Impact of the home environment on the relationship between prenatal exposure to environmental tobacco smoke and child behavior.

The goal of this study was to ascertain whether the effect of prenatal ETS exposure on behavioral symptoms at age 7 years is modified by the quality of the home environment. In a cohort of 417 children enrolled in a longitudinal birth cohort in New York City, prenatal ETS exposure, child behavior and home environment were assessed. Prenatal ETS was measured by questionnaire and blood cotinine. Child Behavior Checklist (CBCL) and Early Childhood HOME Inventory Scale (HOME) were also used. We detected a significant interaction between prenatal ETS exposure and living in a "better" home environment on reported problems in the rule breaking and externalizing domains (p-value for interaction terms: 0.002 and 0.04, respectively), such that there was no significant adverse impact of ETS exposure on behavior among those who experienced a "better" environment. We also detected a significant interaction between prenatal ETS exposure and living in a "worse" home environment on reported problems in the aggressive and externalizing domains (p-value for interaction terms: 0.03 and 0.02, respectively), such that there was a significant adverse effect of ETS exposure on behavior among children who experienced a "worse" environment. Aspects of the HOME environment, both positive and negative, moderated the effects of prenatal ETS exposure on selected behaviors at 7 years of age. This finding suggests that some negative developmental behavioral effects associated with ETS exposure early in life may be modified by the provision of an enriched learning environment as measured by the HOME inventory.