The Burden of Environmental Tobacco Smoke Exposure on the Respiratory Health of Children 2 Months Through 5 Years of Age in the United States: Third National Health and Nutrition Examination Survey, 1988 to 1994

Gergen, Peter J.; Fowler, Jean A.; Maurer, Kurt R.; Davis, William W.; Overpeck, Mary D.

doi:10.1542/peds.101.2.e8

Cited by 295 publications

(216 citation statements)

References 33 publications

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“…8,9,[11][12][13][14]20 In contrast, we found no association of exposure to environmental tobacco smoke with asthma in older children and adolescents. We did not, however, have a measure of maternal smoking-the most consistent marker for the adverse effects of exposure to environmental tobacco smoke.…”

Section: Discussionmentioning

confidence: 66%

“…We did not, however, have a measure of maternal smoking-the most consistent marker for the adverse effects of exposure to environmental tobacco smoke. 5,9,11,14 Instead, we relied on serum cotinine levels and reported smoking for any adult in the household. Thus, these differences may either represent problems with the measurement of exposure to environmental tobacco smoke or a lack of any association of environmental tobacco smoke and asthma in older children.…”

Section: Discussionmentioning

confidence: 99%

“…The definition of asthma used in this study was based on parent report, as determined by a positive response to the survey question, "Were you ever told by a doctor that your child had asthma?" Prevalence of Doctor-Diagnosed Asthma in NHANES III (1988-1994 A review of the literature on the cause of asthma was conducted to identify environmental and residential risk factors for childhood asthma. We focused on modifiable factors that could be investigated by using NHANES III.…”

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confidence: 99%

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Contribution of Residential Exposures to Asthma in US Children and Adolescents

et al. 2001

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ABSTRACT. Context. Residential exposures are recognized risk factors for asthma, but the relative contribution of specific indoor allergens and their overall contribution to asthma among older children and adolescents in the United States are unknown.Objective. To estimate the relative contributions, population-attributable risks, and costs of residential risk factors for doctor-diagnosed asthma.Design. Nationally representative, cross-sectional survey conducted from 1988 to 1994.Setting and Participants. A total of 5384 children who were 6 to 16 years old and participated in the National Health and Nutrition Examination Survey III, a survey of the health and nutritional status of children and adults in the United States.Main Outcome Measure. Doctor-diagnosed asthma, as reported by the parent.Results. Five hundred three of 5384 children and adolescents (11.4%) had doctor-diagnosed asthma. After adjusting for age, gender, race, urban status, region of country, educational attainment of the head of household, and poverty, predictors of doctor-diagnosed asthma included a history of allergy to a pet (odds ratio [OR: 2.4; 95% confidence interval [CI]: 1.7, 3.3), presence of a pet in the household (OR: 1.5; 95% CI: 1.1, 2.1), and immediate hypersensitivity to dust mite (OR: 1.5; 95% CI: 1.05, 2.0), Alternaria (OR: 1.9; 95% CI: 1.3, 2.8), and cockroach allergens (OR: 1.4; CI: 1.04, 1.9). Family history of atopy (OR: 1.7; 95% CI: 1.1, 2.7) and diagnosis of allergic rhinitis (OR: 2.1; CI: 1.1, 3.7) were also predictors for asthma. The population-attributable risk of having 1 or more residential exposures associated with doctor-diagnosed asthma was 44.4% (95% CI: 29 -60), or an estimated 2 million excess cases. The attributable cost of asthma resulting from residential exposures was $405 million (95% CI: $264 -$547 million) annually.Conclusions. 4 -20 Studies that have implicated certain risk factors for asthma, however, are often limited by small sample size or a restricted focus on a specific age group, geographic distribution, or socioeconomic strata. 4,10,17,21 Thus, the relative contribution of specific allergens or other residential exposures to asthma for children and adolescents in the United States is poorly defined. Moreover, there has not been any attempt to estimate the overall contribution of indoor allergens or residential exposures to asthma. To develop a national strategy to prevent childhood asthma, it is critical to estimate the contribution of specific risk factors and the overall contribution of residential exposures to asthma.In a previous analysis, we estimated that residential exposures-including pets in the household, allergy to a pet, exposure to environmental tobacco smoke, and use of gas stove or oven for heat-accounted for 530 000 excess cases (40%) of doctordiagnosed asthma in children Ͻ6 years old. 20 Risk factors for asthma in early childhood, however, are often distinct from those that predict asthma in later childhood and adolescence. 6,9 Moreover, skin testing was not conducted among ch...

