Measuring secondhand smoke exposure in children: an ecological measurement approach.

OBJECTIVE Behavioral, environmental, and biological measures of secondhand smoke (SHS) exposure are reviewed with special consideration of medically at-risk children. METHODS An ecological measurement framework is introduced to examine SHS exposure of children in the context of their physical and social environments. RESULTS The proposed approach emphasizes the need to measure (a) who uses tobacco, (b) where and when exposure takes place, (c) what media are contaminated, (d) how exposure takes place, (e) how much a child was exposed, and (f) factors that contribute to why tobacco is used in a child's environment. CONCLUSIONS Existing research suggests that medically at-risk children are among the most vulnerable populations for the harmful effects of SHS exposure. Yet, little is currently known about how SHS exposure affects these populations. The proposed approach provides a framework for the comprehensive assessment of SHS exposure to study its health effects and to design effective interventions.