title: Family hardships and serum cotinine in children with asthma.
abstract: OBJECTIVE
  A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma.
  
  
  METHODS
  We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child's caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine.
  
  
  RESULTS
  We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported ≥ 1 hardship, and 41% reported ≥ 4 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with ≥ 4 hardships had 3.7-fold (95% confidence interval, 2.0-7.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine.
  
  
  CONCLUSIONS
  Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.
authors.affiliation: Department of Pediatrics, Penn State Milton S. Hershey Children's Hospital, Hershey, Pennsylvania; aspanier@peds.umaryland.edu.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Spanier
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: McGrady
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and.
authors.forename: Dennis D
authors.initials: DD
authors.lastname: Drotar
authors.affiliation: Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Roy W A
authors.initials: RW
authors.lastname: Peake
authors.affiliation: Clinical Epidemiologic Research Laboratory, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Kellogg
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio; and.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003367:Cotinine / Q000097:blood*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D009820:Ohio; D011203:Poverty; D011446:Prospective Studies; D064890:Social Determinants of Health; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D035862:Vulnerable Populations
chemical_list: D014028:Tobacco Smoke Pollution; D003367:Cotinine
keywords: asthma; hospital readmission; parental smoking; pediatrics; secondhand smoke; tobacco smoke exposure