written report baby's urinary cotinine:creatinine ratios and their mother's salivary cotinine. The study shows that both mothers' and fathers' tobacco smoke make substantial contributions to infant exposure to tobacco fume. Households were more likely to contain a smoking father than mother, with over two-thirds of households including a smoking father. In households where both parents smoke, fathers' tobacco consumption was establish to be significantly higher than in households where just the father smokes. This suggests that the interaction between parents needs to be considered rather than focusing on mothers' or fathers' smoking behaviour in isolation. The implications for wellness promotion programmes are discussed, particularly the demand to place more emphasis on tackling fathers' smoking. Currently, fathers' smoking receives far less inquiry or health promotion attention than mothers' smoking. Protecting infants from fathers' as well as mothers' smoking is key to reducing environmental tobacco exposure in early infancy, when the risk of Sudden Infant Death is highest.
Introduction
Children'due south exposure to environmental tobacco smoke continues to be an area of public health business organisation. It is associated with a number of poor child health outcomes, including asthma and other respiratory conditions, otitis media, and conductive deafness ( Etzel et al., 1992; Chilmonczyk et al., 1993). Among infants, passive smoking is a take chances factor for Sudden Infant Expiry Syndrome (Department of Health, 1996), although the evidence suggests that prenatal exposure is more important than exposure in the postnatal period (Sullivan and Barlow, 2001). Although health promotion campaigns to reduce the number of deaths from Sudden Infant Death Syndrome accept been associated with improvements in some risk factors such as sleeping position and use of bed coverings, smoking behaviours in infant households announced to have been less influenced (Hiley and Morley, 1994). Equally a high proportion of Sudden Baby Deaths occur in smoking households ( Blair et al., 1996), at that place is an imperative to understand smoking patterns and influences on smoking in baby households. Reducing exposure to environmental tobacco smoke, particularly exposure to parental tobacco smoke in infancy, is probable to bring about meaning improvements in infant wellness ( Nafstad et al., 1997; Margolis et al., 1998).
The majority of exposure to environmental tobacco smoke occurs within the habitation and the major source is parental smoking ( Jarvis et al., 1992, 2000). Other people's tobacco fume in the habitation and exposure exterior of the home has been shown to exist quantitatively less important in children ( Cook et al., 1994; Jarvis et al., 2000). Mothers' smoking has been shown to exist the most harmful ( Cook et al., 1994), and has been the focus for inquiry and of wellness promotion programmes to reduce passive smoking among infants and children. Fathers' smoking has received significantly less attending, but has also been linked with agin wellness outcomes. Previous work has indicated that for respiratory illness in infancy, the effect of male parent's smoking in households where the female parent does not smoke is statistically significant (Cook and Strachan, 1999).
Understanding smoking and babe exposure patterns in households with infants is primal to the evolution of programmes that aim to reduce death rates from Sudden Infant Death Syndrome, promote smoking cessation and encourage the use of harm reduction strategies in households with infants. Yet, at that place are few data on smoking patterns and habits in households with infants. While a number of studies offer some indicative evidence, they lack the level of detail or generalizability to the wider population of infants. A number of studies study on smoking patterns in households with older children, of which a large proportion report on the link between children's exposure to tobacco smoke and poor health outcomes amid children with specific wellness weather condition such as asthma ( Emerson et al., 1994; Strachan and Cook, 1997; Wakefield et al., 2000a). These studies are likely to be poor indicators of smoking patterns in the wider population, equally there is evidence of lower household smoking levels and environmental tobacco exposure in children with these conditions ( Berman et al., 2003). Although a number of studies take examined smoking patterns and ecology tobacco fume exposure in households with historic period ranges which include infants, only a pocket-sized number have studied infant households exterior of the infirmary setting ( Nafstad et al., 1997; Erikson et al., 1996; Dwyer et al., 1999). These studies offer no insights into how tobacco consumption patterns may differ betwixt different people in different types of smoking households with infants.
Few studies have estimated the proportion of infants living with fathers who smoke. While some studies of smoking patterns in households with children have recorded mothers' smoking habits in some item, many accept subsumed fathers' smoking habits within the category of 'other' household smoker. Although smoking rates vary internationally, a small number of studies from North America, the United kingdom of great britain and northern ireland, Italy and Scandinavia that have recorded fathers' smoking status and habits indicated that between l and eighty% of children in smoking households lived with a begetter who smoked ( Dell'Orco et al., 1995; Erikson and Bruusgaard, 1995; Berman et al., 2003).
Detailed tobacco consumption data are cardinal to agreement sources of exposure to tobacco smoke. The study nosotros report here examined, in detail, tobacco smoked by mothers and fathers in infant homes and measured baby smoke exposure using a biologic mensurate (cotinine:creatinine ratios) in a sample of smoking households with infants. Studies of the validity of measures of environmental tobacco fume point that parent-reported measures of tobacco consumption and sources of tobacco smoke are valid and reliable (Matt et al., 1997; Hovell et al., 2000). Estimation of how much nicotine is absorbed requires a biologic measure out. Cotinine, a metabolite of nicotine, has been shown to be a valid quantitative measure of ecology tobacco smoke exposure and correlates well with daily tobacco consumption (Benowitz, 1996; Haufroid and Lison, 1998). Nosotros have plant no other published studies that study, in item, on differences in tobacco consumption between mothers and fathers in various types of smoking households, and examine how different categories of parental smokers contribute to the full amount of tobacco smoke infants are exposed to in early on infancy.
Methods
Nosotros used a cantankerous-sectional survey design to collect data from a population-based sample of primary carers of young infants living in smoking households. All main carers of all infants born to mothers living within the boundaries of two Community NHS Trusts in the Due west Midlands, England, over a ix-month menstruum were asked to participate by their family unit health visitors at the first or second visit to the new babe. Parents of infants with a major perinatal affliction were excluded. Trained nurse interviewers using a structured interview schedule interviewed participants, 98% of whom were the infant's mothers, at dwelling house. Participants whose outset language was not English were given the opportunity to be interviewed with the aid of an interpreter in their own language. Interviews took place when infants were between 4 and 24 weeks old.
