title: Trends in children's exposure to second-hand smoke in the INMA-Granada cohort: an evaluation of the Spanish anti-smoking law.
abstract: The smoke-free legislation implemented in Spain in 2006 imposed a partial ban on smoking in public and work places, but the result did not meet expectations. Therefore, a more restrictive anti-smoking law was passed five years later in 2011 prohibiting smoking in all public places, on public transport, and the workplace. With the objective of assessing the impact of the latter anti-smoking legislation on children's exposure to second-hand smoke (SHS), we assessed parent's smoking habits and children's urine cotinine (UC) concentrations in 118 boys before (2005-2006) and after (2011-2012) the introduction of this law. Repeated cross-sectional follow-ups of the "Environment and Childhood Research Network" (INMA-Granada), a Spanish population-based birth cohort study, at 4-5 years old (2005-2006) and 10-11 years old (2011-2012), were designed. Data were gathered by ad-hoc questionnaire, and median UC levels recorded as an objective indicator of overall SHS exposure. Multivariable logistic regression was used to examine the association between parent's smoking habits at home and SHS exposure, among other potential predictors. An increase was observed in the prevalence of families with at least one smoker (39.0% vs. 50.8%) and in the prevalence of smoking mothers (20.3% vs. 29.7%) and fathers (33.9% vs. 39.0%). Median UC concentration was 8.0ng/mL (interquartile range [IQR]: 2.0-21.8) before legislation onset and 8.7ng/mL (IQR: 2.0-24.3) afterwards. In the multivariable analysis, the smoking status of parents and smoking habits at home were statistically associated with the risk of SHS exposure and with UC concentrations in children. These findings indicate that the recent prohibition of smoking in enclosed public and workplaces in Spain has not been accompanied by a decline in the exposure to SHS among children, who continue to be adversely affected. There is a need to target smoking at home in order to avoid future adverse health effects in a population that has no choice in the acceptance or not of SHS exposure-derived risk.
authors: Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Radiology Department, University of Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain. Electronic address: marieta@ugr.es.
authors: Mariana F
authors: MF
authors: Fernández
authors: Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Radiology Department, University of Granada, Granada, Spain.
authors: Francisco
authors: F
authors: Artacho-Cordón
authors: CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil.
authors: Carmen
authors: C
authors: Freire
authors: San Cecilio University Hospital, Granada, Spain.
authors: Rocío
authors: R
authors: Pérez-Lobato
authors: San Cecilio University Hospital, Granada, Spain.
authors: Irene
authors: I
authors: Calvente
authors: San Cecilio University Hospital, Granada, Spain.
authors: Rosa
authors: R
authors: Ramos
authors: Biodonostia, Instituto de Investigación Biomédica, San Sebastián, Spain.
authors: Ane M
authors: AM
authors: Castilla
authors: Obstetric and Gynecology Department, University of Granada, 18071 Granada, Spain.
authors: Olga
authors: O
authors: Ocón
authors: San Cecilio University Hospital, Granada, Spain.
authors: Cristina
authors: C
authors: Dávila
authors: Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Unidad de Gestión Clínica de Oncología Integral, Virgen de las Nieves University Hospital, Granada, Spain.
authors: Juan P
authors: JP
authors: Arrebola
authors: Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Radiology Department, University of Granada, Granada, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.
authors: Nicolás
authors: N
authors: Olea
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis* / Q000331:legislation & jurisprudence; D002648:Child; D002675:Child, Preschool; D003367:Cotinine / Q000652:urine; D003430:Cross-Sectional Studies; D005500:Follow-Up Studies; D006801:Humans; D019570:Inhalation Exposure / Q000331:legislation & jurisprudence; D008297:Male; D015995:Prevalence; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence*; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014028:Tobacco Smoke Pollution / Q000032:analysis* / Q000331:legislation & jurisprudence
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine
keywords: Anti-smoking law; Children; Second-hand smoke; Spain; Urine cotinine