title: Socioeconomic Status, Smoke Exposure, and Health Outcomes in Young Children With Cystic Fibrosis.
abstract: BACKGROUND
  Lower socioeconomic status (SES) and environmental tobacco smoke (ETS) exposure are both associated with poorer disease outcomes in cystic fibrosis (CF), and children with low SES are disproportionately exposed to ETS. We analyzed a large cohort of young children with CF to distinguish the impact of SES and ETS on clinical outcomes.
  
  
  METHODS
  The Early Pseudomonas Infection Control Observational study enrolled Pseudomonas-negative young children with CF <13 years of age. An enrollment survey assessed SES and ETS exposures. Forced expiratory volume in 1 second (FEV1), crackles and wheezes, and weight-for-age percentile were assessed at each clinical encounter over at least 4 years. Repeated measures analyses estimated the association of SES and ETS exposures with longitudinal clinical outcomes, adjusting for confounders.
  
  
  RESULTS
  Of 1797 participants, 1375 were eligible for analysis. Maternal education was high school or less in 28.1%, 26.8% had household income <$40 000, and 43.8% had Medicaid or no insurance. Maternal smoking after birth was present in 24.8%, more prevalent in household with low SES. In separate models, lower SES and ETS exposure were significantly associated with lower FEV1% predicted, presence of crackles or wheezes, and lower weight percentile. In combined models, effect estimates for SES changed minimally after adjustment for ETS exposures, whereas estimates for ETS exposures were attenuated after adjusting for SES.
  
  
  CONCLUSIONS
  ETS exposure was disproportionately high in low SES families in this cohort of children with CF. Lower SES and ETS exposure had independent adverse effects on pulmonary and nutritional outcomes. Estimated effect of SES on FEV1decreased minimally after ETS adjustment, suggesting health disparity risks independent of ETS exposure.
authors.affiliation: Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington; thida.ong@seattlechildrens.org.
authors.forename: Thida
authors.initials: T
authors.lastname: Ong
authors.affiliation: Division of Pulmonary Medicine, Department of Pediatrics, Virginia Commonwealth University, Children's Hospital of Richmond at VCU, Richmond, Virginia.
authors.forename: Michael
authors.initials: M
authors.lastname: Schechter
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia; and.
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.affiliation: Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia; and.
authors.forename: Limin
authors.initials: L
authors.lastname: Peng
authors.affiliation: Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Julia
authors.initials: J
authors.lastname: Emerson
authors.affiliation: Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Gibson
authors.affiliation: Departments of Pediatrics and Physiology, Pediatric Pulmonary Center, University of Arizona, Tucson, Arizona.
authors.forename: Wayne
authors.initials: W
authors.lastname: Morgan
authors.affiliation: Division of Pulmonary and Sleep Medicine, Department of Pediatrics, University of Washington, Seattle, Washington.
authors.forename: Margaret
authors.initials: M
authors.lastname: Rosenfeld
mesh_terms: D001835:Body Weight; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D012135:Respiratory Sounds; D012959:Socioeconomic Factors; D014028:Tobacco Smoke Pollution / Q000009:adverse effects* / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution