title: A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago.
abstract: 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.
authors.affiliation: Division of Allergy, Children's Memorial Hospital, Chicago, Ill. Electronic address: rkumar@childrensmemorial.org.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Laura Marie
authors.initials: LM
authors.lastname: Curtis
authors.affiliation: Division of Allergy, Rush Medical School, Chicago, Ill.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Khiani
authors.affiliation: Division of Allergy, Rush Medical School, Chicago, Ill.
authors.forename: James
authors.initials: J
authors.lastname: Moy
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors.forename: Madeleine U
authors.initials: MU
authors.lastname: Shalowitz
authors.affiliation: Department of Family Medicine, University of Illinois at Chicago, Chicago, Ill.
authors.forename: Lisa
authors.initials: L
authors.lastname: Sharp
authors.affiliation: Loyola University Medical Center, Chicago, Ill.
authors.forename: Ramon A
authors.initials: RA
authors.lastname: Durazo-Arvizu
authors.affiliation: John H. Stroger Jr, Hospital of Cook County, Chicago, Ill.
authors.forename: John Jay
authors.initials: JJ
authors.lastname: Shannon
authors.affiliation: Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill; Hines VA Hospital, Chicago, Ill.
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Weiss
mesh_terms: 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
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine