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Haji T, Lyzwinski L, Dhaliwal C, Leung G, Giangioppo S, Radhakrishnan D. A real-world evaluation of the effectiveness and Sufficiency of Current Emergency Department Preventative Strategies for Reducing Emergency Department revisits in a Canadian children's hospital: a retrospective cohort study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2024; 20:37. [PMID: 38918807 PMCID: PMC11197375 DOI: 10.1186/s13223-024-00900-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/21/2024] [Indexed: 06/27/2024]
Abstract
BACKGROUND Despite asthma guidelines' recommended emergency department preventative strategies (EDPS), repeat asthma-related emergency department (ED) visits remain frequent. METHODS We performed a retrospective cohort study of children aged 1-17 years presenting with asthma to the Children's Hospital of Eastern Ontario (CHEO) ED between September 1, 2014 - August 31, 2015. EDPS was defined as provision of education on trigger avoidance and medication technique plus documentation of an asthma action plan, a prescription for an inhaled controller medication or referral to a specialist. Logistic regression was used to identify factors associated with receipt of EDPS. We further compared the odds of repeat presentation to the ED within the following year among children who had received EDPS versus those who had not. RESULTS 1301 patients were included, and the mean age of those who received EDPS was 5.0 years (SD = 3.7). Those with a moderate (OR = 3.67, 95% CI: 2.49, 5.52) to severe (OR = 3.69, 95% CI: 2.50, 5.45) asthma presentation were most likely to receive EDPS. Receiving EDPS did not significantly reduce the adjusted odds of repeat ED visits, (OR = 0.82, 95% CI: 0.56, 1.18, p = 0.28). CONCLUSIONS Patients with higher severity asthma presentations to the ED were more likely to receive EDPS, but this did not appear to significantly decrease the proportion with a repeat asthma ED visit. These findings suggest that receipt of EDPS in the ED may not be sufficient to prevent repeat asthma ED visits in all children.
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Affiliation(s)
- Tahereh Haji
- Children's Hospital of Eastern Ontario, Ontario, Canada
| | | | - Cara Dhaliwal
- Children's Hospital of Eastern Ontario, Ontario, Canada
| | - Garvin Leung
- Children's Hospital of Eastern Ontario, Ontario, Canada
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2
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Leroue MK, Williamson KM, Curtin PC, Sontag MK, Wagner BD, Ambroggio L, Bixby M, Busgang SA, Murphy SE, Peterson LA, Vevang KR, Sipe CJ, Kirk Harris J, Reeder RW, Locandro C, Carpenter TC, Maddux AB, Simões EAF, Osborne CM, Robertson CE, Langelier C, Carcillo JA, Meert KL, Pollack MM, McQuillen PS, Mourani PM. Tobacco smoke exposure, the lower airways microbiome and outcomes of ventilated children. Pediatr Res 2023; 94:660-667. [PMID: 36750739 PMCID: PMC9903281 DOI: 10.1038/s41390-023-02502-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/18/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND Tobacco smoke exposure increases the risk and severity of lower respiratory tract infections in children, yet the mechanisms remain unclear. We hypothesized that tobacco smoke exposure would modify the lower airway microbiome. METHODS Secondary analysis of a multicenter cohort of 362 children between ages 31 days and 18 years mechanically ventilated for >72 h. Tracheal aspirates from 298 patients, collected within 24 h of intubation, were evaluated via 16 S ribosomal RNA sequencing. Smoke exposure was determined by creatinine corrected urine cotinine levels ≥30 µg/g. RESULTS Patients had a median age of 16 (IQR 568) months. The most common admission diagnosis was lower respiratory tract infection (53%). Seventy-four (20%) patients were smoke exposed and exhibited decreased richness and Shannon diversity. Smoke exposed children had higher relative abundances of Serratia spp., Moraxella spp., Haemophilus spp., and Staphylococcus aureus. Differences were most notable in patients with bacterial and viral respiratory infections. There were no differences in development of acute respiratory distress syndrome, days of mechanical ventilation, ventilator free days at 28 days, length of stay, or mortality. CONCLUSION Among critically ill children requiring prolonged mechanical ventilation, tobacco smoke exposure is associated with decreased richness and Shannon diversity and change in microbial communities. IMPACT Tobacco smoke exposure is associated with changes in the lower airways microbiome but is not associated with clinical outcomes among critically ill pediatric patients requiring prolonged mechanical ventilation. This study is among the first to evaluate the impact of tobacco smoke exposure on the lower airway microbiome in children. This research helps elucidate the relationship between tobacco smoke exposure and the lower airway microbiome and may provide a possible mechanism by which tobacco smoke exposure increases the risk for poor outcomes in children.
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Affiliation(s)
- Matthew K Leroue
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA.
| | - Kayla M Williamson
- Biostatistics and Informatics, University of Colorado, Colorado School of Public Health, Aurora, CO, USA
| | - Paul C Curtin
- CHEAR Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Marci K Sontag
- Epidemiology, University of Colorado, Colorado School of Public Health, Aurora, CO, USA
| | - Brandie D Wagner
- Biostatistics and Informatics, University of Colorado, Colorado School of Public Health, Aurora, CO, USA
| | - Lilliam Ambroggio
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Moira Bixby
- CHEAR Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stefanie A Busgang
- CHEAR Data Center, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Lisa A Peterson
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Karin R Vevang
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | | | - J Kirk Harris
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Ron W Reeder
- Pediatrics, University of Utah, Salt Lake City, UT, USA
| | | | - Todd C Carpenter
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Aline B Maddux
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Eric A F Simões
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Epidemiology, University of Colorado, Colorado School of Public Health, Aurora, CO, USA
| | - Christina M Osborne
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Charles E Robertson
- Medicine, Division of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
| | - Charles Langelier
- Medicine, Division of Infectious Diseases, University of California San Francisco, San Francisco, CA, USA
- Chan Zuckerberg Biohub, San Francisco, CA, USA
| | | | - Kathleen L Meert
- Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, MI, USA
| | | | | | - Peter M Mourani
- Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, USA
- Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, USA
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3
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Mourino N, Pérez-Ríos M, Yolton K, Lanphear BP, Chen A, Buckley JP, Kalkwarf HJ, Cecil KM, Braun JM. Pre- and postnatal exposure to secondhand tobacco smoke and cardiometabolic risk at 12 years: Periods of susceptibility. ENVIRONMENTAL RESEARCH 2023; 224:115572. [PMID: 36841524 PMCID: PMC10726317 DOI: 10.1016/j.envres.2023.115572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND To identify periods of heightened susceptibility to the association of secondhand tobacco smoke (SHS) exposure with cardiometabolic (CM) risk at age 12 years. METHODS We used data from 212 adolescents from the HOME Study, a prospective pregnancy and birth cohort in Cincinnati, OH. Using multiple informant models, we estimated associations of maternal serum cotinine (mean of concentrations at 16 and 26 weeks of pregnancy) and children's serum cotinine concentrations (mean of concentrations at ages 1, 2, 3, and 4 years) with a CM risk summary score constructed of five risk components measured at age 12 years. We determined if these associations differed for pre- and postnatal exposure periods, and adolescent's sex. RESULTS We found some evidence that the cotinine-outcome associations differed by exposure period and sex. Postnatal, but not prenatal, cotinine was associated with higher CM risk scores and individual CM risk component values (interaction p-values = 0.04 to 0.35). Each 10-fold increase in postnatal cotinine was associated with 0.57 (95% CI: 0.32, 1.45), 0.09 (95% CI: 0.13, 0.31), 0.14 (-0.08, 0.35), 0.07 (95% CI: 0.34, 0.48), and 0.11 (95% CI: 0.04, 0.27) higher CM risk, HOMA-IR, TG to HDL-C ratio, leptin to adiponectin ratio, and visceral fat area. Postnatal cotinine was associated with higher visceral fat area among females but not males (sex × period × cotinine interaction p-value = 0.01). CONCLUSIONS Serum cotinine concentrations during the postnatal period had greater influence on adolescent's CM risk compared to the prenatal period, and these associations may be sex-specific. This study reinforces the need for ongoing public health interventions to minimize children's exposure to SHS.
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Affiliation(s)
- Nerea Mourino
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain; Consortium for Biomedical Research in Epidemiology and Public health (CIBERESP), Madrid, Spain.
| | - Kimberly Yolton
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Bruce P Lanphear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Aimin Chen
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, USA
| | - Heidi J Kalkwarf
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim M Cecil
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Joseph M Braun
- Department of Epidemiology, Brown University, Providence, RI, USA
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Carcinogenic and tobacco smoke-derived particulate matter biomarker uptake and associated healthcare patterns among children. Pediatr Res 2023; 93:143-153. [PMID: 35383260 PMCID: PMC9535039 DOI: 10.1038/s41390-022-02031-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/10/2021] [Accepted: 12/14/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND The objective was to assess the associations of child tobacco smoke exposure (TSE) biomarkers (urinary cotinine, NNAL, and nicotelline N-oxides) and parent-reported smoking and child TSE patterns with total hospital visits, pediatric emergency department (PED) visits, urgent care (UC), revisits, and hospital admissions among 0-9-year-olds. METHODS A convenience sample of PED/UC patients (N = 242) who presented to a large, US children's hospital who had baseline urine samples assayed for the TSE biomarkers of interest were included. Biomarker levels were log-transformed, and linear and Poisson regression models were built. RESULTS The geometric means of child cotinine, creatinine-adjusted NNAL, and N-oxide levels were 11.2 ng/ml, 30.9 pg/mg creatinine, and 24.1 pg/ml, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.2 (6.1) cigarettes. Each one-unit increase in log-NNAL levels was associated with an increase in total UC visits (aRR = 1.68, 95% CI = 1.18-2.39) among 0-9-year-olds, while controlling for the covariates. Each one-unit increase in child log-NNAL/cotinine ratio (×103) values was associated with an increase in total hospital visits (aRR = 1.39, 95% CI = 1.10-1.75) and UC visits (aRR = 1.56, 95% CI = 1.14-2.13) over 6 months. CONCLUSION Systematic screening for child TSE should be conducted during all hospital visits. The comprehensive assessment of TSE biomarkers should be considered to objectively measure young children's exposure. IMPACT Higher levels of cotinine, a widely used tobacco smoke exposure biomarker, have been associated with higher healthcare utilization patterns among children. Less is known on the associations of carcinogenic and tobacco smoke-derived particulate matter biomarker uptake with child healthcare utilization patterns. This study assessed the associations of several biomarkers with healthcare utilization patterns among pediatric emergency department patients ages 0-9 years who lived with tobacco smokers. Higher urinary NNAL biomarker levels, in individual and ratio form with cotinine, increased children's risk for urgent care visits over 6 months. Higher parent-reported cumulative child tobacco smoke exposure increased children's risk for hospital admissions.
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Affiliation(s)
- Ashley L Merianos
- University of Cincinnati, School of Human Services, Cincinnati, OH, USA.
| | - Roman A Jandarov
- University of Cincinnati, College of Medicine, Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, Division of Emergency Medicine, University of Cincinnati, College of Medicine, Cincinnati, OH, USA
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Velasco-Arnaiz E, Batllori M, Monsonís M, Valls A, Ríos-Barnes M, Simó-Nebot S, Gamell A, Fortuny C, Tebruegge M, Noguera-Julian A. Host, technical, and environmental factors affecting QuantiFERON-TB Gold In-Tube performance in children below 5 years of age. Sci Rep 2022; 12:19908. [PMID: 36402803 PMCID: PMC9675832 DOI: 10.1038/s41598-022-24433-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022] Open
Abstract
Interferon-gamma release assays performance can be impaired by host-related, technical and environmental factors, but data in young children are limited. We performed a cross-sectional study of children < 5 years-of-age at risk of tuberculosis (TB), using QuantiFERON-TB Gold In-Tube (QFT-GIT) assays. The impact of the following was evaluated: (i) host-related [age; hematological parameters; erythrocyte sedimentation rate (ESR); C-reactive protein (CRP); and tobacco smoke exposure (TSE) based on serum cotinine concentrations], (ii) technical (pre-analytical delay) and (iii) environmental factors (annual season; monthly temperatures). Of 204 children, 35 (17.2%) were diagnosed with latent TB infection or TB disease. QFT-GIT results were indeterminate in 14 (6.9%) patients. In multivariate analysis, younger age and higher ESR were associated with lower positive control responses (beta: 0.247, p = 0.002 and - 0.204, p = 0.007, respectively), and increasing age was associated with lower rates of indeterminate QFT-GIT results [OR (95% CI) 0.948 (0.903-0.996) per month, p = 0.035]. In children with positive QFT-GIT results, average monthly temperatures correlated with antigen responses (r = 0.453, p = 0.020); also, antigen responses were lower in winter than in other seasons (p = 0.027). Serum cotinine concentrations determined in a subgroup of patients (n = 41) indicated TSE in 36 (88%), positive control responses being lower in children with TSE (p = 0.034). In children < 5 years-of-age, young age, elevated ESR, temperature, annual season and TSE can affect the performance of QFT-GIT assays.
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Affiliation(s)
- Eneritz Velasco-Arnaiz
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Marta Batllori
- grid.411160.30000 0001 0663 8628Laboratori de Bioquímica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Manuel Monsonís
- grid.411160.30000 0001 0663 8628Servei de Microbiologia. Hospital Sant Joan de Déu, Barcelona, Spain
| | - Anna Valls
- grid.411160.30000 0001 0663 8628Laboratori de Bioquímica, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Ríos-Barnes
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Sílvia Simó-Nebot
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Anna Gamell
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Clàudia Fortuny
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain
| | - Marc Tebruegge
- grid.83440.3b0000000121901201Department of Infection, Immunity and Inflammation, UCL Great Ormond Street Institute of Child Health, University College London, London, UK ,grid.1008.90000 0001 2179 088XDepartment of Pediatrics, University of Melbourne, Parkville, Australia ,Department of Paediatrics, Klinik Ottakring, Wiener Gesundheitsverbund, Vienna, Austria
| | - Antoni Noguera-Julian
- grid.411160.30000 0001 0663 8628Malalties Infeccioses i Resposta Inflamatòria Sistèmica en Pediatria; Servei d’Infectologia Pediàtrica, Institut de Recerca Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain ,grid.5841.80000 0004 1937 0247Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain ,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain ,grid.411160.30000 0001 0663 8628Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain
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Mourino N, Ruano-Raviña A, Varela Lema L, Fernández E, López MJ, Santiago-Pérez MI, Rey-Brandariz J, Giraldo-Osorio A, Pérez-Ríos M. Serum cotinine cut-points for secondhand smoke exposure assessment in children under 5 years: A systemic review. PLoS One 2022; 17:e0267319. [PMID: 35511766 PMCID: PMC9070924 DOI: 10.1371/journal.pone.0267319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Serum cotinine has become the most widely used biomarker of secondhand smoke exposure (SHS) over time in all ages. The aim of this study was to review the serum cotinine cut-points used to classify children under 5 years as exposed to SHS. Methods A systematic review performed in the Pubmed (MEDLINE) and EMBASE databases up to April 2021 was conducted using as key words "serum cotinine", “tobacco smoke pollution” (MeSH), "secondhand smoke", "environmental tobacco smoke" and “tobacco smoke exposure”. Papers which assessed SHS exposure among children younger than 5 years old were included. The PRISMA 2020 guidelines were followed. Analysis was pre-registered in PROSPERO (registration number: CRD42021251263). Results 247 articles were identified and 51 fulfilled inclusion criteria. The selected studies were published between 1985–2020. Most of them included adolescents and adults. Only three assessed postnatal exposure exclusively among children under 5 years. None of the selected studies proposed age-specific cut-points for children < 5 years old. Cut-point values to assess SHS exposure ranged from 0.015 to 100 ng/ml. The most commonly used cut-point was 0.05 ng/ml, derived from the assay limit of detection used by the National Health and Nutrition Examination Survey (NHANES). Conclusions No studies have calculated serum cotinine age-specific cut-points to ascertained SHS exposure among children under 5 years old. Children’s age-specific cut-points are warranted for health research and public health purposes aimed at accurately estimating the prevalence of SHS exposure and attributable burden of disease to such exposure, and at reinforcing 100% smoke-free policies worldwide, both in homes, private vehicles and public places.
