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Smoke-free homes in England: prevalence, trends and validation by cotinine in children
  1. Martin J Jarvis1,*,
  2. Jennifer Mindell1,
  3. Anna Gilmore2,
  4. Colin Feyerabend3,
  5. Robert West1
  1. 1 University College London, United Kingdom;
  2. 2 University of Bath, United Kingdom;
  3. 3 ABS Laboratories, United Kingdom
  1. To whom correspondence should be addressed. E-mail: martin.jarvis{at}


Objective: To examine the prevalence of smoke-free homes in England between 1996 and 2007 and their impact on children’s exposure to secondhand smoke.

Design: A series of annual cross-sectional surveys: the Health Survey for England.

Setting and participants: Nationally representative samples of non-smoking children aged 4-15 (N=13,365) and their parents interviewed in the home.

Main outcome measures: Cotinine measured in saliva. Smoke-free homes defined by ‘no’ response to “Does anyone smoke inside this house/flat on most days?” Self-reported smoking status of parents and self-reported and cotinine validated smoking status in children.

Results: The proportion of homes where one parent was a smoker that were smoke-free increased from 21% in 1996 to 37% in 2007, and where both parents were smokers from 6% to 21%. The overwhelming majority of homes with non-smoking parents were smoke-free (95% in 1996; 99% in 2007). For children with non-smoking parents and living in a smoke-free home the geometric mean cotinine across all years was 0.22ng/ml, For children with one smoking parent geometric mean cotinines were 0.37 ng/ml when the home was smoke-free and 1.67ng/ml when there was smoking in the home; and for those with two smoking parents, 0.71ng/ml and 2.46ng/ml. There were strong trends across years for declines in cotinine concentrations in children in smoke-free homes for both children of smokers and non-smokers.

Conclusion: There has been a marked secular trend towards smoke-free homes, even when parents themselves are smokers. Living in a smoke-free home offers children a considerable, but not complete, degree of protection against exposure to parental smoking.

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