Participants were asked about their own, their partner's and other household residents' tobacco consumption: usual total consumption, consumption in the house and in the house in the 48 hours prior to the interview. Information on tobacco consumption in the 48 hours prior to the interview were collected and then that consumption data could be correlated with urinary cotinine:creatinine ratio data. Data were as well collected on sociodemographic characteristics and fabric living conditions. If consent was obtained, a sample of the infant'southward urine for interpretation of the urinary cotinine:creatinine ratio was collected. Urinary cotinine was estimated using ELISA, a competitive enzyme immunoassay method that has the specificity and sensitivity to detect urinary cotinine in infant urine, where cotinine levels may exist very depression. The ratio of cotinine (ng/ml) to creatinine (mmol/l) was measured to suit for the effect of fluid dilution. Only canteen fed babies were included in this analysis equally nicotine and cotinine are transmitted through breast milk ( Mascola et al., 1998). The number of canteen-fed infants with urine samples in households where neither parent smoked but with another resident smoker was to modest for meaningful analyses, thus urinary continine:creatinine ratios are not reported. Participants were asked to provide a sample of saliva for cotinine estimation so that reported consumption could exist examined against a biologic measure out of tobacco consumption.
For data analysis purposes, smoking households were divers as households with a resident who smoked tobacco (cigarettes, pipes or cigars). Frequencies and bivariate analyses were used to depict and assess differences in smoking patterns between households. Equally cigarette consumption, urinary cotinine:creatinine ratio and salivary cotinine data were non usually distributed, the median values were recorded and non-parametric tests (Mann–Whitney U) were used to examine differences. To test between-group differences in the frequency distribution of categorical variables we used the Pearson χ2 test, except in the example of 2 × ii tables, when the Yates' Correction for Continuity was recorded (Pallet, 2001). The data reported in this newspaper are for cigarette consumption only (only 13 smoking households contained cigar smokers who smoked 1 or more cigars per month and 2 households independent a male parent who smoked pipe tobacco).
Results
In total, 314 smoking households with immature infants were recruited to the report. At the fourth dimension of the interview, the mean historic period of the infants was ten weeks. The sociodemographic characteristics of these households are reported in Table I. Compared to a representative sample of UK households with infants (Department of Wellness, 1997), the study households were more likely to have left school historic period xvi or less and be from a manual or unclassified social course, reflecting the association between tobacco utilize and social disadvantage. The 236 households who declined to have office were more likely to be younger and from a black or minority ethnic group. The proportions of participants from black and minority ethnic groups were, however, similar to those in the communities from which they were recruited.
Tabular array I.
Sociodemographic characteristics of respondents
| Household characteristics | N | % |
|---|---|---|
| Housing tenure | ||
| owner-occupied | 147 | 46.viii |
| rented and other | 167 | 53.2 |
| Family size (no. of children) | ||
| 1 | 108 | 34.4 |
| two–6 | 182 | 62.two |
| 7+ | 12 | three.8 |
| Marital status | ||
| married/co-habiting | 268 | 85.four |
| unmarried parent | 46 | fourteen.half-dozen |
| Ethnicity | ||
| White European | 258 | 82.2 |
| Black | 12 | 3.8 |
| Asian | 39 | 12.iv |
| mixed/other | five | 1.6 |
| Social grade of household | ||
| not-manual | 70 | 22.3 |
| manual | 145 | 46.2 |
| unclassified (missing 2) | 97 | 30.ix |
| Household income (£/year) | ||
| <ten 000 | 133 | 42.four |
| 10 000–29 999 | 120 | 38.2 |
| ≥30 000 | 61 | 19.4 |
| Overcrowding (excluding kitchen, bath and toilet) | ||
| ≤ane room per person | 103 | 32.eight |
| >1 room per person (missing 7) | 204 | 65.0 |
| Principal carer's educational qualifications | ||
| no qualifications | 72 | 22.9 |
| qualifications | 242 | 77.1 |
| Household characteristics | N | % |
|---|---|---|
| Housing tenure | ||
| owner-occupied | 147 | 46.8 |
| rented and other | 167 | 53.2 |
| Family size (no. of children) | ||
| 1 | 108 | 34.4 |
| 2–6 | 182 | 62.two |
| 7+ | 12 | 3.8 |
| Marital condition | ||
| married/co-habiting | 268 | 85.4 |
| single parent | 46 | xiv.half dozen |
| Ethnicity | ||
| White European | 258 | 82.ii |
| Black | 12 | iii.viii |
| Asian | 39 | 12.4 |
| mixed/other | 5 | 1.vi |
| Social class of household | ||
| not-transmission | 70 | 22.3 |
| manual | 145 | 46.2 |
| unclassified (missing 2) | 97 | 30.9 |
| Household income (£/year) | ||
| <10 000 | 133 | 42.4 |
| x 000–29 999 | 120 | 38.2 |
| ≥30 000 | 61 | 19.4 |
| Overcrowding (excluding kitchen, bathroom and toilet) | ||
| ≤1 room per person | 103 | 32.viii |
| >1 room per person (missing 7) | 204 | 65.0 |
| Primary carer's educational qualifications | ||
| no qualifications | 72 | 22.9 |
| qualifications | 242 | 77.1 |
Table I.
Sociodemographic characteristics of respondents
| Household characteristics | North | % |
|---|---|---|
| Housing tenure | ||
| owner-occupied | 147 | 46.eight |
| rented and other | 167 | 53.2 |
| Family unit size (no. of children) | ||
| 1 | 108 | 34.4 |
| two–6 | 182 | 62.2 |
| 7+ | 12 | 3.8 |
| Marital condition | ||
| married/co-habiting | 268 | 85.4 |
| unmarried parent | 46 | 14.6 |
| Ethnicity | ||
| White European | 258 | 82.2 |
| Black | 12 | 3.viii |
| Asian | 39 | 12.four |
| mixed/other | 5 | 1.half dozen |
| Social course of household | ||
| non-transmission | 70 | 22.3 |
| manual | 145 | 46.2 |
| unclassified (missing 2) | 97 | xxx.9 |
| Household income (£/year) | ||
| <ten 000 | 133 | 42.4 |
| ten 000–29 999 | 120 | 38.2 |
| ≥30 000 | 61 | nineteen.4 |
| Overcrowding (excluding kitchen, bathroom and toilet) | ||
| ≤1 room per person | 103 | 32.viii |
| >1 room per person (missing 7) | 204 | 65.0 |
| Main carer's educational qualifications | ||
| no qualifications | 72 | 22.9 |
| qualifications | 242 | 77.ane |
| Household characteristics | Northward | % |
|---|---|---|
| Housing tenure | ||
| owner-occupied | 147 | 46.8 |
| rented and other | 167 | 53.ii |
| Family size (no. of children) | ||
| 1 | 108 | 34.4 |
| ii–half-dozen | 182 | 62.2 |
| 7+ | 12 | three.8 |
| Marital status | ||
| married/co-habiting | 268 | 85.4 |
| unmarried parent | 46 | fourteen.half dozen |
| Ethnicity | ||
| White European | 258 | 82.two |
| Black | 12 | 3.eight |
| Asian | 39 | 12.four |
| mixed/other | 5 | 1.6 |
| Social class of household | ||
| non-manual | 70 | 22.3 |
| manual | 145 | 46.2 |
| unclassified (missing two) | 97 | thirty.9 |
| Household income (£/year) | ||
| <ten 000 | 133 | 42.iv |
| ten 000–29 999 | 120 | 38.ii |
| ≥30 000 | 61 | nineteen.4 |
| Overcrowding (excluding kitchen, bathroom and toilet) | ||
| ≤1 room per person | 103 | 32.8 |
| >1 room per person (missing vii) | 204 | 65.0 |
| Main carer'due south educational qualifications | ||
| no qualifications | 72 | 22.9 |
| qualifications | 242 | 77.1 |
We classified smoking households according to the smoking status of the study babe's parent(s) (Tabular array 2). The most prevalent type of smoking household was those where only the father smoked and the to the lowest degree prevalent was those where the report infant's parent(due south) did not fume, only where there was some other resident smoker. A slightly greater pct of infants (67.5%) lived with a father smoker than a mother smoker (60.8%) (Tabular array II). The data for infants in households with no parent smokers, just where another smoker was resident, are not presented in the remaining sections of this paper as numbers were too small for meaningful analyses (n = 10).
