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King LM, Barnett TE, Allen AC, Maizel JL, Wilson RE. Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences. J Ethn Subst Abuse 2024; 23:381-411. [PMID: 35839212 DOI: 10.1080/15332640.2022.2093812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.
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Affiliation(s)
| | - Tracey E Barnett
- University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
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Grant TL, Wood RA. The influence of urban exposures and residence on childhood asthma. Pediatr Allergy Immunol 2022; 33:e13784. [PMID: 35616896 PMCID: PMC9288815 DOI: 10.1111/pai.13784] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 12/19/2022]
Abstract
Children with asthma who live in urban neighborhoods experience a disproportionately high asthma burden, with increased incident asthma and increased asthma symptoms, exacerbations, and acute visits and hospitalizations for asthma. There are multiple urban exposures that contribute to pediatric asthma morbidity, including exposure to pest allergens, mold, endotoxin, and indoor and outdoor air pollution. Children living in urban neighborhoods also experience inequities in social determinants of health, such as increased poverty, substandard housing quality, increased rates of obesity, and increased chronic stress. These disparities then in turn can increase the risk of urban exposures and compound asthma morbidity as poor housing repair is a risk factor for pest infestation and mold exposure and poverty is a risk factor for exposure to air pollution. Environmental interventions to reduce in-home allergen concentrations have yielded inconsistent results. Population-level interventions including smoking bans in public places and legislation to decrease traffic-related air pollution have been successful at reducing asthma morbidity and improving lung function growth. Given the interface and synergy between urban exposures and social determinants of health, it is likely population and community-level changes will be needed to decrease the excess asthma burden in children living in urban neighborhoods.
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Affiliation(s)
- Torie L Grant
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Wood
- Division of Pediatric Allergy, Immunology, and Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jassal MS, Lewis-Land C, Thompson RE, Butz A. Randomised pilot trial of cash incentives for reducing paediatric asthmatic tobacco smoke exposures from maternal caregivers and members of their social network. Arch Dis Child 2021; 106:345-354. [PMID: 33004310 PMCID: PMC7982931 DOI: 10.1136/archdischild-2019-318352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 08/22/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network. DESIGN Randomised control pilot trial over a 6-month study follow-up time period. The study was undertaken from May 2017 to -May 2018. Once monthly follow-up visits occurred over the 6-month study period. SETTING Baltimore City, Maryland, USA. PARTICIPANTS We grouped 135 participants into 45 triads (asthmatic child (2-12 years of age), maternal caregiver and social network member). Triads were assigned in a 1:1 allocation ratio. The maternal caregiver and social network members were active smokers and contributed to paediatric TSE. INTERVENTIONS Triads were randomised to receive either usual care (TSE education and quitline referrals) or usual care plus financial incentives. Cash incentives up to $1000 were earned by caregivers and designated social network participants. Incentives for either caregivers or social network participants were provided contingent on their individual reduction of tobacco usage measured by biomarkers of tobacco usage. Study visits occurred once a month during the 6-month trial. MAIN OUTCOME MEASURES The main outcome measure was mean change in monthly paediatric cotinine levels over 6 months of follow-up interval and was analysed on an intention-to-treat basis. RESULTS The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI -0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort's caregivers (difference in slope (control-intervention)=3.30 ng/mL/month, CI -7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control-intervention)=-1.59 ng/mL/month, CI -3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group. CONCLUSIONS Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels. TRIAL REGISTRATION NUMBER NCT03099811.
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Affiliation(s)
- Mandeep S Jassal
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Cassia Lewis-Land
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Richard E Thompson
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Arlene Butz
- Department of Pediatrics, Johns Hopkins Medicine, Baltimore, Maryland, USA
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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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Arcury TA, Trejo G, Moore D, Howard TD, Quandt SA, Ip EH, Sandberg JC. "It's Worse to Breathe It Than to Smoke It": Secondhand Smoke Beliefs in a Group of Mexican and Central American Immigrants in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8630. [PMID: 33233697 PMCID: PMC7699747 DOI: 10.3390/ijerph17228630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022]
Abstract
This analysis describes beliefs about secondhand smoke and its health effects held by Mexican and Central American immigrants in North Carolina. Data from 60 semistructured, in-depth interviews were subjected to saliency analysis. Participant discussions of secondhand smoke centered on four domains: (1) familiarity and definition of secondhand smoke, (2) potency of secondhand smoke, (3) general health effects of secondhand smoke, and (4) child health effects of secondhand smoke. Secondhand smoke was generally believed to be more harmful than primary smoke. Mechanisms for the potency and health effects of secondhand smoke involved the smell of secondhand smoke, secondhand smoke being an infection and affecting the immune system, and personal strength being protective of secondhand smoke. Understanding these health beliefs informs a framework for further health education and intervention to reduce smoking and secondhand smoke exposure in this vulnerable population.
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Affiliation(s)
- Thomas A. Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (G.T.); (J.C.S.)
| | - Grisel Trejo
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (G.T.); (J.C.S.)
| | - DaKysha Moore
- Department of Visual, Performing, & Communication Arts, Johnson C. Smith University, Charlotte, NC 28216, USA;
| | - Timothy D. Howard
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Sara A. Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Edward H. Ip
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA;
| | - Joanne C. Sandberg
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA; (G.T.); (J.C.S.)
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Mahabee-Gittens EM, Merianos AL, Dexheimer JW, Meyers GT, Stone L, Tabangin M, Khoury JC, Gordon JS. Utilization of a Clinical Decision Support Tool to Reduce Child Tobacco Smoke Exposure in the Urgent Care Setting. Pediatr Emerg Care 2020; 36:527-531. [PMID: 30346363 PMCID: PMC6474832 DOI: 10.1097/pec.0000000000001646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clinical decision support systems (CDSS) may facilitate caregiver tobacco screening and counseling by pediatric urgent care (UC) nurses. OBJECTIVE This study aimed to assess the feasibility of a CDSS to address caregivers' tobacco use and child tobacco smoke exposure (TSE). METHODS We conducted a 3-month prospective study on caregivers screened using a CDSS. Nurses used the CDSS to advise, assess, and assist caregivers to quit. We assessed caregiver sociodemographics, smoking habits, and child TSE. RESULTS We screened 185 caregivers whose children were exposed to TSE for study inclusion; 155 (84%) met the eligibility criteria, and 149 (80.5%) were included in the study. Study nurses advised 35.2% of the caregivers to quit, assessed 35.9% for readiness to quit, and assisted 32.4%. Of the 149 participants, 83.1% were female; 47.0% were white and 45.6% African American; 84.6% had public insurance or were self-pay; 71.1% were highly nicotine dependent; 50.0% and 50.7% allowed smoking in the home and car, respectively; and 81.3% of children were biochemically confirmed to be exposed to tobacco smoke. At follow-up (86.6% retention), 58.9% reported quit attempts at 3 months. There was a significant decrease in nicotine dependence and a significant increase in motivation to quit. Self-reported quit rate was 7.8% at 3 months. CONCLUSIONS An electronic health record-embedded CDSS was feasible to incorporate into busy UC nurses' workloads and was associated with encouraging changes in the smoking behavior of caregivers. More research on the use of CDSS to screen and counsel caregivers who smoke in the UC and other acute care settings is warranted.
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Affiliation(s)
| | | | - Judith W. Dexheimer
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Division of Biomedical Informatics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Gabe T. Meyers
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Meredith Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jane C. Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Associations between a smoke-free homes intervention and childhood admissions to hospital in Scotland: an interrupted time-series analysis of whole-population data. LANCET PUBLIC HEALTH 2020; 5:e493-e500. [PMID: 32888442 DOI: 10.1016/s2468-2667(20)30178-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/17/2020] [Accepted: 07/23/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many children are exposed to second-hand smoke in the home and are at increased risk of asthma and other respiratory conditions. In Scotland, a public health mass-media campaign was launched on March 24, 2014, called Take it Right Outside (TiRO), with a focus on reducing the exposure of children to domestic second-hand smoke. In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland. METHODS For an interrupted time-series analysis, data were obtained on all hospital admissions in Scotland between 2000 and 2018 for children aged younger than 16 years. We studied changes in the monthly incidence of admissions for conditions potentially related to second-hand smoke exposure (asthma, lower respiratory tract infection, bronchiolitis, croup, and acute otitis media) per 1000 children following the 2014 TiRO campaign, while considering national legislation banning smoking in public spaces from 2006. We considered asthma to be the primary condition related to second-hand smoke exposure, with monthly asthma admissions as the primary outcome. Gastroenteritis was included as a control condition. The analysis of asthma admissions considered subgroups stratified by age and area quintile of the Scottish Index of Multiple Deprivations (SIMD). FINDINGS 740 055 hospital admissions were recorded for children. 138 931 (18·8%) admissions were for respiratory conditions potentially related to second-hand smoke exposure, of which 32 342 (23·3%) were for asthma. After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (-0·48% [-0·85 to -0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5-15 years). Asthma admissions did not change after TiRO among children 0-15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, independent of TiRO, asthma admissions decreased in both younger children (-0·36% [-0·67 to -0·05], p=0·021) and older children (-0·68% [-1·00 to -0·36], p<0·0001), and in children from the most deprived (SIMD 1; -0·49% [-0·87 to -0·11], p=0·011) and intermediate deprived (SIMD 3; -0·70% [-1·17 to -0·23], p=0·0043) area quintiles, but not in those from the least deprived (SIMD 5) area quintile. INTERPRETATION Our findings suggest that smoke-free home interventions could be an important tool to reduce asthma admissions in young children, and that smoke-free public space legislation might improve child health for many years, especially in the most deprived communities. FUNDING University of Aberdeen Research Excellence Framework 2021 Impact Support Award Scheme.
