Objective To examine parents' reported knowledge\ud and use of harm reduction strategies to protect their\ud infants from exposure to tobacco smoke in the home,\ud and the relation between reported use of strategies\ud and urinary cotinine to creatinine ratios in the infants.\ud Design Cross sectional survey.\ud Settings Coventry and Birmingham.\ud Main outcome measures Parents’ reported\ud knowledge and use of harm reduction strategies and\ud urinary cotinine to creatinine ratios in their infants.\ud Participants 314 smoking households with infants.\ud Results 86% of parents (264/307) believed that\ud environmental tobacco smoke is harmful, 90%\ud (281/314) believed that infants can be protected from\ud it in the home, and 10% (32/314) were either unaware\ud of measures or reported using none. 65% of parents\ud (205/314) reported using two or more measures, but\ud only 18% (58/314) reported not allowing smoking in\ud the home. No difference was found in mean log e\ud transformed urinary cotinine to creatinine ratio in\ud infants from households that used no measures\ud compared with households that used less strict\ud measures. Mean log cotinine to creatinine ratios were\ud significantly different in households banning smoking\ud in the home compared with those using less strict or\ud no measures. Banning smoking in the home was\ud independently associated with a significant reduction\ud in urinary cotinine to creatinine ratio by a factor of\ud 2.6 (1.6 to 4.2) after adjustment for average household\ud cigarette consumption, tenure, and overcrowding.\ud Conclusions Less than a fifth of parents in smoking\ud households ban smoking in the home. Banning\ud smoking was associated with a small but significant\ud reduction in urinary cotinine to creatinine ratio in\ud infants, whereas less strict measures compared with\ud no measures had no effect on the infants’ exposure to\ud environmental tobacco smoke
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