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Contribution of Residential Exposures to Asthma in US Children and Adolescents

et al. 2001

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“…Consequently, there are two odds ratios of interest: (1) the relative change in the odds of asthma comparing an individual in the medium category to an individual in the low category and (2) the relative change in the odds of asthma comparing an individual in the high category to an individual in the low category. Confounders/precision variables based on published literature were gender, parental asthma, presence of a household smoker, and income (Gergen et al, 1998;Jaakkola et al, 2001). For the first set of analyses (without interaction terms) we considered two sets of models: an unadjusted model using traffic exposure alone and an adjusted model that includes the additional confounder and precision variables outlined above.…”

Section: Discussionmentioning

confidence: 99%

An investigation of the association between traffic exposure and the diagnosis of asthma in children

Gordian

Haneuse

Wakefield

2005

J Expo Sci Environ Epidemiol

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This study investigated whether proximity to traffic at residence location is associated with being diagnosed with asthma as a young child. A survey of parents of children (aged 5-7) in kindergarten and first-grade in 13 schools was completed in Anchorage, Alaska, and Geographical Information System (GIS) mapping was used to obtain an exposure measure based on traffic density within 100 m of the cross streets closest to the child's residence. Using the range of observed exposure values, a score of low, medium or high traffic exposure was assigned to each child. After controlling for individual level confounders, relative to the low referent group, relative risks (95% confidence intervals) of 1.40 (0.77, 2.55) and 2.83 (1.23,6.51) were obtained in the medium and high exposure groups, respectively. For the null hypothesis of no difference in risk, a significance level of 0.056 was obtained, which suggests that further investigation would be worthwhile. Children without a family history of asthma were more likely to have an asthma diagnosis if they resided in a high traffic area than children who had one or more parents with asthma. The relative risk for children without a family history of asthma is 2.43 (1.12, 5.28) for medium exposure and 5.43 (2.08, 13.74) for high exposure. For children with a family history of asthma, the relative risk is 0.66 (0.25, 1.74) for medium exposure and 0.67 (0.12, 3.69) for high exposure. The P-value for the overall ''exposure-effect'' (i.e. both main effects AND interaction terms) is 0.0097.

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“…Several studies found that SHS was associated with asthma exacerbations or bronchial hyperactivity in older children, whereas others did not. 3,6,7,43,44 The vast majority of studies relied on parents' reports of smoking behavior to quantify the risk of asthma, wheezing, or diminished pulmonary functions associated with SHS exposure; fewer studies used objective biomarkers such as cotinine levels. 7,43,44 Although we found a significant reduction in the number of unscheduled asthma visits among children, there was not a corresponding reduction in the gaseous phase of tobacco smoke, as assessed with objective measures of air nicotine levels and biomarkers of internal doses.…”

Section: Discussionmentioning

confidence: 99%

Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke

2010

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT:Exposure to secondhand smoke (SHS) is associated with asthma exacerbations in children. Anticipatory guidance has failed to reduce SHS in controlled trials. It is not known whether high-efficiency, particlearresting (HEPA) air cleaners can reduce SHS or improve asthma symptoms in children. WHAT THIS STUDY ADDS:HEPA air cleaners led to reductions in unscheduled asthma visits and fine airborne particle levels but not asthma symptoms or cotinine levels. HEPA air cleaners may be useful as part of a multifaceted strategy to reduce asthma morbidity among children. abstract OBJECTIVE:The goal was to test the effects of high-efficiency, particulatearresting (HEPA) air cleaners on unscheduled asthma visits and symptoms among children with asthma exposed to secondhand smoke. METHODS:We enrolled 225 eligible children who were 6 to 12 years of age, had physician-diagnosed asthma, and were exposed to Ն5 cigarettes per day. We conducted a double-blind, randomized trial. Children were assigned randomly to receive 2 active or inactive HEPA air cleaners. RESULTS:Of 225 enrolled children, 110 (49%) were assigned to the intervention group and 115 (51%) to the control group; 215 (95%) completed the trial. During the trial, there were 42 fewer unscheduled asthma visits among children in the intervention group (18.5% [95% confidence interval: 1.25%-82.75%]; P ϭ .043), compared with those in the control group, after adjustment for baseline differences. There was a significant difference in the reductions of levels of particles of Ͼ0.3 m according to group assignment; there was a 25% reduction in particle levels in the intervention group, compared with a 5% reduction in the control group (P ϭ .026). There were no significant differences in parent-reported asthma symptoms, exhaled nitric-oxide levels, air nicotine levels, or cotinine levels according to group assignment. CONCLUSIONS:These results hold promise for using HEPA air cleaners as part of a multifaceted strategy to reduce asthma morbidity, but further research is necessary before they can be recommended routinely for the medical management of asthma.

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The Burden of Environmental Tobacco Smoke Exposure on the Respiratory Health of Children 2 Months Through 5 Years of Age in the United States: Third National Health and Nutrition Examination Survey, 1988 to 1994

Cited by 295 publications

References 33 publications

Contribution of Residential Exposures to Asthma in US Children and Adolescents

Contribution of Residential Exposures to Asthma in US Children and Adolescents

An investigation of the association between traffic exposure and the diagnosis of asthma in children

Effects of HEPA Air Cleaners on Unscheduled Asthma Visits and Asthma Symptoms for Children Exposed to Secondhand Tobacco Smoke

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