Exploring Children’s Secondhand Smoke Exposure with Early Child Care Providers Jennifer R. Warren, PhD, Phyllis Sloan, MA, Michele Allen, MD, MS, Kolawole S. Okuyemi, MD, MPH Background: Exposure to secondhand smoke (SHS) is a contributor to the increased morbidity and mortality experienced by inner-city African-American children. Limited evidence-based program- ming exists regarding how to address the negative effects of SHS in this community. Purpose: A collaboration with an early child care center provided an opportunity to explore factors related to young children’s SHS exposure as the fırst step in developing strategies to reduce exposure. Methods: Survey data were obtained between 2008 and 2009 from 63 African-American parents of infants and children aged 5 years at two early child care centers located in an urban Minneapolis neighborhood. Forty-three of these children had salivary cotinine levels assessed. Results: Parents living below the poverty level were more likely to report that their children were regularly exposed to SHS by family/friends (p=0.01). Sixty-eight percent of participants reported complete home smoking restrictions, which was signifıcantly correlated with advice from the child’s health provider (p=0.001). Nonsmokers and older parents were less likely to receive advice (p=0.03). Of the 43 children in whom cotinine levels were assessed, 39.5% had levels 0.64 ng/ml, which suggests high SHS exposure. Lower cotinine levels were signifıcantly correlated with living in detached houses. Conclusions: Exposure to SHS was common for children in this study. These fındings, if supported by additional research, can be used to develop and disseminate targeted health messages about childhood SHS sources/negative effects and strategies to reduce exposure. (Am J Prev Med 2010;39(6S1):S44 –S47) © 2010 American Journal of Preventive Medicine Background N ine million children aged less than 5 years may be exposed to secondhand smoke (SHS) in the U.S. 1,2 SHS exposure is particularly high among lower-income African-American children, in whom se- rum cotinine levels have been measured at more than two times the level observed in white and Mexican-American children. 3 Among young children, exposure to SHS is associated with intellectual defıcits, and diseases such as asthma 4,5 that result in large numbers of hospital visits. 6 Asthma disproportionately affects African-American children living in low-income households. 6–8 In inner- city Minneapolis, Minnesota, nearly one in fıve house- holds report that children aged less than 6 years are ex- posed to SHS, and there is also a high concentration of children with asthma in this community. 9 The implementation of smoking restrictions by par- ents has been shown to greatly reduce the negative effects of SHS exposure among young children. 3,10,11 Unfortu- nately, lower-income African-American households are less likely to establish home smoking restrictions. 3 One reason may be that these parents are less likely to be given advice from their physician to protect their children from SHS exposure, as is true for more than half of parents. 12,13 If parents do receive such advice, cultural factors, includ- ing mistrust, can affect African Americans’ interaction with health providers, 14 causing parents to perceive ad- vice on the negative effects of SHS as calling into question their parenting skills. Because of the negative effects of SHS for young children and potential barriers to SHS reduction within lower- income and inner-city African-American communities, From the Department of Communication (Warren), School of Communi- cation and Information, Rutgers, The State University of New Jersey, New Brunswick, New Jersey; La Crèche Early Childhood Centers, Inc. (Sloan); and the Department of Family Medicine and Community Health (Allen, Okuyemi), University of Minnesota Medical School, Minneapolis, Minnesota Address correspondence to: Jennifer R. Warren, PhD, Department of Communication, School of Communication and Information, Rutgers, The State University of New Jersey, 4 Huntington Street, Room 216, New Brunswick NJ 08901. E-mail: jrwarren@rutgers.edu. 0749-3797/$17.00 doi: 10.1016/j.amepre.2010.09.005 S44 Am J Prev Med 2010;39(6S1):S44 –S47 © 2010 American Journal of Preventive Medicine • Published by Elsevier Inc.