Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use

Merianos, Ashley L.; Jandarov, Roman; Mahabee‐Gittens, E. Melinda

doi:10.1542/peds.2018-0266

Cited by 17 publications

(13 citation statements)

References 38 publications

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“…When parents quit smoking, their children benefit because they are no longer exposed to their tobacco smoke, which may result in fewer illnesses, better overall health, and fewer health care visits. 1,2 In addition, children of former smokers are also less likely to initiate smoking themselves. 3 Parental smokers who bring their children to the Pediatric Emergency Department (PED) or Urgent Care (UC) have high rates of smoking and their children have high rates of tobacco smoke exposure (TSE).…”

Section: Introductionmentioning

confidence: 99%

Tobacco Use Behaviors and Perceptions of Parental Smokers in the Emergency Department Setting

et al. 2019

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Background: More information is needed about modifiable child tobacco smoke exposure (TSE) patterns in racially diverse parental smokers to tailor interventions designed to help parents quit smoking and reduce their child’s TSE. Our objectives were to determine whether there were differences in smoking and TSE patterns based on parental race and child age and whether these patterns differed based on child age within black and white parental smokers. Secondary objectives were to assess the relationship between parental perceptions about the effects of smoking and the benefits of quitting on their child based on child age, race, and reported TSE patterns and to examine biochemically verified TSE levels by child age, race, and parent-reported TSE patterns. Methods: Participants (N = 415) were non-Hispanic black and non-Hispanic white parental smokers, mean age (standard deviation [SD]) = 31.2 (7.2) years, who visited the Pediatric Emergency Department (PED) or Urgent Care (UC) with their child, mean age (SD) = 4.7 (4.6) years. Parents reported sociodemographics, smoking, and child TSE patterns. We conducted chi-square tests, independent t-tests, and general linear regression models to answer our primary objectives and linear regression models to answer our secondary objectives. Results: Parents were 56.1% non-Hispanic black; 87.5% women; mean (SD) number of cigarettes smoked/day was 10.5(6.8). A higher proportion of parents with younger children <3 years old reported smoking bans compared with parents with older children ⩾3 to <18 years old (41.3% vs 19.7%, P < .0001). Subsequent analyses revealed this pattern for both black and white parents. A total of 212 (51%) of children had biochemical assessment of TSE; 89.6% had detectable TSE. Younger children had significantly higher cotinine levels than older children independent of their race ( P < .001). Conclusions: Children of parental smokers who visit the PED/UC were highly tobacco smoke exposed. Both black and white parental smokers with younger children were more likely to enforce smoking bans, but younger children had higher TSE levels than older children. Interventions that target this group of parental smokers with younger children may be more effective than interventions geared to all parental smokers.

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Section: Introductionmentioning

confidence: 99%

Tobacco Use Behaviors and Perceptions of Parental Smokers in the Emergency Department Setting

et al. 2019

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“…Future research should assess the associations between tobacco smoke exposure and health care visit locations individually, because exposure is prevalent among those with low income who may be high users of certain settings (eg, ED). 17 We were unable to control for prenatal exposure to nicotine, which may impair in utero airway development and lead to decreased pulmonary function and increased respiratory-related illnesses during childhood. 44,46 Interpretation This study demonstrates an association between biochemically validated and self-reported tobacco smoke exposure and pulmonary function among US adolescents without asthma.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14] Prior work indicates that tobacco smoke exposure is associated with reduced respiratory health and increased health-care utilization. [15][16][17] National research among adolescents without asthma found that self-reported tobacco smoke exposure increases the likelihood of experiencing respiratory symptoms such as wheeze and dry cough, and missed school days. 17 Concerning health-care utilization, research indicates that children who live with a smoker and are exposed to tobacco smoke in their homes are more likely to have a past year medical visit.…”

mentioning

confidence: 99%

“…[15][16][17] National research among adolescents without asthma found that self-reported tobacco smoke exposure increases the likelihood of experiencing respiratory symptoms such as wheeze and dry cough, and missed school days. 17 Concerning health-care utilization, research indicates that children who live with a smoker and are exposed to tobacco smoke in their homes are more likely to have a past year medical visit. 16 Tobacco smoke-exposed children are at two times the risk of having a higher number of hospital admissions.…”

mentioning

confidence: 99%

“…15 Prior work on tobacco smoke exposure and related respiratory symptoms and health-care utilization outcomes commonly use self-reported measures of exposure or respiratory health and health-care utilization. [16][17][18] Existing studies are limited to younger children, 19,20 wide age ranges, 7,13,15,16 and only those with asthma. 9,10,17,[21][22][23][24] Thus, relationships of tobacco smoke exposure with respiratory health and health-care utilization among US adolescents need to be further explored, using objective measures of exposure and spirometry.…”

