title: Involuntary smoking and asthma severity in children: data from the Third National Health and Nutrition Examination Survey.
abstract: OBJECTIVE
  We sought to determine the indicators of asthma severity among children in the United States with high and low levels of tobacco smoke exposure.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Nationally representative survey of participants in the Third National Health and Nutrition Examination Survey (from 1988 to 1994).
  
  
  METHODS
  Five hundred twenty-three children with physician-diagnosed asthma.
  
  
  RESULTS
  We stratified the study participants into tertiles on the basis of serum levels of cotinine (a metabolite of nicotine that indicates tobacco smoke exposure). We used logistic and linear regression modeling, adjusting for known covariates, to determine the effect of high environmental tobacco smoke exposure on the following outcomes: asthma severity (determined using reported symptom and respiratory illness frequency); lung function; physician visits; and school absence. Among our study sample, 78.6% of children had mild asthma, 6.8% of children had moderate asthma, and 14.6% of children had severe asthma. Asthmatic children with high levels of smoke exposure, compared with those with low levels of exposure, were more likely to have moderate or severe asthma (odds ratio, 2.7 95% confidence interval [CI], 1.1 to 6.8) and decreased lung function, with a mean FEV(1) decrement of 213 mL or 8.1% (95% CI, -14.7 to -3.5).
  
  
  CONCLUSIONS
  Involuntary smoke exposure is associated with increased asthma severity and worsened lung function in a nationally representative group of US children with asthma.
authors.affiliation: Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. dmannino@cdc.gov
authors.forename: David M
authors.initials: DM
authors.lastname: Mannino
authors.forename: David M
authors.initials: DM
authors.lastname: Homa
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Redd
mesh_terms: D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D002675:Child, Preschool; D003367:Cotinine / Q000097:blood; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009749:Nutrition Surveys; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine