Assessment of Smoking Behaviors in the Home and Their Influence on Childrenʹs Passive Smoking: Development of a Questionnaire

Purpose To construct and validate a questionnaire aiming to measure childrenʹs exposure to environmental tobacco smoke (ETS) in the home. Methods The development of the instrument included epidemiological studies, qualitative interviews, pilot studies, and validation with biomarkers and is described in seven consecutive steps. Parents of preschool children, from different population-based samples in south-east Sweden, have participated in the studies. Results Content and face validity was tested by an expert panel and core elements for the purpose of the instrument identified. Reliability was shown with test-retest of the first version. The validation with biomarkers indicated that the sensitivity of the instrument was high enough to discriminate between childrenʹs ETS exposure levels. Cotinine/creatinine levels were related to parentsʹ described smoking behaviors. Differences were shown between children from non-smoking homes, and all groups with smoking parents, independent of their smoking behavior (p < 0.01), as well as between parents smoking strictly outdoors and parents reporting indoor smoking (p < 0.001). Conclusion The results indicate that the presented instrument can be used to discriminate between different levels of ETS exposure and when childrenʹs level of tobacco smoke exposure is to be assessed.