Table II.
Smoking status of the parents of infants living in smoking households
| | N | % |
|---|---|---|
| Parental smoking condition | ||
| mother just smokes | 92 | 29.3 |
| father but smokes | 113 | 36.0 |
| both parents smoke | 99 | 31.5 |
| neither parent smokes but other resident smoker | x | 3.ii |
| Households containing a mother who smokes | 191 | 60.viii |
| Households containing a begetter who smokes | 212 | 67.five |
| | N | % |
|---|---|---|
| Parental smoking status | ||
| female parent merely smokes | 92 | 29.3 |
| father just smokes | 113 | 36.0 |
| both parents smoke | 99 | 31.5 |
| neither parent smokes only other resident smoker | ten | three.two |
| Households containing a mother who smokes | 191 | sixty.8 |
| Households containing a father who smokes | 212 | 67.5 |
Table 2.
Smoking status of the parents of infants living in smoking households
| | N | % |
|---|---|---|
| Parental smoking status | ||
| mother only smokes | 92 | 29.3 |
| father only smokes | 113 | 36.0 |
| both parents smoke | 99 | 31.5 |
| neither parent smokes but other resident smoker | ten | 3.2 |
| Households containing a mother who smokes | 191 | lx.eight |
| Households containing a father who smokes | 212 | 67.5 |
| | N | % |
|---|---|---|
| Parental smoking status | ||
| female parent only smokes | 92 | 29.iii |
| father simply smokes | 113 | 36.0 |
| both parents smoke | 99 | 31.5 |
| neither parent smokes just other resident smoker | 10 | iii.two |
| Households containing a mother who smokes | 191 | lx.8 |
| Households containing a begetter who smokes | 212 | 67.5 |
Table III examines mothers' and fathers' usual cigarette consumption. There were no meaning differences between the median number of cigarettes mothers' and fathers' usually smoked in total. However, the median number of cigarettes usually smoked by mothers in the house was significantly higher than that of fathers. A significantly higher proportion of mothers smoked in the house than fathers.
Table III.
Usual cigarette consumption as reported past principal carer
| Usual cigarette consumption | Mothers | Fathers | P |
|---|---|---|---|
| Median total daily cigarette consumption | 11.ix (189)a | 12.9 (200)b | 0.127 |
| Median daily cigarette consumption in the house | 6.0 (185)c | three.7 (194)d | <0.001 |
| Usually smoked daily in the house | |||
| 0 cigarettes smoked in firm | 18.9% (35) | 35.6% (69) | <0.001 |
| ≥1 cigarettes per twenty-four hours | 81.one% (150) | 64.4% (125) | |
| Usual cigarette consumption | Mothers | Fathers | P |
|---|---|---|---|
| Median total daily cigarette consumption | eleven.9 (189)a | 12.9 (200)b | 0.127 |
| Median daily cigarette consumption in the house | 6.0 (185)c | 3.7 (194)d | <0.001 |
| Unremarkably smoked daily in the house | |||
| 0 cigarettes smoked in house | 18.9% (35) | 35.half dozen% (69) | <0.001 |
| ≥1 cigarettes per day | 81.1% (150) | 64.iv% (125) | |
Missing cases: a n = 2, b due north = 12, c due north = half-dozen, d due north = 18.
Table III.
Usual cigarette consumption as reported by main carer
| Usual cigarette consumption | Mothers | Fathers | P |
|---|---|---|---|
| Median total daily cigarette consumption | xi.9 (189)a | 12.9 (200)b | 0.127 |
| Median daily cigarette consumption in the house | 6.0 (185)c | 3.7 (194)d | <0.001 |
| Commonly smoked daily in the house | |||
| 0 cigarettes smoked in house | 18.9% (35) | 35.6% (69) | <0.001 |
| ≥i cigarettes per day | 81.i% (150) | 64.iv% (125) | |
| Usual cigarette consumption | Mothers | Fathers | P |
|---|---|---|---|
| Median total daily cigarette consumption | 11.9 (189)a | 12.ix (200)b | 0.127 |
| Median daily cigarette consumption in the house | vi.0 (185)c | iii.7 (194)d | <0.001 |
| Usually smoked daily in the firm | |||
| 0 cigarettes smoked in house | 18.ix% (35) | 35.6% (69) | <0.001 |
| ≥ane cigarettes per 24-hour interval | 81.1% (150) | 64.4% (125) | |
Missing cases: a due north = 2, b north = 12, c north = half-dozen, d north = 18.
Tabular array Iv examines cigarette consumption for mothers and fathers co-ordinate to whether they alive with a partner who smoked. When cigarette consumption among mothers in mother-but smoking households was compared with those for mothers living in households where both parents smoked, there were no meaning differences for whatever of the measures. A different blueprint emerged among fathers. Fathers living in both-parent smoking households, when compared to those in father-only smoking households, were reported as having a college median usual daily cigarette consumption in total, a higher median usual daily cigarette consumption in the house and a higher median cigarette consumption in the firm during the 48 hours prior to the interview.
Table Iv.