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Affiliation(s)
- Nerea Mourino
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alberto Ruano-Raviña
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
| | - Leonor Varela Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- * E-mail:
| | - Esteve Fernández
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d’Oncologia (ICO), Badalona, Spain
- Tobacco Control Research Group, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), Barcelona, Spain
- School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- CIBER of Respiratory Diseases (CIBERES), Madrid, Spain
| | - María José López
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
- Servicio de Evaluación y Métodos de Intervención, Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d’Investigació Biomèdica de Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Julia Rey-Brandariz
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Alexandra Giraldo-Osorio
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- Departamento de Salud Pública, Grupo de investigación Promoción de la Salud y Prevención de la Enfermedad (GIPSPE), Universidad de Caldas, Manizales, Colombia
- Fundación Carolina, Madrid, Spain
| | - Mónica Pérez-Ríos
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain
- CIBER Epidemiology and Public Health, CIBERESP, Madrid, Spain
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7
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Association between Diet Quality and Adolescent Wheezing: Effect Modification by Environmental Tobacco Smoke Exposure. Ann Am Thorac Soc 2022; 19:1328-1337. [PMID: 35263245 DOI: 10.1513/annalsats.202107-837oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Protective effects of a high quality diet on respiratory health, particularly among youths exposed to environmental tobacco smoke (ETS), are unknown. OBJECTIVES To assess if a higher quality diet is associated with improved respiratory symptoms and lung function among adolescents, and if these associations are modified by ETS exposure. METHODS This was a cross-sectional study on 7,026 nonsmoking adolescents of the 2003-2012 National Health and Nutrition Examination Survey. Diet quality was assessed using the Healthy Eating Index-2010 score (HEI-2010), categorized into quintiles. ETS exposure was measured using serum cotinine, dichotomized as high (>2.99 ng/ml) or low (≤2.99 ng/ml). Outcomes included the presence of wheezing and cough symptoms in the past 12 months, and in a sub-group, spirometric lung function. Survey-design adjusted logistic and linear models evaluated associations between diet and 1) respiratory symptoms and 2) lung function, respectively, and assessed the interaction between HEI-2010 and serum cotinine. RESULTS While there were no significant associations between diet quality and respiratory symptoms, there was a significant interaction between HEI-2010 and serum cotinine on wheezing (pint = 0.011). In models stratified by serum cotinine, adolescents with high serum cotinine and the healthiest diet (5th quintile HEI-2010) experienced lower wheezing odds (OR, 0.10; 95% CI, 0.02-0.61), compared to those with the poorest diet (1st quintile HEI-2010). In contrast, among adolescents with low serum cotinine, there were no significant differences in any respiratory symptoms between those with the highest, compared to the lowest diet quality. Of the sub-group with spirometry data (n = 3,166), there was a trend towards better lung function with improving diet quality, although this did not achieve statistical significance. There was no effect modification by ETS exposure on the relationship between diet quality and lung function. CONCLUSIONS Consuming a higher quality diet was associated with lower wheezing odds in adolescents with substantial ETS exposure. While longitudinal studies are needed, public health interventions to improve diet quality in vulnerable, environmentally-exposed populations merit consideration.
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Studenmund C, Williams J, Hernandez A, Young E, Hui YY, Cruz E, Gribben V. Quality Improvement Approach to Increase Inpatient Pediatric Secondhand Smoke Exposure Screening. Hosp Pediatr 2022; 12:45-53. [PMID: 34866157 DOI: 10.1542/hpeds.2021-005941] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Secondhand smoke exposure (SHSe) is highly prevalent among children and has numerous adverse health effects. Consistent screening for SHSe is an essential first step to helping families break the toxic cycle of smoking. METHODS With this quality improvement project, we evaluated a SHSe screening and cessation resource distribution protocol in a general pediatrics inpatient unit of a safety-net hospital. Our primary outcome measure was the percent of admissions screened for SHSe, with a goal of increasing our documented rate of SHSe screening from 0% to 70% within 6 months of implementation. Our secondary outcome measure was the percent of those who screened positive for SHSe who were offered smoking cessation resources. Process measures included tracking nurse confidence in screening and compliance with new workflow training. Balancing measures were nurse satisfaction and brevity of screening. RESULTS From May 1, 2019, to April 30, 2020, nurses screened 97.2% of the 394 patients admitted to the pediatric unit for SHSe. Of the patients screened, 15.7% were exposed to cigarettes or other tobacco products, 5.6% to e-cigarettes, and 6.5% to marijuana. Nurses documented offering "Quit Kits" with cessation materials to 45 caregivers (72.6% of positive screen results) and offering 33 referrals to the California Smokers' Helpline (53.2% of positive screen results). CONCLUSION In this project, we successfully implemented a screening protocol for SHSe to tobacco, e-cigarettes, and marijuana and a workflow for cessation resource distribution in an inpatient pediatric setting that far exceeded goals. Requiring minimal maintenance and using just a simple paper-based format, the workflow could be adopted at other institutions.
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Affiliation(s)
- Christine Studenmund
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - Jazzmin Williams
- School of Medicine, University of California, San Francisco, San Francisco, California
| | | | - Elda Young
- San Francisco Department of Public Health, San Francisco, California
| | - Ying Ying Hui
- San Francisco Department of Public Health, San Francisco, California
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Merianos AL, Jandarov RA, Cataletto M, Mahabee-Gittens EM. Tobacco smoke exposure and fractional exhaled nitric oxide levels among U.S. adolescents. Nitric Oxide 2021; 117:53-59. [PMID: 34688860 DOI: 10.1016/j.niox.2021.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 03/14/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fractional exhaled nitric oxide (FeNO) can objectively guide clinical practice in the assessment, diagnosis, and treatment of eosinophilic airway inflammation. FeNO values may be affected by current smoking, but the role of tobacco smoke exposure (TSE) is understudied. OBJECTIVE This study investigated the associations between biochemically validated and self-reported TSE and FeNO levels among U.S. nonsmoking adolescents without asthma. METHODS National Health and Nutrition Examination Survey 2007-2012 data were used. TSE was assessed via serum cotinine and self-reported measures. We assessed FeNO continuously and using cutpoints of >35 ppb and >50 ppb to indicate likely eosinophilic inflammation in children and adults, respectively. We conducted linear and logistic regression adjusting for potential covariates. RESULTS Overall, 34.0% of adolescents had low cotinine (0.05-2.99 ng/ml), 6.2% had high cotinine (≥3.00 ng/ml), and 11.9% had home TSE. Compared to adolescents with no/minimal cotinine, adolescents with high cotinine were at reduced odds to have FeNO >35 ppb (adjusted odds ratio [aOR] = 0.54, 95%CI = 0.43,0.69). Adolescents with low cotinine had lower FeNO values (β = -2.05, 95%CI = -3.61,-0.49), and were also at decreased odds to have FeNO >35 ppb (aOR = 0.74, 95%CI = 0.66,0.83) and FeNO >50 ppb (aOR = 0.62, 95%CI = 0.53,0.72). Adolescents with home TSE were at reduced odds to have FeNO >50 ppb (aOR = 0.72, 95%CI = 0.57,0.91) than adolescents without home TSE. Adolescents with a higher number of cigarettes/day smoked inside their home were at reduced odds to have FeNO >35 ppb (OR = 0.98, 95%CI = 0.97,0.99) and FeNO >50 ppb (OR = 0.98, 95%CI = 0.96,0.99). CONCLUSIONS TSE was associated with decreased FeNO levels. The addition of TSE may be clinically important when interpreting thresholds for FeNO.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA.
