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Secondhand smoke exposure and asthma outcomes among African-American and Latino children with asthma
  1. Andreas M Neophytou1,
  2. Sam S Oh2,
  3. Marquitta J White2,
  4. Angel C Y Mak2,
  5. Donglei Hu2,
  6. Scott Huntsman2,
  7. Celeste Eng2,
  8. Denise Serebrisky3,
  9. Luisa N Borrell4,
  10. Harold J Farber5,
  11. Kelley Meade6,
  12. Adam Davis6,
  13. Pedro C Avila7,
  14. Shannon M Thyne8,
  15. William Rodríguez-Cintrón9,
  16. José R Rodríguez-Santana10,
  17. Rajesh Kumar11,12,
  18. Emerita Brigino-Buenaventura13,
  19. Saunak Sen14,
  20. Michael A Lenoir15,
  21. L Keoki Williams16,17,
  22. Neal L Benowitz2,
  23. John R Balmes1,2,
  24. Ellen A Eisen1,
  25. Esteban G Burchard2
  1. 1 Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
  2. 2 Department of Medicine, University of California, San Francisco, San Francisco, California, USA
  3. 3 Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, New York, USA
  4. 4 Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York City, New York, USA
  5. 5 Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas, USA
  6. 6 Department of Pediatrics, Children’s Hospital and Research Center, Oakland, California, USA
  7. 7 Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  8. 8 Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
  9. 9 Veterans Caribbean Health Care System, San Juan, Puerto Rico
  10. 10 Centro de Neumología Pediátrica, San Juan, Puerto Rico
  11. 11 Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
  12. 12 Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, Illinois, USA
  13. 13 Department of Allergy and Immunology, Kaiser Permanente-Vallejo Medical Center, Vallejo, California, USA
  14. 14 Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  15. 15 Bay Area Pediatrics, Oakland, California, USA
  16. 16 Department of Internal Medicine, Henry Ford Health System, Detroit, Michigan, USA
  17. 17 Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan, USA
  1. Correspondence to Dr Andreas M Neophytou, Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA; aneophytou{at}


Background Secondhand smoke (SHS) exposures have been linked to asthma-related outcomes but quantitative dose–responses using biomarkers of exposure have not been widely reported.

Objectives Assess dose–response relationships between plasma cotinine-determined SHS exposure and asthma outcomes in minority children, a vulnerable population exposed to higher levels of SHS and under-represented in the literature.

Methods We performed analyses in 1172 Latino and African-American children with asthma from the mainland USA and Puerto Rico. We used logistic regression to assess relationships of cotinine levels ≥0.05 ng/mL with asthma exacerbations (defined as asthma-related hospitalisations, emergency room visits or oral steroid prescription) in the previous year and asthma control. The shape of dose–response relationships was assessed using a continuous exposure variable in generalised additive logistic models with penalised splines.

Results The OR for experiencing asthma exacerbations in the previous year for cotinine levels ≥0.05 ng/mL, compared with <0.05 ng/mL, was 1.40 (95% CI 1.03 to 1.89), while the OR for poor asthma control was 1.53 (95% CI 1.12 to 2.13). Analyses for dose–response relationships indicated increasing odds of asthma outcomes related with increasing exposure, even at cotinine levels associated with light SHS exposures.

Conclusions Exposure to SHS was associated with higher odds of asthma exacerbations and having poorly controlled asthma with an increasing dose–response even at low levels of exposure. Our results support the conclusion that there are no safe levels of SHS exposures.

  • asthma epidemiology
  • tobacco and the lung
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  • Contributors AMN was responsible for data analyses and manuscript preparation with input from SSO, MW, AM, NLB, JRB, EAE and EGB. DH and SH performed statistical analyses. CE, DS, LNB, EBB, HJF, KM, AD, PCA, SMT, WRC, JRRS, SS, MAL, LKW, RK and EGB participated in the design and coordination of the initial study. All coauthors contributed to interpretation of results, and provided revisions and approval of the final manuscript.

  • Funding This study was supported in part by the Sandler Family Foundation, the American Asthma Foundation, the RWJF Amos Medical Faculty Development Program, Harry Wm and Diana V Hind Distinguished Professor in Pharmaceutical Sciences II, the Tobacco-Related Disease Research Program under Award No 24RT-0025, a grant by the Flight Attendants Medical Research Institute (FAMRI), and the following institutes of the National Institutes of Health: National Heart Lung and Blood Institute (NHLBI) 1R01HL117004, R01Hl128439, R01HL135156, 1X01HL134589, R01HL118267; National Institute of Environmental Health Sciences (NIEHS) R01ES015794, R21ES24844, K99ES027511; the National Institute on Minority Health and Health Disparities (NIMHD) 1P60MD006902, U54MD009523, 1R01MD010443; and National Institute of Allergy and Infectious Diseases (NIAID) R01AI079139.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval University of California, San Francisco.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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