Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma

doi:10.1067/mai.2002.125832

Journal of Allergy and Clinical Immunology

Volume 110, Issue 1, July 2002, Pages 147-153

https://doi.org/10.1067/mai.2002.125832 Get 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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A total of 1,945 studies were identified and 25 studies met the inclusion criteria. Children with asthma and SHS exposure were twice as likely to be hospitalized for asthma (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.20–2.86, P = .01) than children with asthma but without SHS exposure. SHS exposure also was significantly associated with emergency department or urgent care visits (OR 1.66, 95% CI 1.02–2.69, P = 0.04), wheeze symptoms (OR 1.32, 95% CI 1.24, 1.41, P < .001), and lower ratio of forced expiratory volume in 1 second to forced vital capacity (OR −3.34, 95% CI −5.35 to −1.33, P = .001).
Children with asthma and SHS exposure are nearly twice as likely to be hospitalized with asthma exacerbation and are more likely to have lower pulmonary function test results.
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Of the 2219 children included in the study, SHS exposure was reported in 785 (35.4%), including 325 (14.8%) with ≥2 smokers in the home. Compared with nonexposed children, the children exposed to ≥2 smokers had longer length of stay (median, 70.4 hours vs 64.4 hours; adjusted hazard ratio, 0.85; 95% CI, 0.75-0.97) and were more likely to receive intensive care (25.2% vs 20.9%; aOR, 1.44; 95% CI, 1.05-1.96), but not mechanical ventilation. Outcomes in children exposed to only 1 household smoker were similar to those in nonexposed children.
Children hospitalized with CAP from households with ≥2 smokers had a longer length of stay and were more likely to require intensive care compared with children from households with no smokers, suggesting that they experienced greater pneumonia severity.
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^☆: Supported by grants HL 5201304 and HL 5283303 from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

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

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

Abstract

Section snippets

Methods

Demographic, health care, and environmental characteristics

Discussion

Acknowledgements

J Allergy Clin Immunol

Aust N Z J Public Health

J Clin Epidemiol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

Respiratory health effects of passive smoking: lung cancer and other disorders

Asthma mortality and hospitalization among children and young adults—United States, 1980-1993

MMWR Morb Mortal Wkly Rep

Characteristics of asthma mortality and morbidity in African-Americans

J Asthma

Routine emergency department use for sick care by children in the United States

Pediatrics

Environmental risk factors of childhood asthma in urban centers

Environ Health Perspect

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

Pediatrics

Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood

Thorax

Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children

Thorax

Effect of cigarette smoking on the pulmonary function of children and adolescents

Am Rev Respir Dis

Longitudinal study of the effects of maternal smoking on pulmonary function in children

N Engl J Med

Effect of parental cigarette smoking on the pulmonary function of children

Am J Epidemiol

Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991

JAMA

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