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    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Second-hand smoke &#40;SHS&#41; is the smoke released into the environment mainly by burning cigarette tobacco&#46; It is composed of a complex mixture of thousands of gases and micro-particles&#44; including nicotine and several carcinogens&#44; toxic and irritating substances&#46; In 1992&#44; the U&#46;S&#46; Environmental Protection Agency &#40;EPA&#41;<a href="&#35;bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> declared SHS as a group A amongst human carcinogens&#44; concluding that there is no safe limit to this exposure&#46; In 2000&#44; the World Health Organization &#40;WHO&#41; European Office published the indoor air quality guidelines also concluding that it is not possible to define a safe limit for SHS exposure&#46;<a href="&#35;bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a></p><p class="elsevierStylePara">Exposure to SHS causes lung cancer and cardiovascular diseases and has a particularly negative impact on pregnancy and on children&#39;s health&#44; namely&#44; causing reduced intrauterine growth&#44; spontaneous abortion&#44; preterm birth&#44; low birth weight&#44; sudden death syndrome&#44; ear problems&#44; and respiratory diseases&#46;<a href="&#35;bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a></p><p class="elsevierStylePara">Children are particularly vulnerable to SHS since they have a less developed airways system and a still immature immune system&#46;<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> Prevalence of chronic respiratory symptoms&#44; such as cough&#44; wheezing and dyspnoea&#44; is higher among children exposed to SHS&#46;<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> These children have also a greater risk of lower respiratory tract infections &#40;pneumonia and bronchiolitis&#41;&#44; asthma attacks&#44; and recurrent otitis media&#46;<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a></p><p class="elsevierStylePara">Children&#39;s exposure to SHS is quite often the result of the tobacco smoked by their parents at home and&#47;or from permissiveness towards the smoking behaviour of others indoors&#46;<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> Another important risk of this parental behaviour is the proven influence on the likelihood of children becoming smokers in the future&#46;<a href="&#35;bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a></p><p class="elsevierStylePara">Despite these consequences&#44; the WHO estimates that worldwide about half of the children &#40;700 million&#41; are exposed to SHS&#44; mainly in their own homes&#46;<a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> Two Portuguese studies revealed that 38&#37; and 41&#37; of the children were daily or occasionally exposed to SHS caused by their parents&#8217; smoke&#46;<a href="&#35;bib31" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib32" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib33" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a></p><p class="elsevierStylePara">To better prevent children&#39;s exposure to SHS we need more information about the parents&#44; other cohabitants and houseguests smoking habits&#46; This study describes smoking habits in Portugal and children&#39;s exposure to SHS at home&#46; It was carried out by region to get a more detailed view of the situation and to support decisions on prevention of this risk for children&#39;s health&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Material and methods</span><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Study design and sampling procedure</span><p class="elsevierStylePara">This is a cross-sectional study conducted in the school year of 2010&#47;2011 based on a self-administered questionnaire filled in by 3187 Portuguese children in the 4th grade &#40;mean age 9&#46;05&#160;&#177;&#160;0&#46;7 years&#59; 51&#46;1&#37; male&#41;&#46;</p><p class="elsevierStylePara">Convenience and random sampling methods were combined to select the participants of this study&#46; Nine municipalities &#40;Angra do Hero&#237;smo&#44; Braga&#44; Covilh&#227;&#44; &#201;vora&#44; Faro&#44; Funchal&#44; Lisboa&#44; Porto&#44; Viana do Castelo&#41; representing the seven main regions of Portugal &#40;NUTs II&#58; Azores&#44; Alentejo&#44; Algarve&#44; Centre&#44; Lisbon&#44; Madeira and North&#41; were chosen for the sake of convenience&#46; Considering the number of 4th grade students from the nine municipalities as a total population&#44; and estimating that each class has 20 students&#44; a proportional number of classes per each municipality were randomly chosen to participate in the study&#46; The students&#8217; response rate per municipality was between 69&#46;2&#37; &#40;Funchal&#41; and 91&#46;9&#37; &#40;Angra do Hero&#237;smo&#41; with an average of 77&#46;5&#37;&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Questionnaire</span><p class="elsevierStylePara">The questionnaire that was used had been developed and validated for this study&#46; It contained multiple choice questions and four open-ended questions to measure the following variables&#58;</p><p class="elsevierStylePara">Socio-demographic variables&#58; Age&#44; Sex&#44; Fathers&#8217; and Mothers&#8217; Education level and Socio-economic level&#46;</p><p class="elsevierStylePara">Children&#39;s exposure to SHS at home&#58; Smoker family members &#40;&#8220;does not smoke&#8221;&#44; &#8220;yes&#44; sometimes&#8221;&#44; &#8220;yes&#44; every day&#8221; or &#8220;I don&#8217;t know&#47;I do not have any&#8221;&#41;&#44; Family members and visitors&#8217; permission to smoke at home &#40;&#8220;does not smoke&#8221;&#44; &#8220;yes&#44; every day&#8221;&#44; &#8220;yes&#44; sometimes&#8221; and &#8220;does not smoke at home&#8221; or &#8220;I don&#8217;t know&#47;I do not have any&#47;does not live in my house&#8221;&#41; and rules concerning smoking inside the house &#40;&#8220;smoking is not allowed in any part of the house&#8221;&#59; &#8220;smoking is allowed in some parts&#47;rooms of the house&#8221;&#59; &#8220;smoking is allowed in any parts&#47;rooms of the house&#8221; and &#8220;smoking is allowed only on special occasions&#8221;&#41;&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Procedure</span><p class="elsevierStylePara">The project and the questionnaire were approved by the Portuguese Ministry of Education&#46; Once authorization was granted by the Governing Body of each School Group&#44; head teachers were contacted and guidelines were given about obtaining parental or guardian authorization and about administration of the questionnaire&#46; The questionnaires were administered according to a protocol in the classrooms by trained teachers or by members of the project team&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Data analysis</span><p class="elsevierStylePara">The data gathered were analyzed through the statistical software IBM SPSS Statistics version 20 for <span class="elsevierStyleItalic">Windows</span>&#46; Frequencies&#44; contingency tables&#44; chi-squared tests and logistic regressions were used to perform the data analysis&#46; Bi-variable analyses were conducted using chi-square to compare categorical variables and crude odds ratios &#40;ORs&#41; when appropriate&#46; A two-sided <span class="elsevierStyleItalic">p</span> value less than 0&#46;05 was considered statistically significant&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p 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align="left"><td>&#160;</td><td colspan="2">Total &#40;<span class="elsevierStyleItalic">N</span>&#160;&#61;&#160;<span class="elsevierStyleItalic">3187</span>&#41;</td><td colspan="2">North &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1356&#41;</td><td colspan="2">Centre &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;139&#41;</td><td colspan="2">Lisbon &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;949&#41;</td><td colspan="2">Alentejo &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;153&#41;</td><td colspan="2">Algarve &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;<span class="elsevierStyleItalic">196</span>&#41;</td><td colspan="2">Madeira &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;239&#41;</td><td colspan="2">Azores &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;155&#41;</td><td colspan="2">Chi-squared test</td></tr><tr align="left"><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">N</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Sex</span></td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>16&#46;584</td><td>&#60;0&#46;011</td></tr><tr align="left"><td>Male</td><td>1626</td><td>51&#46;1</td><td>709</td><td>52&#46;5</td><td>66</td><td>47&#46;5</td><td>442</td><td>46&#46;6</td><td>82</td><td>53&#46;6</td><td>117</td><td>59&#46;7</td><td>130</td><td>54&#46;4</td><td>80</td><td>51&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Female</td><td>1555</td><td>48&#46;9</td><td>642</td><td>47&#46;5</td><td>73</td><td>52&#46;5</td><td>506</td><td>53&#46;4</td><td>71</td><td>46&#46;4</td><td>79</td><td>40&#46;3</td><td>109</td><td>45&#46;6</td><td>75</td><td>48&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td colspan="19"><span class="elsevierStyleItalic">Age</span></td></tr><tr align="left"><td>8</td><td>24</td><td>0&#46;8</td><td>6</td><td>0&#46;5</td><td>&#8211;</td><td>&#8211;</td><td>16</td><td>1&#46;7</td><td>&#8211;</td><td>&#8211;</td><td>1</td><td>0&#46;5</td><td>&#8211;</td><td>&#8211;</td><td>1</td><td>0&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>9</td><td>1824</td><td>58&#46;3</td><td>935</td><td>70&#46;6</td><td>75</td><td>54&#46;0</td><td>489</td><td>52&#46;4</td><td>74</td><td>48&#46;7</td><td>101</td><td>53&#46;4</td><td>106</td><td>44&#46;5</td><td>44</td><td>28&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>10</td><td>1081</td><td>34&#46;5</td><td>356</td><td>26&#46;9</td><td>60</td><td>43&#46;2</td><td>345</td><td>36&#46;9</td><td>64</td><td>42&#46;1</td><td>76</td><td>40&#46;2</td><td>107</td><td>45&#46;0</td><td>73</td><td>47&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>11</td><td>170</td><td>5&#46;3</td><td>25</td><td>1&#46;9</td><td>4</td><td>2&#46;9</td><td>67</td><td>7&#46;2</td><td>11</td><td>7&#46;2</td><td>9</td><td>4&#46;8</td><td>22</td><td>9&#46;2</td><td>32</td><td>20&#46;8</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>12</td><td>27</td><td>0&#46;9</td><td>3</td><td>0&#46;2</td><td>&#8211;</td><td>&#8211;</td><td>12</td><td>1&#46;3</td><td>3</td><td>2&#46;0</td><td>2</td><td>1&#46;1</td><td>3</td><td>1&#46;3</td><td>4</td><td>2&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>13</td><td>5</td><td>0&#46;2</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>5</td><td>0&#46;5</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Average &#40;DP&#41;</td><td>9&#46;5 &#40;0&#46;7&#41;</td><td>9&#46;3 &#40;0&#46;5&#41;</td><td>9&#46;5 &#40;0&#46;6&#41;</td><td>9&#46;6 &#40;0&#46;8&#41;</td><td>9&#46;6 &#40;0&#46;7&#41;</td><td>9&#46;5 &#40;0&#46;6&#41;</td><td>9&#46;7 &#40;0&#46;7&#41;</td><td>10&#46;0 &#40;0&#46;8&#41;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Father&#39;s education level</span></td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>52&#46;544</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#8804;9 years old</td><td>930</td><td>48&#46;8</td><td>406</td><td>50&#46;6</td><td>34</td><td>38&#46;2</td><td>272</td><td>50&#46;0</td><td>49</td><td>41&#46;9</td><td>38</td><td>32&#46;5</td><td>56</td><td>40&#46;6</td><td>75</td><td>75&#46;8</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#62;9 years old</td><td>977</td><td>51&#46;2</td><td>397</td><td>49&#46;4</td><td>55</td><td>61&#46;8</td><td>272</td><td>50&#46;0</td><td>68</td><td>58&#46;1</td><td>79</td><td>67&#46;5</td><td>82</td><td>59&#46;4</td><td>24</td><td>24&#46;2</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Mother&#39;s education level</span></td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>74&#46;178</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#8804;9 years old</td><td>980</td><td>45&#46;5</td><td>460</td><td>49&#46;4</td><td>29</td><td>29&#46;0</td><td>292</td><td>48&#46;9</td><td>38</td><td>29&#46;9</td><td>33</td><td>25&#46;0</td><td>56</td><td>36&#46;6</td><td>72</td><td>63&#46;7</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#62;9 years old</td><td>1174</td><td>54&#46;5</td><td>472</td><td>50&#46;6</td><td>71</td><td>71&#46;0</td><td>305</td><td>50&#46;1</td><td>89</td><td>70&#46;1</td><td>99</td><td>75&#46;0</td><td>97</td><td>63&#46;4</td><td>41</td><td>36&#46;3</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Graffard&#39;s Index</span> &#40;<span class="elsevierStyleItalic">socio-economic level</span>&#41;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>39&#46;120</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Classes A and B</td><td>882</td><td>31&#46;1</td><td>383</td><td>31&#46;5</td><td>53</td><td>42&#46;4</td><td>219</td><td>27&#46;0</td><td>51</td><td>35&#46;4</td><td>67</td><td>38&#46;3</td><td>82</td><td>39&#46;4</td><td>26</td><td>17&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Classes C and D</td><td>1950</td><td>68&#46;9</td><td>835</td><td>68&#46;5</td><td>72</td><td>57&#46;6</td><td>593</td><td>73&#46;0</td><td>93</td><td>64&#46;6</td><td>108</td><td>61&#46;7</td><td>126</td><td>60&#46;6</td><td>123</td><td>82&#46;6</td><td>&#160;</td><td>&#160;</td></tr></table><p class="elsevierStylePara">More than half &#40;52&#46;0&#37;&#41; of the children had at least one smoking mother or father &#40;<a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a>&#41;&#44; consequently&#44; these children were potentially exposed to SHS in their own homes&#46; The differences between the various regions regarding the prevalence of a smoking mother or father were statistically significant &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#160;&#61;&#160;26&#46;6&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; and vary from 46&#46;4&#37; in the Centre Region to 58&#46;5&#37; in the Lisbon Region &#40;OR&#160;&#61;&#160;1&#46;6&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;007&#41;&#46;</p><p class="elsevierStylePara">Table 2&#46; Prevalence of smokers among mothers&#44; fathers&#44; both parents and mother or father&#44; by region and total&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Regions</td><td colspan="4">Mother smokes</td><td colspan="4">Father smokes</td><td colspan="4">Both parents smoke</td><td colspan="4">Mother or father smokes</td></tr><tr align="left"><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td><td><span class="elsevierStyleItalic">n</span></td><td><span class="elsevierStyleItalic">&#37;</span></td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td>North</td><td>308</td><td>23&#46;3</td><td>1</td><td>&#8211;</td><td>535</td><td>41&#46;2</td><td>1&#46;11 &#40;0&#46;81&#8211;1&#46;52&#41;</td><td>0&#46;521</td><td>198</td><td>14&#46;8</td><td>1</td><td>&#8211;</td><td>645</td><td>48&#46;1</td><td>1&#46;07 &#40;0&#46;75&#8211;1&#46;52&#41;</td><td>&#60;0&#46;700</td></tr><tr align="left"><td>Centre</td><td>38</td><td>27&#46;2</td><td>1&#46;3 &#40;0&#46;9&#8211;1&#46;9&#41;</td><td>0&#46;248</td><td>54</td><td>40&#46;9</td><td>1&#46;10 &#40;0&#46;70&#8211;1&#46;73&#41;</td><td>0&#46;693</td><td>28</td><td>20&#46;3</td><td>1&#46;47 &#40;0&#46;95&#8211;2&#46;29&#41;</td><td>0&#46;087</td><td>64</td><td>46&#46;4</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Lisbon</td><td>347</td><td>38&#46;2</td><td>2&#46;03 &#40;1&#46;7&#8211;2&#46;4&#41;</td><td>&#60;0&#46;001</td><td>427</td><td>48&#46;4</td><td>1&#46;48 &#40;1&#46;07&#8211;2&#46;05&#41;</td><td>0&#46;017</td><td>226</td><td>24&#46;1</td><td>1&#46;84 &#40;1&#46;49&#8211;2&#46;27&#41;</td><td>&#60;0&#46;001</td><td>548</td><td>58&#46;5</td><td>1&#46;63 &#40;1&#46;14&#8211;2&#46;34&#41;</td><td>&#60;0&#46;007</td></tr><tr align="left"><td>Alentejo</td><td>42</td><td>28&#46;2</td><td>1&#46;3 &#40;0&#46;9&#8211;1&#46;9&#41;</td><td>0&#46;187</td><td>65</td><td>44&#46;5</td><td>1&#46;27 &#40;0&#46;82&#8211;1&#46;97&#41;</td><td>0&#46;286</td><td>26</td><td>17&#46;0</td><td>1&#46;18 &#40;0&#46;76&#8211;1&#46;85&#41;</td><td>0&#46;465</td><td>81</td><td>52&#46;9</td><td>1&#46;30 &#40;0&#46;82&#8211;2&#46;06&#41;</td><td>0&#46;264</td></tr><tr align="left"><td>Algarve</td><td>56</td><td>29&#46;3</td><td>1&#46;4 &#40;1&#46;0&#8211;1&#46;9&#41;</td><td>0&#46;070</td><td>72</td><td>38&#46;7</td><td>1</td><td>&#8211;</td><td>32</td><td>16&#46;5</td><td>1&#46;14 &#40;0&#46;76&#8211;1&#46;72&#41;</td><td>0&#46;528</td><td>96</td><td>49&#46;5</td><td>1&#46;13 &#40;0&#46;73&#8211;1&#46;75&#41;</td><td>0&#46;577</td></tr><tr align="left"><td>Madeira</td><td>69</td><td>29&#46;5</td><td>1&#46;4 &#40;1&#46;0&#8211;1&#46;9&#41;</td><td>0&#46;043</td><td>95</td><td>42&#46;4</td><td>1&#46;17 &#40;0&#46;78&#8211;1&#46;73&#41;</td><td>0&#46;448</td><td>41</td><td>17&#46;3</td><td>1&#46;21 &#40;0&#46;84&#8211;1&#46;75&#41;</td><td>0&#46;316</td><td>123</td><td>51&#46;9</td><td>1&#46;25 &#40;0&#46;82&#8211;1&#46;90&#41;</td><td>0&#46;303</td></tr><tr align="left"><td>Azores</td><td>45</td><td>29&#46;6</td><td>1&#46;4 &#40;1&#46;0&#8211;2&#46;0&#41;</td><td>0&#46;086</td><td>68</td><td>47&#46;2</td><td>1&#46;42 &#40;0&#46;91&#8211;2&#46;20&#41;</td><td>0&#46;121</td><td>32</td><td>20&#46;9</td><td>1&#46;53 &#40;1&#46;01&#8211;2&#46;32&#41;</td><td>0&#46;047</td><td>81</td><td>52&#46;9</td><td>1&#46;30 &#40;0&#46;82&#8211;2&#46;06&#41;</td><td>0&#46;264</td></tr><tr align="left"><td><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> &#40;p&#41;</td><td>57&#46;70 &#40;&#60;0&#46;001&#41;</td><td>&#160;</td><td>14&#46;34 &#40;&#61;0&#46;026&#41;</td><td>&#160;</td><td>34&#46;06 &#40;&#60;0&#46;001&#41;</td><td>&#160;</td><td>&#160;</td><td>26&#46;60 &#40;&#60;0&#46;001&#41;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="17">&#160;</td></tr><tr align="left"><td>Total</td><td>905</td><td>29&#46;3</td><td>&#160;</td><td>&#160;</td><td>1316</td><td>43&#46;7</td><td>&#160;</td><td>&#160;</td><td>583</td><td>18&#46;5</td><td>&#160;</td><td>&#160;</td><td>1638</td><td>52&#46;0</td><td>&#160;</td><td>&#160;</td></tr></table><p class="elsevierStylePara">In this sample&#44; 43&#46;7&#37; of the fathers and 29&#46;3&#37; of the mothers were smokers&#46; The prevalence of smoking fathers differs by region &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">2</span></span></span>&#160;&#61;&#160;24&#46;3&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;026&#41; from 38&#46;7&#37; in Algarve to 48&#46;4&#37; in Lisbon&#46; Also among mothers&#44; the smoking prevalence varies significantly by region&#44; from 23&#46;3&#37; in the North to 38&#46;2&#37; in Lisbon &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">2</span></span></span>&#160;&#61;&#160;57&#46;7&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46;</p><p class="elsevierStylePara">Among the participants&#44; 18&#46;5&#37; both parents were smokers&#46; The differences between regions in this category were statistically significant &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#160;&#61;&#160;34&#46;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; and vary between 14&#46;8&#37; in the North to 24&#46;1&#37; in Lisbon&#46;</p><p class="elsevierStylePara">Children&#39;s exposure to SHS at home is presented in <a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#46; In the total sample&#44; 29&#46;5&#37; of the participants claimed they were exposed to SHS caused by a smoking parent&#8211;mother and&#47;or father &#40;16&#46;9&#37; occasionally and 12&#46;6&#37; on a daily basis&#41;&#46; The exposure to the fathers&#8217; smoke &#40;23&#46;5&#37; in total and 30&#46;0&#37; in Lisbon&#41; is more common than the exposure to the mothers&#8217; smoke &#40;18&#46;2&#37; in total and 25&#46;9&#37; in Lisbon&#41;&#46; A smoking guest was the most frequent cause of children&#39;s exposure to SHS and affected around a third of the participants &#40;32&#46;6&#37;&#44; 18&#46;3&#37; occasionally and 14&#46;3&#37; daily&#41;&#46;</p><p class="elsevierStylePara">Table 3&#46; Prevalence of children&#39;s SHS exposure at home&#44; considering family member smoking status&#44; by region and total&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Regions</td><td>Family member</td><td>Total</td><td colspan="2">Smokes daily at home</td><td colspan="2">Smokes occasionally at home</td><td colspan="2">Does not smoke or does not smoke at home</td><td colspan="2">Chi-squared test</td><td colspan="2">Logistic regression</td></tr><tr align="left"><td>&#160;</td><td>&#160;</td><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td><td><span class="elsevierStyleItalic">p</span></td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td>North</td><td>Only mother</td><td>1286</td><td>80</td><td>6&#46;2</td><td>111</td><td>8&#46;6</td><td>1095</td><td>85&#46;1</td><td>&#160;</td><td>&#160;</td><td>1&#46;37 &#40;0&#46;80&#8211;2&#46;36&#41;</td><td>0&#46;251</td></tr><tr align="left"><td>Centre</td><td>&#160;</td><td>134</td><td>1</td><td>0&#46;7</td><td>18</td><td>13&#46;4</td><td>115</td><td>85&#46;8</td><td>&#160;</td><td>&#160;</td><td>1&#46;30 &#40;0&#46;64&#8211;2&#46;65&#41;</td><td>0&#46;468</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>885</td><td>89</td><td>10&#46;1</td><td>140</td><td>15&#46;8</td><td>656</td><td>74&#46;1</td><td>&#160;</td><td>&#160;</td><td>2&#46;75 &#40;1&#46;60&#8211;4&#46;72&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>142</td><td>6</td><td>4&#46;2</td><td>10</td><td>7&#46;0</td><td>126</td><td>88&#46;7</td><td>63&#46;59</td><td>&#60;0&#46;001</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>185</td><td>13</td><td>7&#46;0</td><td>23</td><td>12&#46;4</td><td>149</td><td>80&#46;5</td><td>&#160;</td><td>&#160;</td><td>1&#46;90 &#40;1&#46;01&#8211;3&#46;59&#41;</td><td>0&#46;047</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>229</td><td>11</td><td>4&#46;8</td><td>18</td><td>7&#46;9</td><td>200</td><td>87&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;14 &#40;0&#46;60&#8211;2&#46;19&#41;</td><td>0&#46;689</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>148</td><td>12</td><td>8&#46;1</td><td>17</td><td>11&#46;5</td><td>119</td><td>80&#46;4</td><td>&#160;</td><td>&#160;</td><td>1&#46;92 &#40;0&#46;99&#8211;3&#46;71&#41;</td><td>0&#46;053</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>North</td><td>Only father</td><td>1234</td><td>107</td><td>8&#46;7</td><td>148</td><td>12&#46;0</td><td>979</td><td>79&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;64 &#40;1&#46;09&#8211;2&#46;49&#41;</td><td>0&#46;019</td></tr><tr align="left"><td>Centre</td><td>&#160;</td><td>129</td><td>8</td><td>6&#46;2</td><td>23</td><td>17&#46;8</td><td>98</td><td>76&#46;0</td><td>&#160;</td><td>&#160;</td><td>2&#46;00 &#40;1&#46;34&#8211;3&#46;50&#41;</td><td>0&#46;016</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>833</td><td>103</td><td>12&#46;4</td><td>147</td><td>17&#46;6</td><td>583</td><td>70&#46;0</td><td>&#160;</td><td>&#160;</td><td>2&#46;71 &#40;1&#46;78&#8211;4&#46;11&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>138</td><td>10</td><td>7&#46;2</td><td>16</td><td>11&#46;6</td><td>112</td><td>81&#46;2</td><td>46&#46;32</td><td>&#60;0&#46;001</td><td>1&#46;47 &#40;0&#46;82&#8211;2&#46;61&#41;</td><td>0&#46;196</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>175</td><td>14</td><td>8&#46;0</td><td>23</td><td>13&#46;1</td><td>138</td><td>78&#46;9</td><td>&#160;</td><td>&#160;</td><td>1&#46;69 &#40;0&#46;99&#8211;2&#46;89&#41;</td><td>0&#46;054</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>212</td><td>12</td><td>5&#46;7</td><td>17</td><td>8&#46;0</td><td>183</td><td>86&#46;3</td><td>&#160;</td><td>&#160;</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>136</td><td>16</td><td>11&#46;8</td><td>26</td><td>19&#46;1</td><td>94</td><td>69&#46;1</td><td>&#160;</td><td>&#160;</td><td>2&#46;82 &#40;1&#46;65&#8211;4&#46;81&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>North</td><td>Mother and&#47;or</td><td>1326</td><td>154</td><td>11&#46;6</td><td>193</td><td>14&#46;6</td><td>979</td><td>73&#46;8</td><td>&#160;</td><td>&#160;</td><td>1&#46;47 &#40;1&#46;04&#8211;2&#46;09&#41;</td><td>0&#46;029</td></tr><tr align="left"><td>Centre</td><td>Father</td><td>136</td><td>9</td><td>6&#46;6</td><td>28</td><td>20&#46;6</td><td>99</td><td>72&#46;8</td><td>&#160;</td><td>&#160;</td><td>1&#46;55 &#40;0&#46;94&#8211;2&#46;56&#41;</td><td>0&#46;083</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>922</td><td>151</td><td>16&#46;4</td><td>197</td><td>21&#46;4</td><td>574</td><td>60&#46;5</td><td>&#160;</td><td>&#160;</td><td>2&#46;52 &#40;1&#46;77&#8211;3&#46;58&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>150</td><td>13</td><td>8&#46;7</td><td>21</td><td>14&#46;0</td><td>116</td><td>77&#46;3</td><td>56&#46;66</td><td>&#60;0&#46;001</td><td>1&#46;22 &#40;0&#46;74&#8211;2&#46;01&#41;</td><td>0&#46;441</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>188</td><td>24</td><td>12&#46;8</td><td>30</td><td>16&#46;0</td><td>134</td><td>71&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;68 &#40;1&#46;06&#8211;2&#46;64&#41;</td><td>0&#46;026</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>232</td><td>19</td><td>8&#46;2</td><td>26</td><td>11&#46;2</td><td>187</td><td>80&#46;6</td><td>&#160;</td><td>&#160;</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>150</td><td>20</td><td>13&#46;3</td><td>29</td><td>19&#46;3</td><td>101</td><td>67&#46;3</td><td>&#160;</td><td>&#160;</td><td>2&#46;02 &#40;1&#46;26&#8211;3&#46;23&#41;</td><td>0&#46;002</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>North</td><td>Guests</td><td>1337</td><td>180</td><td>13&#46;5</td><td>212</td><td>15&#46;9</td><td>945</td><td>70&#46;7</td><td>&#160;</td><td>&#160;</td><td>1&#46;49 &#40;1&#46;07&#8211;2&#46;07&#41;</td><td>0&#46;019</td></tr><tr align="left"><td>Centre</td><td>&#160;</td><td>137</td><td>10</td><td>7&#46;3</td><td>29</td><td>21&#46;2</td><td>98</td><td>71&#46;5</td><td>&#160;</td><td>&#160;</td><td>1&#46;43 &#40;0&#46;88&#8211;2&#46;32&#41;</td><td>0&#46;149</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>931</td><td>169</td><td>18&#46;2</td><td>220</td><td>23&#46;6</td><td>542</td><td>58&#46;2</td><td>&#160;</td><td>&#160;</td><td>2&#46;58 1&#46;84&#8211;3&#46;61&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>151</td><td>14</td><td>9&#46;3</td><td>23</td><td>15&#46;2</td><td>114</td><td>75&#46;5</td><td>68&#46;61</td><td>&#60;0&#46;001</td><td>1&#46;17 &#40;0&#46;72&#8211;1&#46;89&#41;</td><td>0&#46;537</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>189</td><td>29</td><td>15&#46;3</td><td>29</td><td>15&#46;3</td><td>131</td><td>69&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;59 &#40;1&#46;02&#8211;2&#46;46&#41;</td><td>0&#46;038</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>234</td><td>24</td><td>10&#46;3</td><td>27</td><td>11&#46;5</td><td>183</td><td>78&#46;2</td><td>&#160;</td><td>&#160;</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>150</td><td>21</td><td>14&#46;0</td><td>33</td><td>22&#46;0</td><td>96</td><td>64&#46;0</td><td>&#160;</td><td>&#160;</td><td>2&#46;02 &#40;1&#46;28&#8211;3-18&#41;</td><td>0&#46;003</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>Total</td><td>Mother</td><td>3009</td><td>212</td><td>7&#46;0</td><td>337</td><td>11&#46;2</td><td>2460</td><td>81&#46;8</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#160;</td><td>Father</td><td>2857</td><td>270</td><td>9&#46;5</td><td>400</td><td>14&#46;0</td><td>2187</td><td>76&#46;5</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#160;</td><td>Mother and&#47;or father</td><td>3104</td><td>390</td><td>12&#46;6</td><td>524</td><td>16&#46;9</td><td>2190</td><td>70&#46;6</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#160;</td><td>Guests</td><td>3129</td><td>447</td><td>14&#46;3</td><td>573</td><td>18&#46;3</td><td>2109</td><td>67&#46;4</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr></table><p class="elsevierStylePara">Comparing children with non-smoking parents and with smoking parents &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#41;&#44; we found great differences in the prevalence of children&#39;s exposure to SHS at home&#46; These differences are statistically significant in the total sample and in all regions considered&#46; For instance&#44; in relation to the total sample&#44; of the children with non-smoking parents&#44; 19&#46;2&#37; were exposed to SHS at home&#44; whereas of the children with smoking parents&#44; the prevalence rate of those exposed was 63&#46;3&#37; &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#160;&#61;&#160;598&#46;8&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; On the other hand&#44; in the subgroup with smoking parents&#44; 37&#46;1&#37; of the participants declared that they were not exposed to SHS at home&#46;</p><p class="elsevierStylePara">Table 4&#46; Prevalence of children&#39;s SHS exposure at home&#44; comparing cases with non smoking parents and cases with smoking parents&#44; by region and total&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Regions</td><td>Parents smoking behaviour</td><td>Total</td><td colspan="2">There&#39;s SHS at home &#40;regularly or occasionally&#41;</td><td colspan="2">There&#39;s no SHS at home</td><td colspan="2">Chi-squared test</td></tr><tr align="left"><td>&#160;</td><td>&#160;</td><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">&#967;</span>2</td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td>North</td><td>Parents are no-smokers</td><td>667</td><td>128</td><td>19&#46;2</td><td>539</td><td>80&#46;8</td><td>246&#46;6</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>645</td><td>399</td><td>61&#46;9</td><td>246</td><td>38&#46;1</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Centre</td><td>Parents are no-smokers</td><td>71</td><td>11</td><td>15&#46;5</td><td>60</td><td>84&#46;5</td><td>31&#46;5</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>64</td><td>41</td><td>64&#46;1</td><td>23</td><td>35&#46;9</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Lisbon</td><td>Parents are no-smokers</td><td>363</td><td>77</td><td>21&#46;2</td><td>286</td><td>78&#46;8</td><td>202&#46;0</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>548</td><td>381</td><td>69&#46;5</td><td>167</td><td>30&#46;5</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Alentejo</td><td>Parents are no-smokers</td><td>68</td><td>11</td><td>16&#46;2</td><td>57</td><td>83&#46;8</td><td>17&#46;8</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>81</td><td>41</td><td>50&#46;6</td><td>40</td><td>49&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Algarve</td><td>Parents are no-smokers</td><td>95</td><td>13</td><td>13&#46;7</td><td>82</td><td>86&#46;3</td><td>44&#46;4</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>96</td><td>59</td><td>61&#46;5</td><td>37</td><td>38&#46;5</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Madeira</td><td>Parents are no-smokers</td><td>106</td><td>21</td><td>19&#46;8</td><td>85</td><td>80&#46;2</td><td>16&#46;7</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>123</td><td>57</td><td>46&#46;3</td><td>66</td><td>53&#46;7</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Azores</td><td>Parents are no-smokers</td><td>66</td><td>14</td><td>21&#46;2</td><td>52</td><td>78&#46;8</td><td>26&#46;9</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>81</td><td>53</td><td>65&#46;4</td><td>28</td><td>34&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Total</td><td>Parents are no-smokers</td><td>1436</td><td>275</td><td>19&#46;2</td><td>1161</td><td>80&#46;8</td><td>598&#46;8</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>1638</td><td>1031</td><td>62&#46;9</td><td>607</td><td>37&#46;1</td><td>&#160;</td><td>&#160;</td></tr></table><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion and conclusions</span><p class="elsevierStylePara">This study aims to describe children&#39;s exposure to SHS at home based on a sample of Portuguese children attending the 4th school