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Nardone N, Jain S, Addo N, St Helen G, Jacob P, Benowitz NL. Sources and Biomarkers of Secondhand Tobacco Smoke Exposure in Urban Adolescents. Acad Pediatr 2020. [PMID: 31866460 DOI: 10.1016/j.acap.2019.12.006.sources] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
OBJECTIVE In an urban adolescent population, we evaluated sources of exposure to secondhand smoke exposure (SHS), examined differences in exposure by race/ethnicity, age and sex, and determined the relationship between exposure source(s) and the biomarkers cotinine and NNAL. METHODS Participants were recruited from a public hospital-based outpatient clinic in San Francisco, CA, USA. RESULTS Of a sample of N = 298 adolescents screened, 235 were biologically confirmed to be exposed to tobacco smoke. Of those, N = 16 were active smokers and N = 219 were exposed to SHS; 91 (39%) were heavily SHS exposed (median cotinine = 0.76 ng/mL) and 128 (54%) had light SHS exposure (median cotinine = 0.11 ng/mL). Within those SHS exposed, the most common source of exposure was in a public area. No significant racial/ethnic differences were found, although African American adolescents were more likely to live in a home that allowed smoking. Older adolescents were more likely to be exposed across several difference sources, and females more likely to be exposed in a car and in public areas. Past 7-day exposure in the home, in a car, and current blunt use were significantly related to biomarkers of exposure. CONCLUSIONS Urban adolescents are exposed to SHS across a variety of sources. Although exposure in a public area is most common, exposure in the home and in cars significantly influences tobacco biomarker levels. Interventions to reduce exposure would have the greatest impact in this population if they focused on reducing exposure in the home and in cars. History of blunt use is a strong determinant of tobacco exposure.
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Affiliation(s)
- Natalie Nardone
- Division of Cardiology, Department of Medicine, Program in Clinical Pharmacology, University of California San Francisco (N Nardone, N Addo, and G St.Helen).
| | - Shonul Jain
- Department of Pediatrics, University of California San Francisco (S Jain)
| | - Newton Addo
- Division of Cardiology, Department of Medicine, Program in Clinical Pharmacology, University of California San Francisco (N Nardone, N Addo, and G St.Helen)
| | - Gideon St Helen
- Division of Cardiology, Department of Medicine, Program in Clinical Pharmacology, University of California San Francisco (N Nardone, N Addo, and G St.Helen); Center for Tobacco Control Research and Education, University of California San Francisco (G St.Helen and NL Benowitz)
| | - Peyton Jacob
- Division of Cardiology, Departments of Medicine and Psychiatry, Clinical Pharmacology Research Laboratory, University of California San Francisco (P Jacob)
| | - Neal L Benowitz
- Center for Tobacco Control Research and Education, University of California San Francisco (G St.Helen and NL Benowitz); Department of Medicine and Bioengineering and Therapeutic Sciences, University of California San Francisco (NL Benowitz)
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Mahabee-Gittens EM, Merianos AL, Gordon JS, Stone L, Semenova O, Matt GE. Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients. Hosp Pediatr 2020; 9:659-664. [PMID: 31451583 DOI: 10.1542/hpeds.2018-0247] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Documentation of children's tobacco smoke exposure (TSE) in the electronic health record (EHR) can have important implications for clinical care. However, it may not be accurate if it is not based on biochemical assessment, the most reliable method of verifying TSE. Our objectives were to compare the accuracy of EHR classification of TSE with cotinine verification and to explore parent and child variables associated with biochemically verified TSE. METHODS Participants were 171 hospitalized pediatric patients (ages 0-17 years; mean age 5.1 [SD 3.7] years) who had EHR documentation of TSE and measured salivary cotinine. Children with cotinine levels >1 ng/mL were classified as having biochemical verification of TSE. Parents reported sociodemographic characteristics, and children's EHRs were abstracted for TSE status, past medical history, and diagnoses. We conducted χ2 tests to assess the agreement between EHR classification of TSE status and cotinine levels. Then, we assessed the relationship between sociodemographic and clinical variables and cotinine using crude and adjusted logistic regression models. RESULTS Overall, 71% (121 of 171) of EHR classifications were correct on the basis of cotinine levels. Specificity analyses showed that 77% (53 of 69) were correctly identified as exposed to tobacco smoke. Sensitivity analyses showed that 67% (68 of 102) were correctly identified as unexposed. The negative predictive value was 0.61 (53 of 87); 39% (34 of 87) were misclassified as unexposed. The positive predictive value was 0.81 (68 of 84); 19% (16 of 84) were misclassified as exposed. CONCLUSIONS Almost 40% of children were misclassified in the EHR as unexposed to tobacco smoke. Biochemical verification should be used as part of universal TSE screening during pediatric hospitalizations.
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Affiliation(s)
- E Melinda Mahabee-Gittens
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; .,College of Medicine and
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, Ohio
| | - Judith S Gordon
- College of Nursing, The University of Arizona, Tucson, Arizona; and
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Olga Semenova
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, California
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Osorio-Yáñez C, Clemente DBP, Maitre L, Vives-Usano M, Bustamante M, Martinez D, Casas M, Alexander J, Thomsen C, Chatzi L, Gützkow KB, Grazuleviciene R, Martens DS, Plusquin M, Slama R, McEachan RC, Wright J, Yang TC, Urquiza J, Tamayo I, Sunyer J, Vafeiadi M, Nawrot TS, Vrijheid M. Early life tobacco exposure and children's telomere length: The HELIX project. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 711:135028. [PMID: 32000334 DOI: 10.1016/j.scitotenv.2019.135028] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
Telomere length and mitochondrial DNA content are considered biomarkers of cellular aging, oxidative stress, and inflammation, but there is almost no information on their association with tobacco smoke exposure in fetal and early life. The aim of this study was to assess whether prenatal and childhood tobacco exposure were associated with leukocyte telomere length (LTL) and mitochondrial DNA (mtDNA) content in children. As part of a multi-centre European birth cohort study HELIX (Human Early-Life Exposome) (n = 1396) we assessed maternal smoking status during pregnancy through questionnaires, and through urinary cotinine levels that were then used to classify women as not exposed to smoking (<10 µg/L), exposed to secondhand smoke (SHS) (10-50 µg/L) and active smokers (>50 µg/L). When the children were around 8 years of age (range: 5.4-12.0 years), childhood SHS tobacco smoke exposure was assessed through an extensive questionnaire and through measurements of urinary cotinine (<3.03 µg/L non-detected, >3.03 µg/L detected). Leukocyte mtDNA content and LTL were measured in the children at 8 years employing real time polymerase chain reaction (qPCR). Effect estimates were calculated using multivariate linear regression models for prenatal and childhood exposures adjusted for potential confounders. Maternal cotinine levels indicative of SHS exposure during pregnancy were associated with a decrease of 3.90% in LTL in children (95% CI: -6.68, -0.91), compared with non-smoking, whereas the association for maternal cotinine levels indicative of active smoking did not reach statistical significance (-3.24%; 95% CI: -6.59, 0.21). Childhood SHS tobacco exposure was not associated with LTL in children. Global SHS exposure during childhood was associated with an increase of 3.51% (95% CI: 0.78, 6.27) in mtDNA content. Our findings suggest that tobacco smoke exposure during pregnancy, even at SHS levels, may accelerate telomere shortening in children and thus induce biological aging from an early age.
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Affiliation(s)
- Citlalli Osorio-Yáñez
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), México DF, Mexico
| | - Diana B P Clemente
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Lea Maitre
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Martha Vives-Usano
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mariona Bustamante
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - David Martinez
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Maribel Casas
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | | | | | - Leda Chatzi
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Genetics and Cell Biology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | | | - Dries S Martens
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Michelle Plusquin
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium
| | - Remy Slama
- Team of Environmental Epidemiology, IAB, Institute for Advanced Biosciences, Inserm, CNRS, CHU-Grenoble-Alpes, University Grenoble-Alpes, CNRS, Grenoble, France
| | - Rosemary C McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Jose Urquiza
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Ibon Tamayo
- ISGlobal, Institute for Global Health, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Statistics, Faculty of Arts and Sciences, Harvard University, Cambridge, MA, USA
| | - Jordi Sunyer
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain
| | - Marina Vafeiadi
- Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Tim S Nawrot
- Center for Environmental Sciences, Hasselt University, Hasselt, Belgium; Department of Public Health & Primary Care, Unit Environment & Health, Leuven University, Leuven, Belgium
| | - Martine Vrijheid
- ISGlobal, Institute for Global Health, Barcelona, Spain; Univeristat Pompeu Fabra, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain.
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Clawson AH, McQuaid EL, Dunsiger S, Borrelli B. Smokers with children with asthma: Parental perceptions about prototype intervention messages focused on reducing child tobacco exposure and use. J Child Health Care 2020; 24:106-122. [PMID: 30198313 DOI: 10.1177/1367493518798436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Formative research is needed to develop effective interventions that eliminate secondhand smoke exposure (SHSe) and prevent tobacco use (TU) among children with asthma. This online study included 300 parents who smoke and had a child with asthma (ages 10-14) and evaluated their perceptions about prototypes of parent-directed and child-directed feedback intervention messages focused on reducing child SHSe and future TU; correlates of perceptions were explored. Parents rated examples of parent-directed messages on motivation and helpfulness for eliminating SHSe and promoting conversations about TU and also rated child-directed messages on acceptability and helpfulness for promoting conversations about TU. Messages differed by level of personalization, theoretical background, or message content. Parents found all parent-directed messages similarly motivating and helpful and all child-directed messages similarly acceptable and helpful for reducing child tobacco exposure. Differences in perceptions about feedback emerged based on parent gender, parent readiness to quit, smoking ban status, and the presence of additional smokers in the home. Overall, parents rated parent-directed and child-directed feedback message prototypes positively, including established and novel types of feedback. Parent-child feedback interventions may hold promise for breaking the intergenerational transmission of smoking among families with a parent who smokes and a child with asthma.
