The authors compared three methods used to measure exposure to environmental tobacco smoke in pregnant women : personal air monitor, urine cotinine, and questionnaire.

Environmental tobacco smoke exposure assessment methods were compared for agreement using Cohen's Kappa and the Spearman rank order correlation coefficient.

Women who reported exposure had significantly higher levels of air nicotine concentration compared with women who reported no exposure, but urine cotinine did not differ.

Air nicotine was more highly correlated with home exposure (r=0.34) than work exposure (r=0.18).

Urine cotinine correlated with work exposure (r=0.14) but neither home nor social exposure.

Agreement was « fair » (Kappa=0.29) when self-reported exposure was compared with air monitor, but agreement was « poor » when urine cotinine was compared with self-report (Kappa=0.08) and air monitor (Kappa=0.10).

In low environmental tobacco smoke exposure environments, all three methods for measuring exposure may have a role, although modification to monitoring protocols will be needed to improve monitoring sensitivity and exposure classification.