grade&#46; The study presents data from the total sample and from the main Portuguese administrative regions &#40;NUTs II&#41;&#58; Alentejo&#44; Algarve&#44; Azores&#44; Centre&#44; Lisbon&#44; Madeira and North&#46; The SHS at home is caused by the smoking of parents&#44; other family members and guests&#46;</p><p class="elsevierStylePara">In this sample&#44; 43&#46;7&#37; of the fathers and 29&#46;3&#37; of the mothers were smokers&#46; Comparing this with the prevalence for the group 35&#8211;44 years old obtained in the latest National Health Survey&#44; the results of this study are similar for men &#40;43&#46;7&#37; and 44&#46;6&#37;&#41; and are substantially higher for women &#40;29&#46;3&#37; and 20&#46;9&#37;&#41;&#46;<a href="&#35;bib34" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a></p><p class="elsevierStylePara">More than half of the participants had a smoking parent &#40;mother or father&#41; and for almost a fifth both parents smoked&#44; thus increasing the risk of exposure to SHS and the severity of this exposure&#46; These data were substantially different within the various regions studied&#44; thus reinforcing the hypothesis that people&#39;s social context is an important determinant of parents smoking behaviour and of children&#39;s exposure to SHS at home&#46;</p><p class="elsevierStylePara">A guest who smokes is the most common cause for children&#39;s exposure to SHS at home&#44; suggesting that rules concerning smoking at home are more easily ignored when the family has visitors&#46; Children&#39;s exposure to SHS at home due to the smoking of their parents &#40;mother&#44; father or both&#41; is also common&#44; including 30&#37; of the study participants&#46; Children&#39;s exposure to SHS resulting from the smoking of the father is slightly higher than that resulting from the smoking of the mother&#44; but the percentage of smoking mothers who smoke at home was higher than the one of smoking fathers&#46; These results put even more stress on the risks of female smoking and the need for more information and more awareness campaigns on this issue targeted to women&#46;</p><p class="elsevierStylePara">The results show that a substantial proportion of smoking parents do not smoke at home&#46; This is an important finding&#44; confirming that it is possible to be a smoker and&#44; yet&#44; partially protect children and the family house from SHS &#8211; only partially since smokers pollute their house even when they do not smoke there because they carry toxic tobacco substances on their clothes and body &#40;third-hand smoke&#41;&#46;<a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a></p><p class="elsevierStylePara">Of the parents who smoke at home&#44; the majority smoke only occasionally&#44; which might be seen as a sign that they are aware of the risks and that they are actively trying to avoid them&#46; Investing in increasing the awareness of the smoking parents about the SHS risks may expand this home-protecting behaviour&#46;</p><p class="elsevierStylePara">Comparing the subgroups with smoking and non-smoking parents&#44; we found great differences in children&#39;s exposure to SHS&#46; On the one hand&#44; even in cases with non-smoking parents about a fifth of the children was exposed to SHS at home and&#44; on the other hand&#44; in cases with smoking parents more than a third seems to be protected from SHS exposure at home&#46; These results confirm the need to raise awareness about this risk among general population and to insist on measures to prevent it&#46;</p><p class="elsevierStylePara">The analysis by region reveals both significant and coherent differences&#46; Lisbon has the highest prevalence of children exposed to SHS at home&#46; In relation to the National Health Survey&#44; Lisbon is also the Portuguese region with the highest prevalence of women who smoke&#46;<a href="&#35;bib34" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a> Lisbon is the main region of Portugal&#44; so&#44; these results may work as a negative forecast&#44; suggesting that the Portuguese situation may worsen in the coming years&#46;</p><p class="elsevierStylePara">This study has some limitations&#46; First of all&#44; the sample only includes children attending the 4th school grade&#44; which is an important limitation to take into account&#46; The sample size is quite small in some regions and the sampling method is limited&#44; which means that the sample is not always totally representative at regional and at national levels&#46; The data gathering was based on children&#39;s self-report without a biological validation&#44; which is another limitation of the study&#58; these limitations are the result of budgetary restrictions&#46; Despite these limitations&#44; this is the first study performed in Portugal with a large sample of the population attending the 4th school grade which includes participants from all of the seven main regions of Portugal&#44; thus allowing a good description of the situation regarding Portuguese children&#39;s exposure to SHS at home&#46;</p><p class="elsevierStylePara">To conclude&#44; Portuguese children&#39;s exposure to SHS was high&#44; especially when their parents smoke&#46; SHS exposure association with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control&#46; Our findings highlight the need of effective prevention measures to avoid children&#39;s SHS exposure at home and to promote a more equitable society&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article&#46;</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article&#46;</p><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Acknowledgments</p><p class="elsevierStylePara">The authors would also like to thank all schools and teachers who collaborated in the study implementation and all students who took part in the study&#46;</p><p class="elsevierStylePara">This work was supported by FEDER through the Programa Operacional Factores de Competitividade &#8211; COMPETE &#40;FCOMP-01-0124-FEDER-009117&#41;&#44; and by FCT &#8211; Funda&#231;&#227;o para a Ci&#234;ncia e a Tecnologia &#40;Ref&#46; PTDC&#47;CPE-CED&#47;098281&#47;2008&#41;&#46;</p><p class="elsevierStylePara">Received 15 June 2014 <br></br>Accepted 14 September 2014 </p><p class="elsevierStylePara">Corresponding author&#46; pvitoria&#64;fcsaude&#46;ubi&#46;pt</p>"
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            0 => "Tobacco smoke pollution"
            1 => "Child welfare"
            2 => "Smoking"
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        "resumen" => "<span class="elsevierStyleSectionTitle"> Abstract</span><br/><p class="elsevierStylePara"> Second-hand tobacco smoke &#40;SHS&#41; is a major indoor pollutant that causes serious health problems for all exposed&#44; especially children&#46; Children are often exposed to SHS at home&#44; due to parental or other households&#8217; or guests&#8217; smoking&#46; This study describes Portuguese children&#39;s exposure to SHS at home &#40;total and by Portuguese main regions&#41;&#46;</p><p class="elsevierStylePara"> In 2010&#47;2011&#44; a questionnaire was applied to a sample of Portuguese children in the 4th grade &#40;<span class="elsevierStyleItalic">N</span>&#160;&#61;&#160;3187&#44; mean age 9&#46;05&#160;&#177;&#160;0&#46;7 years&#44; 51&#46;1&#37; male&#41;&#46; Descriptive analysis&#44; chi-square tests and crude odds ratios were performed&#46;</p><p class="elsevierStylePara"> Of the participants&#44; 62&#46;9&#37; of those with smoking parents and 19&#46;2&#37; of those with non-smoking parents were exposed to SHS at their home&#46; Parental smoking varied significantly among regions and was significantly associated with children&#39;s exposure to SHS at home&#46;</p><p class="elsevierStylePara"> Children&#39;s exposure to SHS at home was high&#44; especially if their parents smoke&#46; Children living in Lisbon Region presented the highest SHS exposure rate&#46; The association of SHS exposure with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control effectiveness&#46; Our findings highlight the need to effectively prevent children&#39;s SHS exposure at their home and to develop tailored tobacco control measures by region&#46;</p>"
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Children's exposure to second hand smoke at home: A cross-sectional study in Portugal
Paulo D. Vitóriaa,
,b
, José Cunha Machadoc, Ana Carolina Araújod, Sofia B. Ravarae,f, Catarina Samorinhag, Henedina Antunesh, Manuel Rosasi, Elisardo Becoñaj, José Preciosod
a Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
b CIS-IUL, Instituto Universitário de Lisboa (ISCTE-IUL), Av. Das Forças Armadas, Lisboa, Portugal
c Instituto de Ciências Sociais, Universidade do Minho, Campus de Gualtar, Braga, Portugal
d Instituto de Educação, Universidade do Minho, Campus de Gualtar, Braga, Portugal
e Centro de Investigação de Ciências da Saúde, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
f Centro Hospitalar da Cova da Beira, Unidade de Cessação Tabágica, Covilhã, Portugal
g Instituto de Saúde Pública, Universidade do Porto, R. Das Taipas, 135, Porto, Portugal
h Serviço de Pediatria, Hospital de Braga, Instituto de Investigação em Ciências da Vida e da Saúde (ICVS), Escola de Ciências da Saúde, Universidade do Minho e ICVS/3B's – Laboratório Associado, Braga/Guimarães, Campus de Gualtar, Braga, Portugal
i Divisão da Promoção da Saúde, Câmara Municipal de Viana do Castelo, Passeio das Mordomas da Romaria, Viana do Castelo, Portugal
j Unidade de Tabaquismo, Faculdade de Psicoloxía, Universidade de Santiago de Compostela, Campus Vida, Santiago de Compostela, Spain
