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Implementing tobacco control policies for minority youth with second-hand smoke exposure and respiratory disease
  1. Arlene M Butz
  1. Correspondence to Dr Arlene M Butz, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA; abutz{at}

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In Thorax, Neophytou and colleagues present evidence of a dose-response between second-hand smoke (SHS) exposure and asthma exacerbations and poor asthma control in minority children enrolled in either the Gene-environments and Admixture in Latino Americans (GALA II) or the Study of African-Americans, Asthma, Genes and Environments (SAGE II) studies.1 SHS exposure, defined as plasma cotinine level >0.05 ng/mL or above the limit of quantitation/concentration for reporting results with high confidence, was significantly associated with increased odds of poorly controlled asthma in African-American children. This association was not as strong in Latino youth. Further, the odds for experiencing an asthma exacerbation in the prior 12 months based on plasma cotinine levels >0.05 ng/mL was 1.40 (95% CI 1.03 to 1.89) but was not significant based on self-reported SHS exposure.1 Even at low exposure concentrations, a dose-response between plasma cotinine and asthma exacerbations was noted. Why is this significant? The study provides convincing data, in terms of asthma outcomes, that there are no safe levels of SHS exposure, irrespective of the child’s racial/ethnic group.

In 2017, WHO developed the Framework Convention on Tobacco Control (WHO FCTC) based on the six ‘MPOWER’ measures to provide global ‘best practice’ guidelines to reduce tobacco consumption and second-hand smoke exposure via national tobacco control programmes.2 Implementation of the six MPOWER strategies (monitor tobacco use and prevention policies, protect people from tobacco smoke, assistance …

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  • Funding The author is funded by National Institute of Nursing Research, National Institutes of Health (NIH) grant number NR013486.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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