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Affiliation(s)
- Ashley H Clawson
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University, The Miriam Hospital, RI, USA.,Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Rhode Island Hospital, RI, USA.,Department of Psychology, Oklahoma State University, OK, USA
| | - Elizabeth L McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Rhode Island Hospital, RI, USA
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University, The Miriam Hospital, RI, USA
| | - Belinda Borrelli
- Henry M. Goldman School of Dental Medicine, Boston University, MA, USA
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12
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Nardone N, Jain S, Addo N, St.Helen G, Jacob P, Benowitz NL. Sources and Biomarkers of Secondhand Tobacco Smoke Exposure in Urban Adolescents. Acad Pediatr 2020; 20:493-500. [PMID: 31866460 PMCID: PMC7967984 DOI: 10.1016/j.acap.2019.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/09/2019] [Accepted: 12/12/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In an urban adolescent population, we evaluated sources of exposure to secondhand smoke exposure (SHS), examined differences in exposure by race/ethnicity, age and sex, and determined the relationship between exposure source(s) and the biomarkers cotinine and NNAL. METHODS Participants were recruited from a public hospital-based outpatient clinic in San Francisco, CA, USA. RESULTS Of a sample of N = 298 adolescents screened, 235 were biologically confirmed to be exposed to tobacco smoke. Of those, N = 16 were active smokers and N = 219 were exposed to SHS; 91 (39%) were heavily SHS exposed (median cotinine = 0.76 ng/mL) and 128 (54%) had light SHS exposure (median cotinine = 0.11 ng/mL). Within those SHS exposed, the most common source of exposure was in a public area. No significant racial/ethnic differences were found, although African American adolescents were more likely to live in a home that allowed smoking. Older adolescents were more likely to be exposed across several difference sources, and females more likely to be exposed in a car and in public areas. Past 7-day exposure in the home, in a car, and current blunt use were significantly related to biomarkers of exposure. CONCLUSIONS Urban adolescents are exposed to SHS across a variety of sources. Although exposure in a public area is most common, exposure in the home and in cars significantly influences tobacco biomarker levels. Interventions to reduce exposure would have the greatest impact in this population if they focused on reducing exposure in the home and in cars. History of blunt use is a strong determinant of tobacco exposure.
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Affiliation(s)
- Natalie Nardone
- Division of Cardiology, Department of Medicine, Program in Clinical Pharmacology, University of California San Francisco (N Nardone, N Addo, and G St.Helen).
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13
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Mahabee-Gittens EM, Merianos AL, Fulkerson PC, Stone L, Matt GE. The Association of Environmental Tobacco Smoke Exposure and Inflammatory Markers in Hospitalized Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234625. [PMID: 31766400 PMCID: PMC6926853 DOI: 10.3390/ijerph16234625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/07/2019] [Accepted: 11/16/2019] [Indexed: 12/13/2022]
Abstract
Background: Environmental tobacco smoke (ETS) exposure is associated with altered cytokine levels in children. We sought to examine ETS exposure prevalence and the relationship between ETS exposure and cytokine levels in a sample of hospitalized children. (2) Methods: Inflammatory markers (IL-8, IL-1β, IL-10, and TNF-α) and cotinine were measured in saliva of hospitalized, nonsmoking children (N = 112). To assess the association between ETS exposure and immune system response, we built a multivariate regression model including the four inflammatory markers as the response variables and cotinine, age, sex, and discharge diagnosis as explanatory variables while assessing possible interaction effects. (3) Results: Mean age (SD) was 5.8(5.0) years; Geometric Mean (GeoM) cotinine = 1.8 [95% CI = 1.4–2.2]. Children with non-inflammatory other diagnoses had lower IL-10 (p = 0.003) and TNF-α (p = 0.009) levels than children with inflammatory other diagnoses. Children with asthma (p = 0.01) and bacterial illnesses and/or pneumonia (p = 0.002) had higher IL-8 levels. Independent of diagnosis, there was a significant curvilinear association between cotinine and IL-1β (p = 0.002) reflecting no association for cotinine levels <5 ng/mL and a positive association for >5 ng/mL. (4) Conclusions: Children with higher ETS exposure levels have higher IL-1β levels regardless of age, sex, and diagnosis. ETS exposure may increase pro-inflammatory immune responses in children and may interfere with native immune responses and the ability to heal and fight infection.
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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
| | - Ashley L. Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH 45221, USA;
| | - Patricia C. Fulkerson
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati; College of Medicine, Cincinnati, OH 45229, USA;
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center; University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA;
| | - Georg E. Matt
- Department of Psychology, San Diego State University, San Diego, CA 92123, USA;
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14
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Azmeh R, Greydanus DE, Agana MG, Dickson CA, Patel DR, Ischander MM, Lloyd RD. Update in Pediatric Asthma: Selected Issues. Dis Mon 2019; 66:100886. [PMID: 31570159 DOI: 10.1016/j.disamonth.2019.100886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a complex condition that affects 14% of the world's children and the approach to management includes both pharmacologic as well as non-pharmacologic strategies including attention to complex socioeconomic status phenomena. After an historical consideration of asthma, allergic and immunologic aspects of asthma in children and adolescents are presented. Concepts of socioeconomic aspects of asthma are considered along with environmental features and complications of asthma disparities. Also reviewed are links of asthma with mental health disorders, sleep disturbances and other comorbidities. A stepwise approach to asthma management is discussed that includes pharmacologic and non-pharmacologic strategies in the pediatric population. The role of immunotherapy and use of various immunomodulators are considered as well.
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Affiliation(s)
- Roua Azmeh
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Marisha G Agana
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Cheryl A Dickson
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Health Equity and Community Affairs, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Mariam M Ischander
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Robert D Lloyd
- Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, United States
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15
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Butz AM, Tsoukleris M, Elizabeth Bollinger M, Jassal M, Bellin MH, Kub J, Mudd S, Ogborn CJ, Lewis-Land C, Thompson RE. Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma. J Asthma 2019; 56:915-926. [PMID: 30307351 PMCID: PMC6551304 DOI: 10.1080/02770903.2018.1509989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.
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Affiliation(s)
- Arlene M Butz
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Mona Tsoukleris
- b The Univeristy of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Mary Elizabeth Bollinger
- c Department of Pediatrics, The University of Maryland School of Medicine , Baltimore , MD , USA
| | - Mandeep Jassal
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Melissa H Bellin
- d The University of Maryland School of Social Work , Baltimore , MD , USA
| | - Joan Kub
- e Department of Nursing, The USC Suzanne Dworak-Peck School of Social Work , Los Angeles , CA , USA
| | - Shawna Mudd
- f The Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - C Jean Ogborn
- g Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Cassia Lewis-Land
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Richard E Thompson
- h Biostatistics Department, The Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
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16
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Mahabee-Gittens EM, Merianos AL, Stone L, Tabangin ME, Khoury JC, Gordon JS. Tobacco Use Behaviors and Perceptions of Parental Smokers in the Emergency Department Setting. Tob Use Insights 2019; 12:1179173X19841392. [PMID: 31258335 PMCID: PMC6585244 DOI: 10.1177/1179173x19841392] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 03/10/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND More information is needed about modifiable child tobacco smoke exposure (TSE) patterns in racially diverse parental smokers to tailor interventions designed to help parents quit smoking and reduce their child's TSE. Our objectives were to determine whether there were differences in smoking and TSE patterns based on parental race and child age and whether these patterns differed based on child age within black and white parental smokers. Secondary objectives were to assess the relationship between parental perceptions about the effects of smoking and the benefits of quitting on their child based on child age, race, and reported TSE patterns and to examine biochemically verified TSE levels by child age, race, and parent-reported TSE patterns. METHODS Participants (N = 415) were non-Hispanic black and non-Hispanic white parental smokers, mean age (standard deviation [SD]) = 31.2 (7.2) years, who visited the Pediatric Emergency Department (PED) or Urgent Care (UC) with their child, mean age (SD) = 4.7 (4.6) years. Parents reported sociodemographics, smoking, and child TSE patterns. We conducted chi-square tests, independent t-tests, and general linear regression models to answer our primary objectives and linear regression models to answer our secondary objectives. RESULTS Parents were 56.1% non-Hispanic black; 87.5% women; mean (SD) number of cigarettes smoked/day was 10.5(6.8). A higher proportion of parents with younger children <3 years old reported smoking bans compared with parents with older children ⩾3 to <18 years old (41.3% vs 19.7%, P < .0001). Subsequent analyses revealed this pattern for both black and white parents. A total of 212 (51%) of children had biochemical assessment of TSE; 89.6% had detectable TSE. Younger children had significantly higher cotinine levels than older children independent of their race (P < .001). CONCLUSIONS Children of parental smokers who visit the PED/UC were highly tobacco smoke exposed. Both black and white parental smokers with younger children were more likely to enforce smoking bans, but younger children had higher TSE levels than older children. Interventions that target this group of parental smokers with younger children may be more effective than interventions geared to all parental smokers.