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, 162 Kettering Lab Building, 160 Panzeca Way, Cincinnati, OH, 45267-0056, USA.
| | - Mary Cataletto
- Department of Pediatrics, NYU Long Island School of Medicine, 222 Station Plaza North, Mineola, NY, 11501, USA.
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, 3333 Burnet Avenue, MLC 2008, Cincinnati, OH, 45229, USA.
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10
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Mahabee-Gittens EM, Matt GE, Ding L, Merianos AL. Comparison of Levels of Three Tobacco Smoke Exposure Biomarkers in Children of Smokers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211803. [PMID: 34831559 PMCID: PMC8622785 DOI: 10.3390/ijerph182211803] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 12/13/2022]
Abstract
Objectives: Cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), and N-oxides are biomarkers of tobacco smoke exposure (TSE) used to assess short- and longer-term TSE. The objective of this study was to assess the associations between these TSE biomarkers, sociodemographics, parental smoking, and child TSE patterns among 0–17-year-olds. Methods: A convenience sample of 179 pediatric patients (mean (SD) age = 7.9 (4.3) years) who lived with ≥1 smoker and who had parental assessments completed and urine samples analyzed for the three TSE biomarkers of interest were included. Biomarker levels were log-transformed, univariate regression models were built and Pearson correlations were assessed. Results: In total, 100% of children had detectable levels of cotinine and >96% had detectable NNAL and N-oxide levels. The geometric means of cotinine, NNAL, and N-oxide levels were 10.1 ng/mL, 25.3 pg/mL, and 22.9 pg/mL, respectively. The mean (SD) number of daily cigarettes smoked by parents was 10.6 (6.0) cigarettes. Child age negatively correlated with urinary cotinine (r = −0.202, p = 0.007) and log NNAL levels (r = −0.275, p < 0.001). The highest log-cotinine levels were in children who were younger, of African American race, and whose parents had a lower education, an annual income ≤USD15,000, and no smoking bans. The highest log-NNAL and N-oxide levels were in children whose parents had a lower education, had no smoking bans, and were around higher numbers of cigarettes. Conclusion: Children of smokers who were younger, African American, and had no smoking bans had the highest TSE biomarker levels. Targeted interventions are needed to reduce TSE levels among high-risk children.
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Affiliation(s)
- E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
- Correspondence: ; Tel.: +1-513-636-7966; Fax: +1-513-636-7967
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA;
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
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11
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Williams BS, Nacht C, Fiore MC, Kelly MM. Smoke Exposure Disclosure: Parental Perspectives of Screening in the Inpatient Setting. Hosp Pediatr 2021; 11:e210-e217. [PMID: 34507976 DOI: 10.1542/hpeds.2021-005808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Current screening questions for pediatric tobacco smoke exposure are suboptimal. Factors influencing screening accuracy, particularly in the pediatric inpatient setting, are unknown. Our objective was to identify facilitators of and barriers to parental disclosure of smoke exposure when screened during their child's hospitalization and strategies to promote accurate disclosure. METHODS This qualitative study was conducted with a convenience sample of parents of children admitted to the medical and surgical unit of a Midwest tertiary care children's hospital. Eligible parents included those with documented disclosure of smoke exposure in the child's electronic health record. A researcher trained in qualitative methods conducted semistructured, in-depth interviews with parents regarding their experiences with smoke exposure screening in the inpatient pediatric setting. Two researchers independently identified concepts directed at barriers, facilitators, and strategies for effective screening, which were compared and reconciled by a third researcher. RESULTS Facilitators of disclosing their child's smoke exposure included the following: (1) the caregiver's internal characteristic(s) promoting disclosure, (2) perceived relevance of the screening question to the child's health, and (3) the questioner being viewed positively. Barriers included the following: (1) fear of negative consequences, (2) a vague question, (3) lack of knowledge, (4) guilt, and (5) unconducive environment and timing. The strategies parents suggested to improve screening for smoke exposure included the following: (1) communicate preemptively, (2) provide specific exposure examples, (3) improve questioner-caregiver rapport, and (4) improve screening environment and timing. CONCLUSIONS Parents identified various mechanisms to improve tobacco smoke exposure screening. The facilitators, barriers, and strategies provide opportunities to improve the inpatient pediatric screening process.
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Affiliation(s)
- Brian S Williams
- Departments of Pediatrics .,Medicine, School of Medicine and Public Health.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison
| | | | - Michael C Fiore
- Medicine, School of Medicine and Public Health.,Center for Tobacco Research and Intervention, University of Wisconsin-Madison
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12
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Jung J, Park HJ, Jung M. Association between Parental Cotinine-verified Smoking Status and Childhood Asthma: a Population-based Nationally Representative Analysis. J Korean Med Sci 2021; 36:e193. [PMID: 34342184 PMCID: PMC8329391 DOI: 10.3346/jkms.2021.36.e193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/22/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Environmental tobacco smoke exposure due to parents is a modifiable risk factor for childhood asthma, but many studies have evaluated parental smoking using self-reported data. Therefore, we aimed to analyze the relationship between parental cotinine-verified smoking status and asthma in their children. METHODS This population-based cross-sectional study used data from the Korean National Health and Nutrition Examination Survey from 2014 to 2017. Participants aged 0 to 18 years with complete self-reported physician-diagnosed childhood asthma and measurement of their parental urinary cotinine levels were included. Parental urinary cotinine-verified smoking status was defined using both urinary cotinine levels and self-report, as active, passive, and non-smoker. Sample weights were applied to all statistical analyses because of a complex, multistage and clustered survey design. Logistic regression model was used to analyze the relationship between childhood asthma and parental smoking. RESULTS A total of 5,264 subjects aged < 19 years were included. The prevalence of asthma was 3.4%. The proportions of paternal and maternal urinary cotinine-verified active smokers during the study period were 50.4% and 16.9%, respectively. When parental urinary cotinine level increased, the proportion of parental low household income was increased (P < 0.001). There was no significant association between the parental urinary cotinine-verified smoking group and childhood asthma group. However, the adjusted odds ratios of childhood asthma in the middle and highest tertile of paternal urinary cotinine levels compared with those in lowest tertile were 1.95 (95% confidence interval [CI], 0.98-3.89) and 2.34 (95% CI, 1.21-4.54), respectively. CONCLUSION There seems to be a dose-related association between paternal urinary cotinine levels and the risk of childhood asthma. Because of the high rate of paternal smoking, further studies are needed to develop a targeted strategy to reduce parental smoking for childhood asthma.
