title: Secondhand Smoke Exposure and Illness Severity among Children Hospitalized with Pneumonia.
abstract: OBJECTIVE
  To assess the relationship between secondhand smoke (SHS) exposure and disease severity among children hospitalized with community-acquired pneumonia (CAP).
  
  
  METHODS
  Children hospitalized with clinical and radiographic CAP were enrolled between January 1, 2010, and June 30, 2012 at 3 hospitals in Tennessee and Utah as part of the Centers for Disease Control and Prevention's Etiology of Pneumonia in the Community study. Household SHS exposure was defined based on the number of smokers in the child's home. Outcomes included hospital length of stay, intensive care unit admission, and mechanical ventilation. Proportional hazards and logistic regression models were used to assess associations between SHS exposure and outcomes. All models were adjusted for age, sex, race/ethnicity, household education level, government insurance, comorbidities, enrollment site, year, and season.
  
  
  RESULTS
  Of the 2219 children included in the study, SHS exposure was reported in 785 (35.4%), including 325 (14.8%) with ≥2 smokers in the home. Compared with nonexposed children, the children exposed to ≥2 smokers had longer length of stay (median, 70.4 hours vs 64.4 hours; adjusted hazard ratio, 0.85; 95% CI, 0.75-0.97) and were more likely to receive intensive care (25.2% vs 20.9%; aOR, 1.44; 95% CI, 1.05-1.96), but not mechanical ventilation. Outcomes in children exposed to only 1 household smoker were similar to those in nonexposed children.
  
  
  CONCLUSIONS
  Children hospitalized with CAP from households with ≥2 smokers had a longer length of stay and were more likely to require intensive care compared with children from households with no smokers, suggesting that they experienced greater pneumonia severity.
authors.affiliation: Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Anna
authors.initials: A
authors.lastname: Ahn
authors.affiliation: Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Edwards
authors.affiliation: Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.affiliation: Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Wesley H
authors.initials: WH
authors.lastname: Self
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Yuwei
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN; Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: James D
authors.initials: JD
authors.lastname: Chappell
authors.affiliation: Department of Pediatrics, LeBonheur Children's Hospital and University of Tennessee Health Sciences Center, Memphis, TN.
authors.forename: Sandra R
authors.initials: SR
authors.lastname: Arnold
authors.affiliation: Department of Pediatrics, LeBonheur Children's Hospital and University of Tennessee Health Sciences Center, Memphis, TN; Department of Pediatrics, St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: McCullers
authors.affiliation: Department of Pediatrics, Primary Children's Medical Center and University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Krow
authors.initials: K
authors.lastname: Ampofo
authors.affiliation: Department of Pediatrics, Primary Children's Medical Center and University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Pavia
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Bramley
authors.affiliation: Influenza Division, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Seema
authors.initials: S
authors.lastname: Jain
authors.affiliation: Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN; Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN. Electronic address: derek.williams@vanderbilt.edu.
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
mesh_terms: D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000503:physiopathology; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011014:Pneumonia / Q000175:diagnosis* / Q000503:physiopathology; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012121:Respiration, Artificial; D013714:Tennessee; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*; D014589:Utah
chemical_list: D014028:Tobacco Smoke Pollution