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confidence: 99%

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Tobacco Smoke Exposure, Respiratory Health, and Health-care Utilization Among US Adolescents

Merianos

Jandarov

Mahabee‐Gittens

2020

Chest

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BACKGROUND: Tobacco smoke exposure adversely affects respiratory health. However, the effects of exposure on adolescents without asthma are not well known. RESEARCH QUESTION: To what degree are biochemically measured and self-reported tobacco smoke exposure associated with pulmonary function and health-care utilization among US nonsmoking adolescents? STUDY DESIGN AND METHODS: We analyzed 2007-2012 National Health and Nutrition Examination Survey data (N ¼ 2,482). Tobacco smoke exposure was assessed with serum cotinine and self-reported home exposure. We built multiple regression, logistic regression, and Poisson regression models, depending on the outcome. RESULTS: Approximately 3% of adolescents had high cotinine (3.00-15.00 ng/mL), 35.7% had low cotinine (0.05-2.99 ng/mL), and 10.9% had home exposure. Adolescents with high cotinine had significantly lower FEV 1 % (mean, 97.4; SE, 2.09; b, À8.99; 95% CI, À15.64 to À2.33) and FVC % (mean, 97.4; SE, 2.06; b, À8.42; 95% CI, À14.74 to À2.11) than adolescents with no/minimal cotinine (< 0.05 ng/mL; mean, 101.0; SE, 0.45; mean, 99.9; SE, 0.46, respectively). Adolescents with high cotinine were less likely to have a past year health-care visit (adjusted OR [aOR], 0.57; 95% CI, 0.38 to 0.88), but more likely to have an overnight hospital stay (aOR, 4.82; 95% CI, 2.58 to 9.00), and at increased risk of having a higher number of overnight hospital stays (adjusted relative risk [aRR], 4.04; 95% CI, 2.27 to 7.21). Adolescents with low cotinine were less likely to have a health-care visit (aOR, 0.84; 95% CI, 0.71 to 0.99), but more likely to have an overnight hospital stay (aOR, 4.82; 95% CI, 2.58 to 9.00) than adolescents with no/minimal cotinine. Adolescents with low cotinine were at increased risk of having a higher number of health-care visits (aRR, 1.06; 95% CI, 1.02 to 1.11) and overnight hospital stays (aRR, 2.02; 95% CI, 1.46 to 2.81). Adolescents with home exposure had lower FEV 1 % (mean, 99.9; SE, 1.17; b, À5.11; 95% CI, À9.26 to À0.96) and FVC% (mean, 100.0; SE, 1.16; b, À5.36; 95% CI, À9.30 to À1.42) than adolescents with no home exposure (mean, 101.0; SE, 0.38; mean, 100.2; SE, 0.39, respectively). Adolescents with home exposure were more likely to have an overnight hospital stay (aOR, 5.65; 95% CI, 3.66 to 8.73) and at increased risk of having a higher number of overnight hospital stays (aRR, 4.08; 95% CI, 2.76 to 6.03). INTERPRETATION: Detectable serum cotinine levels and self-reported home exposure were distinctively associated with decreased pulmonary function and increased health-care utilization.

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Sources and Biomarkers of Secondhand Tobacco Smoke Exposure in Urban Adolescents

Nardone

Jain

Addo

et al. 2020

Academic Pediatrics

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Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use

Cited by 17 publications

References 38 publications

Tobacco Use Behaviors and Perceptions of Parental Smokers in the Emergency Department Setting

Tobacco Use Behaviors and Perceptions of Parental Smokers in the Emergency Department Setting

Tobacco Smoke Exposure, Respiratory Health, and Health-care Utilization Among US Adolescents

Sources and Biomarkers of Secondhand Tobacco Smoke Exposure in Urban Adolescents

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