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Affiliation(s)
- Jinho Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Hyun Joon Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea
| | - Minyoung Jung
- Department of Pediatrics, Kosin University Gospel Hospital, Kosin University School of Medicine, Busan, Korea.
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13
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Masonbrink AR, Hunt JA, Bhandal A, Randell KA, Mermelstein S, Wells S, Miller MK. Self-reported and Documented Substance Use Among Adolescents in the Pediatric Hospital. Pediatrics 2021; 147:e2020031468. [PMID: 33941583 PMCID: PMC8168602 DOI: 10.1542/peds.2020-031468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Adolescent substance use is associated with numerous adverse health outcomes. A hospitalization represents an opportunity to identify and address substance use. We sought to describe self-reported and documented substance use among hospitalized adolescents. METHODS We conducted a cross-sectional survey of adolescents aged 14 to 18 years old admitted to two pediatric hospitals between August 2019 and March 2020. Using previously validated questions, we assessed the proportion of adolescents reporting ever, monthly, and weekly use of alcohol, marijuana, tobacco, electronic cigarettes, and other illicit drugs and nonmedical use of prescription medications. We reviewed medical records for substance use documentation. RESULTS Among 306 respondents, 57% were older (16-18 years old), 53% were female, and 55% were of non-Hispanic white race and ethnicity. The most frequently reported substances ever used were alcohol (39%), marijuana (33%), and electronic cigarettes (31%); 104 (34%) respondents reported ever use of >1 substance. Compared with younger adolescents, those aged 16 to 18 years were more likely to report ever use of alcohol (29% vs 46%; P = .002), marijuana (22% vs 41%; P < .001), and ≥2 drugs (26% vs 40%; P = .009). A positive substance use history was rarely documented (11% of records reviewed), and concordance between documented and self-reported substance use was also rare. CONCLUSIONS In this study of hospitalized adolescents, the most commonly reported substances used were alcohol, marijuana, and electronic cigarettes. Positive substance use documentation was rare and often discordant with self-reported substance use. Efforts to improve systematic screening for substance use and interventions for prevention and cessation in hospitalized adolescents are critically needed.
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Affiliation(s)
- Abbey R Masonbrink
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Jane Alyce Hunt
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Avleen Bhandal
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Kimberly A Randell
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Sarah Mermelstein
- Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Sarah Wells
- School of Medicine, University of Missouri-Kansas City, Missouri; and
| | - Melissa K Miller
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
- School of Medicine, University of Missouri-Kansas City, Missouri; and
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14
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Klein JD, Chamberlin ME, Kress EA, Geraci MW, Rosenblatt S, Boykan R, Jenssen B, Rosenblatt SM, Milberger S, Adams WG, Goldstein AO, Rigotti NA, Hovell MF, Holm AL, Vandivier RW, Croxton TL, Young PL, Blissard L, Jewell K, Richardson L, Ostrow J, Resnick EA. Asking the Right Questions About Secondhand Smoke. Nicotine Tob Res 2021; 23:57-62. [PMID: 31407779 DOI: 10.1093/ntr/ntz125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/25/2019] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Despite knowledge about major health effects of secondhand tobacco smoke (SHS) exposure, systematic incorporation of SHS screening and counseling in clinical settings has not occurred. METHODS A three-round modified Delphi Panel of tobacco control experts was convened to build consensus on the screening questions that should be asked and identify opportunities and barriers to SHS exposure screening and counseling. The panel considered four questions: (1) what questions should be asked about SHS exposure; (2) what are the top priorities to advance the goal of ensuring that these questions are asked; (3) what are the barriers to achieving these goals; and (4) how might these barriers be overcome. Each panel member submitted answers to the questions. Responses were summarized and successive rounds were reviewed by panel members for consolidation and prioritization. RESULTS Panelists agreed that both adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from any tobacco products in their usual environment. The panel found that consistent clinician training, quality measurement or other accountability, and policy and electronic health records interventions were needed to successfully implement consistent screening. CONCLUSIONS The panel successfully generated screening questions and identified priorities to improve SHS exposure screening. Policy interventions and stakeholder engagement are needed to overcome barriers to implementing effective SHS screening. IMPLICATIONS In a modified Delphi panel, tobacco control and clinical prevention experts agreed that all adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from tobacco products. Consistent training, accountability, and policy and electronic health records interventions are needed to implement consistent screening. Increasing SHS screening will have a significant impact on public health and costs.
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Affiliation(s)
- Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA.,Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Itasca, IL, USA
| | | | | | - Mark W Geraci
- Department of Medicine, Indiana University, Indianapolis, IN, USA
| | - Susan Rosenblatt
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Rachel Boykan
- Department of Pediatrics, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Brian Jenssen
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Sharon Milberger
- Michigan Developmental Disabilities Institute, Wayne State University, Detroit, MI, USA
| | - William G Adams
- Department of Pediatrics, Boston University School of Medicine, Boston, MA, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, USA
| | - Melbourne F Hovell
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | - Amanda L Holm
- Center of Health Promotion and Disease Prevention, Henry Ford Health System, Detroit, MI, USA
| | - Richard W Vandivier
- Department of Medicine, Pulmonary Sciences & Critical Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Thomas L Croxton
- Division of Lung Diseases, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Patricia L Young
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Lani Blissard
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Kate Jewell
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Leisa Richardson
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - John Ostrow
- Flight Attendant Medical Research Institute, Coral Gables, FL, USA
| | - Elissa A Resnick
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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15
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Merianos AL, Jandarov RA, Gordon JS, Lyons MS, Mahabee-Gittens EM. Healthcare resources attributable to child tobacco smoke exposure. PLoS One 2021; 16:e0247179. [PMID: 33621228 PMCID: PMC7901732 DOI: 10.1371/journal.pone.0247179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/02/2021] [Indexed: 12/02/2022] Open
Abstract
Background Tobacco smoke exposure (TSE) places an economic toll on the U.S. healthcare system. There is a gap in the literature on pediatric emergency department (ED) and urgent care related healthcare costs and utilization specific to tobacco smoke-exposed patients. The objectives were to assess pediatric ED visits, urgent care visits and hospital admissions longitudinally, and baseline visit costs among tobacco smoke-exposed children (TSE group) relative to unexposed children (non-TSE group). Methods and findings We conducted a retrospective study using electronic medical records of 380 children ages 0–17 years in the TSE group compared to 1,140 in the non-TSE group propensity score matched via nearest neighbor search by child age, sex, race, and ethnicity. Linear and Poisson regression models were used. Overall, children had a mean of 0.19 (SE = 0.01) repeat visits within 30-days, and 0.69 (SE = 0.04) pediatric ED visits and 0.87 (SE = 0.03) urgent care visits over 12-months following their baseline visit. The percent of children with ≥ 1 urgent care visit was higher among the TSE group (52.4%) than the non-TSE group (45.1%, p = 0.01). Children in the TSE group (M = $1,136.97, SE = 76.44) had higher baseline pediatric ED visit costs than the non-TSE group (M = $1,018.96, SE = 125.51, p = 0.01). Overall, children had 0.08 (SE = 0.01) hospital admissions over 12-months, and the TSE group (M = 0.12, SE = 0.02) had higher mean admissions than the non-TSE group (M = 0.06, SE = 0.01, p = 0.02). The child TSE group was at 1.85 times increased risk of having hospital admissions (95% CI = 1.23, 2.79, p = 0.003) than the non-TSE group. Conclusions Tobacco smoke-exposed children had higher urgent care utilization and hospital admissions over 12-months, and higher pediatric ED costs at baseline. Pediatric ED visits, urgent care visits, and hospitalizations may be opportune times for initiating tobacco control interventions, which may result in reductions of preventable acute care visits.