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    "textoCompleto" => "<a name="sec0005" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Introduction</span><p class="elsevierStylePara">Second-hand smoke &#40;SHS&#41; is the smoke released into the environment mainly by burning cigarette tobacco&#46; It is composed of a complex mixture of thousands of gases and micro-particles&#44; including nicotine and several carcinogens&#44; toxic and irritating substances&#46; In 1992&#44; the U&#46;S&#46; Environmental Protection Agency &#40;EPA&#41;<a href="&#35;bib18" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">1</span></a> declared SHS as a group A amongst human carcinogens&#44; concluding that there is no safe limit to this exposure&#46; In 2000&#44; the World Health Organization &#40;WHO&#41; European Office published the indoor air quality guidelines also concluding that it is not possible to define a safe limit for SHS exposure&#46;<a href="&#35;bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a></p><p class="elsevierStylePara">Exposure to SHS causes lung cancer and cardiovascular diseases and has a particularly negative impact on pregnancy and on children&#39;s health&#44; namely&#44; causing reduced intrauterine growth&#44; spontaneous abortion&#44; preterm birth&#44; low birth weight&#44; sudden death syndrome&#44; ear problems&#44; and respiratory diseases&#46;<a href="&#35;bib19" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib20" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a></p><p class="elsevierStylePara">Children are particularly vulnerable to SHS since they have a less developed airways system and a still immature immune system&#46;<a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib23" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a> Prevalence of chronic respiratory symptoms&#44; such as cough&#44; wheezing and dyspnoea&#44; is higher among children exposed to SHS&#46;<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib24" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">7</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a> These children have also a greater risk of lower respiratory tract infections &#40;pneumonia and bronchiolitis&#41;&#44; asthma attacks&#44; and recurrent otitis media&#46;<a href="&#35;bib21" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib22" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">5</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib25" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">8</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a></p><p class="elsevierStylePara">Children&#39;s exposure to SHS is quite often the result of the tobacco smoked by their parents at home and&#47;or from permissiveness towards the smoking behaviour of others indoors&#46;<a href="&#35;bib27" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">10</span></a> Another important risk of this parental behaviour is the proven influence on the likelihood of children becoming smokers in the future&#46;<a href="&#35;bib28" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib29" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">12</span></a></p><p class="elsevierStylePara">Despite these consequences&#44; the WHO estimates that worldwide about half of the children &#40;700 million&#41; are exposed to SHS&#44; mainly in their own homes&#46;<a href="&#35;bib26" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">9</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a> Two Portuguese studies revealed that 38&#37; and 41&#37; of the children were daily or occasionally exposed to SHS caused by their parents&#8217; smoke&#46;<a href="&#35;bib31" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib32" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44; </span><a href="&#35;bib33" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">16</span></a></p><p class="elsevierStylePara">To better prevent children&#39;s exposure to SHS we need more information about the parents&#44; other cohabitants and houseguests smoking habits&#46; This study describes smoking habits in Portugal and children&#39;s exposure to SHS at home&#46; It was carried out by region to get a more detailed view of the situation and to support decisions on prevention of this risk for children&#39;s health&#46;</p><a name="sec0010" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Material and methods</span><a name="sec0015" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Study design and sampling procedure</span><p class="elsevierStylePara">This is a cross-sectional study conducted in the school year of 2010&#47;2011 based on a self-administered questionnaire filled in by 3187 Portuguese children in the 4th grade &#40;mean age 9&#46;05&#160;&#177;&#160;0&#46;7 years&#59; 51&#46;1&#37; male&#41;&#46;</p><p class="elsevierStylePara">Convenience and random sampling methods were combined to select the participants of this study&#46; Nine municipalities &#40;Angra do Hero&#237;smo&#44; Braga&#44; Covilh&#227;&#44; &#201;vora&#44; Faro&#44; Funchal&#44; Lisboa&#44; Porto&#44; Viana do Castelo&#41; representing the seven main regions of Portugal &#40;NUTs II&#58; Azores&#44; Alentejo&#44; Algarve&#44; Centre&#44; Lisbon&#44; Madeira and North&#41; were chosen for the sake of convenience&#46; Considering the number of 4th grade students from the nine municipalities as a total population&#44; and estimating that each class has 20 students&#44; a proportional number of classes per each municipality were randomly chosen to participate in the study&#46; The students&#8217; response rate per municipality was between 69&#46;2&#37; &#40;Funchal&#41; and 91&#46;9&#37; &#40;Angra do Hero&#237;smo&#41; with an average of 77&#46;5&#37;&#46;</p><a name="sec0020" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Questionnaire</span><p class="elsevierStylePara">The questionnaire that was used had been developed and validated for this study&#46; It contained multiple choice questions and four open-ended questions to measure the following variables&#58;</p><p class="elsevierStylePara">Socio-demographic variables&#58; Age&#44; Sex&#44; Fathers&#8217; and Mothers&#8217; Education level and Socio-economic level&#46;</p><p class="elsevierStylePara">Children&#39;s exposure to SHS at home&#58; Smoker family members &#40;&#8220;does not smoke&#8221;&#44; &#8220;yes&#44; sometimes&#8221;&#44; &#8220;yes&#44; every day&#8221; or &#8220;I don&#8217;t know&#47;I do not have any&#8221;&#41;&#44; Family members and visitors&#8217; permission to smoke at home &#40;&#8220;does not smoke&#8221;&#44; &#8220;yes&#44; every day&#8221;&#44; &#8220;yes&#44; sometimes&#8221; and &#8220;does not smoke at home&#8221; or &#8220;I don&#8217;t know&#47;I do not have any&#47;does not live in my house&#8221;&#41; and rules concerning smoking inside the house &#40;&#8220;smoking is not allowed in any part of the house&#8221;&#59; &#8220;smoking is allowed in some parts&#47;rooms of the house&#8221;&#59; &#8220;smoking is allowed in any parts&#47;rooms of the house&#8221; and &#8220;smoking is allowed only on special occasions&#8221;&#41;&#46;</p><a name="sec0025" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Procedure</span><p class="elsevierStylePara">The project and the questionnaire were approved by the Portuguese Ministry of Education&#46; Once authorization was granted by the Governing Body of each School Group&#44; head teachers were contacted and guidelines were given about obtaining parental or guardian authorization and about administration of the questionnaire&#46; The questionnaires were administered according to a protocol in the classrooms by trained teachers or by members of the project team&#46;</p><a name="sec0030" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Data analysis</span><p class="elsevierStylePara">The data gathered were analyzed through the statistical software IBM SPSS Statistics version 20 for <span class="elsevierStyleItalic">Windows</span>&#46; Frequencies&#44; contingency tables&#44; chi-squared tests and logistic regressions were used to perform the data analysis&#46; Bi-variable analyses were conducted using chi-square to compare categorical variables and crude odds ratios &#40;ORs&#41; when appropriate&#46; A two-sided <span class="elsevierStyleItalic">p</span> value less than 0&#46;05 was considered statistically significant&#46;</p><a name="sec0035" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStylePara">Participant socio-demographic characteristics and their distribution throughout the Portuguese regions &#40;NUTs II&#41; are presented in <a href="&#35;t0005" class="elsevierStyleCrossRefs">Table 1</a>&#46; Fathers&#8217; education level was inferior or equal to the 9th grade in 48&#46;8&#37; of the cases&#46; Mothers&#8217; education level was inferior or equal to the 9th grade in 45&#46;5&#37; of the cases&#46; In terms of socioeconomic level&#44; 68&#46;9&#37; of the cases were classified in the lowest level &#40;classes C and D&#41; and the remaining in the classes A and B&#46; Observed differences according to sex&#44; fathers&#8217; and mothers&#8217; education level and socioeconomic level by Portuguese regions were statistically significant&#46;</p><p class="elsevierStylePara">Table 1&#46; Socio-demographic characteristics&#44; by total and region&#46;</p><a name="t0005" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>&#160;</td><td colspan="2">Total &#40;<span class="elsevierStyleItalic">N</span>&#160;&#61;&#160;<span class="elsevierStyleItalic">3187</span>&#41;</td><td colspan="2">North &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;1356&#41;</td><td colspan="2">Centre &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;139&#41;</td><td colspan="2">Lisbon &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;949&#41;</td><td colspan="2">Alentejo &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;153&#41;</td><td colspan="2">Algarve &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;<span class="elsevierStyleItalic">196</span>&#41;</td><td colspan="2">Madeira &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;239&#41;</td><td colspan="2">Azores &#40;<span class="elsevierStyleItalic">n</span>&#160;&#61;&#160;155&#41;</td><td colspan="2">Chi-squared test</td></tr><tr align="left"><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">N</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td><span class="elsevierStyleItalic">Sex</span></td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>16&#46;584</td><td>&#60;0&#46;011</td></tr><tr align="left"><td>Male</td><td>1626</td><td>51&#46;1</td><td>709</td><td>52&#46;5</td><td>66</td><td>47&#46;5</td><td>442</td><td>46&#46;6</td><td>82</td><td>53&#46;6</td><td>117</td><td>59&#46;7</td><td>130</td><td>54&#46;4</td><td>80</td><td>51&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Female</td><td>1555</td><td>48&#46;9</td><td>642</td><td>47&#46;5</td><td>73</td><td>52&#46;5</td><td>506</td><td>53&#46;4</td><td>71</td><td>46&#46;4</td><td>79</td><td>40&#46;3</td><td>109</td><td>45&#46;6</td><td>75</td><td>48&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td colspan="19"><span class="elsevierStyleItalic">Age</span></td></tr><tr