Factors Associated with Second-Hand Smoke Exposure in Young Inner-City Children with Asthma

Abstract

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 report. 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 between 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 age 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 concentration 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 <0.05). 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 <0.001, R2 = 0.35). Conclusion Over half of young inner-city children with asthma were exposed to second hand smoke and caregivers are the predominant household smoker. 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.

Family Beliefs and Behaviors About Smoking and Young Children’s Secondhand Smoke Exposure

“…In fact, most general psychosocial factors were not associated with HSB or SHSe at all, highlighting the relative importance of targeting individuals' SHSe beliefs and behaviors over targeting general psychosocial factors in SHSe reduction interventions. 16,23,35 One exception is the association between depressive symptoms and salivary cotinine reported by Butz and colleauges 9 was replicated in this study, but was not extended to other SHSe outcomes of air nicotine or HSB existence. Similarly, Butz et al's 9 finding relating stress with cotinine was not replicated here.…”

“…16,23,35 One exception is the association between depressive symptoms and salivary cotinine reported by Butz and colleauges 9 was replicated in this study, but was not extended to other SHSe outcomes of air nicotine or HSB existence. Similarly, Butz et al's 9 finding relating stress with cotinine was not replicated here. Because few other studies have evaluated general psychosocial functioning with the SHSe outcomes evaluated in this study, the current findings contribute to our knowledge about the potential importance of modifiable factors and determining which factors should be targeted for intervention.…”

“…For example, routines (e.g., eating together, consistent discipline) and caregiver stress and depression are associated with parenting behaviors that impact their children's health (e.g., car seat use, administering vitamins/medications, healthy feeding/sleep practices) [24][25][26][27][28][29] and may influence children's SHSe. 9,28,30 Stress and depression are also associated with more smoking in adults, 31,32 further raising the risk for SHSe. Health beliefs, such as perceived importance of and confidence to engage in health behaviors, are associated with smoking cessation, 33,34 and the few studies that have examined caregivers' perspectives about SHSe suggest likely links with HSB existence and children's SHSe.…”

US Prevalence and Trends in Tobacco Smoke Exposure Among Children and Adolescents With Asthma

“…However, other researchers have described high ETS exposure among youth with asthma in different populations. 24,25 For example, in 1 inner-city community approximately half of youth with asthma were exposed to ETS. 24 The prevalence of smoking and other forms of tobacco use among adolescents with asthma is not as well described in the literature.…”

Continued Deficits of the Perceived Harms of Cigarette Smoking Among Young Adults: Insights from Participants on Amazon Mechanical Turk

“…This is particularly impactful among families with a lower socioeconomic status with higher rates of smoking and subsequent respiratory morbidities [11,12].…”