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Affiliation(s)
- Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, United States of America
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
| | - Roman A. Jandarov
- Department of Environmental and Public Health Sciences, Division of Biostatistics and Bioinformatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Judith S. Gordon
- College of Nursing, The University of Arizona, Tucson, Arizona, United States of America
| | - Michael S. Lyons
- Center for Addiction Research, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
- Department of Emergency Medicine, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
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16
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. High Cotinine and Healthcare Utilization Disparities Among Low-Income Children. Am J Prev Med 2021; 60:267-275. [PMID: 33131989 PMCID: PMC7854767 DOI: 10.1016/j.amepre.2020.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/12/2020] [Accepted: 06/03/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION This study assesses the associations of child salivary cotinine, parent-reported smoking, and child tobacco smoke exposure with the number of child healthcare visits and hospital admissions over a 6-month period. This study also assesses the relationships between participant characteristics and child cotinine. METHODS Longitudinal data were evaluated from a sample of 313 clinically ill children aged 0-9 years who lived with a smoker and presented to a pediatric emergency department or urgent care in 2016-2018. In 2020, cotinine measurements were log transformed, and Poisson and linear regression were performed. RESULTS The majority of the children came from low-income homes (66.1%) and had public insurance/self-pay (95.5%). Child cotinine concentrations ranged from 0.1 to 332.0 ng/mL (geometric mean=4.8 ng/mL, 95% CI=4.1, 5.5). Poisson regression results indicated that each 1-unit increase of log-cotinine concentration was associated with an increase in pediatric emergency department visits over a 6-month period after the baseline visit, with an adjusted RR of 1.16 (95% CI=1.01, 1.34). Each 1-unit increase of log-cotinine concentration was associated with an increase in the frequency of hospital admissions over the 6-month period, with an adjusted RR of 1.50 (95% CI=1.08, 2.09). No differences were found between parent-reported smoking or child tobacco smoke exposure and healthcare utilization. Linear regression results indicated that children who were younger (β= -0.227, p=0.049), were White (geometric mean=5.5 ng/mL), had a medical history of prematurity (geometric mean=8.1 ng/mL), and had a winter baseline visit (geometric mean=6.5 ng/mL) had higher cotinine concentrations. Children living in apartments (geometric mean=5.5 ng/mL) and multiunit homes (geometric mean=5.5 ng/mL) had higher cotinine concentrations than those in single-family homes (geometric mean=3.6 ng/mL). CONCLUSIONS Routine biochemical screening could identify children who are in need of intensive tobacco smoke exposure reduction interventions.
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Affiliation(s)
- Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio.
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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17
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Child tobacco smoke exposure and healthcare resource utilization patterns. Pediatr Res 2020; 88:571-579. [PMID: 32505125 PMCID: PMC7529841 DOI: 10.1038/s41390-020-0997-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The objective was to examine the relationship between healthcare resource utilization patterns in tobacco smoke-exposed children (TSE group) compared with unexposed children (non-TSE group). METHODS We matched 380 children in the TSE group with 1140 children in the non-TSE group based on child age, sex, race, and ethnicity using propensity scores. Healthcare resource utilization variables included respiratory-related procedures, diagnostic testing, disposition, and medications. Logistic and linear regression models were built. RESULTS Child mean age was 4.9 (SD = 0.1) years, 50.5% were female, 55.5% black, and 73.2% had public insurance/self-pay. Compared to the non-TSE group, the TSE group was at increased odds to have the following performed/obtained: nasal bulb suctioning, infectious diagnostic tests, laboratory tests, and radiologic tests. The TSE group was more likely to be admitted to the hospital, and more likely to receive steroids and intravenous fluids during their visit. Among asthmatics, the TSE group was more likely to receive steroids, albuterol, or ipratropium alone, or a combination of all three medications during their visit, and be prescribed albuterol alone or steroids and albuterol. CONCLUSION Tobacco smoke-exposed children are more likely to have higher resource utilization patterns, highlighting the importance of screening and providing TSE prevention and remediation interventions. IMPACT Tobacco smoke exposure may affect the healthcare resource utilization patterns of children. Evidence is lacking concerning these associations among the highly vulnerable pediatric emergency department patient population. This study examined the association between tobacco smoke exposure and healthcare resource utilization patterns among pediatric emergency department patients. Tobacco smoke exposure increased the risk of pediatric patients having respiratory-related procedures, respiratory-related and non-respiratory-related testing, medications administered during the pediatric emergency department visit, and medications prescribed for home administration. Tobacco smoke-exposed patients were more likely to be admitted to the hospital compared to unexposed patients.
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18
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Merianos AL, Mahabee-Gittens EM. Screening, Counseling, and Health Care Utilization Among a National Sample of Adolescent Smokers. Clin Pediatr (Phila) 2020; 59:467-475. [PMID: 32054291 PMCID: PMC7216227 DOI: 10.1177/0009922820905875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to assess the association between cigarette smoking and tobacco use screening and advising to quit use by a clinician among adolescents nationwide. We also examined the relationships between smoking and health-related indicators and health care utilization. A secondary analysis of the 2017 National Survey on Drug Use and Health was conducted (N = 11 884). Ever smokers were less likely to be screened for tobacco use. Current smokers and those who were nicotine dependent were more likely to have been advised to quit use. Ever and current smokers were significantly more likely to report good/fair/poor health status, illness-related school absenteeism in the past 30 days, and were more likely to have had an emergency department visit or an overnight hospital stay. Standardized tobacco control efforts are needed in health care settings to support clinicians to screen all adolescents for tobacco use and advise every smoker irrespective of smoking frequency to quit use.
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Affiliation(s)
| | - E. Melinda Mahabee-Gittens
- University of Cincinnati, Cincinnati, OH, USA,Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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19
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Tobacco Smoke Exposure, Respiratory Health, and Health-care Utilization Among US Adolescents. Chest 2020; 158:1104-1114. [PMID: 32272115 DOI: 10.1016/j.chest.2020.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 03/10/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tobacco smoke exposure adversely affects respiratory health. However, the effects of exposure on adolescents without asthma are not well known. RESEARCH QUESTION To what degree are biochemically measured and self-reported tobacco smoke exposure associated with pulmonary function and health-care utilization among US nonsmoking adolescents? STUDY DESIGN AND METHODS We analyzed 2007-2012 National Health and Nutrition Examination Survey data (N = 2,482). Tobacco smoke exposure was assessed with serum cotinine and self-reported home exposure. We built multiple regression, logistic regression, and Poisson regression models, depending on the outcome. RESULTS Approximately 3% of adolescents had high cotinine (3.00-15.00 ng/mL), 35.7% had low cotinine (0.05-2.99 ng/mL), and 10.9% had home exposure. Adolescents with high cotinine had significantly lower FEV1% (mean, 97.4; SE, 2.09; β, -8.99; 95% CI, -15.64 to -2.33) and FVC% (mean, 97.4; SE, 2.06; β, -8.42; 95% CI, -14.74 to -2.11) than adolescents with no/minimal cotinine (< 0.05 ng/mL; mean, 101.0; SE, 0.45; mean, 99.9; SE, 0.46, respectively). Adolescents with high cotinine were less likely to have a past year health-care visit (adjusted OR [aOR], 0.57; 95% CI, 0.38 to 0.88), but more likely to have an overnight hospital stay (aOR, 4.82; 95% CI, 2.58 to 9.00), and at increased risk of having a higher number of overnight hospital stays (adjusted relative risk [aRR], 4.04; 95% CI, 2.27 to 7.21). Adolescents with low cotinine were less likely to have a health-care visit (aOR, 0.84; 95% CI, 0.71 to 0.99), but more likely to have an overnight hospital stay (aOR, 4.82; 95%CI, 2.58 to 9.00) than adolescents with no/minimal cotinine. Adolescents with low cotinine were at increased risk of having a higher number of health-care visits (aRR, 1.06; 95% CI, 1.02 to 1.11) and overnight hospital stays (aRR, 2.02; 95% CI, 1.46 to 2.81). Adolescents with home exposure had lower FEV1% (mean, 99.9; SE, 1.17; β, -5.11; 95% CI, -9.26 to -0.96) and FVC% (mean, 100.0; SE, 1.16; β, -5.36; 95% CI, -9.30 to -1.42) than adolescents with no home exposure (mean, 101.0; SE, 0.38; mean, 100.2; SE, 0.39, respectively). Adolescents with home exposure were more likely to have an overnight hospital stay (aOR, 5.65; 95% CI, 3.66 to 8.73) and at increased risk of having a higher number of overnight hospital stays (aRR, 4.08; 95% CI, 2.76 to 6.03). INTERPRETATION Detectable serum cotinine levels and self-reported home exposure were distinctively associated with decreased pulmonary function and increased health-care utilization.
