How bad is it for children to live with adults who smoke? We know that such second-hand exposure to smoke puts children at risk for ear infections, asthma attacks and other health problems. (See here and here) We know that many parents try to protect their children from such exposure by smoking outside the house.  Now doctors can test children to find out their level of smoke exposure. But do parents want such a test? A recent study suggests that they do.

Of the 477 parents (i.e., adults with at least one child 18 years or younger living with them) completing a telephone survey, 60.1% would accept such testing for their children. This number went up by 10-13% when parents were given the option of conducting an exposure test using blood already drawn for other tests. More surprisingly, and contrary to the pre-study hypothesis of the researchers, parents who smoke are more willing to have their children tested for smoke exposure than are parents who don't smoke.

Such information might be important in a few ways. In some cases, this information may motivate attempts at cessation by parents and other caregivers. In other cases, it may lead to significant changes in where smoking takes place (e.g., always outside and never in a home or car) or where children live or spend time (e.g., in multi-unit housing or with child care facilities that enforce strict non-smoking policies). Both outcomes would be an important improvement for the affected children.

So why don't all doctors offer such testing? There seem to be a couple of reasons. First, the test is not reimbursable by insurance companies. Second, there is no ideal test. The most widely used test is a measure of cotinine - a breakdown product of nicotine. It can be measured in blood, urine, saliva, or even hair. Each assay has different levels of accuracy in different contexts.

When cotinine is measured, most children have significantly higher exposure than the parents estimated. Many parents think that their children have no exposure to tobacco smoke. Most children who live with a smoker do have such exposure. If we really are going to take seriously the risks of tobacco exposure to chidlren, then we'll need to start measuring actual exposure with tests of cotinine levels. Parents want this, doctors can do it. What will it take to change insurance company policy?