Mothers' and fathers' cigarette consumption in female parent-only, male parent-only and both parent smoking households
| | Mothers living in | Fathers living in | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| | Female parent-only smoking households | Both-parent smoking households | P | Father-only smoking households | Both-parent smoking households | P | ||||
| Usual daily cigarette consumption in total | ||||||||||
| Median | 11.iv (91)a | 12.0 (99)b | 0.618 | 12.ane (107)c | 15 (93)d | 0.013 | ||||
| 1–9 cigarettes | 28.61% (26) | 32.7% (33) | 0.653 | 35.8% (39) | 20.iv% (xix) | 0.025 | ||||
| ≥10 cigarettes | 71.four% (65) | 68.3% (66) | 64.2% (68) | 79.6% (74) | ||||||
| Usual daily consumption in the house | ||||||||||
| Median | 5.4 (89)e | 6.ane (96)f | 0.131 | 0.7 (104)thousand | 5.half-dozen (89)h | <0.001 | ||||
| 0 cigarettes | 22.5% (20) | xv.6% (fifteen) | 0.317 | 49.5% (51) | 21.three% (nineteen) | <0.001 | ||||
| ≥i cigarettes | 77.5% (69) | 84.four% (81) | l.5% (53) | 78.vii% (lxx) | ||||||
| 0–nine cigarettes | 73.0% (65) | 66.seven% (64) | 0.434 | 88.5% (92) | 67.8% (60) | <0.001 | ||||
| ≥10 cigarettes | 27.0% (24) | 33.3% (32) | 11.5% (12) | 32.ii% (29) | ||||||
| Consumption in house last 48 hours | ||||||||||
| Median | seven.5% (86)i | 10.0 (97)j | 0.359 | 3.0 (107)k | 10.0 (97)l | <0.001 | ||||
| 0 cigarettes | 23.3% (xx) | 21.6% (21) | 0.934 | 45.8% (49) | 18.half-dozen% (18) | <0.001 | ||||
| ≥1 cigarettes | 76.7% (66) | 78.4% (76) | 54.ii% (58) | 81.four% (79) | ||||||
| 0–ix cigarettes | 52.iii% (45) | 38.1% (37) | 0.076 | 71.0%( 76) | 42.three% (41) | <0.001 | ||||
| ≥ten cigarettes | 47.seven% (41) | 61.nine% (sixty) | | 29.0% (31) | 57.7% (56) | | ||||
| | Mothers living in | Fathers living in | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| | Mother-merely smoking households | Both-parent smoking households | P | Begetter-only smoking households | Both-parent smoking households | P | ||||
| Usual daily cigarette consumption in full | ||||||||||
| Median | xi.4 (91)a | 12.0 (99)b | 0.618 | 12.1 (107)c | fifteen (93)d | 0.013 | ||||
| 1–9 cigarettes | 28.61% (26) | 32.7% (33) | 0.653 | 35.8% (39) | 20.4% (19) | 0.025 | ||||
| ≥10 cigarettes | 71.4% (65) | 68.3% (66) | 64.ii% (68) | 79.6% (74) | ||||||
| Usual daily consumption in the house | ||||||||||
| Median | 5.4 (89)e | 6.i (96)f | 0.131 | 0.7 (104)m | 5.half-dozen (89)h | <0.001 | ||||
| 0 cigarettes | 22.five% (20) | 15.6% (15) | 0.317 | 49.five% (51) | 21.3% (nineteen) | <0.001 | ||||
| ≥1 cigarettes | 77.5% (69) | 84.4% (81) | fifty.5% (53) | 78.seven% (70) | ||||||
| 0–9 cigarettes | 73.0% (65) | 66.7% (64) | 0.434 | 88.five% (92) | 67.8% (lx) | <0.001 | ||||
| ≥10 cigarettes | 27.0% (24) | 33.3% (32) | 11.5% (12) | 32.2% (29) | ||||||
| Consumption in business firm final 48 hours | ||||||||||
| Median | 7.v% (86)i | 10.0 (97)j | 0.359 | three.0 (107)k | 10.0 (97)l | <0.001 | ||||
| 0 cigarettes | 23.three% (20) | 21.6% (21) | 0.934 | 45.8% (49) | 18.6% (18) | <0.001 | ||||
| ≥one cigarettes | 76.7% (66) | 78.iv% (76) | 54.ii% (58) | 81.4% (79) | ||||||
| 0–9 cigarettes | 52.3% (45) | 38.one% (37) | 0.076 | 71.0%( 76) | 42.iii% (41) | <0.001 | ||||
| ≥10 cigarettes | 47.vii% (41) | 61.ix% (60) | | 29.0% (31) | 57.7% (56) | | ||||
Missing cases: a due north = 1, b n = 0, c n = 6, d due north = 6, e n = 3, f n = 3, g n = 11, h n = 10, i n = 6, j northward = 2, k northward = half-dozen, l north = 6.
Table IV.
Mothers' and fathers' cigarette consumption in mother-only, male parent-simply and both parent smoking households
| | Mothers living in | Fathers living in | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| | Mother-only smoking households | Both-parent smoking households | P | Father-just smoking households | Both-parent smoking households | P | ||||
| Usual daily cigarette consumption in total | ||||||||||
| Median | eleven.four (91)a | 12.0 (99)b | 0.618 | 12.1 (107)c | fifteen (93)d | 0.013 | ||||
| 1–9 cigarettes | 28.61% (26) | 32.vii% (33) | 0.653 | 35.eight% (39) | 20.4% (nineteen) | 0.025 | ||||
| ≥10 cigarettes | 71.four% (65) | 68.3% (66) | 64.2% (68) | 79.6% (74) | ||||||
| Usual daily consumption in the house | ||||||||||
| Median | 5.4 (89)e | vi.1 (96)f | 0.131 | 0.7 (104)g | v.six (89)h | <0.001 | ||||
| 0 cigarettes | 22.5% (twenty) | 15.half dozen% (fifteen) | 0.317 | 49.v% (51) | 21.three% (19) | <0.001 | ||||
| ≥one cigarettes | 77.5% (69) | 84.4% (81) | 50.five% (53) | 78.vii% (lxx) | ||||||
| 0–ix cigarettes | 73.0% (65) | 66.7% (64) | 0.434 | 88.5% (92) | 67.eight% (60) | <0.001 | ||||
| ≥x cigarettes | 27.0% (24) | 33.3% (32) | 11.5% (12) | 32.ii% (29) | ||||||
| Consumption in house last 48 hours | ||||||||||
| Median | 7.five% (86)i | 10.0 (97)j | 0.359 | 3.0 (107)k | ten.0 (97)l | <0.001 | ||||
| 0 cigarettes | 23.iii% (xx) | 21.six% (21) | 0.934 | 45.8% (49) | 18.6% (xviii) | <0.001 | ||||
| ≥1 cigarettes | 76.7% (66) | 78.4% (76) | 54.2% (58) | 81.4% (79) | ||||||
| 0–9 cigarettes | 52.3% (45) | 38.i% (37) | 0.076 | 71.0%( 76) | 42.3% (41) | <0.001 | ||||
| ≥x cigarettes | 47.seven% (41) | 61.9% (sixty) | | 29.0% (31) | 57.7% (56) | | ||||
| | Mothers living in | Fathers living in | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| | Mother-only smoking households | Both-parent smoking households | P | Father-only smoking households | Both-parent smoking households | P | ||||
| Usual daily cigarette consumption in full | ||||||||||
