Income Inequality and US Children's Secondhand Smoke Exposure: Distinct Associations by Race-Ethnicity.
BACKGROUND
Prior studies have found considerable racial and ethnic disparities in secondhand smoke (SHS) exposure. Although a number of individual-level determinants of this disparity have been identified, contextual determinants of racial and ethnic disparities in SHS exposure remain unexamined. The objective of this study was to examine disparities in serum cotinine in relation to area-level income inequality among 14 649 children from the National Health and Nutrition Examination Survey.


METHODS
We fit log-normal regression models to examine disparities in serum cotinine in relation to Metropolitan Statistical Areas level income inequality among 14 649 nonsmoking children aged 3-15 from the National Health and Nutrition Examination Survey (1999-2012).


RESULTS
Non-Hispanic black children had significantly lower serum cotinine than non-Hispanic white children (-0.26; 95% CI: -0.38, -0.15) in low income inequality areas, but this difference was attenuated in areas with high income inequality (0.01; 95% CI: -0.16, 0.18). Serum cotinine declined for non-Hispanic white and Mexican American children with increasing income inequality. Serum cotinine did not change as a function of the level of income inequality among non-Hispanic black children.


CONCLUSIONS
We have found evidence of differential associations between SHS exposure and income inequality by race and ethnicity. Further examination of environments which engender SHS exposure among children across various racial/ethnic subgroups can foster a better understanding of how area-level income inequality relates to health outcomes such as levels of SHS exposure and how those associations differ by race/ethnicity.


CONCLUSIONS
In the United States, the association between children's risk of SHS exposure and income inequality is modified by race/ethnicity in a manner that is inconsistent with theories of income inequality. In overall analysis this association appears to be as predicted by theory. However, race-specific analyses reveal that higher levels of income inequality are associated with lower levels of SHS exposure among white children, while levels of SHS exposure among non-Hispanic black children are largely invariant to area-level income inequality. Future examination of the link between income inequality and smoking-related health outcomes should consider differential associations across racial and ethnic subpopulations.
School of Public Health, Maternal and Child Health Program, Department of Family Science, University of Maryland, College Park, MD.|Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD.|School of Public Health, Department of Epidemiology and Biostatistics, Brown University, Providence, RI.|School of Medicine, Department of Epidemiology and Biostatistics, University of Maryland, Baltimore, MD.
Edmond D
ED
Shenassa
Centers for Disease Control and Prevention, Office of Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, MD.
Lauren M
LM
Rossen
ICF, Fairfax, VA.
Jonathan
J
Cohen
School of Public Health, Department of Environmental Science Policy and Management, University of California, Berkeley, CA.
Rachel
R
Morello-Frosch
School of Public Health, Maryland Institute for Applied Environmental Health, University of Maryland, College Park, MD.
Devon C
DC
Payne-Sturges
D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003367:Cotinine / Q000097:blood*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D009749:Nutrition Surveys; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology
D014028:Tobacco Smoke Pollution; D003367:Cotinine