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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, USA
| | - Ashley L Merianos
- School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Lara Stone
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Meredith E Tabangin
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jane C Khoury
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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17
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Podlecka D, Malewska-Kaczmarek K, Jerzyńska J, Stelmach W, Stelmach I. Secondhand smoke exposure increased the need for inhaled corticosteroids in children with asthma. Ann Allergy Asthma Immunol 2018; 121:119-121. [PMID: 29709642 DOI: 10.1016/j.anai.2018.04.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/15/2018] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Daniela Podlecka
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Kamila Malewska-Kaczmarek
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Joanna Jerzyńska
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Wlodzimierz Stelmach
- Social Medicine Institute Department of Social and Preventive Medicine, Medical University of Lodz, Lodz, Poland
| | - Iwona Stelmach
- Department of Pediatrics and Allergy, N. Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland.
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18
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Delgado-Rendon A, Boley Cruz T, Soto D, Baezconde-Garbanati L, Unger JB. Second and Thirdhand Smoke Exposure, Attitudes and Protective Practices: Results from a Survey of Hispanic Residents in Multi-unit Housing. J Immigr Minor Health 2017; 19:1148-1155. [PMID: 28074306 PMCID: PMC7453492 DOI: 10.1007/s10903-016-0540-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Secondhand and third hand smoke (SHS, THS) exposure is prevalent in multi-unit housing (MUH). Minorities and low-income MUH residents are disproportionally exposed to SHS and THS compared to other populations. This study describes the characteristics, attitudes, knowledge, and behaviors related to SHS, THS and marijuana smoke exposure (MSHS) of a sample of Hispanic tenants in randomly selected MUH units in eastern metro Los Angeles (n = 402). Although most participants (97%) banned smoking inside their homes, 80% reported infiltration of SHS inside their apartments within the last year. Most (85%) favored a complete ban on smoking in apartment buildings. Twenty-eight percent did not know that marijuana (MSHS) smoke exposure is also harmful to their health. Knowledge scores were higher among Spanish-speakers (p < 0.05). Given the interpersonal barriers to advocating for change, widespread policy and communication interventions are also necessary to protect Hispanic MUH residents' rights to clean air in their living space.
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Affiliation(s)
- Angelica Delgado-Rendon
- Department of Preventive Medicine, Keck School of Medicine, Institute for Prevention Research, University of Southern California, 2001N. Soto Ave., Los Angeles, CA 90034, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, Keck School of Medicine, Institute for Prevention Research, University of Southern California, 2001N. Soto Ave., Los Angeles, CA 90034, USA
| | - Daniel Soto
- Department of Preventive Medicine, Keck School of Medicine, Institute for Prevention Research, University of Southern California, 2001N. Soto Ave., Los Angeles, CA 90034, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, Institute for Prevention Research, University of Southern California, 2001N. Soto Ave., Los Angeles, CA 90034, USA
| | - Jennifer B. Unger
- Department of Preventive Medicine, Keck School of Medicine, Institute for Prevention Research, University of Southern California, 2001N. Soto Ave., Los Angeles, CA 90034, USA
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19
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Clawson AH, McQuaid EL, Borrelli B. Smokers who have children with asthma: Perceptions about child secondhand smoke exposure and tobacco use initiation and parental willingness to participate in child-focused tobacco interventions. J Asthma 2017; 55:373-384. [PMID: 28759279 DOI: 10.1080/02770903.2017.1339797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study examined, among parents who smoke and have children with asthma, perceptions about child secondhand smoke exposure (SHSe), child tobacco use (TU) initiation, and parent willingness to participate in child-focused tobacco interventions. METHODS Participants were 300 caregivers who smoked and had a child with asthma (aged 10-14). Parents completed an online survey and self-reported perceptions about child SHSe elimination, child TU prevention, and willingness to participate in three types of interventions with and without their child (SHSe reduction intervention, tobacco prevention intervention, and the combination of the two). Correlates of perceptions and willingness were examined. RESULTS Parents who were ready to quit smoking and who reported home smoking bans (HSBs) were more motivated to eliminate SHSe (p < 0.05). Being white, younger, ready to quit, and having HSBs were associated with greater confidence to eliminate SHSe (p < 0.05). Parents with HSBs reported higher perceived importance about preventing child TU (p < 0.05). Parents were less confident about preventing male children from using tobacco (p = 0.001). Parents were highly willing to participate in all the described intervention approaches, with or without their child. CONCLUSIONS Parents were willing to participate in child-focused tobacco interventions, with or without their child with asthma, including interventions that address both child SHSe and TU prevention. This research demonstrates the acceptability of child-focused tobacco interventions among a high-risk population and may be a foundational step for intervention development.
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Affiliation(s)
- Ashley H Clawson
- a Centers for Behavioral and Preventive Medicine , Alpert Medical School of Brown University and The Miriam Hospital. Providence , RI , USA.,b Bradley/Hasbro Children's Research Center , Alpert Medical School of Brown University and Rhode Island Hospital. Providence , RI , USA.,c Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Elizabeth L McQuaid
- b Bradley/Hasbro Children's Research Center , Alpert Medical School of Brown University and Rhode Island Hospital. Providence , RI , USA
| | - Belinda Borrelli
- d Department of Health Policy & Health Services Research , Boston University, Henry M. Goldman School of Dental Medicine , Boston , MA , USA
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20
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Miadich SA, Everhart RS, Heron KE, Cobb CO. Medication use, sleep, and caregiver smoking status among urban children with asthma. J Asthma 2017; 55:588-595. [PMID: 28759271 DOI: 10.1080/02770903.2017.1350969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Children living in urban settings from low-income, minority families are at a high risk for experiencing asthma morbidity. Environmental tobacco smoke (ETS, i.e., secondhand) exposure, typically from caregiver smoking, has been associated with increased quick-relief medication use and child nocturnal awakenings due to increased asthma symptoms as well as worse sleep quality in children with asthma. This study investigated the moderating role of caregiver smoking status on the association between quick-relief medication use and child's sleep quality in urban children with persistent asthma. METHODS Fifty-four urban children with persistent asthma and their primary caregivers completed a baseline research session. Caregivers then completed ecological momentary assessment surveys via smartphones twice daily for two weeks in which smoking behaviors, child quick-relief medication use, and child's sleep quality were assessed. RESULTS Twenty caregivers (37%) reported smoking at least one day across the two-week period. The caregiver smoking status significantly moderated the association between quick-relief medication use and child's sleep quality after controlling for child age and monthly household income. The caregiver smoking status exacerbated the association between quick-relief medication use and child's sleep quality, such that more medication usage was associated with worse sleep quality. CONCLUSIONS Findings suggest that in urban families with a caregiver who smokes, more daily quick-relief medication use may put children at an increased risk for worse sleep quality. The effects of ETS exposure on child's sleep quality in addition to child asthma symptoms should be an integral part of discussions between pediatric healthcare providers and families of children with asthma.
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Affiliation(s)
- Samantha A Miadich
- a Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Robin S Everhart
- a Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
| | - Kristin E Heron
- b Department of Psychology , Old Dominion University , Norfolk , VA , USA
| | - Caroline O Cobb
- a Department of Psychology , Virginia Commonwealth University , Richmond , VA , USA
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21
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Peters KO, Williams DAL, Abubaker S, Curtin-Brosnan J, McCormack MC, Peng R, Breysse PN, Matsui EC, Hansel NN, Diette GB, Strickland PT. Predictors of polycyclic aromatic hydrocarbon exposure and internal dose in inner city Baltimore children. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:290-298. [PMID: 27966668 PMCID: PMC5516642 DOI: 10.1038/jes.2016.57] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 09/23/2016] [Indexed: 05/29/2023]
Abstract
Polycyclic aromatic hydrocarbons (PAHs), the by-products of incomplete combustion of organic materials, are commonly found on particulate matter (PM) and have been associated with the development of asthma and asthma exacerbation in urban populations. We examined time spent in the home and outdoors as predictors of exposures to airborne PAHs and measured urinary 1-hydroxypyrene-glucuronide (1-OHPG) as internal dose of PAHs in 118 children aged 5-12 years from Baltimore, MD. During weeklong periods (Saturday-Saturday) in each of four seasons: daily activities were assessed using questionnaires, indoor air nicotine and PM concentrations were monitored, and urine specimens were collected on Tuesday (day 3) and Saturday (day 7) for measurement of 1-OHPG. Time spent in non-smoking homes was associated with significantly decreased 1-OHPG concentration in urine (β=-0.045, 95% CI (-0.076, -0.013)), and secondhand smoke (SHS) exposures modified these associations, with higher urinary 1-OHPG concentrations in children spending time in smoking homes than non-smoking homes (P-value for interaction=0.012). Time spent outdoors was associated with increased urinary 1-OHPG concentrations (β=0.097, 95% CI (0.037, 0.157)) in boys only. Our results suggest that SHS and ambient (outdoor) air pollution contribute to internal dose of PAHs in inner city children.
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Affiliation(s)
- Kamau O. Peters
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - D’ Ann L. Williams
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Salahadin Abubaker
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jean Curtin-Brosnan
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Meredith C. McCormack
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Roger Peng
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Patrick N. Breysse
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elizabeth C. Matsui
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nadia N. Hansel
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gregory B. Diette
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Paul T. Strickland
- Department of Environmental Health Sciences, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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22
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Merianos AL, Odar Stough C, Nabors LA, Mahabee-Gittens EM. Tobacco Smoke Exposure and Health-Care Utilization Among Children in the United States. Am J Health Promot 2017; 32:123-130. [PMID: 29214835 DOI: 10.1177/0890117116686885] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to assess patterns of health-care utilization among children who potentially had tobacco smoke exposure (TSE) compared to those who were not exposed. DESIGN A secondary data analysis of the 2011 to 2012 National Survey on Children's Health was performed. SETTING Households nationwide were selected. PARTICIPANTS A total of 95 677 children aged 0 to 17 years. MEASURES Sociodemographic characteristics, TSE status, and health-care visits were measured. ANALYSIS Multivariable logistic regression models were performed. RESULTS A total of 24.1% of children lived with smokers. Approximately 5% had home TSE. Participants who lived with a smoker were significantly more likely to have had a medical care visit (odds ratio [OR] = 1.22, confidence interval [CI] = 1.21-1.22) and were more likely to seek sick care or health advice at an emergency department (OR = 1.23, CI = 1.23-1.24) but were less likely to have had a dental care visit (OR = 0.82, CI = 0.82-0.83) than those who did not live with a smoker. Similar findings were found among participants who had home TSE. CONCLUSION TSE is a risk factor for increased use of pediatric medical care. Based on the high number of children who potentially had TSE and received sick care or health advice at an emergency emergency department, this setting may be a venue to deliver health messages to caregivers.
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Affiliation(s)
- Ashley L Merianos
- 1 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - Cathy Odar Stough
- 2 Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Laura A Nabors
- 1 Health Promotion and Education Program, School of Human Services, University of Cincinnati, Cincinnati, OH, USA
| | - E Melinda Mahabee-Gittens
- 3 Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London. NPJ Prim Care Respir Med 2016; 26:16049. [PMID: 27537194 PMCID: PMC4989925 DOI: 10.1038/npjpcrm.2016.49] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 06/08/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022] Open
Abstract
Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK’s recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)–linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1–3 (4–12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20–2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04–5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79–4.69, Step 4/5: OR 9.42; 95% CI 5.27–16.84), and among Black (OR 2.30; 95% CI 1.64–3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36–2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups.
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Hoehn JL, Riekert KA, Borrelli B, Rand CS, Eakin MN. Barriers and motivators to reducing secondhand smoke exposure in African American families of head start children: a qualitative study. HEALTH EDUCATION RESEARCH 2016; 31:450-64. [PMID: 27329373 PMCID: PMC4945858 DOI: 10.1093/her/cyw028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 05/20/2016] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To identify barriers and motivators for reducing secondhand smoke exposure (SHSe) for families of African-American, low-income, urban children. METHOD Audiotaped intervention sessions of 52 African-American caregivers of Head Start children who reported being a smoker and/or had at least one smoker in the home were randomly sampled from a larger trial examining the effectiveness of a motivational-interviewing intervention in reducing child's SHSe. Counseling sessions were qualitatively coded to identify barriers and motivators to implementing a home smoking ban or quitting smoking. RESULTS African-American families identified several themes that were either or both barriers and motivators for SHSe reduction, including: asking others not to smoke, other family living in the home, neighborhood safety, absence of childcare, cost/availability of cessation tools, physician support and prevention of health problems. DISCUSSION Urban, low-income African-American families face numerous barriers to reducing SHSe. Families were able to identify many motivators for reducing SHSe, suggesting an awareness of the importance for SHSe reduction but uncertainty in their confidence to change behaviors. Counseling should include tailoring to be most effective in supporting health behavior change. Greater emphasis on motivators is needed, such as low-cost/free cessation tools, engagement from physicians and greater involvement of extended family members.
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Affiliation(s)
- Jessica L Hoehn
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, 21250, USA
| | - Kristin A Riekert
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA
| | - Belinda Borrelli
- Boston University, Henry M. Goldman School of Dental Medicine, Boston, MA, 02118, USA
| | - Cynthia S Rand
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA
| | - Michelle N Eakin
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, 21224, USA
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Difficult-to-control asthma: epidemiology and its link with environmental factors. Curr Opin Allergy Clin Immunol 2016; 15:397-401. [PMID: 26226354 DOI: 10.1097/aci.0000000000000195] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW The aim of the present review was to discuss the epidemiology of inadequate asthma control with an examination of contributing environmental factors. RECENT FINDINGS Despite advances in asthma therapies, a proportion of patients with asthma continue to have difficulty in gaining adequate asthma control. Asthma severity and control in childhood are of particular importance as they translate to asthma morbidity in adulthood. Children with comorbid severe allergic rhinitis were more likely to have uncontrolled asthma. Recent data suggest that mouse allergen, more so than cockroach allergen, may be the most relevant urban allergen exposure. Tobacco smoke exposure, even passive exposure, leads to increased asthma symptoms and decreased response to inhaled corticosteroids. Efforts to ban smoking in public places have resulted in promising asthma results for entire populations. Energy-saving efforts to tighten a home's air leaks can lead to increased indoor pollutant levels and, therefore, must be accompanied by efforts to reduce, filter, or exchange indoor pollutants. Obesity is independently associated with decreased asthma control. Furthermore, the detrimental effects of pollutant exposure are enhanced in an overweight individual with asthma. SUMMARY Lack of asthma control can be because of a complex web of factors including adherence, intrinsic factors, and environmental exposures. Further research into intervention strategies is needed to achieve improved rates of asthma control.
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Abstract
INTRODUCTION Children with difficult asthma have significant morbidity and fail to achieve asthma control despite being prescribed high dose maintenance treatment. If control remains poor after diagnostic confirmation, detailed assessments of the reasons for asthma being difficult-to-control are needed. Underlying modifiable factors including non-adherence to medication, persistent environmental exposures that trigger asthma symptoms and psychosocial factors contribute to poor control in these patients. AREAS COVERED The focus of this review is to provide a practical approach to the diagnosis and management of difficult asthma including an overview of long term assessments to identify potential progression to true, severe asthma. A multi-disciplinary team is critical to enable modifiable factors to be identified and addressed. Significant resources are required to manage paediatric difficult asthma optimally and only specialist centres should be tasked with the assessment of these patients. Although this may have an impact on healthcare resources, long term benefits for lung health are significant. Expert commentary: The management of paediatric difficult asthma is not simple and involves numerous professionals with varied expertise. However, if it is not undertaken with the appropriate skills, there is a significant risk of children receiving inappropriate invasive investigations and therapies that will have no impact on morbidity.
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Affiliation(s)
- Sejal Saglani
- a Inflammation, Repair and Development , National Heart & Lung Institute, Imperial College London , London , UK.,b Respiratory Paediatrics , Royal Brompton Hospital , London , UK
| | - Louise Fleming
- a Inflammation, Repair and Development , National Heart & Lung Institute, Imperial College London , London , UK.,b Respiratory Paediatrics , Royal Brompton Hospital , London , UK
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Clawson AH, Borrelli B, McQuaid EL, Dunsiger S. The role of caregiver social support, depressed mood, and perceived stress in changes in pediatric secondhand smoke exposure and asthma functional morbidity following an asthma exacerbation. Health Psychol 2016; 35:541-51. [PMID: 26867039 PMCID: PMC4868653 DOI: 10.1037/hea0000318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Caregiver depressed mood and stress are associated with increased child asthma functional morbidity (AFM) and secondhand smoke exposure (SHSe), whereas social support (SS) reduces risk. This study extends previous literature by examining (1) longitudinal patterns of pediatric AFM and SHSe and (2) how caregiver stress, depressed mood, and SS are related to child SHSe and AFM changes. METHOD Participants were 334 caregivers who smoked, had a child with asthma, and were enrolled in a smoking cessation induction/asthma intervention. SHSe and AFM were measured at baseline and 4, 6, and 12 months. All measures were caregiver self-report. We used an autoregressive latent trajectory model to examine the intercept, linear, and quadratic growth factors and autoregressive and cross-lagged effects of SHSe and AFM. RESULTS After an asthma exacerbation, decreases in child AFM and SHSe were followed by respective increases over time. Child SHSe at 4 months and 6 months predicted subsequent child AFM. Autoregressive paths were significant for only AFM. Higher baseline caregiver depressed mood and stress predicted higher baseline child AFM but not other growth factors. Higher baseline caregiver self-esteem SS was associated with only lower baseline child AFM and fewer increases in AFM across time. Exploratory analyses indicated higher baseline caregiver depressed mood and stress were associated with less-favorable changes in child SHSe and AFM. CONCLUSIONS Caregiver depressed mood, stress, and SS should be considered when addressing pediatric SHSe and AFM. Caregiver support may be needed to maintain intervention gains. (PsycINFO Database Record
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Affiliation(s)
- Ashley H. Clawson
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University and Rhode Island Hospital
| | | | - Elizabeth L. McQuaid
- Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University and Rhode Island Hospital
| | - Shira Dunsiger
- Centers for Behavioral and Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital
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Asthma in Urban Children: Epidemiology, Environmental Risk Factors, and the Public Health Domain. Curr Allergy Asthma Rep 2016; 16:33. [DOI: 10.1007/s11882-016-0609-6] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Robinson LA, Clawson AH, Weinberg JA, Salgado-Garcia FI, Ali JS. Physician Intervention for Improving Tobacco Control Among Parents Who Use Tobacco. Clin Pediatr (Phila) 2015; 54:1044-50. [PMID: 25609099 DOI: 10.1177/0009922814567304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research has demonstrated that parents who smoke are often inadvertent sources of their children's first cigarettes. Teaching parents to restrict their tobacco may give pediatricians another method for helping parents who are not ready to quit smoking. This purpose of this study was to determine the feasibility of a program training pediatricians to discuss tobacco control with smoking parents and to examine changes in parents' tobacco control after the physician intervention. One month after the intervention by pediatricians, parents reported significantly improved tobacco control. They were more likely to count their packs and cigarettes and to keep their tobacco products at work and on their person. Parents reported restricting household control of adult smoking, and children were exposed to significantly less secondhand smoke. These results showed that it is possible to integrate advice about tobacco control into a busy pediatric practice and to improve parents' restrictions of their tobacco products.
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Hilliard ME, Riekert KA, Hovell MF, Rand CS, Welkom JS, Eakin MN. Family Beliefs and Behaviors About Smoking and Young Children's Secondhand Smoke Exposure. Nicotine Tob Res 2015; 17:1067-75. [PMID: 25480933 PMCID: PMC4553755 DOI: 10.1093/ntr/ntu250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 11/11/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Home smoking bans (HSBs) reduce children's secondhand smoke exposure (SHSe), a contributor to health disparities. General psychosocial characteristics and SHSe beliefs and behaviors within the family may relate to HSB existence. This study's aim was to identify general psychosocial characteristics and SHSe beliefs associated with HSB presence and lower SHSe among children living with a smoker. METHODS Caregivers (n = 269) of Head Start preschool students (age 1-6 years) living with a smoker reported on HSBs, caregiver depressive symptoms and stress, family routines, SHSe beliefs, and household smoking characteristics. SHSe biomarkers included air nicotine in 2 areas of the home and child salivary cotinine. RESULTS One-quarter of families reported complete HSBs, and HSBs were more common among nonsmoking (37%) versus smoking caregivers (21%; p < .01). Perceived importance of HSBs differed between nonsmoking (9.7±1.0) versus smoking caregivers (9.1±2.0; p < .01). Smoking caregivers, more smokers in the home, and lower self-efficacy and intent to implement an HSB were consistently associated with lower likelihood of HSB existence and children's higher SHSe. Caregiver SHSe beliefs were more consistently associated with HSBs and SHSe than were general psychosocial factors. CONCLUSIONS Despite greater HSB likelihood and higher perceived importance of HSBs among nonsmoking versus smoking primary caregivers, SHSe reduction self-efficacy and intent are protective for Head Start students at high-risk for exposure. Pediatric healthcare providers and early education professionals may be able to support SHSe reduction efforts (e.g., smoking cessation, HSB implementation) and reduce children's SHSe with counseling strategies to address caregivers' HSB self-efficacy, intent, and related behaviors.
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Affiliation(s)
| | - Kristin A Riekert
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Melbourne F Hovell
- Graduate School of Public Health, San Diego State University, San Diego, CA
| | - Cynthia S Rand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Josie S Welkom
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Michelle N Eakin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
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Shah S, Ainsworth H, Fairhurst C, Tilbrook H, Sheikh A, Amos A, Parrott S, Torgerson D, Thompson H, King R, Mir G, Siddiqi K. Muslim communities learning about second-hand smoke: a pilot cluster randomised controlled trial and cost-effectiveness analysis. NPJ Prim Care Respir Med 2015; 25:15052. [PMID: 26313312 PMCID: PMC4551097 DOI: 10.1038/npjpcrm.2015.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/04/2015] [Accepted: 06/22/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the United Kingdom, men of Bangladeshi and Pakistani origin have higher smoking rates than the general population. This makes non-smokers in their households more vulnerable to second-hand smoke (SHS) exposure than the general population. AIMS The aim of this study was to investigate the feasibility of implementing and pilot testing the effectiveness and cost-effectiveness of a 'Smoke-free Homes' (SFH) intervention in Islamic religious settings to encourage families of Bangladeshi and Pakistani origin to apply smoking restrictions in their homes. METHODS We allocated Islamic religious settings (clusters) to either receive SFH-an educational intervention-or to a control arm. Within each cluster, we recruited households with at least one smoker and one non-smoker. SHS exposure among non-smokers was measured using salivary cotinine. RESULTS Seven (50%) clusters were randomised to each trial arm. A total of 468 households were assessed for eligibility and 62% (n=289) were eligible, of which 74% (n=213) agreed to participate in the trial. Six of the seven intervention clusters delivered the intervention, and all clusters were retained throughout the trial. In all, 81% (n=172) of households provided data at follow-up. No evidence of a difference in log cotinine level was observed (adjusted mean difference -0.02, 95% confidence interval (CI) -1.28-1.23, P=0.97) between the two trial arms. The direct mean cost of delivering the intervention was £18.18 per household (range £3.55-42.20). CONCLUSIONS It was possible to recruit, randomise and retain Islamic religious settings and participant households. However, some of the original assumptions, in particular our ability to collect primary outcome data, need to be revisited before a definitive trial.
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Affiliation(s)
- Sarwat Shah
- Department of Health Sciences, University of York, York, UK
| | - Hannah Ainsworth
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Helen Tilbrook
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Aziz Sheikh
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK
| | - Amanda Amos
- Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Heather Thompson
- The Office of The Director of Public Health, Leeds City Council, Leeds, UK
| | - Rebecca King
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ghazala Mir
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
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Butz AM, Ogborn J, Mudd S, Ballreich J, Tsoukleris M, Kub J, Bellin M, Bollinger ME. Factors associated with high short-acting β2-agonist use in urban children with asthma. Ann Allergy Asthma Immunol 2015; 114:385-92. [PMID: 25840499 PMCID: PMC4426068 DOI: 10.1016/j.anai.2015.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/10/2015] [Accepted: 03/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND One goal of guideline-based asthma therapy is minimal use of short-acting β₂ agonist (SABA) medications. Inner-city children with asthma are known to have high SABA use. OBJECTIVE To examine factors associated with high SABA use in inner-city children with asthma. METHODS One hundred inner-city children with persistent asthma were enrolled into a randomized controlled trial of an emergency department (ED) and home intervention. All children underwent serologic allergen specific IgE and salivary cotinine testing at the ED enrollment visit. Pharmacy records for the past 12 months were obtained. Number of SABA fills during the past 12 months was categorized into low- to moderate- vs high-use groups. SABA groups were compared by the number of symptom days and nights, allergen sensitization, and exposures. Regression models were used to predict high SABA use. RESULTS Mean number of SABA fills over 12 months was 3.12. Unadjusted bivariate analysis showed that high SABA users were more than 5 times more likely to have an asthma hospitalization, almost 3 times more likely to have an asthma intensive care unit admission, and more than 3 times more likely to have prior specialty asthma care or positive cockroach sensitization than low to moderate SABA users. In the final regression model, for every additional inhaled corticosteroid fill, a child was 1.4 times more likely and a child with positive cockroach sensitization was almost 7 times more likely to have high SABA use when controlling for prior intensive care unit admission, receipt of specialty care, child age, and income. CONCLUSION Providers should closely monitor SABA and controller medication use, allergen sensitization, and exposures in children with persistent asthma. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT01981564.
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Affiliation(s)
- Arlene M Butz
- Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jean Ogborn
- Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawna Mudd
- The Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Jeromie Ballreich
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Mona Tsoukleris
- The University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Joan Kub
- The Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Melissa Bellin
- The University of Maryland School of Social Work, Baltimore, Maryland
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Peck KR, Tyc VL, Huang Q, Zhang H. Reduction of Secondhand Smoke Exposure in the Cars of Children With Cancer. J Pediatr Oncol Nurs 2015; 32:401-9. [DOI: 10.1177/1043454214563755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study examined whether an intervention designed to reduce secondhand smoke exposure (SHSe) among children being treated for cancer had effects in the specific setting of a motor vehicle. The parents or guardians (n = 71) of children being treated for cancer were randomized to either a behavioral secondhand smoke (SHS) reduction program or a standard care control group. Parental reports of SHSe were collected over the course of 12 months. Younger children were exposed at baseline more than their older counterparts. The greatest initial declines in car exposure were observed among children ≤5 years old in the intervention group compared with same-aged peers in the control group. After the 3-month time point, the control group showed greater reductions in car exposure in comparison with the intervention group. Interventions that teach parents strategies to manage their smoking while driving in their personal vehicles may produce even greater reductions in child exposure and should be developed. Based on the age-specific results reported here, future studies should account for effects of child age and use setting-specific measures of SHS.
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Affiliation(s)
| | | | - Qinlei Huang
- St Jude Children’s Research Hospital, Memphis, TN, USA
| | - Hui Zhang
- St Jude Children’s Research Hospital, Memphis, TN, USA
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Abstract
The inner city has long been recognized as an area of high asthma morbidity and mortality. A wide range of factors interact to create this environment. These factors include well-recognized asthma risk factors that are not specific to the inner city, the structure and delivery of health care, the location and function of the urban environment, and social inequities. In this article, these facets are reviewed, and successful and unsuccessful interventions are discussed, to understand what is needed to solve this problem.
