title: Factors associated with second-hand smoke exposure in young inner-city children with asthma.
abstract: OBJECTIVE
  To examine the association of social and environmental factors with levels of second-hand smoke (SHS) exposure, as measured by salivary cotinine, in young inner-city children with asthma.
  
  
  METHODS
  We used data drawn from a home-based behavioral intervention for young high-risk children with persistent asthma post-emergency department (ED) treatment (N = 198). SHS exposure was measured by salivary cotinine and caregiver reports. Caregiver demographic and psychological functioning, household smoking behavior, and asthma morbidity were compared with child cotinine concentrations. Chi-square and ANOVA tests and multivariate regression models were used to determine the association of cotinine concentrations with household smoking behavior and asthma morbidity.
  
  
  RESULTS
  Over half (53%) of the children had cotinine levels compatible with SHS exposure and mean cotinine concentrations were high at 2.42 ng/ml (SD 3.2). The caregiver was the predominant smoker in the home (57%) and 63% reported a total home smoking ban. Preschool aged children and those with caregivers reporting depressive symptoms and high stress had higher cotinine concentrations than their counterparts. Among children living in a home with a total home smoking ban, younger children had significantly higher mean cotinine concentrations than older children (cotinine: 3-5 year olds, 2.24 ng/ml (SD 3.5); 6-10 year olds, 0.63 ng/ml (SD 1.0); p < .05). In multivariate models, the factors most strongly associated with high child cotinine concentrations were increased number of household smokers (β = 0.24) and younger child age (3-5 years) (β = 0.23; p < .001, R(2) = 0.35).
  
  
  CONCLUSIONS
  Over half of the young inner-city children with asthma were exposed to SHS, and caregivers are the predominant household smokers. Younger children and children with depressed and stressed caregivers are at significant risk of smoke exposures, even when a household smoking ban is reported. Further advocacy for these high-risk children is needed to help caregivers quit and to mitigate smoke exposure.
authors.affiliation: Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD, USA. abutz@jhmi.edu
authors.forename: Arlene M
authors.initials: AM
authors.lastname: Butz
authors.forename: Jill S
authors.initials: JS
authors.lastname: Halterman
authors.forename: Melissa
authors.initials: M
authors.lastname: Bellin
authors.forename: Mona
authors.initials: M
authors.lastname: Tsoukleris
authors.forename: Michele
authors.initials: M
authors.lastname: Donithan
authors.forename: Joan
authors.initials: J
authors.lastname: Kub
authors.forename: Richard E
authors.initials: RE
authors.lastname: Thompson
authors.forename: Cassia Lewis
authors.initials: CL
authors.lastname: Land
authors.forename: Jennifer
authors.initials: J
authors.lastname: Walker
authors.forename: Mary Elizabeth
authors.initials: ME
authors.lastname: Bollinger
mesh_terms: D017677:Age Distribution; D000704:Analysis of Variance; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D015142:Baltimore / Q000453:epidemiology; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003367:Cotinine / Q000032:analysis*; D005191:Family Characteristics; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D011203:Poverty; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012463:Saliva / Q000737:chemistry; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data*; D014505:Urban Population
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine