Measurement of urine cotinine levels provides further evidence of an association between exposure to environmental tobacco smoke and pulmonary morbidity in children with asthma. These data emphasize the need for systematic, persistent efforts to stop the exposure of children with asthma to environmental tobacco smoke.

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We collected information about household smoking habits from 518 mothers when they made their first well child visit with a 6 to 8-week old infant. A urine sample was also collected from the infant, the cotinine concentration measured, and the measurement correlated with data provided by the mother. Eight percent of the infant urine cotinine values fell at or above 10 ,ug/L in the 305 households where no smoking was reported. Corresponding rates were 44 percent in the % households where a member other than the mother smoked, 91 percent in the 43 households where only the IntroductionInfants and young children chronically exposed to environmental tobacco smoke (ETS) have a higher risk of developing acute respiratory illnesses than their unexposed counterparts, and hospitalization is more often necessary to manage these conditions.'-4 The studies defining this risk relied upon family reporting (usually by the mother) of numbers of cigarettes smoked in the household and other locations where the infant or child might be exposed. The availability of biochemical markers capable of measuring tobacco smoke products quantitatively in blood, saliva, and urine now offers the opportunity to obtain a more accurate estimate of actual tobacco smoke absorption by infants and children, irrespective of location. Cotinine, a metabolic derivative of nicotine, has proven particularly useful, because it is chemically stable, is not found in nature (thereby avoiding false-positive test results), can be measured reliably in non-smokers exposed to ETS, and has a circulating half-life ofabout one day.5.6 Greenberg, et al,7,8 have recently reported their observations on urine cotinine levels in infants exposed to ETS, documenting the relation between self-reported exposure and urine cotinine levels. The present report provides further data on this relation, based on analyses from a large, population-based study focused on 6 to 8-week-old infants receiving routine well child care in private physician offices and clinics in a mid-sized city in the United States.

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