title: Adult household smoking is associated with increased child emotional and behavioral problems.
abstract: BACKGROUND
  Although maternal smoking has been associated with child emotional and behavioral problems, to our knowledge, no study has evaluated the association between overall household smoking and such problems.
  
  
  OBJECTIVE
  To investigate whether children who live with smokers are more likely than children who do not live with smokers to have emotional or behavioral problems and to explore this association in households with nonsmoking mothers.
  
  
  METHODS
  Nationally representative data from the 2000 to 2004 medical expenditure panel surveys, involving 30,668 children aged 5 to 17 years, were used. Associations between child emotional or behavioral problems and household smoking, and child, maternal, and family characteristics were examined. SUDAAN software was used to adjust for complex sampling design.
  
  
  METHODS
  Overall score on the Columbia Impairment Scale, a 13-item parent-report measure of child emotional or behavioral functioning (range, 0-52, >or=16 indicates a child with such problems).
  
  
  RESULTS
  Children in smoking versus nonsmoking households were significantly more likely to have behavioral problems (17.39% vs 9.29%, p < .001). After adjusting for all covariates, male sex, older age of child, younger age of mother, unmarried mother, maternal depression, and below average maternal physical and mental health, each were independently associated with increased likelihood of emotional and behavioral problems, as was the presence of one or more adult smokers in the household (adjusted odds ratio 1.42; 95% confidence interval: 1.26-1.60). The odds of Columbia Impairment Scale score >or=16 increased with increasing number of smokers in the household, even among children whose mothers did not smoke.
  
  
  CONCLUSIONS
  Children living with smokers are at increased risk for emotional or behavioral problems, and rates of such problems increase with increasing numbers of smokers in the household, even in the absence of maternal smoking.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, NY 10016, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Poole-Di Salvo
authors.forename: Ying-Hua
authors.initials: YH
authors.lastname: Liu
authors.forename: Samantha
authors.initials: S
authors.lastname: Brenner
authors.forename: Michael
authors.initials: M
authors.lastname: Weitzman
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D005190:Family; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D019964:Mood Disorders / Q000453:epidemiology*; D009035:Mothers; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology*; D012959:Socioeconomic Factors