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Affiliation(s)
| | - Roman A Jandarov
- Division of Biostatistics and Bioinformatics, Department of Environmental and Public Health Sciences, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; College of Medicine, University of Cincinnati, Cincinnati, OH
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Abstract
PURPOSE OF REVIEW Children with poor asthma control despite maximal maintenance therapy have problematic severe asthma (PSA). A step-wise approach including objective adherence monitoring and a detailed multidisciplinary team assessment to identify modifiable factors contributing to poor control is needed prior to considering therapy escalation. Pathophysiological phenotyping in those with true severe therapy-resistant asthma (STRA) and the current array of add-on therapies will be discussed. RECENT FINDINGS Adherence monitoring using electronic devices has shown that only 20-30% of children with PSA have STRA and need additional therapies. Omalizumab and mepolizumab are licensed for children with STRA aged 6 years and older. Although robust safety and efficacy data, with reduced exacerbations, are available for omalizumab, biomarkers predicting response to treatment are lacking. Paediatric safety data are available for mepolizumab, but efficacy data are unknown for those aged 6-11 years and minimal for those 12 years and older. A sub-group of children with STRA have neutrophilia, but the clinical significance and contribution to disease severity remains uncertain. SUMMARY Most children with PSA have steroid sensitive disease which improves with adherence to maintenance inhaled corticosteroids. Add-on therapies are only needed for the minority with STRA. Paediatric efficacy data of novel biologics and biomarkers that identify the optimal add-on for each child are lacking. If we are to progress toward individualized therapy for STRA, pragmatic clinical trials of biologics in accurately phenotyped children are needed.
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Health-Related Quality of Life and Medical Resource Use in Patients with Osteoporosis and Depression: A Cross-Sectional Analysis from the National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031124. [PMID: 32050694 PMCID: PMC7037867 DOI: 10.3390/ijerph17031124] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 12/27/2022]
Abstract
Background: Patients with either osteoporosis or depression are prone to develop other diseases and require more medical resources than do the general population. However, there are no studies on health-related quality of life (HRQoL) and medical resource use by osteoporosis patients with comorbid depression. We conducted this study for clarifying it. Methods: This cross-sectional study from 2005 to 2010 (6 years) analyzed 9776 National Health and Nutrition Examination Survey (NHANES) patients > 40 years old. Each patient was assigned to one of four groups: osteoporosis-positive(+) and depression-positive(+) (O+/D+); O+/D−; O−/D+; O−/D−. We used multivariate linear and logistic regression model to analyze the HRQoL and medical resource use between groups. Results: The O+/D+ group reported more unhealthy days of physical health, more unhealthy days of mental health, and more inactive days during a specified 30 days. The adjusted odds ratios (AORs) of O+/D+ patients who had poor general health (7.40, 95% CI = 4.80–11.40), who needed healthcare (3.25, 95% CI = 2.12–5.00), and who had been hospitalized overnight (2.71, 95% CI = 1.89–3.90) were significantly highest. Conclusions: Low HRQoL was significantly more prevalent in D+/O+ patients. We found that depression severity more significantly affected HRQoL than did osteoporosis. However, both diseases significantly increased the risk of high medical resource use.
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Dai S, Chan KC. Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong. Tob Induc Dis 2020; 18:02. [PMID: 31966027 PMCID: PMC6964497 DOI: 10.18332/tid/114461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 11/18/2019] [Accepted: 11/20/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Young children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age. METHODS A secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms. RESULTS The analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016). CONCLUSIONS Household ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.
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Affiliation(s)
- Siyu Dai
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Kate C Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Association of secondhand smoke exposure with asthma symptoms, medication use, and healthcare utilization among asthmatic adolescents. J Asthma 2019; 56:369-379. [PMID: 29641269 PMCID: PMC6181790 DOI: 10.1080/02770903.2018.1463379] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 02/27/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To investigate the association between secondhand smoke exposure (SHSe) and asthma symptoms, medication use, and emergency department (ED)/urgent care (UC) utilization among adolescents. METHODS We performed a secondary cross-sectional analysis of Population Assessment of Tobacco and Health Study Wave 2 (2014-2015) including asthmatic adolescents (N = 2198). Logistic regression models and Poisson regression models were built. RESULTS Participants with SHSe ≥1 hour in the past 7 days were at increased risk of reporting shortness of breath and harder to exercise aOR, 1.22; 95% CI, 1.04-1.43), wheezing (aOR, 1.26; 95% CI, 1.01-1.56), wheezing disturbing sleep (aOR, 1.88; 95% CI, 1.35-2.63), wheezing during/after exercise (aOR, 1.41; 95% CI, 1.19-1.66), wheezing limiting speech (aOR, 2.11; 95% CI, 1.55-2.86), dry cough at night (aOR, 1.86; 95% CI, 1.54-2.24), and asthma symptoms disturbing sleep (aOR, 2.25; 95% CI, 1.81-2.79). Participants with SHSe ≥1 hour were more likely to take asthma medications (aOR, 1.25; 95% CI, 1.03-1.52), including steroids (aOR, 1.86; 95% CI, 1.19-2.91), oxygen therapy (aOR, 2.88; 95% CI, 1.82-4.54), and controlling medications (aOR, 1.50; 95% CI, 1.24-1.82). Symptoms and medications varied by living with a smoker and home SHSe. Participants with SHSe were at increased risk of having a higher number of asthma attacks that required steroid use. Participants who lived with a smoker and had home SHSe were at increased risk of having higher ED/UC visits for asthma. CONCLUSIONS SHSe reduction efforts are needed for asthmatic adolescents, and EDs/UCs are promising venues.
