Sources, Locations, and Predictors of Environmental Tobacco Smoke Exposure Among Young Children From Inner-city Families

doi:10.1016/j.pedhc.2010.04.014

Journal of Pediatric Health Care

Volume 25, Issue 6, November–December 2011, Pages 365-372

https://doi.org/10.1016/j.pedhc.2010.04.014 Get rights and content

Abstract

Introduction

The purpose of this study was to determine the levels, sources, and locations of and influential factors for exposure to environmental tobacco smoke (ETS) among pediatric patients from inner-city families.

Method

Descriptive and associative analysis of ETS exposure in children 6 to 10 years of age was performed with survey data collected at Children's Hospital of Michigan through mothers' report and children's urine cotinine.

Results

The sample included 397 participants, 82.4% of whom were African American. Urine cotinine levels were correlated with reported ETS exposure and 71% of children with urine cotinine levels > 10 ng/mL. The mean duration of ETS exposure was 14.3 minutes (SD = 11.0) in the past week and 58.9 minutes (SD = 50.8) in the past month. Smoking parents (∼30%), grandparents (∼30%), and non-family members (∼28%) were the major ETS sources, and relatives' homes (∼40%), the children's own homes (∼24%), automobiles (∼15%), and friends' homes (∼11%) were the main ETS locations. Child ETS exposure was inversely correlated with having a non-single mother, maternal education, income, use of prenatal preventive care, and satisfactory parenting.

Discussion

ETS exposure in inner-city children was prevalent. Findings of this study may aid pediatric practitioners and public health workers in providing targeted interventions.

Section snippets

Data Source and Study Design

Data used for this analysis were part of a study that examined interactions between ETS exposure and gene polymorphisms on child development. Detailed procedures for data collection are described elsewhere (Chen & Woodcroft, 2009). Briefly, data collection was conducted from October 2006 to March 2008. Mothers (N = 400) who accompanied their children to the General Outpatient Clinics at Children's Hospital of Michigan were recruited in the clinic settings. Mothers with a child from 6 to 10

Sample Characteristics

Table 1 summarizes the major characteristics of the study sample. Among the 397 children, 209 (52.6%) were male. Age of the children ranged from 6 to 10 years (mean = 7.9, SD = 0.85). The majority of mothers (82.0%) and children (82.4%) were African American, 49% of the mothers were single, and 52% had a high school level education. The mean and median monthly household income was $1950 and $1500, respectively. The mean number of household members was 3.56 (SD = 0.72).

Levels of Recent ETS Exposure

Among the 397 children,

Discussion and Conclusions

In this study we have described the levels, sources, and locations of involuntary ETS exposure among a pediatric sample of 397 participants, predominantly African American children. Among the children sample, 70.7% had urine cotinine levels ≥ 10 ng/mL, indicating current exposure to ETS. This level of exposure is close to 75%, the rate among pediatric patients from the same hospital assessed about a decade ago with a similar ethnic composition of approximately 80% African American children (

Xinguang Chen, Professor, Department of Pediatrics, Prevention Research Center, Wayne State University, Detroit, MI.

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In study from Thailand, it was indicated that the SHS exposure rate of infants decreases with the increase of educational level of parents.27 Chen et al. from USA reported an inverse correlation between maternal education level and urinary cotinine levels of children.28 The educational level was directly related with socio-economical status of parents.
Secondhand smoke exposure is one of the important public health problems especially infants and children. The aim of this study was to assess prevalence and social predictors of secondhand smoke exposure of newborns and infants in household.
A cross sectional study conducted with a sample of 763 infants from 1 June to 31 August 2012 in Burdur. A questionnaire developed by was used for this study. It includes questions about socio- and bio-demographic features of participants and smoking related data by self reports of participants. Second hand smoke exposure of infants was considered as smoking someone at least one day per a week in the house.
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Studies documenting the trends in US TSE often focus on in-home exposure.5,17–19 There has also been limited research on exposure outside the home, highlighting its relevance.20,21 For example, during 2009–2010 approximately 9% of non-smoking US adults and over 20% of US middle and high school students reported being exposed to smoke in the car in the past seven days.18,22
Tobacco smoke exposure (TSE) is associated with many adverse health outcomes. The goal of this study was to provide insight into the prevalence and location of self-reported TSE outside the home for US adults and children.
Cross-sectional survey.
Data from a nationally representative sample of US adults from 2014 were included. Participants who responded that they smelled smoke during the past seven days in various settings were considered to have been exposed to TSE. Parents were asked about TSE exposure of their children.
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The growing evidence base of the association of SHS exposure and behavioral outcomes may be a motivator for a subset of parents with a strong family history of mental illness. Pediatric providers can discuss these risks with parents and other caregivers and provide smoking cessation advice, perform targeted screening and ongoing surveillance of child's behavior and functioning for early-onset manifestations of behavioral conditions (Chen, Stanton, Hopper, & Khankari, 2011). Several randomized controlled trials of smoking cessation counseling with parents to protect their children from potential negative health effects have been found to be effective and doable within the scope of primary care practice (Abdullah, Mak, Loke, & Lam, 2005; Curry et al., 2003; Emmons et al., 2001; Rosen et al., 2012).
Little is known about the association of secondhand smoke (SHS) exposure and behavioral conditions among preschoolers. A cross-sectional analysis was used to examine billing and pharmacy claims from November 2004 to June 2012 linked to medical encounter-level data for 2,441 children from four pediatric community health clinics. Exposure to SHS was associated with attention deficit-hyperactivity disorder/ADHD and disruptive behavior disorder/DBD after adjusting for potential confounding factors. Assessment of exposure to SHS and parental depressive symptoms in early childhood may increase providers' ability to identify children at higher risk of behavioral issues and provide intervention at the earliest stages.
Asking the right questions to ascertain early childhood secondhand smoke exposures
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Of our 4 secondhand smoke questions, Q3 (the number of hours around secondhand smoke per day) and Q4 (secondhand smoke in the car) were the most strongly correlated with hair cotinine levels at 2 years of age among those with lower (r = 0.49, P < .0001) and higher income (r = 0.24, P < .0001), respectively, further demonstrating the importance of these additional questions. Families with lower socioeconomic status have disparately higher levels of parental reported secondhand smoke exposures.2 By asking additional questions about the number of smokers living in the home, the number of hours per day around smoke, and whether anyone ever smokes in the car with the child, we identified that over half of the children would have been misclassified as unexposed if maternal smoking was the sole indicator.
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Written informed consent was used for subject recruitment. More details regarding sampling and data collection procedure can be found in previously published manuscripts (Chen, Stanton, Hopper, & Khankari, 2010; Chen & Woodcroft, 2009). In-person interviews were conducted to collect data by the same research associate who recruited the study participants.
The negative consequences of environmental tobacco smoke (ETS) in children have been well documented. Our objective is to assess whether children of unplanned pregnancies are at increased risk for ETS exposure.
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Among the sample of 399 children, 125 (31.3%) were born from unplanned pregnancies; 47.2% of the unplanned children and 25.6% of the planned children were exposed to ETS (χ² = 18.4, p < .01). Unplanned children of non-smoking mothers also experienced higher levels of exposure to ETS compared with planned children (22.45% vs. 10.05%, χ² = 5.50, p < .05). The association remained significant after controlling for covariates (adjusted odds ratio = 2.45; 95% confidence interval = 1.03, 5.84; p < .05).
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El objetivo principal del estudio es analizar la relación entre la exposición al humo ambiental de tabaco (HAT) en niños/as y el asma, las sibilancias y la salud percibida.
Estudio transversal mediante encuesta telefónica a una muestra representativa de 2411 menores de 12 años de España. Se describió la exposición al HAT en el ámbito privado y en el ámbito público, así como la prevalencia de asma, sibilancias y mala salud percibida autodeclaradas. La asociación entre los indicadores de salud y la exposición al HAT se analizó mediante modelos multivariados de regresión de Poisson con variancia robusta según edad y nivel de estudios.
La prevalencia de exposición al HAT en menores fue del 29,2% en el ámbito privado y del 42,5% en el ámbito público. No se observó asociación entre la exposición al HAT y el asma, las sibilancias y la mala salud percibida en menores de 5 años. En menores de 6-11 años con padres/madres con estudios primarios o secundarios, presentar asma (razón de prevalencia ajustada [RPa]: 2,1; intervalo de confianza del 95% [IC95%]: 1,2-3,8) y una peor salud percibida (RPa: 1,6; IC95%: 1,1-2,1) se asociaron positivamente con la exposición al HAT en el ámbito privado. En menores con progenitores o tutores con estudios universitarios se observó una asociación negativa entre presentar asma (RPa: 0,3; IC95%: 0,1-0,7) y sibilancias (RPa: 0,3; IC95%: 0,1-0,8) y la exposición al HAT.
Existen diferencias en la asociación entre la exposición al HAT y el asma, las sibilancias y una peor salud percibida según el nivel de estudios. Se deberían planificar intervenciones con perspectiva de equidad dirigidas a disminuir la exposición al HAT en la infancia.
This study aimed to estimate the association between second-hand smoke (SHS) exposure in children and asthma, wheezing and perceived health.
A cross-sectional study based on a telephone survey was performed on a representative sample of 2411 children under 12 years old in Spain. Exposure to SHS in private and public settings, and the prevalence of asthma, wheezing and perceived poor health were described. The association between health indicators and SHS exposure was analyzed using multivariate Poisson regression models with robust variance according to age and educational level.
The prevalence of SHS exposure in children was 29.2% in private settings and 42.5% in public settings. There was no association between SHS exposure and asthma, wheezing and perceived poor health in children ≤5 years. In children aged 6-11 years with parents with primary/secondary education, presenting asthma (adjusted prevalence ratio [aPR]: 2.1; 95% confidence interval [95%CI]: 1.2-3.8) and worse perceived health (aPR: 1.6; 95%CI: 1.1-2.1) were positively associated with SHS exposure in private settings. In children with parents with university studies, a negative association between SHS exposure and asthma (aPR: .3; 95%CI: 0.1-0.7) and wheezing (aPR: 0.3; 95%CI: 0.1-0.8) was observed.
There are differences in the association between SHS exposure and asthma, wheezing and poor perceived health according to educational level. Interventions with an equity perspective aimed at reducing SHS exposure in childhood should be implemented.

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Xinguang Chen, Professor, Department of Pediatrics, Prevention Research Center, Wayne State University, Detroit, MI.

Bonita Stanton, Professor, Department of Pediatrics, Prevention Research Center, Wayne State University, Detroit, MI.

John Hopper, Associate Professor, Department of Pediatrics, Prevention Research Center, Wayne State University, Detroit, MI, and Department of Internal Medicine, St. Joseph Mercy Hospital, Ypsilanti, MI.

Nikhil Khankari, Graduate Assistant, Department of Pediatrics, Prevention Research Center, Wayne State University, Detroit, MI.

: This study was co-funded by Children's Research Center of Michigan (Award No. 25NH5) and the Department of Pediatrics at Wayne State University School of Medicine, Detroit, MI.

: Conflicts of interest: None to report.

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ArticleSources, Locations, and Predictors of Environmental Tobacco Smoke Exposure Among Young Children From Inner-city Families

Abstract

Introduction

Method

Results

Discussion

Section snippets

Data Source and Study Design

Sample Characteristics

Levels of Recent ETS Exposure

Discussion and Conclusions

Early Human Development

Ambulatory Pediatrics

Social Science Medicine

Environmental tobacco smoke and middle ear disease in preschool-age children

Archives of Pediatric and Adolescent Medicine

AAP calls for ban on all advertising of tobacco products

AAP News

Use of continine immunoassay test strips for preclassifying urine samples from smokers and nonsmokers prior to analysis by LC-MS-MS

Journal of Analytic Toxicology

Polymorphisms in metabolic genes CYP1A1 and GSTM1 and changes in maternal smoking during pregnancy

Nicotine and Tobacco Research

Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children

Thorax

Environmental tobacco smoke exposure in low-income 6-year-olds: Parent report and urine cotinine measures

Nicotine and Tobacco Research

Reported difficulties in access to quality care for children with asthma in the inner city

Archives of Pediatric and Adolescent Medicine

Prenatal and postnatal environmental tobacco smoke exposure and children's health

Pediatrics

The life history calendar: A technique for collecting retrospective data

Sociological Methodology

Public health approaches to tobacco use prevention and cessation in the U.S

Journal of Public Health Management Practices

Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: A cross-sectional study of U.S.- and Mexico-born Hispanic women with young children

BMC Public Health

A closer look at smoking among young adults: Where tobacco control should focus its attention

American Journal of Public Health

Smoking behaviors of women whose children attend an urban pediatric primary care clinic

Women Health

Screening for environmental tobacco smoke exposure among inner-city children with asthma

Pediatrics

Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment

Current Opinions in Pediatrics

Article
Sources, Locations, and Predictors of Environmental Tobacco Smoke Exposure Among Young Children From Inner-city Families