align="left"><td>8</td><td>24</td><td>0&#46;8</td><td>6</td><td>0&#46;5</td><td>&#8211;</td><td>&#8211;</td><td>16</td><td>1&#46;7</td><td>&#8211;</td><td>&#8211;</td><td>1</td><td>0&#46;5</td><td>&#8211;</td><td>&#8211;</td><td>1</td><td>0&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>9</td><td>1824</td><td>58&#46;3</td><td>935</td><td>70&#46;6</td><td>75</td><td>54&#46;0</td><td>489</td><td>52&#46;4</td><td>74</td><td>48&#46;7</td><td>101</td><td>53&#46;4</td><td>106</td><td>44&#46;5</td><td>44</td><td>28&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>10</td><td>1081</td><td>34&#46;5</td><td>356</td><td>26&#46;9</td><td>60</td><td>43&#46;2</td><td>345</td><td>36&#46;9</td><td>64</td><td>42&#46;1</td><td>76</td><td>40&#46;2</td><td>107</td><td>45&#46;0</td><td>73</td><td>47&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>11</td><td>170</td><td>5&#46;3</td><td>25</td><td>1&#46;9</td><td>4</td><td>2&#46;9</td><td>67</td><td>7&#46;2</td><td>11</td><td>7&#46;2</td><td>9</td><td>4&#46;8</td><td>22</td><td>9&#46;2</td><td>32</td><td>20&#46;8</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>12</td><td>27</td><td>0&#46;9</td><td>3</td><td>0&#46;2</td><td>&#8211;</td><td>&#8211;</td><td>12</td><td>1&#46;3</td><td>3</td><td>2&#46;0</td><td>2</td><td>1&#46;1</td><td>3</td><td>1&#46;3</td><td>4</td><td>2&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>13</td><td>5</td><td>0&#46;2</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>5</td><td>0&#46;5</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#8211;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Average &#40;DP&#41;</td><td>9&#46;5 &#40;0&#46;7&#41;</td><td>9&#46;3 &#40;0&#46;5&#41;</td><td>9&#46;5 &#40;0&#46;6&#41;</td><td>9&#46;6 &#40;0&#46;8&#41;</td><td>9&#46;6 &#40;0&#46;7&#41;</td><td>9&#46;5 &#40;0&#46;6&#41;</td><td>9&#46;7 &#40;0&#46;7&#41;</td><td>10&#46;0 &#40;0&#46;8&#41;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Father&#39;s education level</span></td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>52&#46;544</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#8804;9 years old</td><td>930</td><td>48&#46;8</td><td>406</td><td>50&#46;6</td><td>34</td><td>38&#46;2</td><td>272</td><td>50&#46;0</td><td>49</td><td>41&#46;9</td><td>38</td><td>32&#46;5</td><td>56</td><td>40&#46;6</td><td>75</td><td>75&#46;8</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#62;9 years old</td><td>977</td><td>51&#46;2</td><td>397</td><td>49&#46;4</td><td>55</td><td>61&#46;8</td><td>272</td><td>50&#46;0</td><td>68</td><td>58&#46;1</td><td>79</td><td>67&#46;5</td><td>82</td><td>59&#46;4</td><td>24</td><td>24&#46;2</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Mother&#39;s education level</span></td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>74&#46;178</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#8804;9 years old</td><td>980</td><td>45&#46;5</td><td>460</td><td>49&#46;4</td><td>29</td><td>29&#46;0</td><td>292</td><td>48&#46;9</td><td>38</td><td>29&#46;9</td><td>33</td><td>25&#46;0</td><td>56</td><td>36&#46;6</td><td>72</td><td>63&#46;7</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#62;9 years old</td><td>1174</td><td>54&#46;5</td><td>472</td><td>50&#46;6</td><td>71</td><td>71&#46;0</td><td>305</td><td>50&#46;1</td><td>89</td><td>70&#46;1</td><td>99</td><td>75&#46;0</td><td>97</td><td>63&#46;4</td><td>41</td><td>36&#46;3</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="19">&#160;</td></tr><tr align="left"><td><span class="elsevierStyleItalic">Graffard&#39;s Index</span> &#40;<span class="elsevierStyleItalic">socio-economic level</span>&#41;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>39&#46;120</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Classes A and B</td><td>882</td><td>31&#46;1</td><td>383</td><td>31&#46;5</td><td>53</td><td>42&#46;4</td><td>219</td><td>27&#46;0</td><td>51</td><td>35&#46;4</td><td>67</td><td>38&#46;3</td><td>82</td><td>39&#46;4</td><td>26</td><td>17&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>Classes C and D</td><td>1950</td><td>68&#46;9</td><td>835</td><td>68&#46;5</td><td>72</td><td>57&#46;6</td><td>593</td><td>73&#46;0</td><td>93</td><td>64&#46;6</td><td>108</td><td>61&#46;7</td><td>126</td><td>60&#46;6</td><td>123</td><td>82&#46;6</td><td>&#160;</td><td>&#160;</td></tr></table><p class="elsevierStylePara">More than half &#40;52&#46;0&#37;&#41; of the children had at least one smoking mother or father &#40;<a href="&#35;t0010" class="elsevierStyleCrossRefs">Table 2</a>&#41;&#44; consequently&#44; these children were potentially exposed to SHS in their own homes&#46; The differences between the various regions regarding the prevalence of a smoking mother or father were statistically significant &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#160;&#61;&#160;26&#46;6&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; and vary from 46&#46;4&#37; in the Centre Region to 58&#46;5&#37; in the Lisbon Region &#40;OR&#160;&#61;&#160;1&#46;6&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;007&#41;&#46;</p><p class="elsevierStylePara">Table 2&#46; Prevalence of smokers among mothers&#44; fathers&#44; both parents and mother or father&#44; by region and total&#46;</p><a name="t0010" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Regions</td><td colspan="4">Mother smokes</td><td colspan="4">Father smokes</td><td colspan="4">Both parents smoke</td><td colspan="4">Mother or father smokes</td></tr><tr align="left"><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td><td><span class="elsevierStyleItalic">n</span></td><td><span class="elsevierStyleItalic">&#37;</span></td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td>North</td><td>308</td><td>23&#46;3</td><td>1</td><td>&#8211;</td><td>535</td><td>41&#46;2</td><td>1&#46;11 &#40;0&#46;81&#8211;1&#46;52&#41;</td><td>0&#46;521</td><td>198</td><td>14&#46;8</td><td>1</td><td>&#8211;</td><td>645</td><td>48&#46;1</td><td>1&#46;07 &#40;0&#46;75&#8211;1&#46;52&#41;</td><td>&#60;0&#46;700</td></tr><tr align="left"><td>Centre</td><td>38</td><td>27&#46;2</td><td>1&#46;3 &#40;0&#46;9&#8211;1&#46;9&#41;</td><td>0&#46;248</td><td>54</td><td>40&#46;9</td><td>1&#46;10 &#40;0&#46;70&#8211;1&#46;73&#41;</td><td>0&#46;693</td><td>28</td><td>20&#46;3</td><td>1&#46;47 &#40;0&#46;95&#8211;2&#46;29&#41;</td><td>0&#46;087</td><td>64</td><td>46&#46;4</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Lisbon</td><td>347</td><td>38&#46;2</td><td>2&#46;03 &#40;1&#46;7&#8211;2&#46;4&#41;</td><td>&#60;0&#46;001</td><td>427</td><td>48&#46;4</td><td>1&#46;48 &#40;1&#46;07&#8211;2&#46;05&#41;</td><td>0&#46;017</td><td>226</td><td>24&#46;1</td><td>1&#46;84 &#40;1&#46;49&#8211;2&#46;27&#41;</td><td>&#60;0&#46;001</td><td>548</td><td>58&#46;5</td><td>1&#46;63 &#40;1&#46;14&#8211;2&#46;34&#41;</td><td>&#60;0&#46;007</td></tr><tr align="left"><td>Alentejo</td><td>42</td><td>28&#46;2</td><td>1&#46;3 &#40;0&#46;9&#8211;1&#46;9&#41;</td><td>0&#46;187</td><td>65</td><td>44&#46;5</td><td>1&#46;27 &#40;0&#46;82&#8211;1&#46;97&#41;</td><td>0&#46;286</td><td>26</td><td>17&#46;0</td><td>1&#46;18 &#40;0&#46;76&#8211;1&#46;85&#41;</td><td>0&#46;465</td><td>81</td><td>52&#46;9</td><td>1&#46;30 &#40;0&#46;82&#8211;2&#46;06&#41;</td><td>0&#46;264</td></tr><tr align="left"><td>Algarve</td><td>56</td><td>29&#46;3</td><td>1&#46;4 &#40;1&#46;0&#8211;1&#46;9&#41;</td><td>0&#46;070</td><td>72</td><td>38&#46;7</td><td>1</td><td>&#8211;</td><td>32</td><td>16&#46;5</td><td>1&#46;14 &#40;0&#46;76&#8211;1&#46;72&#41;</td><td>0&#46;528</td><td>96</td><td>49&#46;5</td><td>1&#46;13 &#40;0&#46;73&#8211;1&#46;75&#41;</td><td>0&#46;577</td></tr><tr align="left"><td>Madeira</td><td>69</td><td>29&#46;5</td><td>1&#46;4 &#40;1&#46;0&#8211;1&#46;9&#41;</td><td>0&#46;043</td><td>95</td><td>42&#46;4</td><td>1&#46;17 &#40;0&#46;78&#8211;1&#46;73&#41;</td><td>0&#46;448</td><td>41</td><td>17&#46;3</td><td>1&#46;21 &#40;0&#46;84&#8211;1&#46;75&#41;</td><td>0&#46;316</td><td>123</td><td>51&#46;9</td><td>1&#46;25 &#40;0&#46;82&#8211;1&#46;90&#41;</td><td>0&#46;303</td></tr><tr align="left"><td>Azores</td><td>45</td><td>29&#46;6</td><td>1&#46;4 &#40;1&#46;0&#8211;2&#46;0&#41;</td><td>0&#46;086</td><td>68</td><td>47&#46;2</td><td>1&#46;42 &#40;0&#46;91&#8211;2&#46;20&#41;</td><td>0&#46;121</td><td>32</td><td>20&#46;9</td><td>1&#46;53 &#40;1&#46;01&#8211;2&#46;32&#41;</td><td>0&#46;047</td><td>81</td><td>52&#46;9</td><td>1&#46;30 &#40;0&#46;82&#8211;2&#46;06&#41;</td><td>0&#46;264</td></tr><tr align="left"><td><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span> &#40;p&#41;</td><td>57&#46;70 &#40;&#60;0&#46;001&#41;</td><td>&#160;</td><td>14&#46;34 &#40;&#61;0&#46;026&#41;</td><td>&#160;</td><td>34&#46;06 &#40;&#60;0&#46;001&#41;</td><td>&#160;</td><td>&#160;</td><td>26&#46;60 &#40;&#60;0&#46;001&#41;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="17">&#160;</td></tr><tr align="left"><td>Total</td><td>905</td><td>29&#46;3</td><td>&#160;</td><td>&#160;</td><td>1316</td><td>43&#46;7</td><td>&#160;</td><td>&#160;</td><td>583</td><td>18&#46;5</td><td>&#160;</td><td>&#160;</td><td>1638</td><td>52&#46;0</td><td>&#160;</td><td>&#160;</td></tr></table><p class="elsevierStylePara">In this sample&#44; 43&#46;7&#37; of the fathers and 29&#46;3&#37; of the mothers were smokers&#46; The prevalence of smoking fathers differs by region &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">2</span></span></span>&#160;&#61;&#160;24&#46;3&#59; <span class="elsevierStyleItalic">p</span>&#160;&#61;&#160;0&#46;026&#41; from 38&#46;7&#37; in Algarve to 48&#46;4&#37; in Lisbon&#46; Also among mothers&#44; the smoking prevalence varies significantly by region&#44; from 23&#46;3&#37; in the North to 38&#46;2&#37; in Lisbon &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">2</span></span></span>&#160;&#61;&#160;57&#46;7&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46;</p><p class="elsevierStylePara">Among the participants&#44; 18&#46;5&#37; both parents were smokers&#46; The differences between regions in this category were statistically significant &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#160;&#61;&#160;34&#46;1&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41; and vary between 14&#46;8&#37; in the North to 24&#46;1&#37; in Lisbon&#46;</p><p class="elsevierStylePara">Children&#39;s exposure to SHS at home is presented in <a href="&#35;t0015" class="elsevierStyleCrossRefs">Table 3</a>&#46; In the total sample&#44; 29&#46;5&#37; of the participants claimed they were exposed to SHS caused by a smoking parent&#8211;mother and&#47;or father &#40;16&#46;9&#37; occasionally and 12&#46;6&#37; on a daily basis&#41;&#46; The exposure to the fathers&#8217; smoke &#40;23&#46;5&#37; in total and 30&#46;0&#37; in Lisbon&#41; is more common than the exposure to the mothers&#8217; smoke &#40;18&#46;2&#37; in total and 25&#46;9&#37; in Lisbon&#41;&#46; A smoking guest was the most frequent cause of children&#39;s exposure to SHS and affected around a third of the participants &#40;32&#46;6&#37;&#44; 18&#46;3&#37; occasionally and 14&#46;3&#37; daily&#41;&#46;</p><p class="elsevierStylePara">Table 3&#46; Prevalence of children&#39;s SHS exposure at home&#44; considering family member smoking status&#44; by region and total&#46;</p><a name="t0015" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Regions</td><td>Family member</td><td>Total</td><td colspan="2">Smokes daily at home</td><td colspan="2">Smokes