The impact of environmental tobacco smoke on children with asthma, United States, 2003-2010
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The impact of environmental tobacco smoke on children with asthma, United States, 2003-2010

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  • English

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    • Alternative Title:
      Acad Pediatr
    • Description:

      Given widespread interventions to reduce environmenal tobacco smoke (ETS) exposure and improve asthma control, we sought to assess the current impact of ETS exposure on children with asthma.


      We analyzed 2003-2010 data for non-smoking children 6-19 years with asthma from the National Health and Nutrition Examination Survey. Outcomes (sleep disturbance, missed school days, healthcare visits, activity limitation, and wheezing with exercise) were compared between ETS exposed children (serum cotinine levels 0.05-10 ng/mL) and unexposed children (<0.05 ng/ml) using ordinal regression adjusted for demographic characteristics. We also assessed whether associations were observable with low ETS exposure levels (0.05-1.0 ng/mL).


      Overall, 53.3% of children 6-19 years with asthma were ETS exposed. Age-stratified models showed associations between ETS exposure and most adverse outcomes among 6-11 year olds, but not 12-19 year olds. Even ETS exposure associated with low serum cotinine levels were associated with adverse outcomes for 6-11 year olds. Race-stratified models for children 6-19 years showed an association between ETS exposure and missing school, healthcare visits, and activity limitation due to wheezing among non-Hispanic white children, and disturbed sleep among non-Hispanic white and Mexican children. Among non-Hispanic black children, there was no elevated risk between ETS exposure and the assessed outcomes: non-Hispanic black children had high rates of adverse outcomes regardless of ETS exposure.


      Among children with asthma 6-11 years of age, ETS exposure was associated with most adverse outcomes. Even ETS exposure resulting in low serum cotinine levels was associated with risks for young children with asthma.

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