More than 75 percent of fourth-graders in urban and rural settings have measurable levels of a nicotine breakdown product in their saliva that documents their second-hand smoke exposure, researchers report.

A study of 428 fourth graders and 453 parents in seven rural and seven urban Georgia schools also showed that the urban children were more likely to be smokers -- 14.9 percent versus 6.6 percent. Additionally urban children have the most exposure to smokers: 79.6 percent versus 75.3 percent, according to findings presented to the 15th World Conference on Tobacco or Health March 20-24 in Singapore.

"It's bad news," said Dr. Martha S. Tingen, Co-Director of Georgia Health Sciences University's Child Health Discovery Institute and Interim Program Leader of the GHSU Cancer Center's Cancer Prevention and Control Program. "Smoking is one of the major causes of low-birth weight infants, it increases the incidence of Sudden Infant Death Syndrome by 10 times, increases breathing problems, asthma-related hospital admissions, ear and upper-respiratory infections, yet all these kids are living in a smoking environment."

The findings are another reminder to pediatricians to talk with parents and children about smoking habits during every checkup and to researchers that more community-based studies are needed to give parents and children alike the skills they need to avoid or stop smoking, Tingen said. They also indicate that geography and health disparities need to figure heavily into tailoring solutions.

In the study group, researchers found children in the rural areas were more likely to be white and living with both parents; children in urban settings tended to be poorer, live with one parent, receive health care at community health clinics and have a parent who smoked.

At GHSU, young pediatricians such as Dr. Ketarah Robinson learn early to be vigilant and forthright about major health issues such as smoking and obesity with the parents and children they see in clinic, asking tough questions about whether the kids are getting pressured to smoke and if they've already given in. Like the children in the study, some kids say "yes" as early as age 10. Then doctors such as Robinson give them readily discernible reasons not to. "At that age we give them more concrete things like: Do you want to stink and have yellow teeth?" said Robinson, Co-Chief Resident in Pediatrics at GHS Children's Medical Center. Robinson and second-year Medical College of Georgia student Prathyusha Mididoddi will present the rural versus urban findings in Singapore. Tingen, who holds the Charles W. Linder Endowed Chair in Pediatrics, is first author.

Mididoddi echoed the fact that a significant percentage of kids getting regular smoke exposure is both "scary" and preventable. She and Robinson agree the findings re-emphasize the need for thorough social histories to get a clear picture of where and how children live.

"At any age, cigarette smoke really affects kids, whether it's a grandmother they visit with on weekends or a parent they are with every day," Robinson said. Now in her fourth year of training, Robinson already has seen educational efforts help parents stop smoking or at least keep them from smoking around their children. But she's also had a few patients start smoking.

Amazingly, some of those young smokers might already have trouble breathing. In a related study of 2,636 eighth-to-10th graders in four rural Georgia schools, GHSU researchers also found that nearly 40 percent of white females and nearly 27 percent of white boys with wheezing, coughing asthma symptoms said they smoked. There were other unhealthy indicators: children with an actual asthma diagnosis -- whether or not they had symptoms -- had a higher percentage of body fat as measured by a higher body mass index.

The study looked at children with no asthma diagnosis, a diagnosis and symptoms, a diagnosis and no symptoms and active symptoms -- but no actual diagnosis -- in a 30 day-period. While smoke exposure is bad for anyone, it's at the top of the list of asthma triggers. The asthma study, along with another study yielding encouraging news that home-based intervention can help black parents feel confident about their ability to make their home tobacco-free, are being presented as posters during the tobacco research meeting.

The study compared general health education to parents learning life skills geared at improving communication, emphasizing their strength as role models and fundamentals such as best parenting practices. The study was in a mix of urban and rural parents who were largely black and an average age of 38. Parents who got life skills training significantly increased their self-efficacy.

"It's an expectation that we are not going to smoke and nobody is going to smoke in our house," said Tingen, who has been taking these types of educational programs to schools and communities for years. "It's an expectation that when you grow up, you are not going to smoke." Tingen hopes this type of positive life-skills training will one day be available to children and parents in every school.

Dr. Dennis Ownby, Chief of the Medical College of Georgia Section of Allergy-Immunology and Rheumatology at GHSU, is Co-Principal Investigator with Tingen on a National Heart, Lung and Blood Institute grant that helped fund the studies and is a co-author on the asthma poster. Other research team members attending the conference include Maudesta Caleb, Research Associate; Kelora Cofer, Research Assistant; and Matthew Humphries; Research Manager, all with the Georgia Prevention Institute and MCG Department of Pediatrics.