Environmental and Occupational Disorders
Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma,☆☆

https://doi.org/10.1067/mai.2002.125832Get rights and content

Abstract

Background: Environmental tobacco smoke (ETS) is a frequent exposure and is linked to asthma among inner-city children. Objective: We sought to examine the relationship among ETS exposure, select asthma symptoms, and consequences among inner-city children with asthma. Methods: Data from interviews with primary caregivers of inner-city elementary school children with asthma were evaluated (n = 590). Caregiver reports of child asthma symptoms, exercise limitations, asthma management, health care use, and ETS exposure were examined. Results: Smoking in the home was reported by 29.4% of primary caregivers. ETS exposure (yes/no) was not related to frequency of child nocturnal symptoms or other select asthma morbidity markers. However, among children exposed to ETS, the frequency and severity of child nocturnal symptoms were highest among children exposed to moderate-to-heavy levels of ETS. After controlling for child age, anti-inflammatory medication use, asthma primary care, and caregiver's education, exposure to higher levels of ETS was associated with nearly a 3-fold increase in nocturnal symptoms in children (odds ratio, 2.83; 95% CI, 1.22-6.55). Conclusion: Among elementary school inner-city children with asthma, exposure to higher levels of ETS was associated with increased frequency of nocturnal symptoms. Reducing the exposure of children with asthma to ETS should be a clear priority in developing effective asthma management plans for inner-city families. (J Allergy Clin Immunol 2002;110:147-53.)

Section snippets

Methods

This study examined data collected from 2 identical baseline surveys designed to evaluate and improve asthma management among inner-city children and their families. In the first study, 24 inner-city elementary schools from Baltimore, Maryland, and 31 inner-city schools from Washington, DC, were invited to participate. In the second study 32 additional inner-city elementary schools in Baltimore were contacted. The surveys were conducted between October 1996 and September 1997 and were approved

Demographic, health care, and environmental characteristics

The majority of the children in our study were African American (98%) and female (60%), with a mean age of 8.2 ± 2.0 years. The child's mother was the caregiver 89% of the time, a family relative 6% of the time, or the child's father 2% of the time. The mean age of the caregivers was 34.7 ± 8.1 years. Ninety percent of the families reported that they had health plans that covered all or part of the cost of prescription medications, and 93% reported having medical assistance or insurance that

Discussion

The primary finding of this study was that caregivers of children with asthma who were exposed to moderate-to-high levels of ETS were more likely to report frequent nocturnal symptoms than those exposed to low levels. Even after controlling for potentially confounding factors, such as child age, caregiver education, and asthma care and management (ie, use of anti-inflammatory medications), in homes with ETS exposure, children with moderate-to-high exposure levels were nearly 3 times as likely

Acknowledgements

We thank Drs Jodi Segal, Jerry Krishnan, and Gregory Diette for their helpful comments on earlier drafts of this manuscript.

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  • Cited by (0)

    Supported by grants HL 5201304 and HL 5283303 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

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    Reprint requests: Susan J. Bartlett, PhD, Johns Hopkins Asthma and Allergy Center, 5501 Hopkins Bayview Circle, Baltimore, MD 21224.

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