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Affiliation(s)
- Peter J Gergen
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA.
| | - Alkis Togias
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA
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Ansarin K, Attaran D, Jamaati H, Masjedi MR, Abtahi H, Alavi A, Aliyali M, Asnaashari AMH, Farid-Hosseini R, Ghayumi SMA, Ghobadi H, Ghotb A, Halvani A, Nemati A, Rahimi Rad MH, Rahimian M, Sami R, Sohrabpour H, Tavana S, Torabi-Nami M, Vahedi P. Approach to Patients with Severe Asthma: a Consensus Statement from the Respiratory Care Experts' Input Forum (RC-EIF), Iran. TANAFFOS 2015; 14:73-94. [PMID: 26528362 PMCID: PMC4629434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Challenges in the assessment, diagnosis and management of severe, difficult-to-control asthma are increasingly regarded as clinical needs yet unmet. The assessments required to determine asthma severity, comorbidities and confounding factors, disease phenotypes and optimal treatment are among the controversial issues in the field. The respiratory care experts' input forum (RC-EIF), comprised of an Iranian panel of experts, reviewed the definition, appraised the available guidelines and provided a consensus for evaluation and treatment of severe asthma in adults. A systematic literature review followed by discussions during and after the forum, yielded the present consensus. The expert panel used the appraisal of guidelines for research and evaluation-II (AGREE-II) protocol to define an initial locally-adapted strategy for the management of severe asthma. Severe asthma is considered a heterogeneous condition with various phenotypes. Issues such as assessment of difficult-to-control asthma, phenotyping, the use of blood and sputum eosinophil count, exhaled nitric oxide to guide therapy, the position of anti-IgE antibody, methotrexate, macrolide antibiotics, antifungal agents and bronchial thermoplasty as well as the use of established, recently-developed and evolving treatment approaches were discussed and unanimously agreed upon in the panel. A systematic approach is required to ensure proper diagnosis, evaluate compliance, and to identify comorbidities and triggering factors in severe asthma. Phenotyping helps select optimized treatment. The treatment approach laid down by the Global Initiative for Asthma (GINA) needs to be followed, while the benefit of using biological therapies should be weighed against the cost and safety concerns.
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Affiliation(s)
- Khalil Ansarin
- Tuberculosis and Lung Disease Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Davood Attaran
- Lung Disease Research Center, Mashhad University of Medical Science, Mashhad, Iran
| | - Hamidreza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Masjedi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Advanced Thoracic Research Center, Pulmonary and Critical Care Department, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Alavi
- Department of Pulmonology, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran
| | - Masoud Aliyali
- Department of Internal Medicine, Pulmonary and Critical Care Division, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Reza Farid-Hosseini
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Mohammad Ali Ghayumi
- Department of Internal Medicine, Division of Pulmonology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hassan Ghobadi
- Department of Internal Medicine, Pulmonary Division, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Atabak Ghotb
- Behphar Scientific Committee, Behphar Group, Tehran, Iran
| | | | - Abbas Nemati
- Department of Pulmonology, Artesh University of Medical Sciences, Tehran, Iran
| | | | - Masoud Rahimian
- Department of Internal medicine, Division of Pulmonary and Critical Care Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ramin Sami
- Department of Pulmonary Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hamid Sohrabpour
- Department of Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sasan Tavana
- Clinical Research & Development Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Torabi-Nami
- Behphar Scientific Committee, Behphar Group, Tehran, Iran,Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence to: Torabi-Nami M, Address: Department of Neuroscience, School of Advanced Medical Sciences and Technologies, Shiraz University of Medical Sciences, Shiraz, Iran, Email address:
| | - Parviz Vahedi
- Division of Pulmonology, Department of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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Mahabee-Gittens EM, Gordon JS, Gordon JS. Missed opportunities to intervene with caregivers of young children highly exposed to secondhand tobacco smoke. Prev Med 2014; 69:304-5. [PMID: 25449690 PMCID: PMC4721516 DOI: 10.1016/j.ypmed.2014.10.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 10/30/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Judith S Gordon
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States
| | - Judith S Gordon
- Department of Family and Community Medicine, University of Arizona, Tucson, AZ, United States
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Kanchongkittiphon W, Gaffin JM, Phipatanakul W. The indoor environment and inner-city childhood asthma. Asian Pac J Allergy Immunol 2014; 32:103-10. [PMID: 25003723 PMCID: PMC4110514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Exposure to indoor pollutants and allergens has been speculated to cause asthma symptoms and exacerbations and influence the risk of developing asthma. The aim of this article is to review the medical literature regarding the role of the indoor environment on inner-city childhood asthma. DATA SOURCES A literature search was performed in PubMed. Studies focusing on inner-city indoor allergen, childhood asthma, and environmental controls were included. RESULTS The prevalence of asthma in children is increasing especially in inner-city area. Exposure to high levels of indoor allergens and pollutants has been related to asthma development. Studies have shown that mouse, cockroach, pets, dust mite, mold, tobacco smoke, endotoxin and nitrogen dioxide are the important exposures. Recent studies have shown that indoor environmental control is beneficial in reducing asthma morbidity and development. CONCLUSIONS Inner-city children are exposed to various indoor allergens and pollutants that may lead to asthma development and exacerbation of existing asthma. Multifaceted environmental controls are beneficial in improving asthma symptom and maybe a viable prevention strategy. Further prospective studies of environmental intervention are needed to further identify effective strategies to improve and prevent asthma symptoms in inner-city children.
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Affiliation(s)
- Watcharoot Kanchongkittiphon
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, U.S
- Harvard Medical School, Boston, MA, U.S
- Department of Pediatrics, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jonathan M. Gaffin
- Harvard Medical School, Boston, MA, U.S
- Division of Respiratory Diseases, Boston Children’s Hospital, Boston, MA, U.S
| | - Wanda Phipatanakul
- Division of Allergy and Immunology, Boston Children’s Hospital, Boston, MA, U.S
- Harvard Medical School, Boston, MA, U.S
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Martinasek MP, Gibson-Young L, Forrest J. Hookah smoking and harm perception among asthmatic adolescents: findings from the Florida youth tobacco survey. THE JOURNAL OF SCHOOL HEALTH 2014; 84:334-341. [PMID: 24707928 DOI: 10.1111/josh.12153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 08/07/2013] [Accepted: 11/09/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Hookah tobacco smoking has increased in prevalence among Florida adolescents and is often viewed as a safer alternative to cigarette smoking by young adults. Asthmatic adolescents are at increased risk of the negative health effects of hookah smoking. The purpose of this study is to examine if hookah use and harm perception vary by asthma status. METHODS The Florida Youth Tobacco Survey was conducted in 2012 among 36,578 high school students. Secondary data analysis was conducted to compare the rates of hookah use among asthmatic youth to their nonasthmatic counterparts. Risk perception of hookah use compared to cigarette smoking was also assessed among asthmatic and nonasthmatic adolescents. RESULTS One in 5 high school students reported lifetime asthma. These asthmatic students have a significantly higher prevalence of hookah smoking and greater perception of hookah use as being less harmful than cigarette smoking, than their nonasthmatic counterparts. Among asthmatics, 12th graders and Hispanic students had the highest prevalence of hookah smoking. CONCLUSION Common misperceptions of hookah smoking as being less harmful than cigarette smoking are prominent among high school students in Florida and are greater among students with asthma than those students who do not have asthma. Efforts to increase education to dispel the myths surrounding hookah smoking as a safer alternative to cigarette smoking needs to exist at the high school level for both students with and without asthma.
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Affiliation(s)
- Mary P Martinasek
- Public Health, Department of Health Sciences and Human Performance, The University of Tampa, 401 W. Kennedy Boulevard, Box 30F, Tampa, FL 33606
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Rees VW, Keske RR, Blaine K, Aronstein D, Gandelman E, Lora V, Savage C, Geller AC. Factors influencing adoption of and adherence to indoor smoking bans among health disparity communities. Am J Public Health 2014; 104:1928-34. [PMID: 25208003 DOI: 10.2105/ajph.2013.301735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed current home smoking behaviors and secondhand smoke (SHS) levels among parents of children in low-income, racial/ethnic minority communities in Massachusetts. METHODS We used a cross-sectional design to assess home smoking rules, smoking status, cigarettes smoked in the home, and barriers and benefits to attaining a smoke-free home among 138 caregivers (mean age=30.0 years; 92% women) of children aged 0 to 6 years, between April 2010 and September 2012. Indoor SHS was assessed using a nicotine dosimeter. RESULTS Households with no ban reported a higher weekly mean number of cigarettes smoked in the home (114 cigarettes/week) than homes with partial (71 cigarettes/week) or complete (30 cigarettes/week) bans (P<.01). Smoking occurred outside more than inside homes with partial or complete bans. Air nicotine levels were positively associated with no household smoking ban, current smoking by the caregiver, and smoking indoors. CONCLUSIONS Strategies to reduce home SHS should focus on a "complete" home smoking ban and smoking cessation. SHS mitigation strategies such as smoking outside were associated with lower SHS among participants unable to maintain a complete ban, and might enhance the likelihood of longer term success while immediately reducing home SHS.
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Affiliation(s)
- Vaughan W Rees
- Vaughan W. Rees and Robyn R. Keske are with the Center for Global Tobacco Control, Department of Social & Behavioral Sciences, Harvard School of Public Health, Boston, MA. Kevin Blaine and Alan C. Geller are with the Department of Social & Behavioral Sciences, Harvard School of Public Health. David Aronstein and Ediss Gandelman are with the Boston Alliance for Community Health. Vilma Lora is with the City of Lawrence Mayor's Health Task Force, MA. Clara Savage is with Common Pathways CHNA 8, Worcester, MA
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McCarville M, Sohn MW, Oh E, Weiss K, Gupta R. Environmental tobacco smoke and asthma exacerbations and severity: the difference between measured and reported exposure. Arch Dis Child 2013; 98:510-4. [PMID: 23606711 DOI: 10.1136/archdischild-2012-303109] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the impact of measured versus reported environmental tobacco smoke (ETS) exposure on asthma severity and exacerbations in an urban paediatric population. DESIGN We analysed cross-sectional data from the Chicago Initiative to Raise Asthma Health Equity study that followed a cohort of 561 children aged 8-14 with physician-diagnosed asthma between 2003 and 2005. Participant sociodemographic data and asthma symptoms were gathered by parental survey; exposures to ETS were determined by salivary cotinine levels and parent report. Multivariable negative binomial and ordered logistic regressions were used to assess associations between ETS and asthma outcomes. RESULTS Among 466 children included in our analysis, 58% had moderate or severe persistent asthma; 32% had >2 exacerbations requiring a hospitalisation or an emergency room visit or same day care in the previous year. Half of caregivers reported that at least one household member smoked. In multivariable analyses, salivary cotinine was significantly associated with frequently reported exacerbations in the previous year (adjusted incidence rate ratio=1.39, 95% CI 1.09 to 1.79), but not significantly associated with asthma severity. Reported household smoking was not significantly associated with either asthma severity or frequency of exacerbations. CONCLUSIONS Salivary cotinine was more predictive of asthma exacerbation frequency but caregiver- reported household smoking was not. Use of a nicotine biomarker may be important in both the clinical and research settings to accurately identify an important risk factor for asthma exacerbations.