| Median | 11.4 (91)a | 12.0 (99)b | 0.618 | 12.1 (107)c | fifteen (93)d | 0.013 | ||||
| 1–9 cigarettes | 28.61% (26) | 32.7% (33) | 0.653 | 35.8% (39) | 20.four% (xix) | 0.025 | ||||
| ≥10 cigarettes | 71.iv% (65) | 68.iii% (66) | 64.ii% (68) | 79.6% (74) | ||||||
| Usual daily consumption in the firm | ||||||||||
| Median | 5.4 (89)e | vi.i (96)f | 0.131 | 0.7 (104)g | 5.6 (89)h | <0.001 | ||||
| 0 cigarettes | 22.5% (20) | 15.6% (fifteen) | 0.317 | 49.5% (51) | 21.iii% (xix) | <0.001 | ||||
| ≥one cigarettes | 77.5% (69) | 84.4% (81) | 50.5% (53) | 78.seven% (70) | ||||||
| 0–9 cigarettes | 73.0% (65) | 66.7% (64) | 0.434 | 88.five% (92) | 67.8% (60) | <0.001 | ||||
| ≥10 cigarettes | 27.0% (24) | 33.3% (32) | xi.v% (12) | 32.2% (29) | ||||||
| Consumption in house last 48 hours | ||||||||||
| Median | 7.five% (86)i | x.0 (97)j | 0.359 | 3.0 (107)grand | 10.0 (97)fifty | <0.001 | ||||
| 0 cigarettes | 23.three% (xx) | 21.6% (21) | 0.934 | 45.8% (49) | 18.6% (18) | <0.001 | ||||
| ≥ane cigarettes | 76.7% (66) | 78.4% (76) | 54.2% (58) | 81.4% (79) | ||||||
| 0–9 cigarettes | 52.iii% (45) | 38.1% (37) | 0.076 | 71.0%( 76) | 42.iii% (41) | <0.001 | ||||
| ≥10 cigarettes | 47.seven% (41) | 61.9% (60) | | 29.0% (31) | 57.7% (56) | | ||||
Missing cases: a n = i, b north = 0, c n = vi, d n = 6, e n = iii, f northward = 3, 1000 due north = 11, h north = 10, i n = 6, j n = 2, k due north = half-dozen, l n = 6.
Urinary cotinine:creatinine ratio data were available on 168 of the 239 bottle fed infants in the study. Missing data on the remaining 71 infants were due to some parents refusing consent to take a urine sample or to failure of the babe to produce sufficient urine for assay at the time of the interview. To identify whether infants without urine samples were likely to be different in terms of exposure to tobacco fume, respondents' ain cigarette consumption in the house in the last 48 hours and reported total household tobacco consumption in the house in previous 48 hours was compared for infants with and without urine samples. There were no pregnant differences for either mensurate (respondent's cigarette consumption in the house in last 48 hours: Isle of mann–Whitney U: z = −0.138, P = 0.890; full household consumption in the business firm in terminal 48 hours: Mann–Whitney U: z = −0.182, P = 0.856).
The range of infant urinary cotinine:creatinine ratios for different categories of smoking households is described in Table V. In smoking households, infant urinary cotinine:creatinine ratios were highest in households where both parents smoked and lowest in households with only begetter smokers. Differences in median urinary cotinine:creatinine ratios between the three types of smoking households were statistically pregnant (P < 0.001). Pair-wise comparisons indicated that median urinary cotinine:creatinine ratios were significantly higher in infants in female parent-only smoking households than father-only smoking households (Isle of man–Whitney U: z = −5.170, P < 0.001), in infants in both-parent smoking households than mother-only smoking households (Mann–Whitney U: z = −2.133, P = 0.033) and in infants in both-parent households than begetter-simply smoking households (Mann-Whitney U: z = −6.589, P < 0.001).
Tabular array V.
Infant urinary cotinine:creatinine ratios (creatinine ng/ml:creatinine mmol/l) by household and parental smoking status
| Blazon of households | N | Min | Max | Median |
|---|---|---|---|---|
| All households | 168 | 0.01 | 279.0 | xiv.0 |
| Both parents smoke | 54 | i.11 | 279.0 | 24.3 |
| Mother only smokes | 57 | 1.00 | 200.0 | 16.7 |
| Father only smokes | 53 | 0.01 | 32.9 | 3.three |
| Type of households | N | Min | Max | Median |
|---|---|---|---|---|
| All households | 168 | 0.01 | 279.0 | 14.0 |
| Both parents fume | 54 | 1.11 | 279.0 | 24.3 |
| Mother simply smokes | 57 | 1.00 | 200.0 | xvi.seven |
| Father only smokes | 53 | 0.01 | 32.ix | 3.iii |
Table Five.
Baby urinary cotinine:creatinine ratios (creatinine ng/ml:creatinine mmol/fifty) by household and parental smoking status
| Type of households | N | Min | Max | Median |
|---|---|---|---|---|
| All households | 168 | 0.01 | 279.0 | 14.0 |
| Both parents smoke | 54 | 1.11 | 279.0 | 24.3 |
| Mother only smokes | 57 | 1.00 | 200.0 | 16.7 |
| Begetter only smokes | 53 | 0.01 | 32.9 | 3.3 |
| Type of households | N | Min | Max | Median |
|---|---|---|---|---|
| All households | 168 | 0.01 | 279.0 | 14.0 |
| Both parents smoke | 54 | i.xi | 279.0 | 24.3 |
| Mother simply smokes | 57 | ane.00 | 200.0 | xvi.7 |
| Male parent only smokes | 53 | 0.01 | 32.9 | 3.3 |
Salivary cotinine data were bachelor on 103 main carers, of which 100 were obtained from the infant's mother. Equally only 3 fathers were main carers, data presented here is for mothers only. Missing information resulted from some participants declining to give a saliva sample and from difficultly obtaining a sample from some participants who did agree to give a sample (some participants could non tolerate keeping the dental roll in their oral cavity for 5 minutes). Differences in median self-reported daily cigarette consumption betwixt those with and without a saliva sample were not significant (Mann–Whitney U: z = −ane.09, P = 0.276). Differences in median salivary cotinine levels between mothers in mother-but smoking households and those in both-parent smoking households were not significant (P = 0.086). This supports the findings based on cocky-reported consumption.
