Trends in children's exposure to second-hand smoke in the INMA-Granada cohort: An evaluation of the Spanish anti-smoking law

• The Spanish anti-smoking law has no reduced SHS exposure in children.
• An increase in the prevalence of families with at least one smoker was observed.
• No major change in boy’s cotinine levels was found between before and after the law.
• Parents should be warned about the potential risks of smoking for their children.
• The family can play an important role in minimizing SHS exposure.

The smoke-free legislation implemented in Spain in 2006 imposed a partial ban on smoking in public and work places, but the result did not meet expectations. Therefore, a more restrictive anti-smoking law was passed five years later in 2011 prohibiting smoking in all public places, on public transport, and the workplace. With the objective of assessing the impact of the latter anti-smoking legislation on children's exposure to second-hand smoke (SHS), we assessed parent’s smoking habits and children’s urine cotinine (UC) concentrations in 118 boys before (2005–2006) and after (2011–2012) the introduction of this law. Repeated cross-sectional follow-ups of the “Environment and Childhood Research Network” (INMA-Granada), a Spanish population-based birth cohort study, at 4–5 years old (2005–2006) and 10–11 years old (2011–2012), were designed. Data were gathered by ad-hoc questionnaire, and median UC levels recorded as an objective indicator of overall SHS exposure. Multivariable logistic regression was used to examine the association between parent’s smoking habits at home and SHS exposure, among other potential predictors. An increase was observed in the prevalence of families with at least one smoker (39.0% vs. 50.8%) and in the prevalence of smoking mothers (20.3% vs. 29.7%) and fathers (33.9% vs. 39.0%). Median UC concentration was 8.0 ng/mL (interquartile range [IQR]: 2.0–21.8) before legislation onset and 8.7 ng/mL (IQR: 2.0–24.3) afterwards. In the multivariable analysis, the smoking status of parents and smoking habits at home were statistically associated with the risk of SHS exposure and with UC concentrations in children. These findings indicate that the recent prohibition of smoking in enclosed public and workplaces in Spain has not been accompanied by a decline in the exposure to SHS among children, who continue to be adversely affected. There is a need to target smoking at home in order to avoid future adverse health effects in a population that has no choice in the acceptance or not of SHS exposure-derived risk.