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Factors associated with second-hand smoke exposure in young inner-city children with asthma
Arlene M Butz1, Jill S Halterman, Melissa Bellin
1Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. abutz@jhmi.edu
Insights
Over half of young inner-city children with asthma are exposed to second-hand smoke (SHS), primarily from caregivers. Younger children and those with stressed or depressed caregivers face higher risks, even with home smoking bans.
Area of Science:
- Environmental Health
- Pediatric Asthma
- Public Health
Background:
- Second-hand smoke (SHS) exposure is a significant risk factor for childhood asthma exacerbations.
- Inner-city children, particularly those with persistent asthma, often face higher environmental exposures.
- Understanding social and environmental determinants of SHS exposure is crucial for targeted interventions.
Purpose of the Study:
- To investigate the association between social and environmental factors and SHS exposure levels in young inner-city children with asthma.
- To identify key risk factors contributing to SHS exposure in this vulnerable population.
- To inform strategies for reducing SHS exposure and improving asthma management.
Main Methods:
- Utilized data from a home-based behavioral intervention study involving 198 high-risk children with persistent asthma.
- Measured SHS exposure using salivary cotinine levels and caregiver reports.
- Employed statistical analyses, including Chi-square, ANOVA, and multivariate regression, to assess associations between cotinine levels and various factors.
Main Results:
- 53% of children exhibited cotinine levels indicative of SHS exposure, with a mean concentration of 2.42 ng/ml.
- Caregivers were the primary source of SHS (57%), despite 63% reporting a total home smoking ban.
- Younger children (3-5 years) and those with caregivers reporting depressive symptoms or high stress showed higher cotinine levels.
- Increased number of household smokers and younger child age were strongly associated with higher SHS exposure (R² = 0.35).
Conclusions:
- A significant proportion of young inner-city children with asthma are exposed to SHS, with caregivers being the main source.
- Younger children and those with caregivers experiencing psychological distress are at elevated risk, even with reported smoking bans.
- Targeted advocacy and interventions are necessary to support caregivers in smoking cessation and mitigate SHS exposure for high-risk children.
Objectives:
To examine the association of social and environmental factors with levels of second-hand smoke (SHS) exposure, as measured by salivary cotinine, in young inner-city children with asthma.
Methods:
We used data drawn from a home-based behavioral intervention for young high-risk children with persistent asthma post-emergency department (ED) treatment (N = 198). SHS exposure was measured by salivary cotinine and caregiver reports. Caregiver demographic and psychological functioning, household smoking behavior, and asthma morbidity were compared with child cotinine concentrations. Chi-square and ANOVA tests and multivariate regression models were used to determine the association of cotinine concentrations with household smoking behavior and asthma morbidity.
Results:
Over half (53%) of the children had cotinine levels compatible with SHS exposure and mean cotinine concentrations were high at 2.42 ng/ml (SD 3.2). The caregiver was the predominant smoker in the home (57%) and 63% reported a total home smoking ban. Preschool aged children and those with caregivers reporting depressive symptoms and high stress had higher cotinine concentrations than their counterparts. Among children living in a home with a total home smoking ban, younger children had significantly higher mean cotinine concentrations than older children (cotinine: 3-5 year olds, 2.24 ng/ml (SD 3.5); 6-10 year olds, 0.63 ng/ml (SD 1.0); p < .05). In multivariate models, the factors most strongly associated with high child cotinine concentrations were increased number of household smokers (β = 0.24) and younger child age (3-5 years) (β = 0.23; p < .001, R(2) = 0.35).
Conclusion:
Over half of the young inner-city children with asthma were exposed to SHS, and caregivers are the predominant household smokers. Younger children and children with depressed and stressed caregivers are at significant risk of smoke exposures, even when a household smoking ban is reported. Further advocacy for these high-risk children is needed to help caregivers quit and to mitigate smoke exposure.
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