occasionally at home</td><td colspan="2">Does not smoke or does not smoke at home</td><td colspan="2">Chi-squared test</td><td colspan="2">Logistic regression</td></tr><tr align="left"><td>&#160;</td><td>&#160;</td><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">2</span></span></td><td><span class="elsevierStyleItalic">p</span></td><td>OR &#40;95&#37; CI&#41;</td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td>North</td><td>Only mother</td><td>1286</td><td>80</td><td>6&#46;2</td><td>111</td><td>8&#46;6</td><td>1095</td><td>85&#46;1</td><td>&#160;</td><td>&#160;</td><td>1&#46;37 &#40;0&#46;80&#8211;2&#46;36&#41;</td><td>0&#46;251</td></tr><tr align="left"><td>Centre</td><td>&#160;</td><td>134</td><td>1</td><td>0&#46;7</td><td>18</td><td>13&#46;4</td><td>115</td><td>85&#46;8</td><td>&#160;</td><td>&#160;</td><td>1&#46;30 &#40;0&#46;64&#8211;2&#46;65&#41;</td><td>0&#46;468</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>885</td><td>89</td><td>10&#46;1</td><td>140</td><td>15&#46;8</td><td>656</td><td>74&#46;1</td><td>&#160;</td><td>&#160;</td><td>2&#46;75 &#40;1&#46;60&#8211;4&#46;72&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>142</td><td>6</td><td>4&#46;2</td><td>10</td><td>7&#46;0</td><td>126</td><td>88&#46;7</td><td>63&#46;59</td><td>&#60;0&#46;001</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>185</td><td>13</td><td>7&#46;0</td><td>23</td><td>12&#46;4</td><td>149</td><td>80&#46;5</td><td>&#160;</td><td>&#160;</td><td>1&#46;90 &#40;1&#46;01&#8211;3&#46;59&#41;</td><td>0&#46;047</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>229</td><td>11</td><td>4&#46;8</td><td>18</td><td>7&#46;9</td><td>200</td><td>87&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;14 &#40;0&#46;60&#8211;2&#46;19&#41;</td><td>0&#46;689</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>148</td><td>12</td><td>8&#46;1</td><td>17</td><td>11&#46;5</td><td>119</td><td>80&#46;4</td><td>&#160;</td><td>&#160;</td><td>1&#46;92 &#40;0&#46;99&#8211;3&#46;71&#41;</td><td>0&#46;053</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>North</td><td>Only father</td><td>1234</td><td>107</td><td>8&#46;7</td><td>148</td><td>12&#46;0</td><td>979</td><td>79&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;64 &#40;1&#46;09&#8211;2&#46;49&#41;</td><td>0&#46;019</td></tr><tr align="left"><td>Centre</td><td>&#160;</td><td>129</td><td>8</td><td>6&#46;2</td><td>23</td><td>17&#46;8</td><td>98</td><td>76&#46;0</td><td>&#160;</td><td>&#160;</td><td>2&#46;00 &#40;1&#46;34&#8211;3&#46;50&#41;</td><td>0&#46;016</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>833</td><td>103</td><td>12&#46;4</td><td>147</td><td>17&#46;6</td><td>583</td><td>70&#46;0</td><td>&#160;</td><td>&#160;</td><td>2&#46;71 &#40;1&#46;78&#8211;4&#46;11&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>138</td><td>10</td><td>7&#46;2</td><td>16</td><td>11&#46;6</td><td>112</td><td>81&#46;2</td><td>46&#46;32</td><td>&#60;0&#46;001</td><td>1&#46;47 &#40;0&#46;82&#8211;2&#46;61&#41;</td><td>0&#46;196</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>175</td><td>14</td><td>8&#46;0</td><td>23</td><td>13&#46;1</td><td>138</td><td>78&#46;9</td><td>&#160;</td><td>&#160;</td><td>1&#46;69 &#40;0&#46;99&#8211;2&#46;89&#41;</td><td>0&#46;054</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>212</td><td>12</td><td>5&#46;7</td><td>17</td><td>8&#46;0</td><td>183</td><td>86&#46;3</td><td>&#160;</td><td>&#160;</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>136</td><td>16</td><td>11&#46;8</td><td>26</td><td>19&#46;1</td><td>94</td><td>69&#46;1</td><td>&#160;</td><td>&#160;</td><td>2&#46;82 &#40;1&#46;65&#8211;4&#46;81&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>North</td><td>Mother and&#47;or</td><td>1326</td><td>154</td><td>11&#46;6</td><td>193</td><td>14&#46;6</td><td>979</td><td>73&#46;8</td><td>&#160;</td><td>&#160;</td><td>1&#46;47 &#40;1&#46;04&#8211;2&#46;09&#41;</td><td>0&#46;029</td></tr><tr align="left"><td>Centre</td><td>Father</td><td>136</td><td>9</td><td>6&#46;6</td><td>28</td><td>20&#46;6</td><td>99</td><td>72&#46;8</td><td>&#160;</td><td>&#160;</td><td>1&#46;55 &#40;0&#46;94&#8211;2&#46;56&#41;</td><td>0&#46;083</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>922</td><td>151</td><td>16&#46;4</td><td>197</td><td>21&#46;4</td><td>574</td><td>60&#46;5</td><td>&#160;</td><td>&#160;</td><td>2&#46;52 &#40;1&#46;77&#8211;3&#46;58&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>150</td><td>13</td><td>8&#46;7</td><td>21</td><td>14&#46;0</td><td>116</td><td>77&#46;3</td><td>56&#46;66</td><td>&#60;0&#46;001</td><td>1&#46;22 &#40;0&#46;74&#8211;2&#46;01&#41;</td><td>0&#46;441</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>188</td><td>24</td><td>12&#46;8</td><td>30</td><td>16&#46;0</td><td>134</td><td>71&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;68 &#40;1&#46;06&#8211;2&#46;64&#41;</td><td>0&#46;026</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>232</td><td>19</td><td>8&#46;2</td><td>26</td><td>11&#46;2</td><td>187</td><td>80&#46;6</td><td>&#160;</td><td>&#160;</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>150</td><td>20</td><td>13&#46;3</td><td>29</td><td>19&#46;3</td><td>101</td><td>67&#46;3</td><td>&#160;</td><td>&#160;</td><td>2&#46;02 &#40;1&#46;26&#8211;3&#46;23&#41;</td><td>0&#46;002</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>North</td><td>Guests</td><td>1337</td><td>180</td><td>13&#46;5</td><td>212</td><td>15&#46;9</td><td>945</td><td>70&#46;7</td><td>&#160;</td><td>&#160;</td><td>1&#46;49 &#40;1&#46;07&#8211;2&#46;07&#41;</td><td>0&#46;019</td></tr><tr align="left"><td>Centre</td><td>&#160;</td><td>137</td><td>10</td><td>7&#46;3</td><td>29</td><td>21&#46;2</td><td>98</td><td>71&#46;5</td><td>&#160;</td><td>&#160;</td><td>1&#46;43 &#40;0&#46;88&#8211;2&#46;32&#41;</td><td>0&#46;149</td></tr><tr align="left"><td>Lisbon</td><td>&#160;</td><td>931</td><td>169</td><td>18&#46;2</td><td>220</td><td>23&#46;6</td><td>542</td><td>58&#46;2</td><td>&#160;</td><td>&#160;</td><td>2&#46;58 1&#46;84&#8211;3&#46;61&#41;</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>Alentejo</td><td>&#160;</td><td>151</td><td>14</td><td>9&#46;3</td><td>23</td><td>15&#46;2</td><td>114</td><td>75&#46;5</td><td>68&#46;61</td><td>&#60;0&#46;001</td><td>1&#46;17 &#40;0&#46;72&#8211;1&#46;89&#41;</td><td>0&#46;537</td></tr><tr align="left"><td>Algarve</td><td>&#160;</td><td>189</td><td>29</td><td>15&#46;3</td><td>29</td><td>15&#46;3</td><td>131</td><td>69&#46;3</td><td>&#160;</td><td>&#160;</td><td>1&#46;59 &#40;1&#46;02&#8211;2&#46;46&#41;</td><td>0&#46;038</td></tr><tr align="left"><td>Madeira</td><td>&#160;</td><td>234</td><td>24</td><td>10&#46;3</td><td>27</td><td>11&#46;5</td><td>183</td><td>78&#46;2</td><td>&#160;</td><td>&#160;</td><td>1</td><td>&#8211;</td></tr><tr align="left"><td>Azores</td><td>&#160;</td><td>150</td><td>21</td><td>14&#46;0</td><td>33</td><td>22&#46;0</td><td>96</td><td>64&#46;0</td><td>&#160;</td><td>&#160;</td><td>2&#46;02 &#40;1&#46;28&#8211;3-18&#41;</td><td>0&#46;003</td></tr><tr align="left"><td colspan="13">&#160;</td></tr><tr align="left"><td>Total</td><td>Mother</td><td>3009</td><td>212</td><td>7&#46;0</td><td>337</td><td>11&#46;2</td><td>2460</td><td>81&#46;8</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#160;</td><td>Father</td><td>2857</td><td>270</td><td>9&#46;5</td><td>400</td><td>14&#46;0</td><td>2187</td><td>76&#46;5</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#160;</td><td>Mother and&#47;or father</td><td>3104</td><td>390</td><td>12&#46;6</td><td>524</td><td>16&#46;9</td><td>2190</td><td>70&#46;6</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td>&#160;</td><td>Guests</td><td>3129</td><td>447</td><td>14&#46;3</td><td>573</td><td>18&#46;3</td><td>2109</td><td>67&#46;4</td><td>&#160;</td><td>&#160;</td><td>&#160;</td><td>&#160;</td></tr></table><p class="elsevierStylePara">Comparing children with non-smoking parents and with smoking parents &#40;<a href="&#35;t0020" class="elsevierStyleCrossRefs">Table 4</a>&#41;&#44; we found great differences in the prevalence of children&#39;s exposure to SHS at home&#46; These differences are statistically significant in the total sample and in all regions considered&#46; For instance&#44; in relation to the total sample&#44; of the children with non-smoking parents&#44; 19&#46;2&#37; were exposed to SHS at home&#44; whereas of the children with smoking parents&#44; the prevalence rate of those exposed was 63&#46;3&#37; &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#160;&#61;&#160;598&#46;8&#59; <span class="elsevierStyleItalic">p</span>&#160;&#60;&#160;0&#46;001&#41;&#46; On the other hand&#44; in the subgroup with smoking parents&#44; 37&#46;1&#37; of the participants declared that they were not exposed to SHS at home&#46;</p><p class="elsevierStylePara">Table 4&#46; Prevalence of children&#39;s SHS exposure at home&#44; comparing cases with non smoking parents and cases with smoking parents&#44; by region and total&#46;</p><a name="t0020" class="elsevierStyleCrossRefs"></a><p class="elsevierStylePara"></p><table><tr align="left"><td>Regions</td><td>Parents smoking behaviour</td><td>Total</td><td colspan="2">There&#39;s SHS at home &#40;regularly or occasionally&#41;</td><td colspan="2">There&#39;s no SHS at home</td><td colspan="2">Chi-squared test</td></tr><tr align="left"><td>&#160;</td><td>&#160;</td><td>&#160;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">n</span></td><td>&#37;</td><td><span class="elsevierStyleItalic">&#967;</span>2</td><td><span class="elsevierStyleItalic">p</span></td></tr><tr align="left"><td>North</td><td>Parents are no-smokers</td><td>667</td><td>128</td><td>19&#46;2</td><td>539</td><td>80&#46;8</td><td>246&#46;6</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>645</td><td>399</td><td>61&#46;9</td><td>246</td><td>38&#46;1</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Centre</td><td>Parents are no-smokers</td><td>71</td><td>11</td><td>15&#46;5</td><td>60</td><td>84&#46;5</td><td>31&#46;5</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>64</td><td>41</td><td>64&#46;1</td><td>23</td><td>35&#46;9</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Lisbon</td><td>Parents are no-smokers</td><td>363</td><td>77</td><td>21&#46;2</td><td>286</td><td>78&#46;8</td><td>202&#46;0</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>548</td><td>381</td><td>69&#46;5</td><td>167</td><td>30&#46;5</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Alentejo</td><td>Parents are no-smokers</td><td>68</td><td>11</td><td>16&#46;2</td><td>57</td><td>83&#46;8</td><td>17&#46;8</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>81</td><td>41</td><td>50&#46;6</td><td>40</td><td>49&#46;4</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Algarve</td><td>Parents are