A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago.
BACKGROUND
Little is known about the level of tobacco exposure and the factors that influence exposure in children with persistent asthma.


OBJECTIVE
We sought to measure tobacco smoke exposure and determine factors associated with exposure in a large urban sample of asthmatic children.


METHODS
This cross-sectional study is based on a community-based cohort of 482 children (8-14 years old) with persistent asthma. Caregiver and household tobacco use were reported by the caregiver. Child tobacco smoke exposure was assessed by using salivary cotinine level. Multivariate linear regression of log-transformed salivary cotinine levels were used to characterize the relationship between smoke exposure and caregiver, household, and demographic characteristics. We used a multivariate logistic model to characterize associations with caregiver smoking.


RESULTS
Overall, 68.5% of children had tobacco smoke exposure. Compared with nonexposed children, those exposed to smoking by a caregiver or another household member had cotinine levels that were 1.68 (95% CI, 1.45-1.94) or 1.40 (95% CI, 1.22-1.62) times higher, respectively. Compared with Hispanic children, African American and white/other children had 1.55 (95% CI, 1.16-2.06) and 1.59 (95% CI, 1.18-2.14) times higher cotinine levels, respectively. Child exposure was also associated with caregiver depression symptoms (odds ratio, 1.01; 95% CI, 1.01-1.02), and higher household income was protective (odds ratio, 0.73; 95% CI, 0.56-0.95). Independent predictors of caregiver smoking included a protective effect of higher education (odds ratio, 0.35; 95% CI, 0.15-0.83) and a positive association with potential problematic drug/alcohol use (odds ratio, 2.30; 95% CI, 1.39-3.83).


CONCLUSIONS
Tobacco smoke exposure was high in this urban sample of asthmatic children. Caregiver smoking was strongly associated with child exposure and also was associated with lower socioeconomic status, non-Hispanic ethnicity, and depression symptoms.
Kumar
Rajesh
R
Division of Allergy, Children's Memorial Hospital, Chicago, Ill. Electronic address: rkumar@childrensmemorial.org.
Curtis
Laura Marie
LM
Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Khiani
Sanjay
S
Division of Allergy, Rush Medical School, Chicago, Ill.
Moy
James
J
Division of Allergy, Rush Medical School, Chicago, Ill.
Shalowitz
Madeleine U
MU
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Sharp
Lisa
L
Department of Family Medicine, University of Illinois at Chicago, Chicago, Ill.
Durazo-Arvizu
Ramon A
RA
Loyola University Medical Center, Chicago, Ill.
Shannon
John Jay
JJ
John H. Stroger Jr, Hospital of Cook County, Chicago, Ill.
Weiss
Kevin B
KB
Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill; Hines VA Hospital, Chicago, Ill.
D000293:Adolescent; D001249:Asthma / Q000453:epidemiology* / Q000208:ethnology / Q000378:metabolism*; D002641:Chicago / Q000453:epidemiology / Q000208:ethnology; D002648:Child; D015331:Cohort Studies; D003367:Cotinine / Q000032:analysis / Q000378:metabolism*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019570:Inhalation Exposure; D008297:Male; D008954:Models, Biological; D012463:Saliva / Q000378:metabolism*; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution
D014028:Tobacco Smoke Pollution; D003367:Cotinine