Do Parents of Urban Children With Persistent Asthma Ban Smoking in Their Homes and Cars?


      Environmental tobacco smoke (ETS) increases morbidity for children with asthma. One method to reduce children’s ETS exposure is to completely ban smoking in the home and car. We sought to evaluate the degree to which urban children with persistent asthma are protected by household and car smoking bans, and to determine whether health care professionals are counseling parents to implement smoking bans.


      We asked parents of children with asthma to complete an in-person interview including questions about asthma symptoms, smokers in the home, smoking bans (home and car), and the receipt of ETS counseling by health care professionals.


      We included 231 children with persistent asthma symptoms (response rate 94%). Nearly half of the children lived with a smoker. Overall, only 64% of households had complete restrictions on smoking in the home and car. Even among the children with severe persistent symptoms, less than two-thirds were protected by a complete smoking ban. Among households with smokers, only 51% had a ban on smoking in the home and 49% in the car. The majority of caregivers had been questioned by health care professionals about home smoke exposure; less were asked about exposure in the car (40%) or given suggestions to decrease the child’s exposure (58%).


      To our knowledge this is the first study to establish the prevalence of smoking bans among children with persistent asthma. Many children with asthma, even those with the most severe symptoms, remain exposed to ETS in the home and in cars. Identifying and reducing smoke exposure among these children should be a health care priority.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mannino D.M.
        • Homa D.M.
        • Redd S.C.
        Involuntary smoking and asthma severity in children.
        Chest. 2002; 122: 409-415
        • Abulhosn R.S.
        • Morray B.H.
        • Llewellyn C.E.
        • et al.
        Passive smoke exposure impairs recovery after hospitalization for acute asthma.
        Arch Pediatr Adolesc Med. 1997; 151: 135-139
        • Murray A.B.
        • Morrison B.J.
        Passive smoking and the seasonal difference of severity of asthma in children.
        Chest. 1988; 94: 701-708
        • Strachan D.P.
        • Cook D.G.
        Health effects of passive smoking. 6.Parental smoking and childhood asthma: longitudinal and case-control studies.
        Thorax. 1998; 53: 204-212
        • Oddoze C.
        • Dubus J.C.
        • Badier M.
        • et al.
        Urinary cotinine and exposure to parental smoking in a population of children with asthma.
        Clin Chem. 1999; 45: 505-509
        • Chilmonczyk B.A.
        • Salmun L.M.
        • Megathlin K.N.
        • et al.
        Association between exposure to environmental tobacco smoke and exacerbations of asthma in children.
        N Engl J Med. 1993; 328: 1665-1669
        • Weiss S.T.
        • Tager I.B.
        • Speizer F.E.
        • et al.
        Persistent wheeze.
        Am Rev Respir Dis. 1980; 122: 697-707
        • Murray A.B.
        • Morrison B.J.
        Passive smoking by asthmatics.
        Pediatrics. 1989; 84: 451-459
        • Canadian Paediatric Society Section on Allergy
        Secondhand cigarette smoke worsens symptoms in children with asthma.
        Can Med Assoc J. 1986; 135: 321-323
        • Institute of Medicine
        Clearing the Air. National Academy Press, Washington, DC2000
        • Murray A.B.
        • Morrison B.J.
        The effect of cigarette smoking from the mother on bronchial responsiveness and severity of symptoms in children with asthma.
        J Allergy Clin Immunol. 1986; 77: 575-581
        • Frischer T.
        • Kuehr J.
        • Meinert R.
        • et al.
        Maternal smoking in early childhood.
        J Pediatr. 1992; 121: 17-22
        • Knight A.
        • Breslin A.B.
        Passive cigarette smoking and patients with asthma.
        Med J Aust. 1985; 142: 194-195
        • Martinez F.D.
        • Antognoni G.
        • Macri F.
        • et al.
        Parental smoking enhances bronchial responsiveness in nine-year-old children.
        Am Rev Respir Dis. 1988; 138: 518-523
        • Weitzman M.
        • Gortmaker S.
        • Walker D.K.
        • et al.
        Maternal smoking and childhood asthma.
        Pediatrics. 1990; 85: 505-511
        • Evans D.
        • Levison M.J.
        • Feldman C.H.
        • et al.
        The impact of passive smoking on emergency room visits of urban children with asthma.
        Am Rev Respir Dis. 1987; 135: 567-572
        • Mannino D.M.
        • Caraballo R.
        • Benowitz N.
        • Repace J.
        Predictors of cotinine levels in US children.
        Chest. 2001; 120: 718-724
        • Centers for Disease Control and Prevention
        Cigarette smoking among adults—United States, 2002.
        MMWR Morb Mort Wkly Rep. 2004; 53: 427-431
        • Weaver V.M.
        • Davoli C.T.
        • Murphy S.E.
        • et al.