Discussion
This paper uses data generated from parental reports of tobacco consumption and smoking habits to examine the relative contribution that mothers' and fathers' tobacco smoke makes to passive smoking among infants. It has generated detailed information on patterns of tobacco consumption and tobacco smoke exposure that raise a number of problems for health promotion. Our study points to the importance of carrying out more detailed analyses of parental tobacco consumption patterns and recording detailed information on fathers' as well as mothers' smoking. Tobacco consumption patterns are complex and vary across different categories of parental smokers. These consumption patterns offer important insights into why environmental tobacco smoke exposure levels vary amid infants and are highest amidst children in households where 2 parents smoke, equally found in this and other studies ( Jarvis et al., 1992; Dell'Orca et al., 1995).
As reported in other studies ( Dell'Orca et al., 1995; Erikson and Bruusgaard, 1995), there was a higher prevalence of infants living in male parent-only smoking households than in mother-only or both-parent smoking households. Overall, infants were more probable to live in a household with a smoking begetter than a smoking mother. The overall design of tobacco consumption identified in this study was that fathers consumed less tobacco in the business firm than mothers. However, a more detailed examination of fathers' smoking behaviour indicated that in households where both parents smoked, fathers' tobacco consumption made a considerable contribution to the total amount of tobacco consumed in the house. Although equally a group, fathers consumed less tobacco in the house than mothers, in households were both parents smoked, fathers' median cigarette consumption was higher than in father-only smoking households. For father smokers, but not mother smokers, living with a partner who smoked was associated with an increment in full tobacco consumption and an increase in tobacco consumption in the babe'due south home.
We found that among mothers, the median number of cigarettes smoked did non vary significantly according to whether they did or did not live with a partner who smoked. Other studies have constitute that women who lived with a partner who smoked were heavier smokers (Graham, 1993) or smoked more in the house (Erikson and Bruusgaard, 1995). A possible explanation for our finding could be that mothers misreported their tobacco consumption. However, salivary cotinine data, used as a biologic measure of mothers' tobacco consumption, likewise showed no significant differences in median tobacco consumption in the 48 hours prior to the interview between mothers. This confirms the finding, based on reported tobacco consumption data, that mothers' tobacco consumption did non vary significantly according to whether they lived in a female parent-just or both-parent smoking household.
A biologic measure of infant fume exposure, continine:creatinine ratios, enabled the relative contribution that mothers' and fathers' tobacco consumption makes to the full amount of smoke their babe absorbed to be examined. Confirming other studies, this study indicates that mothers' tobacco fume makes an important contribution to the total amount of tobacco smoke that infants blot in both mother-only and both-parent smoking households. Urinary cotinine:creatinine ratio values were highest in infants living in households where both parents smoked. As tobacco consumption data suggests that fathers, but not mothers, living in households with two parent smokers increased their tobacco consumption in the house, higher urinary cotinine:creatinine ratios in infants living in homes where both parents fume tin exist explained, at least in function, by their father's tobacco consumption.
Methodological issues
Parent-reported tobacco consumption and a biologic measure of environmental tobacco exposure were utilized. Although some commentators take noted that tobacco consumption can be misreported ( Cook et al., 1994; Ford et al., 1997) either intentionally or unintentionally, studies have constitute practiced agreement betwixt parent reporting of smoking habits and biochemical measures of tobacco consumption in households with immature children (Dell'Orca et al., 1997; Nafstad et al., 1997). Information technology is possible that differences in cigarette consumption betwixt fathers in father-simply smoking households and fathers in both-parent smoking households may be due to inaccurate reporting of fathers' cigarette consumption patterns by the infant'due south mothers. Nonetheless, the consistency of the information beyond measures of usual total consumption, usual consumption in the house and consumption in the previous 48 hours in the house suggest that this is unlikely to be the example. Furthermore, women's proxy reports of their partner's cigarette consumption have been shown to be in understanding with men's own self-reports and accurate plenty to be used with confidence in epidemiological studies ( Passaro et al., 1997).
A strength of this study was the use of salivary cotinine, which verified the accurateness of mothers' ain reported tobacco consumption. Urinary cotinine, as a metabolite of nicotine, has been shown to be a valid quantitative measure of exposure to ecology tobacco smoke in infants (Benowitz, 1996). A limitation of the written report may be that only single measures of urinary cotinine:creatinine ratio were made. Cotinine levels take been shown to vary over time and with the historic period of the child ( Peterson et al., 1997). While multiple measurements have the advantage of establishing a profile of ecology tobacco fume, unmarried measures correlate well with reported parental tobacco consumption ( Cook et al., 1994). In addition to usual cigarette consumption information, we as well included a measure of cigarette consumption in the previous 48 hours. As cotinine has a half-life of about 20 hours and thus reflects smoke exposure in the previous 24–48 hours (Haufroid and Lison, 1998), inclusion of this reported measure is likely to take commencement some of the problems associated with recording but a unmarried measurement of cotinine.
In addition to the number of parental smokers in the home and total number of cigarettes consumed within the dwelling, individual cotinine levels are affected by other factors including the consumption of other household smokers, proximity to smokers, the home, the size of the rooms and the use of harm reduction measures. A limitation of this study is that it did not written report these data. A further limitation is the number of parent carers who declined to participate. In line with upstanding requirements, parents were fully informed of the written report's focus on smoking. This overt focus on smoking, at a time when public health policy depicts smoking well-nigh infants as irresponsible and health damaging, is likely to have had a negative event on the recruitment process. However, participants' social and demographic profile, although more disadvantaged that that of the wider population of babe households, reflected the association between social disadvantage and tobacco utilize.
Implications for smoking intervention in households with infants
Our report findings raise a number of of import bug for smoking intervention programmes. Current smoking cessation and tobacco harm reduction programmes predominantly target mothers who fume. The greater health impact of mothers' than fathers' smoking behaviour on children's health ( Melt et al., 1994; Brooke et al., 1997; Cook and Strachan, 1999) lends some legitimacy to this approach. In mother-only and both-parent smoking households, mothers' smoking makes a significant contribution to the total amount of ecology tobacco fume infants are exposed to in the home. Nevertheless, our data too signal that declining to target actively fathers' smoking may exist questionable for a number of reasons. Starting time, estimates from this study suggest that health promotion interventions that only target households with mother smokers may fail to reach the significant proportion of households where only the father smokes. Although cigarette consumption in the house appears to be low generally in these households, it does not follow that they should not exist targeted. In households where the female parent does not smoke, fathers' smoking has been shown to be associated with illnesses of the lower respiratory tract in infants (Cook and Strachan, 1999). Our study, similar a number of studies, identified that 1-3rd of smoking households with immature infants only comprise fathers who fume. This suggests that in the UK, only targeting female parent smokers may capture less than 2-thirds of all smoking households with infants.
