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1.00 010 a � 0.60 a 0.40 0.20 0.015 0.2 0.4 0.6 Coriiilne level, nplmL 0.8 1.0 FIGURE 2 Percentage of children unexposed by housing type and cotinine level. The y-axis shows the proportion of children who are unexposed at different cotinine levels, which are displayed on the x-axis. The 3 lines represent each of the different housing types: detached house, attached house, and apartment (dashed line). TABLE 2 Percentage of Children Exposed to Tobacco Smoke According to Race/Ethnicity and Housing Type Variable Race/Ethnicity Percentage Exposed P (n) (95% Confidence Interval) Detached house Black (885) 89 (85-92) <.001 White Hispanic (1356) 66(60-71) Other (149) 74 (60-86) .838 White 0170) 68 (61-74) .003 Attached house Black (226)a 92 (83-96) <.05 Hispanic (133) 70 (52-83) .052 Other (22)1,b 80(54-94) .024 Hispanic White (64) 76(61-86) Apartment Black (385), 96 (92-98) <001 Hispanic (473) 73 (64-81) .656 Other Other (34), 64 (40-82) White (49)1,b 99 (91-99) .877 a Relative SE is >30%. Apartment -18.5 (-71.1 to 130.2) .694 b Inadequate sample size. age, includes the housing -by -race interaction. TABLE 3 Tobit Regression Model Predicting the Percentage Change in the Geometric Mean of Cotinine Variable Housing Type Percentage Change P (95% Confidence Interval) Federal poverty -level ratio -28.3 (-34.6to -21.5) <.001 White Detached house 0.0 Attached house -5.5 (-45.4 to 63.6) .838 Apartment 212.2 (50.3-548.7) .003 Black Detached house 0.0 Attached house 40.0 (-0.03 to 96.8) .052 Apartment 45.6 (5.4-101.1) .024 Hispanic Detached house 0.0 Attached house 4.7 (-38.1 to 76.9) .863 Apartment 7.8(-23.0 to 50.9) .656 Other Detached house 0.0 Attached house 12.7(-75.9 to 427.1) .877 Apartment -18.5 (-71.1 to 130.2) .694 Other variables included gender and age, includes the housing -by -race interaction. 8.A. - Page 33 ments may accelerate the current trend of limiting smoking in multiunit housing. One of the public health ben- efits seen from the restriction of smok- ing in the workplace has been a reduc- tion in smoking rates and number of cigarettes smoked. Restrictions in multiunit housing may have a similar effect on residents; however, imple- menting these restrictions without providing smoking -cessation assis- tance for residents also might create a significant burden for low-income smokers. Adult residents of Depart- ment of Housing and Urban Develop- ment -funded housing who are unin- sured will need access to free cessation programs, such as those of- fered by the national network of quitlineS.32 Banning smoking in multiunit dwell- ings by property owners or by regula- tion would be the obvious way to miti- gate contamination and children's exposure to tobacco toxins. Concern has been raised that dictating what can be done in a private dwelling is an infringement on personal privacy and liberty; however, this argument holds only if smoking in an adjacent apart- ment has no impact on one's neigh- bors. Legal doctrine supports restric- tions on private behavior if there are consequences for others, such as noise levels, noxious odors, or release of toxic chemicals.33,34 Tobacco smoke can be categorized both as a noxious odor and a toxic chemical. In addition, there is a strong probabilitythat expo- sure may result in physical harm, par- ticularly for children with underlying illnesses such as asthma. A recent analysiS34 addressing smoke-free pub- lic housing argued that phasing in such a policy as new leases were signed and existing ones renewed would be justified on legal and social justice grounds. The association be- tween living in an apartment and child cotinine levels provides additional PEDIATRICS Volume 127, Number 1 January 2011 89 Downloaded from www.pediatrics.org. Provided by San Mateo Medical Center on December 13, 2010