        Environmental tobacco smoke exposure in inner-city children.
        Cancer Epidemiol Biomarkers Prev. 1996; 5: 135-137
        • National Institutes of Health
        (Expert Panel Report 2. NIH Publication 97-4051)Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, Md1997
        • Frankowski B.
        • Weaver S.
        • Secker-Walker R.
        Advising parents to stop smoking.
        Pediatrics. 1993; 91: 296-300
        • Zapka J.G.
        • Fletcher K.
        • Pbert L.
        • et al.
        The perceptions and practices of pediatricians.
        Pediatrics. 2001; 103: e65
        • Hymowitz N.
        • Schwab J.
        • Haddock C.K.
        • et al.
        The pediatric resident training on tobacco project.
        Prev Med. 2005; 41: 334-341
        • Ashley M.J.
        • Ferrence R.
        Reducing children’s exposure to environmental tobacco smoke in homes.
        Tobacco Control. 1998; 7: 61-65
        • Greenberg R.A.
        • Bauman K.E.
        • Glover L.H.
        • et al.
        Ecology of passive smoking by young infants.
        J Pediatr. 1989; 114: 774-780
        • Wakefield M.
        • Banham D.
        • Martin J.
        • et al.
        Restrictions on smoking at home and urinary cotinine levels among chidren with asthma.
        Am J Prev Med. 2000; 19: 188-192
        • Johansson A.K.
        • Hermansson G.
        • Ludvigsson J.
        How should parents protect their children from environmental tobacco-smoke exposure in the home?.
        Pediatrics. 2004; 113: e291-e295
        • Berman B.A.
        • Wong G.C.
        • Bastani R.
        • et al.
        Household smoking behavior and ETS exposure among children with asthma in low-income, minority households.
        Addictive Behaviors. 2003; 28: 111-128
        • Norman G.J.
        • Ribisl K.M.
        • Howard-Pitney B.
        • et al.
        The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors.
        Am J Health Promot. 2000; 15: 81-88
        • Pizacani B.A.
        • Martin D.P.
        • Stark M.J.
        • et al.
        A prospective study of household smoking bans and subsequent cessation related behaviour.
        Tobacco Control. 2004; 13: 23-28
        • Farkas A.J.
        • Gilpin E.A.
        • Distefan J.M.
        • et al.
        The effects of home smoking restrictions on quitting behaviours.
        Tobacco Control. 1999; 8: 261-265
        • Leung G.M.
        • Ho L.
        • Lam T.
        Secondhand smoke exposure, smoking hygiene, and hospitalization in the first 18 months of life.
        Arch Pediatr Adolesc Med. 2004; 158: 687-693
        • Gergen P.J.
        • Fowler J.A.
        • Maurer K.R.
        • et al.
        The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States.
        Pediatrics. 1998; 101: E8
        • Schuster M.
        • Franke T.
        • Pham C.
        Smoking patterns of household members and visitors in homes with children in the United States.
        Arch Pediatr Adolesc Med. 2002; 156: 1094-1100
        • Kattan M.
        • Mitchell I.I.
        • Eggleston P.
        • et al.
        Characteristics of inner-city children with asthma.
        Pediatr Pulmonol. 1997; 24: 253-262
        • National Asthma Education Program
        (DHHS publication 91-3042)Expert Panel Report. US Department of Health and Human Services, Bethesda, Md1991
        • National Asthma Education Program
        (NIH Publication 97-4051)Expert Panel Report 2. US Department of Health and Human Services, Bethesda, Md1997
        • Hovell M.F.
        • Meltzer S.B.
        • Zakarian J.M.
        • et al.
        Reduction of environmental tobacco smoke exposure among asthmatic children.
        Chest. 1994; 106: 440-446
        • Wahlgren D.R.
        • Hovell M.F.
        • Meltzer S.B.
        • et al.
        Reduction of environmental tobacco smoke exposure in asthmatic children.
        Chest. 1997; 111: 81-88
      1. Borrelli B, McQuaid E, Becker B, et al. Motivating the parents of kids with asthma to quit smoking: preliminary findings from the PAQS Project. Paper presented at: Annual Meeting of the Society of Behavioral Medicine; 2004; Baltimore, Md. March 24-27, 2004.

        • Cabana M.D.
        • Rand C.
        • Slish K.
        • et al.
        Pediatrician self-efficacy for counseling parents of asthmatic children to quit smoking.
        Pediatrics. 2004; 113: 78-81
        • Tanski S.E.
        • Klein J.D.
        • Winickoff J.P.
        • et al.
        Tobacco counseling at well-child and tobacco-influenced illness visits.
        Pediatrics. 2003; 111: e162-e167
        • Wall M.A.
        • Severson H.H.
        • Andrews J.A.
        • et al.
        Pediatric office-based smoking intervention.
        Pediatrics. 1995; 96: 622-628
        • Fiore M.C.
        • Bailey W.C.
        • Cohen S.J.
        Treating Tobacco Use and Dependence Clinical Practice Guideline. US Department of Health and Human Services, Public Health Service, Rockville, Md2000
      2. Silagy C, Ketteridge S. Physician advice for smoking cessation. In: Cochrane Library. San Diego, Calif: Update Software; 1999.