no-smokers</td><td>95</td><td>13</td><td>13&#46;7</td><td>82</td><td>86&#46;3</td><td>44&#46;4</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>96</td><td>59</td><td>61&#46;5</td><td>37</td><td>38&#46;5</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Madeira</td><td>Parents are no-smokers</td><td>106</td><td>21</td><td>19&#46;8</td><td>85</td><td>80&#46;2</td><td>16&#46;7</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>123</td><td>57</td><td>46&#46;3</td><td>66</td><td>53&#46;7</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Azores</td><td>Parents are no-smokers</td><td>66</td><td>14</td><td>21&#46;2</td><td>52</td><td>78&#46;8</td><td>26&#46;9</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>81</td><td>53</td><td>65&#46;4</td><td>28</td><td>34&#46;6</td><td>&#160;</td><td>&#160;</td></tr><tr align="left"><td colspan="9">&#160;</td></tr><tr align="left"><td>Total</td><td>Parents are no-smokers</td><td>1436</td><td>275</td><td>19&#46;2</td><td>1161</td><td>80&#46;8</td><td>598&#46;8</td><td>&#60;0&#46;001</td></tr><tr align="left"><td>&#160;</td><td>One or both parents smoke&#40;s&#41;</td><td>1638</td><td>1031</td><td>62&#46;9</td><td>607</td><td>37&#46;1</td><td>&#160;</td><td>&#160;</td></tr></table><a name="sec0040" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Discussion and conclusions</span><p class="elsevierStylePara">This study aims to describe children&#39;s exposure to SHS at home based on a sample of Portuguese children attending the 4th school grade&#46; The study presents data from the total sample and from the main Portuguese administrative regions &#40;NUTs II&#41;&#58; Alentejo&#44; Algarve&#44; Azores&#44; Centre&#44; Lisbon&#44; Madeira and North&#46; The SHS at home is caused by the smoking of parents&#44; other family members and guests&#46;</p><p class="elsevierStylePara">In this sample&#44; 43&#46;7&#37; of the fathers and 29&#46;3&#37; of the mothers were smokers&#46; Comparing this with the prevalence for the group 35&#8211;44 years old obtained in the latest National Health Survey&#44; the results of this study are similar for men &#40;43&#46;7&#37; and 44&#46;6&#37;&#41; and are substantially higher for women &#40;29&#46;3&#37; and 20&#46;9&#37;&#41;&#46;<a href="&#35;bib34" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a></p><p class="elsevierStylePara">More than half of the participants had a smoking parent &#40;mother or father&#41; and for almost a fifth both parents smoked&#44; thus increasing the risk of exposure to SHS and the severity of this exposure&#46; These data were substantially different within the various regions studied&#44; thus reinforcing the hypothesis that people&#39;s social context is an important determinant of parents smoking behaviour and of children&#39;s exposure to SHS at home&#46;</p><p class="elsevierStylePara">A guest who smokes is the most common cause for children&#39;s exposure to SHS at home&#44; suggesting that rules concerning smoking at home are more easily ignored when the family has visitors&#46; Children&#39;s exposure to SHS at home due to the smoking of their parents &#40;mother&#44; father or both&#41; is also common&#44; including 30&#37; of the study participants&#46; Children&#39;s exposure to SHS resulting from the smoking of the father is slightly higher than that resulting from the smoking of the mother&#44; but the percentage of smoking mothers who smoke at home was higher than the one of smoking fathers&#46; These results put even more stress on the risks of female smoking and the need for more information and more awareness campaigns on this issue targeted to women&#46;</p><p class="elsevierStylePara">The results show that a substantial proportion of smoking parents do not smoke at home&#46; This is an important finding&#44; confirming that it is possible to be a smoker and&#44; yet&#44; partially protect children and the family house from SHS &#8211; only partially since smokers pollute their house even when they do not smoke there because they carry toxic tobacco substances on their clothes and body &#40;third-hand smoke&#41;&#46;<a href="&#35;bib30" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">13</span></a></p><p class="elsevierStylePara">Of the parents who smoke at home&#44; the majority smoke only occasionally&#44; which might be seen as a sign that they are aware of the risks and that they are actively trying to avoid them&#46; Investing in increasing the awareness of the smoking parents about the SHS risks may expand this home-protecting behaviour&#46;</p><p class="elsevierStylePara">Comparing the subgroups with smoking and non-smoking parents&#44; we found great differences in children&#39;s exposure to SHS&#46; On the one hand&#44; even in cases with non-smoking parents about a fifth of the children was exposed to SHS at home and&#44; on the other hand&#44; in cases with smoking parents more than a third seems to be protected from SHS exposure at home&#46; These results confirm the need to raise awareness about this risk among general population and to insist on measures to prevent it&#46;</p><p class="elsevierStylePara">The analysis by region reveals both significant and coherent differences&#46; Lisbon has the highest prevalence of children exposed to SHS at home&#46; In relation to the National Health Survey&#44; Lisbon is also the Portuguese region with the highest prevalence of women who smoke&#46;<a href="&#35;bib34" class="elsevierStyleCrossRefs"><span class="elsevierStyleSup">17</span></a> Lisbon is the main region of Portugal&#44; so&#44; these results may work as a negative forecast&#44; suggesting that the Portuguese situation may worsen in the coming years&#46;</p><p class="elsevierStylePara">This study has some limitations&#46; First of all&#44; the sample only includes children attending the 4th school grade&#44; which is an important limitation to take into account&#46; The sample size is quite small in some regions and the sampling method is limited&#44; which means that the sample is not always totally representative at regional and at national levels&#46; The data gathering was based on children&#39;s self-report without a biological validation&#44; which is another limitation of the study&#58; these limitations are the result of budgetary restrictions&#46; Despite these limitations&#44; this is the first study performed in Portugal with a large sample of the population attending the 4th school grade which includes participants from all of the seven main regions of Portugal&#44; thus allowing a good description of the situation regarding Portuguese children&#39;s exposure to SHS at home&#46;</p><p class="elsevierStylePara">To conclude&#44; Portuguese children&#39;s exposure to SHS was high&#44; especially when their parents smoke&#46; SHS exposure association with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control&#46; Our findings highlight the need of effective prevention measures to avoid children&#39;s SHS exposure at home and to promote a more equitable society&#46;</p><a name="sec0045" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Ethical disclosures</span><a name="sec0050" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Protection of human and animal subjects</span><p class="elsevierStylePara">The authors declare that no experiments were performed on humans or animals for this study&#46;</p><a name="sec0055" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article&#46;</p><a name="sec0060" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p class="elsevierStylePara">The authors declare that no patient data appear in this article&#46;</p><a name="sec0065" class="elsevierStyleCrossRefs"></a><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p class="elsevierStylePara">The authors have no conflicts of interest to declare&#46;</p><p class="elsevierStylePara">Acknowledgments</p><p class="elsevierStylePara">The authors would also like to thank all schools and teachers who collaborated in the study implementation and all students who took part in the study&#46;</p><p class="elsevierStylePara">This work was supported by FEDER through the Programa Operacional Factores de Competitividade &#8211; COMPETE &#40;FCOMP-01-0124-FEDER-009117&#41;&#44; and by FCT &#8211; Funda&#231;&#227;o para a Ci&#234;ncia e a Tecnologia &#40;Ref&#46; PTDC&#47;CPE-CED&#47;098281&#47;2008&#41;&#46;</p><p class="elsevierStylePara">Received 15 June 2014 <br></br>Accepted 14 September 2014 </p><p class="elsevierStylePara">Corresponding author&#46; pvitoria&#64;fcsaude&#46;ubi&#46;pt</p>"
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          "clase" => "keyword"
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            0 => "Tobacco smoke pollution"
            1 => "Child welfare"
            2 => "Smoking"
            3 => "Tobacco"
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        "resumen" => "<span class="elsevierStyleSectionTitle"> Abstract</span><br/><p class="elsevierStylePara"> Second-hand tobacco smoke &#40;SHS&#41; is a major indoor pollutant that causes serious health problems for all exposed&#44; especially children&#46; Children are often exposed to SHS at home&#44; due to parental or other households&#8217; or guests&#8217; smoking&#46; This study describes Portuguese children&#39;s exposure to SHS at home &#40;total and by Portuguese main regions&#41;&#46;</p><p class="elsevierStylePara"> In 2010&#47;2011&#44; a questionnaire was applied to a sample of Portuguese children in the 4th grade &#40;<span class="elsevierStyleItalic">N</span>&#160;&#61;&#160;3187&#44; mean age 9&#46;05&#160;&#177;&#160;0&#46;7 years&#44; 51&#46;1&#37; male&#41;&#46; Descriptive analysis&#44; chi-square tests and crude odds ratios were performed&#46;</p><p class="elsevierStylePara"> Of the participants&#44; 62&#46;9&#37; of those with smoking parents and 19&#46;2&#37; of those with non-smoking parents were exposed to SHS at their home&#46; Parental smoking varied significantly among regions and was significantly associated with children&#39;s exposure to SHS at home&#46;</p><p class="elsevierStylePara"> Children&#39;s exposure to SHS at home was high&#44; especially if their parents smoke&#46; Children living in Lisbon Region presented the highest SHS exposure rate&#46; The association of SHS exposure with geographic regions suggests the influence of social and contextual factors on smoking behaviour and on tobacco control effectiveness&#46; Our findings highlight the need to effectively prevent children&#39;s SHS exposure at their home and to develop tailored tobacco control measures by region&#46;</p>"
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]
Article information
ISSN: 08732159
Original language: English
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