title: The Association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES.
abstract: BACKGROUND
  Few studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children.
  
  
  METHODS
  We used the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3-19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI.
  
  
  RESULTS
  LTBI prevalence in 1999-2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999-2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17-4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87-4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20-5.45) and passive smoking (AOR = 2.27 95% CI 1.09-4.72) were significantly associated with LTBI.
  
  
  CONCLUSIONS
  Active adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.
authors.affiliation: University of California San Francisco, Center for Tobacco Control Research and Education, San Francisco, California, United States of America.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Lindsay
authors.affiliation: University of California Los Angeles, David Geffen School of Medicine, Program in Global Health, Los Angeles, California, United States of America.
authors.forename: Sanghyuk S
authors.initials: SS
authors.lastname: Shin
authors.affiliation: University of California San Diego, Department of Medicine, Division of Global Public Health, San Diego, California, United States of America.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Garfein
authors.affiliation: Vancouver Island Health Authority and University of Victoria, School of Public Health and Social Policy, Victoria, British Columbia, Canada.
authors.forename: Melanie L A
authors.initials: ML
authors.lastname: Rusch
authors.affiliation: San Diego State University, Graduate School of Public Health, San Diego, California, United States of America.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Novotny
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D055985:Latent Tuberculosis / Q000453:epidemiology*; D008297:Male; D012907:Smoking / Q000453:epidemiology*; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution; D014481:United States / Q000453:epidemiology
chemical_list: D014028:Tobacco Smoke Pollution