Second, encouraging fathers to quit smoking, or where this is non possible, to not smoke in the house, may bring well-nigh reductions in infant exposure to tobacco fume as well as making it easier for mothers to quit smoking. Studies propose loftier concordance between long-term smoking cessation among women and the smoking status of their partners ( Waterson et al., 1990; Wakefield et al., 1993; Nafstad et al., 1996). Failing to tackle fathers' smoking may have long-term consequences for smoking cessation rates amidst women. Women acknowledge their partner every bit being an of import influence on their ain smoking behaviour. Partners who smoke make cigarettes readily available and create the social opportunities to smoke, as well equally acting as a constant source of temptation to women who are trying to quit or reduce their cigarette consumption.
Our study suggests that mothers may also shape the smoking behaviour of their partners. For fathers in this study, living with a partner who smoked appeared to be associated with higher total tobacco consumption and increased tobacco consumption in the house. This study did not examine why fathers' tobacco consumption in the house was significantly lower in households where fathers lived with a not-smoking partner but possible explanations may be that non-smoking mothers are more likely to insist on banning smoking from the abode than mothers who smoke, and that for fathers living with a non-smoking partner there are less social opportunities to smoke at home and less temptations to light up a cigarette. How interactions between parents influence smoking patterns and harm-reduction behaviour should be considered in the pattern of wellness promotion programmes to reduce household smoking.
Although the sample of households in this study was broadly representative of infant households, the proportion of households from minority indigenous groups was too small-scale to examine ethnic group differences despite active recruitment in areas with high proportions of minority ethnic groups and the utilise of interpreters. Recent studies of smoking patterns among Pakistani and Bangladeshi households (Nazroo, 1997; Johnson et al., 2000) suggest that among men the proportion of cigarette smokers is loftier and a high median number of cigarettes are consumed. In these households, the tobacco consumption of fathers and other male resident smokers may brand a substantial contribution to the corporeality of tobacco smoke infants are exposed to. In that location are virtually no data on smoking patterns or use of harm reduction measures in minority ethnic households with infants and children, indicating a demand for research in this area.
Reducing infant exposure to tobacco fume, past encouraging parents to quit smoking or banning smoking in the abode, is likely to bring nigh improved health outcomes for children. It may also reduce the likelihood of these infants becoming smokers themselves in later life ( Wakefield et al., 2000b). Taken together, these findings suggest that the interaction betwixt parents needs to be considered rather than focusing on mothers' or fathers' smoking behaviour in isolation. Although this study points to a need to focus wellness promotion programmes on fathers as well every bit mothers, there is fiddling research to underpin such programmes. Dissimilar mothers' smoking, very few studies have examined the factors linked to fathers' smoking. Although men'south smoking has received some research attention, this has generally focused on risk taking behaviour. Men as fathers have received no attention in the literature on smoking. Research efforts are needed in this area.
Nosotros wish to thank the post-obit for their assistance: parents who kindly agreed to participate; health visitors, their managers and staff in the kid wellness departments of the NHS Trusts who helped with recruitment; and the nurse interviewers who undertook the data collection. Nosotros are grateful to the Foundation for the Report of Infant Deaths who awarded a grant (grant no. 266) for this project.
References
Benowitz, N.L. (
1996
) Cotinine as a biomarker of ecology tobacco fume exposure.
Epidemiology Review
,
18
,
188
–204.
Berman, B.A., Wong, Yard.C., Bastani, R., Hoang, T., Jones, C., Goldstein, D.R., Bernert, J.T., Hammond, Yard.S., Tashkin, D. and Lewis, M.A. (
2003
) Household smoking behaviour and ETS exposure among children with asthma in low-income, minority households.
Addictive Behaviours
,
28
,
111
–128.
Blair, P., Fleming, P., Bensley, D., Smith, I., Salary, C., Taylor, E., Berry, J., Golding, J. and Tripp, J. (
1996
) Smoking and the sudden infant death syndrome: results from 1993–5 case-control study for confidential inquiry into stillbirths and deaths in infancy.
British Medical Periodical
,
313
,
195
–198.
Brooke, H., Gibson, A. and Tappin, D. (
1997
) Example-control study of sudden infant expiry syndrome in Scotland, 1992–v.
British Medical Journal
,
314
,
1516
–1520.
Chilmonczyk, B.A., Salmun, L.M., Megathlin, K.N., Neveux L.Chiliad., Palomaki G.Due east., Knight G.J., Pulkkinen A.J. and Haddow J.E. (
1993
) Association between exposure to tobacco fume and exacerbations of asthma in children.
New England Journal of Medicine
,
328
,
1665
–1669.
Cook, D.G. and Strachan, D.P. (
1999
) Summary of furnishings of parental smoking on the respiratory health of children and implications for research.
Thorax
,
54
,
357
–366.
Cook, D.G., Whincup, P.H., Jarvis, One thousand.J., Strachan, D.P., Papacosta, O. and Bryan, A. (
1994
) Passive exposure to tobacco smoke in children anile 5–7 years: individual, family and community factors.
British Medical Journal
,
308
,
384
–389.
Dell'Orca, Grand., Forastiere, F., Agabati, N., Corbo, K.Chiliad., Pistelli, R., Pacifici, R., Zuccaro, P., Pizzabiocca, A., Rosa, M. and Altieri, A. (
1995
) Household and community determinants of exposure to involuntary smoking: a study of urinary cotinine in children and adolescents.
American Journal of Epidemiology
,
142
,
419
–427.
Department of Health (
1996
) Confidential Enquiry into Nevertheless Births and Deaths in Infancy: Third Annual Report. Department of Health, London.
Department of Health (
1997
) Infant Feeding Survey 1995. The Stationery Office, London.
Dwyer, T., Ponsonby, A.Fifty. and Couper, D. (
1999
) Tobacco smoke exposure at 1 month of age and subsequent risk of SIDS—a prospective written report.
American Journal of Epidemiology
,
149
,
593
–602.
Emerson, J.A., Wahlgren, D.R., Hovell, M.F., Meltzer, S.B., Zakarian, J.Yard. and Hofstetter, C.R. (
1994
) Parent smoking and asthmatic children's exposure patterns: a behavioural epidemiology written report.
