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Comparison of parental reports of smoking and residential air nicotine concentrations in children
  1. U Gehring1,2,
  2. B P Leaderer3,
  3. J Heinrich2,
  4. M Oldenwening1,
  5. M E C A Giovannangelo1,
  6. E Nordling4,5,
  7. G Merkel6,
  8. G Hoek1,
  9. T Bellander4,5,
  10. B Brunekreef1,7
  1. 1Utrecht University, Institute for Risk Assessment Sciences, Utrecht, the Netherlands
  2. 2GSF - National Research Center for Environment and Health, Institute of Epidemiology, Neuherberg, Germany
  3. 3Yale University School of Medicine, Center of Perinatal, Pediatric and Environmental Epidemiology, New Haven, CT, USA
  4. 4Karolinska Institutet, Institute of Environmental Medicine, Stockholm, Sweden
  5. 5Stockholm County Council, Department of Occupational and Environmental Health, Stockholm, Sweden
  6. 6University of Rostock, Institute of Medical Microbiology, Virology and Hygiene, Rostock, Germany
  7. 7Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
  1. Correspondence to:
 Dr U Gehring
 Institute for Risk Assessment Sciences, Utrecht University, Jenalaan 18d, 3584 CK Utrecht, the Netherlands; u.gehring{at}


Background: Using questionnaires to assess children’s residential exposure to environmental tobacco smoke (ETS) may result in misclassification from recall and response bias. Questionnaire data have frequently been validated against urinary cotinine measurements, but rarely against actual measurements of residential air nicotine.

Objective: To compare questionnaire reported smoking with air nicotine concentrations in a large population of children and with urinary cotinine levels in a subpopulation; and to assess the potential impact of the symptom status of the children on the agreement between different measures of exposure.

Methods: The authors assessed residential exposure to ETS in 347 German, 335 Dutch, and 354 Swedish preschool and schoolchildren by questionnaire and air nicotine measurements, and in a subset of 307 German children by urinary cotinine measurements. They then compared the different measures of ETS exposure.

Results: In all countries, air nicotine concentrations increased with increasing questionnaire reported smoking in a dose-response fashion. Specificity and negative predictive values of questionnaire reports for nicotine concentrations were excellent. Sensitivity and positive predictive values were moderate to good. Excluding occasional smokers, the overall percentage of homes misclassified was 6.9%, 6.7%, and 5.1% in Germany, the Netherlands, and Sweden, respectively. Similar results were found for the agreement of urinary cotinine concentrations with questionnaire reports and air nicotine levels. There was no indication of underreporting by parents of symptomatic children.

Conclusion: Despite some misclassification, questionnaire reports are an inexpensive and valid estimate of residential ETS exposure among preschool and school children.

  • ETS, environmental tobacco smoke
  • LOD, limit of detection
  • environmental tobacco smoke
  • questionnaire
  • air nicotine
  • urinary cotinine
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  • Published Online First 15 August 2006

  • The AIRALLERG study was funded within the European Union Quality of Life and Management of Living Resources Program, Key action Environment and Health (Proposal No QLK4-2000-00073). Ulrike Gehring was supported by a post-doc fellowship of the German Academic Exchange Service (DAAD).

  • Competing interests: none.

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