title: Relationship between caregivers' smoking at home and urinary levels of cotinine in children.
abstract: OBJECTIVE
  To assess the impact of different smoking behaviors of caregivers on environmental tobacco smoke (ETS) exposure in children aged 5-6 years in Changsha, China.
  
  
  METHODS
  We conducted a cross-sectional, random digit-dial telephone survey of caregivers (n = 543) between August and October 2013. Caregivers' smoking behaviors were collected by a questionnaire. Exposure assessment was based upon determination of urinary cotinine levels in children employing gas chromatography-triple quadrupole mass spectrometry (GC-MS/MS).
  
  
  RESULTS
  In children not living with a smoker, children living with one smoker, and children living with more than one smoker at home, median urinary cotinine concentrations (ng/mL) were 0.72, 2.97, and 4.46, respectively. For children living with one smoker, median urinary cotinine levels of children exposed to ETS were associated with caregiver smoking behaviors, i.e., if a caregiver consumed more cigarettes (>20 compared with ≤10; 7.73 versus 2.29 ng/mL, respectively).
  
  
  CONCLUSIONS
  The magnitude of ETS exposure in children is correlated with the smoking behaviors of the caregiver. Counseling for smoking cessation and educational interventions are needed urgently for smoking caregivers to increase their awareness about ETS exposure and to encourage smoking cessation at home or to take precautions to protect children's health.
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China. xjwangyun@csu.edu.cn.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China. Ym8342@163.com.
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.affiliation: Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha 410013, China. tianlangdoc@163.com.
authors.forename: Lang
authors.initials: L
authors.lastname: Tian
authors.affiliation: Academy of Inspection and Quarantine, Changsha 410004, China. huangzqq@126.com.
authors.forename: Zhiqiang
authors.initials: Z
authors.lastname: Huang
authors.affiliation: Changsha Central for Disease Control and Prevention, Changsha 410001, China. cfm@cscd.gov.cn.
authors.forename: Faming
authors.initials: F
authors.lastname: Chen
authors.affiliation: Changsha Central for Disease Control and Prevention, Changsha 410001, China. hjs009@126.com.
authors.forename: Jingsong
authors.initials: J
authors.lastname: Hu
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China. bengbu_wangfuzhi@126.com.
authors.forename: Fuzhi
authors.initials: F
authors.lastname: Wang
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China. cgwkkk@163.com.
authors.forename: Gui
authors.initials: G
authors.lastname: Chen
authors.affiliation: Department of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, Hunan 410078, China. xiaosy@csu.edu.cn.
authors.forename: Shuiyuan
authors.initials: S
authors.lastname: Xiao
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis*; D015415:Biomarkers / Q000652:urine; D017028:Caregivers; D002675:Child, Preschool; D002681:China; D003367:Cotinine / Q000652:urine*; D003430:Cross-Sectional Studies; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007223:Infant; D008297:Male; D012907:Smoking / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000032:analysis*
chemical_list: D015415:Biomarkers; D014028:Tobacco Smoke Pollution; D003367:Cotinine