Addictive Behaviours
,
19
,
677
–689.
Erikson, W. and Bruusgaard, D. (
1995
) Smoking behaviour in young families: do parents take practical measures to preclude passive smoking by their children?
Scandinavian Journal of Principal Health Intendance
,
13
,
275
–280.
Erikson, W., Sorum, K. and Bruusgaard, D. (
1996
) Is at that place increased lability of parents' smoking behaviour after childbirth?
Scandinavian Journal of Primary Health Intendance
,
14
,
86
–91.
Etzel, R.A., Pattishall, E.N., Haley, Northward.J., Fletcher, R.H. and Henderson, F.W. (
1992
) Passive smoking and middle ear effusion among children in day care.
Pediatrics
,
xc
,
228
–232.
Ford, D.K.R., Tappin, D.M., Schluter, P.J and Wild, C.J. (
1997
) Smoking during pregnancy: how reliable are maternal self reports in New Zealand?
Journal of Epidemiology and Community Health
,
51
,
246
–251.
Graham, H. (
1993
) When Life'due south a Drag: Women, Smoking and Disadvantage. HMSO, London.
Haufroid, V., Lison, D. (
1998
) Urinary cotinine every bit a tobacco-fume exposure index: a minireview.
International Archives of Occupational and Environmental Wellness
,
71
,
162
–168.
Hiley, C.1000.H. and Morley, C.J. (
1994
) Evaluation of authorities'due south entrada to reduce risk of cot death.
British Medical Journal
,
309
,
703
–704.
Hovell, M.F., Zakarian, J.M., Wahlgren, D.R., Matt, G.E. and Emmons, K.One thousand. (
2000
) Reported measures of environmental tobacco fume exposure: trials and tribulations.
Tobacco Command
,
nine
(Suppl. 3),
iii22
–iii28.
Jarvis, Thousand.J., Strachan, D.P. and Feyerabend, C. (
1992
) Determinants of passive smoking in children in Edinburgh, Scotland.
American Journal of Public Health
,
82
,
1225
–1229.
Jarvis, Yard.J., Goddard, East., Higgins, Five., Feyerabend, C. and Bryant, A. (
2000
) Children'southward exposure to passive smoking in England since the 1980s: cotinine evidence from population studies.
British Medical Journal
,
321
,
343
–345.
Johnson, Chiliad., Owen, D. and Blackburn, C. (
2000
) Blackness and Minority Ethnic Groups in England: the 2nd Health and Lifestyles Survey. Health Education Potency, London.
Margolis, P.A., Keyes, L.L., Greenberg, R.A., Bauman, K.A. and LaVange, L.Chiliad. (
1998
) Urinary cotinine and parent history (questionnaire) as indicators of passive smoking and predictors of low respiratory disease in infants.
Pediatric Pulmonology
;
23
,
417
–423.
Mascola, M.A., Van Vunakis, H., Tager I.B., Soeuzer, F.Due east. and Hanrahan, J.P. (
1998
) Exposure of young infants to environmental tobacco fume: chest-feeding among smoking mothers.
American Journal of Public Wellness
,
88
,
893
–896.
Matt, Grand.E., Wahlgren, D.R., Hovell, One thousand.F., Zakarian, J.M., Bernert, J.T., Meltzer, South.B., Pirkle, J.L. and Caudill, S. (
1999
) Measuring ETS exposure in infants and young children through urine cotinine and memory based parental reports: empirical findings and word.
Tobacco Control
,
eight
,
282
–289.
Nafstad, P., Botten, G. and Hagen, J. (
1996
) Partner'due south smoking: a major determinant for changes in women's smoking behaviour during and subsequently pregnancy.
Public Wellness
,
110
,
379
–385.
Nafstad, P., Kongerud, J., Botten, Chiliad., Hagen, J.A. and Jaakkola, J.J. (
1997
) The role of passive smoking in the evolution of bronchial obstacle during the first ii years of life.
Epidemiology
,
8
,
293
–297.
Nazroo, J. (
1997
) The Health of Britain's Ethnic Minorities. Policy Studies Institute, London .
Pallet, J. (
2001
) SPSS Survival Manual. Open Academy Printing, Buckingham.
Passaro, K.T., Noss, J., Savita, D.A. and Fiddling, R.Due east. (
1997
) Agreement between self and partner reports of paternal drinking and smoking. The ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood.
International Journal of Epidemiology
,
26
,
315
–320.
Peterson, E.L., Johnson, C.C. and Ownby, D.R. (
1997
) Use of urinary cotinine and questionnaires in the evaluation of infant exposure to tobacco smoke in epidemiologic studies.
Periodical of Clinical Epidemiology
,
8
,
917
–923.
Strachan, D.P. and Cook, D.G. (
1997
) Parental smoking and lower respiratory affliction in infancy and early childhood.
Thorax
,
52
,
905
–914.
Sullivan, F.G. and Barlow, S.M. (
2001
) Review of run a risk factors for Sudden Infant Death Syndrome.
Paediatric and Perinatal Epidemiology
,
15
,
144
–200.
Wakefield, Chiliad., Gillies, P., Graham, H., Madeley, P. and Symonds, M. (
1993
) Characteristics associated with smoking abeyance during pregnancy amid working grade women.
Habit
,
88
,
1423
–1430.
Wakefield, M., Banham, D., Martin, J., Ruffin, R., McCaul, Chiliad. and Badcock, N. (
2000
a) Restrictions on smoking at home and urinary cotinine among children with asthma.
American Journal of Preventive Medicine
,
19
,
188
–192.
Wakefield, Grand., Chaloupka, F., Kaufman, N., Orleans, C., Barker, D. and Ruel, R. (
2000
b) Effect of restrictions on smoking at home, at school and in public places on teenage smoking: cross sectional study.
British Medical Journal
,
321
,
333
–337.
Waterson, E.J., Evans, D. and Murray-Lyon, I.Chiliad. (
1990
) Is pregnancy a time of changing drinking and smoking patterns for fathers too every bit mothers? An initial investigation.
British Journal of Addiction
,
85
,
389
–396.
Author notes
1School of Health and Social Studies, University of Warwick, Coventry CV4 7AL, 2Department of Health Sciences, University of Leicester, Leicester LE1 6TP and 3Institute of Child Health, Birmingham Children's Infirmary, Birmingham B4 6NH, U.k.
Health Didactics Research Vol.20 no.2, © Oxford University Press 2005; All rights reserved
7 Month Old Baby Co Sleeping With Dad Who Had One Cigar
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