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Affiliation(s)
- Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio, USA
| | - Roman A. Jandarov
- Department of Environmental Health, University of Cincinnati, Cincinnati, Ohio, USA
| | - E. Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
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Semple S, Turner S, O'Donnell R, Adams L, Henderson T, Mitchell S, Lyttle S, Amos A. Using air-quality feedback to encourage disadvantaged parents to create a smoke-free home: Results from a randomised controlled trial. ENVIRONMENT INTERNATIONAL 2018; 120:104-110. [PMID: 30076982 DOI: 10.1016/j.envint.2018.07.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/25/2018] [Accepted: 07/26/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To determine if low-cost air-quality monitors providing personalised feedback of household second-hand smoke (SHS) concentrations plus standard health service advice on SHS were more effective than standard advice in helping parents protect their child from SHS. DESIGN A randomised controlled trial of a personalised intervention delivered to disadvantaged mothers who were exposed to SHS at home. Changes in household concentrations of fine Particulate Matter (PM2.5) were the primary outcome. METHODS Air-quality monitors measured household PM2.5 concentrations over approximately 6 days at baseline and at one-month and six-months post-intervention. Data on smoking and smoking-rules were gathered. Participants were randomised to either Group A (standard health service advice on SHS) or Group B (standard advice plus personalised air-quality feedback). Group B participants received personalised air-quality feedback after the baseline measurement and at 1-month. Both groups received air-quality feedback at 6-months. RESULTS 120 mothers were recruited of whom 117 were randomised. Follow up was completed after 1-month in 102 and at 6-months in 78 participants. There was no statistically significant reduction in PM2.5 concentrations by either intervention type at 1-month or 6-months, nor significant differences between the two groups at 1-month (p = 0.76) and 6-month follow-up (p = 0.16). CONCLUSIONS Neither standard advice nor standard advice plus personalised air-quality feedback were effective in reducing PM2.5 concentrations in deprived households where smoking occurred. Finding ways of identifying homes where air-quality feedback can be a useful tool to change household smoking behaviour is important to ensure resources are targeted successfully.
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Affiliation(s)
- Sean Semple
- Institute for Social Marketing, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland, United Kingdom.
| | - Stephen Turner
- Respiratory Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Rachel O'Donnell
- RCO Consulting, 1 Thorters Place, Edinburgh, Scotland, United Kingdom
| | - Lynn Adams
- Tobacco Control, NHS Lanarkshire, Hamilton, Scotland, United Kingdom
| | - Tracy Henderson
- Tobacco Control, NHS Lanarkshire, Hamilton, Scotland, United Kingdom
| | - Shirley Mitchell
- Tobacco Control, NHS Lanarkshire, Hamilton, Scotland, United Kingdom
| | - Susan Lyttle
- Tobacco Control, NHS Lanarkshire, Hamilton, Scotland, United Kingdom
| | - Amanda Amos
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
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Merianos AL, Jandarov RA, Mahabee-Gittens EM. Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use. Pediatrics 2018; 142:e20180266. [PMID: 30082449 PMCID: PMC6317548 DOI: 10.1542/peds.2018-0266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Our objective was to examine the relationship between distinct tobacco smoke exposure (TSE) measures and TSE-related symptoms and emergency department (ED) and/or urgent care (UC) use among nonsmoking adolescents without asthma diagnoses. METHODS We performed a secondary analysis of 7389 adolescents who completed the Population Assessment of Tobacco and Health Study wave 2. Logistic regression and Poisson regression models were built. RESULTS Adolescents with TSE were at increased risk of reporting: shortness of breath, finding it hard to exercise, wheezing during or after exercise, and dry cough at night. Adolescents who lived with a smoker and had home TSE were at increased odds of reporting wheezing or whistling in the chest, and only adolescents with home TSE were at increased risk of reporting wheezing that disturbed sleep. Adolescents with TSE were less likely to report very good or excellent overall health and physical health but were more likely to report they sometimes, often, or very often missed school because of illness. Participants who lived with a smoker and had TSE ≥1 hour were more likely to have had an ED and/or UC visit. Participants with any TSE were at increased risk of having a higher number of ED and/or UC visits. CONCLUSIONS Different TSE measures uniquely increased the risk of TSE-related symptoms, but any TSE increased the risk of having a higher number of ED and/or UC visits. The providers at these high-volume settings should offer interventions to adolescents who are exposed to tobacco smoke and their families to decrease these symptoms and related morbidity.
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Affiliation(s)
- Ashley L Merianos
- College of Education, Criminal Justice, and Human Services, School of Human Services, University of Cincinnati, Cincinnati, Ohio
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Peiffer G, Underner M, Perriot J. [The respiratory effects of smoking]. REVUE DE PNEUMOLOGIE CLINIQUE 2018; 74:133-144. [PMID: 29793770 DOI: 10.1016/j.pneumo.2018.04.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 02/05/2023]
Abstract
A marked increase in the morbidity and mortality of a large number of broncho-pulmonary diseases has been documented in relation to smoking. The influence of tobacco smoking on various respiratory conditions. is discussed: incidence, severity or natural history modification of some respiratory illnesses: obstructive lung diseases (COPD, asthma), lung cancer, bacterial, viral respiratory infections, with the impact of smoking on tuberculosis. Finally, the relationship of tobacco with diffuse interstitial lung disease: protective role of smoking (controversial in sarcoidosis, real in hypersensitivity pneumonitis). The benefits of smoking cessation are described.
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Affiliation(s)
- G Peiffer
- Service de pneumologie, CHR Metz-Thionville, hôpital de Mercy, 1, allée du Château 57085 Metz cedex 3, France.
| | - M Underner
- Unité de recherche clinique, centre hospitalier Henri-Laborit, 86000 Poitiers, France.
| | - J Perriot
- CLAT 63, dispensaire Emile-Roux, 11, rue Vaucanson, 63100 Clermont-Ferrand, France.
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Coller RJ, Kelly MM, Ehlenbach ML, Goyette E, Warner G, Chung PJ. Hospitalizations for Ambulatory Care-Sensitive Conditions among Children with Chronic and Complex Diseases. J Pediatr 2018; 194:218-224. [PMID: 29198530 PMCID: PMC5826824 DOI: 10.1016/j.jpeds.2017.10.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 08/31/2017] [Accepted: 10/13/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate ambulatory-care sensitive (ACS) hospitalizations for children with noncomplex chronic diseases (NC-CD) and children with medical complexity (CMC), and identify associations with ambulatory care characteristics. Although ACS hospitalizations are potentially preventable in general populations, the specific ambulatory care predictors and influence of medical complexity on them is poorly understood. STUDY DESIGN Retrospective cohort study of NC-CD and CMC hospitalizations at a children's hospital during 2007-2014, excluding labor/delivery and children over 21 years. Pediatric medical complexity algorithm identified NC-CD or CMC. ACS hospitalizations were identified using Agency for Healthcare Research and Quality indicator definitions. Demographic and ambulatory care characteristics were compared between ACS and non-ACS hospitalizations with logistic regression clustered by patient. Measures of ambulatory care during 2 years before admission were explored with 20% random sample of general pediatrics discharges. RESULTS Among 4035 children with NC-CD, 14.6% of 4926 hospitalizations were ACS hospitalizations. Among 5084 CMC, 5.3% of 14 390 discharges were ACS hospitalizations. Among NC-CD discharges, ACS hospitalizations were more likely with no prior-year outpatient visits (OR 1.4, 95% CI 1.1-1.7) and less likely with timely well checks (OR 0.8, 95% CI 0.6-0.9) and phone encounters in the month before admission (OR 0.5, 95% CI 0.2-1.0). Among CMC discharges, the only association observed was with provider continuity (OR 0.3, 95% CI 0.1- 1.0). CONCLUSIONS Provider continuity may be associated with fewer CMC ACS hospitalizations, however, measures of ambulatory care were more consistently associated with ACS hospitalizations for NC-CD. CMC may need more precise ACS hospitalization definitions.
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Affiliation(s)
- Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI.
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI; Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, WI
| | - Mary L Ehlenbach
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - Evan Goyette
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA; RAND Health, RAND Corporation, Santa Monica, CA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; Children's Discovery and Innovation Institute, UCLA Mattel Children's Hospital, Los Angeles, CA
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