Household smoking behavior: effects on indoor air quality and health of urban children with asthma.
The goal of the study was to examine the association between biomarkers and environmental measures of second hand smoke (SHS) with caregiver, i.e. parent or legal guardian, report of household smoking behavior and morbidity measures among children with asthma. Baseline data were drawn from a longitudinal intervention for 126 inner city children with asthma, residing with a smoker. Most children met criteria for moderate to severe persistent asthma (63%) versus mild intermittent (20%) or mild persistent (17%). Household smoking behavior and asthma morbidity were compared with child urine cotinine and indoor measures of air quality including fine particulate matter (PM(2.5)) and air nicotine (AN). Kruskal-Wallis, Wilcoxon rank-sum and Spearman rho correlation tests were used to determine the level of association between biomarkers of SHS exposure and household smoking behavior and asthma morbidity. Most children had uncontrolled asthma (62%). The primary household smoker was the child's caregiver (86/126, 68%) of which 66 (77%) were the child's mother. Significantly higher mean PM(2.5), AN and cotinine concentrations were detected in households where the caregiver was the smoker (caregiver smoker: PM(2.5) μg/m(3): 44.16, AN: 1.79 μg/m(3), cotinine: 27.39 ng/ml; caregiver non-smoker: PM(2.5): 28.88 μg/m(3), AN: 0.71 μg/m(3), cotinine:10.78 ng/ml, all P ≤ 0.01). Urine cotinine concentrations trended higher in children who reported 5 or more symptom days within the past 2 weeks (>5 days/past 2 weeks, cotinine: 28.1 ng/ml vs. <5 days/past 2 weeks, cotinine: 16.2 ng/ml; P = 0.08). However, environmental measures of SHS exposures were not associated with asthma symptoms. Urban children with persistent asthma, residing with a smoker are exposed to high levels of SHS predominantly from their primary caregiver. Because cotinine was more strongly associated with asthma symptoms than environmental measures of SHS exposure and is independent of the site of exposure, it remains the gold standard for SHS exposure assessment in children with asthma.
Butz
Arlene M
AM
Division of General Pediatrics, The Johns Hopkins University School of Medicine, 200 N. Wolfe St, Baltimore, MD 21287, USA. abutz@jhmi.edu
Breysse
Patrick
P
Rand
Cynthia
C
Curtin-Brosnan
Jean
J
Eggleston
Peyton
P
Diette
Gregory B
GB
Williams
D'Ann
D
Bernert
John T
JT
Matsui
Elizabeth C
EC
D016902:Air Pollution, Indoor / Q000032:analysis*; D001249:Asthma; D002648:Child; D003367:Cotinine / Q000652:urine; D003625:Data Collection; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D012907:Smoking; D014028:Tobacco Smoke Pollution; D014481:United States; D014505:Urban Population
D014028:Tobacco Smoke Pollution; D003367:Cotinine
Tob Control. 2006 Jun;15 Suppl 3:iii1-2
16754940
Pediatrics. 1996 Apr;97(4):560-8
8632946
J Allergy Clin Immunol. 2002 Jul;110(1):147-53
12110834
Ann Allergy Asthma Immunol. 2003 May;90(5 Suppl 2):19-23
12772946
MMWR Morb Mortal Wkly Rep. 2009 Nov 13;58(44):1227-32
19910909
Addict Behav. 2003 Jan-Feb;28(1):111-28
12507531
Pediatrics. 2005 Mar;115(3):750-60
15741382
Am J Respir Crit Care Med. 1995 Jun;151(6):1786-93
7767521
Arch Pediatr Adolesc Med. 2002 Nov;156(11):1094-100
12413336
Chest. 2008 Jun;133(6):1367-1374
18339788
Matern Child Health J. 2008 Mar;12(2):188-93
17557199
Am Rev Respir Dis. 1988 Sep;138(3):518-23
3202406
MMWR Surveill Summ. 2007 Oct 19;56(8):1-54
17947969
Stat Med. 2008 Sep 10;27(20):4094-106
18344178
J Expo Anal Environ Epidemiol. 2001 May-Jun;11(3):231-52
11477521
Pediatrics. 2008 Dec;122(6):1277-83
19047246
Arch Pediatr Adolesc Med. 2004 May;158(5):460-7
15123479
Pediatrics. 2001 Jul;108(1):18-24
11433049
J Allergy Clin Immunol. 2008 Oct;122(4):754-759.e1
19014767
Environ Sci Technol. 1987 May 1;21(5):494-7
22296139
Chest. 2002 Aug;122(2):409-15
12171810
J Anal Toxicol. 2005 Nov-Dec;29(8):814-8
16374940
Epidemiol Rev. 1996;18(2):188-204
9021312
Pediatrics. 2003 Nov;112(5):1127-33
14595057
Am J Prev Med. 2000 Oct;19(3):188-92
11020596
Am J Prev Med. 2005 Oct;29(3):218-20
16168872
Addiction. 2024 Dec;119(12):2216-2220
39212115
Clin Chem. 1999 Apr;45(4):505-9
10102910
Environ Health Perspect. 2003 Jun;111(7):909-18
12782491
N Engl J Med. 1995 Jan 19;332(3):133-8
7800004
Environ Health Perspect. 1999 Jun;107 Suppl 3:439-50
10346992
Pediatrics. 2008 Aug;122(2):e363-75
18676523
J Asthma. 2009 May;46(4):392-8
19484676
Pediatr Pulmonol. 1997 Oct;24(4):253-62
9368259
Pediatrics. 2001 May;107(5):1029-36
11331682
Pediatrics. 2009 Nov;124(5):1474-87
19841108
J Pediatr Psychol. 2008 Mar;33(2):156-75
18079169
Environ Res. 2004 Jun;95(2):156-65
15147921
Eur Respir J. 1997 Oct;10(10):2384-97
9387970
Epidemiology. 2000 May;11(3):350-2
10784258
Clin Chem. 1997 Dec;43(12):2281-91
9439445
J Asthma. 2001 May;38(3):239-51
11392364