Family Hardships and Serum Cotinine in Children With Asthma

Abstract

BACKGROUND AND OBJECTIVE: A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma. METHODS:We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine. RESULTS:We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported $1 hardship, and 41% reported $4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with $4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine.

Salivary cotinine measurement for all children with persistent asthma: spit matters

“…This study confirms that SHS exposure is common among urban children with asthma 8 with relative fluctuation in SHS exposure as evidenced by bidirectional change in cotinine levels at 6 months. Perhaps a low baseline (ED visit) cotinine that significantly increased at 6 months reflects some effort to reduce SHS exposure when a child experiences acute asthma symptoms.…”

Financial and Social Hardships in Families of Children with Medical Complexity

“…Children with significant respiratory or cardiovascular comorbidities (e.g., cystic fibrosis, congenital heart disease) were excluded, as outlined previously. 10, 17-20 After consent, study personnel completed face-to-face surveys with English-speaking primary caregivers during the enrollment hospitalization. Given incomplete data on variables of interest, we excluded four respondents from our comparison analysis, yielding a total sample of 770.…”

Active and passive smoking impacts on asthma with quantitative and temporal relations: A Korean Community Health Survey

“…Although there have been several reports on the prolonged risk of asthma in former smokers, few studies have investigated the differential adverse effects of smoking status on the symptoms or diagnosis of asthma 7 – 9 . Like active smoking, passive smoking has also been reported to increase the risk of the development or aggravation of asthma 4 , 10 , 11 . Even in subjects who have never experienced active smoking, subjects with passive smoking have been shown to have an elevated development of asthma, with a hazard ratio of 1.21 compared with never-active non-smokers 4 .…”