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Affiliation(s)
- Megan McCarville
- Department of Pediatrics, University of Illinois at Chicago, 840 South Wood Street, Room 1410, Chicago, IL 60612, USA.
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Kit BK, Simon AE, Brody DJ, Akinbami LJ. US prevalence and trends in tobacco smoke exposure among children and adolescents with asthma. Pediatrics 2013; 131:407-14. [PMID: 23400612 DOI: 10.1542/peds.2012-2328] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine exposure to tobacco smoke products (TSPs), environmental tobacco smoke (ETS), and in-home smoke among youth with asthma in the United States. METHODS Nationally representative, cross-sectional data from 2250 youth aged 4 to 19 years with current asthma in the 1988-1994, 1999-2004, and 2005-2010 National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes were use of TSPs (serum cotinine level >10 ng/mL or self-reported recent use of cigarettes, cigars, or pipes) and, among non-TSP users, ETS exposure (serum cotinine ≥0.05 ng/mL) and in-home smoke exposure (reported). Multiple logistic regression analyses assessed the associations between the outcomes and age, gender, race/ethnicity, and family income. RESULTS Among adolescents (aged 12-19 years) with asthma in 2005-2010, 17.3% reported TSP use. Among youth (aged 4-19 years) with asthma who did not use TSPs, 53.2% were exposed to ETS and 17.6% had in-home smoke exposure. Among low-income youth, 70.1% and 28.1% had exposure to ETS and in-home smoke, respectively. After controlling for sociodemographic factors, higher prevalence of exposure to ETS and in-home smoke persisted among low-income youth. Between 1988-1994 and 2005-2010, there was a decline in ETS and in-home smoke exposure (both P < .001). CONCLUSIONS ETS exposure among youth with asthma declined between 1988-1994 and 2005-2010, but a majority remained exposed in 2005-2010, with higher exposure among low-income youth. More than 1 in 6 youth with asthma in 2005-2010 were exposed to in-home smoke and a similar portion of adolescents used TSPs.
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Affiliation(s)
- Brian K Kit
- Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.
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Bellin MH, Kub J, Frick KD, Bollinger ME, Tsoukleris M, Walker J, Land C, Butz AM. Stress and quality of life in caregivers of inner-city minority children with poorly controlled asthma. J Pediatr Health Care 2013; 27:127-34. [PMID: 23414978 PMCID: PMC3575578 DOI: 10.1016/j.pedhc.2011.09.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 09/21/2011] [Accepted: 09/30/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Caregiver quality of life (QOL) is known to influence asthma management behaviors. Risk factors for low caregiver QOL in families of inner-city children with asthma remain unclear. This study evaluated the interrelationships of asthma control, stress, and caregiver QOL. METHOD Data were analyzed from a home-based behavioral intervention for children with persistent asthma after treatment for asthma in the emergency department. Caregivers reported on baseline demographics, asthma control, asthma management stress, life stress, and QOL. Hierarchical regression analysis examined the contributions of sociodemographic factors, asthma control, asthma management stress, and life stress in explaining caregiver QOL. RESULTS Children (N = 300) were primarily African American (96%) and young (mean age, 5.5 years). Caregivers were predominantly the biological mother (92%), single (70%), and unemployed (54%). Poor QOL was associated with higher caregiver education and number of children in the home, low asthma control, and increased asthma management stress and life stress. The model accounted for 28% of variance in caregiver QOL. DISCUSSION Findings underscore the need for multifaceted interventions to provide tools to caregivers of children with asthma to help them cope with asthma management demands and contemporary life stressors.
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Affiliation(s)
- Melissa H Bellin
- Health Specialization, School of Social Work, University of Maryland, Baltimore, MD 21201, USA.
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Gupta RS, Lau CH, Springston EE, Warren CM, Mears CJ, Dunford CM, Sharp LK, Holl JL. Perceived Factors Affecting Asthma Among Adolescents. ACTA ACUST UNITED AC 2013. [DOI: 10.1177/2150129712472342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To describe the development, implementation, and findings of a participatory media-based asthma afterschool program. Methods: A pilot study was conducted during the 2010/2011 school year in an inner-city Chicago high school with high asthma rates and poor asthma morbidity. Students met after school twice a week over 10 weeks. Students were given basic training in research and media production using photovoice participatory research technique and were instructed to identify personally relevant factors affecting asthma through photography and journaling. Students’ journal entries and photographs were qualitatively coded. Relative frequencies of codes were calculated to determine common themes among identified factors. Students worked with a videographer to compile their findings into informational videos, which were used to educate peers and community members about asthma. Results: Fifteen students aged 13 to 18 attended a mean of 11 sessions (out of 20). One hundred eighty photographs (mean = 12 per student) and 112 journal entries (mean = 7.5 per student) were reviewed, with 4 predominant positive and negative factors identified. Reported factors influencing students’ health and asthma included social support (22% of student photos and journal entries), neighborhood environment (17%), and lifestyle (28%), in addition to well-established asthma factors (43%). Conclusions: Results from the Student Asthma Research Team pilot demonstrate that adolescent students, given appropriate instruction and opportunity, are able to identify factors affecting their asthma. Interventions engaging adolescents via self-directed identification and participatory media production techniques hold promise as vehicles for enabling students to own and share health-related experiences through research and peer/community outreach.
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Affiliation(s)
- Ruchi S. Gupta
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Claudia H. Lau
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Elizabeth E. Springston
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christopher M. Warren
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Cynthia J. Mears
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Christine M. Dunford
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Lisa K. Sharp
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
| | - Jane L. Holl
- Northwestern University Feinberg School of Medicine (RSG, EES, CMW, JLH), Chicago, Illinois
- Smith Child Health Research Program, Ann & Robert H. Lurie Children’s Hospital of Chicago (RSG, CHL), Chicago, Illinois
- Uplift School-Based Health Center, Chicago Public Schools (CJM), Chicago, Illinois
- Department of Anthropology, The Field Museum (CMD), Chicago, Illinois
- Lookingglass Theatre Company (CMD), Chicago, Illinois
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Granger DA, Johnson SB, Szanton SL, Out D, Schumann LL. Incorporating salivary biomarkers into nursing research: an overview and review of best practices. Biol Res Nurs 2012; 14:347-56. [PMID: 22593229 PMCID: PMC3971903 DOI: 10.1177/1099800412443892] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Analytes and biomarkers present in saliva may provide insight into individual differences in environmental chemical exposures, variation in reproductive hormones, therapeutic and illegal substance use, changes in stress-related physiology, and the immunologic footprints of infectious disease. The wealth of information provided by salivary analytes has the potential to enrich biobehavioral nursing research by enabling researchers to measure these individual differences in the clinic as well as in patients' and participants' everyday social worlds. In this article, the authors provide a roadmap for researchers new to this area who would like to learn more about integrating salivary biospecimens into the next generation of health research. In addition, the authors highlight best practices and strategies to avoid common pitfalls for researchers already engaged in this field.
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Affiliation(s)
- Douglas A Granger
- Center for Interdisciplinary Salivary Bioscience Research, The Johns Hopkins University, Baltimore, MD, USA.
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Contribution of stress to asthma worsening through mast cell activation. Ann Allergy Asthma Immunol 2012; 109:14-9. [PMID: 22727152 DOI: 10.1016/j.anai.2012.03.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 02/22/2012] [Accepted: 03/04/2012] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the available evidence linking stress to asthma and to investigate whether mast cells contribute to the effect of stress through activation by corticotropin-releasing hormone (CRH). DATA SOURCE The PubMed database was searched for articles (1998-2011) using the keywords anxiety, asthma, exacerbation, inflammation, mast cells, socioeconomic status, stress, violence, and worsening. STUDY SELECTION Articles were selected based on their relevance to the topic, with emphasis on clinical or epidemiologic data linking stress to asthma and studies that offered possible explanations for how stress may affect asthma. RESULTS Many articles point to an association between stress (socioeconomic status, interpersonal conflicts, emotional distress, terrorism) and asthma exacerbations but without any distinct pathogenetic mechanism. A few articles have reported reduced circulating cortisol and/or sensitivity to corticosteroids. We propose that mast cells, known to be involved in the pathophysiology of asthma, can be activated by CRH, which is secreted under stress in the lungs, leading to selective release of proinflammatory mediators. This effect may be augmented by neuropeptides or cytokines. CRH also reduces T-regulatory cell production of interleukin 10, which in known to inhibit allergic mast cell activation. CONCLUSION More studies are required to investigate lung levels of CRH and selective mast cell mediators. Reducing stress and using CRH receptor antagonists and/or mast cell blockers may serve as possible new therapeutic approaches for asthma.
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