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Chang LY, Chiang TL. Associations of timing, level, and pattern of secondhand smoke exposure with early alcohol initiation: A cohort study. Drug Alcohol Depend 2023; 252:110988. [PMID: 37844480 DOI: 10.1016/j.drugalcdep.2023.110988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/07/2023] [Accepted: 09/21/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Few studies explored the longitudinal link between early-life secondhand smoke (SHS) exposure and later alcohol initiation despite its risk for child behavioral difficulties. We examined the associations of the timing, level, and pattern of SHS exposure from pregnancy to childhood with early alcohol initiation and evaluated the sex differences in these associations. METHODS Data were from 16,440 participants of the Taiwan Birth Cohort Study conducted when the children were aged 6 months, 18 months, 3 years, 5.5 years, 8 years, and 12 years. Group-based trajectory modeling was applied to identified patterns of SHS exposure. A series of multiple logistic regression were conducted to examine study hypotheses. RESULTS Exposure to prenatal SHS was associated with an increased risk of early alcohol initiation (adjusted odds ratio [aOR] = 1.17, 95% confidence interval [CI] = 1.06, 1.30). Compared with the adolescents with a persistent-low-exposure trajectory, those who exhibited prenatal-high-decreasing (aOR = 1.18, 95% CI = 1.04, 1.35) or persistent-high-exposure (aOR = 1.27, 95% CI = 1.12, 1.45) patterns exhibited increased risks of early alcohol initiation. Those with higher cumulative levels of SHS exposure also exhibited an increased risk of early alcohol initiation (aOR = 1.03, 95% CI = 1.01, 1.04). Sex differences were also observed. CONCLUSIONS Varying timing, levels, and longitudinal patterns of SHS exposure during early life had differential effects on early alcohol initiation, with the effects differing by sex. Targeting SHS exposure while considering the nature of exposure and sex differences could help prevent and curb alcohol use in adolescents.
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Affiliation(s)
- Ling-Yin Chang
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Tung-Liang Chiang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Association between Environmental Tobacco Smoke Exposure and Adaptive Behavior in Individuals with Autism Spectrum Disorder. TOXICS 2022; 10:toxics10040189. [PMID: 35448450 PMCID: PMC9027185 DOI: 10.3390/toxics10040189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
The study focuses on current issues of adaptive behavior in individuals with autism spectrum disorder (ASD) and on the possible risk factor of environmental tobacco smoke (ETS). Children examined at the Academic Research Center for Autism (ARCA) in Bratislava were involved in the study. The study sample included 84 children (71 boys) with ASD (average age 5.35 years) and a non-ASD group of 24 children (20 boys; average age 8.10 years). The “ETS Questionnaire” focused on the detection of parental smoking habits and other ETS exposures. The concentrations of cotinine in urine were measured by ELISA kit. A significant delay in adaptive behavior of children with ASD in comparison with the non-ASD group was identified. The significant differences were in adaptive behavior, communication, and everyday skills. Children with ASD were more likely to be exposed to ETS, especially in the household. Good agreement was found between objective and subjective ETS exposure indicators (kappa = 0.613). Self-reported exposure to ETS corresponded significantly with the median levels of urinary cotinine. In addition to evaluation and assessment of the quality of adaptive behavior, an important goal of further research should be to identify, investigate, and eliminate environmental factors that interfere with adaptive behavior.
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Jackson DB, Testa A. Environmental Tobacco Smoke and Early Language Difficulties among U.S. Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6489. [PMID: 34208503 PMCID: PMC8296409 DOI: 10.3390/ijerph18126489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/09/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022]
Abstract
Objective: Environmental Tobacco Smoke (ETS) is a serious public health concern with the potential to interfere with various components of healthy child development. Even so, there has been limited nationally representative research investigating these connections. The current study examines the relationship between ETS and language difficulties among toddlers and preschool-aged children in the United States. Method: Data are derived from the 2018 National Survey of Children's Health and facilitate strategic comparisons between different forms of ETS-namely, children who live with family members who smoke vs. children whose family members smoke inside the housing unit. Results: The findings reveal a robust association between family members smoking inside the housing unit and both receptive and expressive language difficulties, but only among male children. After adjusting for covariates, smoking inside the housing unit is associated with a 182% increase in the rate of early composite language difficulties among male children. These associations persist even when compared to male children who live with smoking family members who do not smoke inside the housing unit. Conclusions: The findings suggest a need for interventions designed to reduce ETS in households with young children and increase targeted language skill training for vulnerable children in an effort to enhance child development and well-being. To maximize this effort, we advocate for interdisciplinary teams, including medical and public health practitioners, educators, and researchers, to work together to develop and implement evidence-based strategies to limit ETS in homes and facilitate healthy language development among young children.
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Affiliation(s)
- Dylan B. Jackson
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Alexander Testa
- Department of Criminology & Criminal Justice, University of Texas at San Antonio, San Antonio, TX 78249, USA;
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Park B, Park B, Kim EJ, Kim YJ, Lee H, Ha EH, Park H. Longitudinal association between environmental tobacco smoke exposure and behavioral problems in children from ages 5 to 9. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 746:141327. [PMID: 32758989 DOI: 10.1016/j.scitotenv.2020.141327] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/01/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
Few studies have assessed the cumulative effects of exposure to environmental tobacco smoke (ETS1) in relation to children's neurobehavioral problems over time. We assessed the longitudinal associations between ETS exposure at age 5 and behavioral problems at ages 5, 7, and 9 using the Ewha Birth and Growth Cohort, in Seoul, Korea. Children with available urinary cotinine levels at age 5 and one or more behavioral problem scores measured with the Korean Version of Child Behavior Checklist (CBCL2) at age 5, 7, and 9 were included in the study. Those whose mothers smoked during pregnancy were excluded, and a total of 179 children were included in the analysis. A linear mixed-model analysis using a REPEATED statement was conducted to assess whether ETS exposure was associated with the total, internalizing, and externalizing behavioral problem scores of the CBCL. The group with higher levels of cotinine showed continuously higher total and external behavioral problem scores from ages 5 to 9, which was seen after adjusting for preterm birth, father's education level, and television watching time. In addition, the difference in the total and external behavioral problem scores between the higher and lower cotinine groups at age 5 was statistically significant after a Bonferroni correction (p = 0.02 and 0.04, respectively), even though the fixed effect of cotinine level was almost but not statistically significant (p = 0.07 and 0.08, respectively). The results of this longitudinal cohort study provide evidence regarding the negative effects of ETS exposure in early childhood and their behavioral problems over time. This study supports the strengthening of anti-smoking policies used in educational interventions for parents, in order to reduce early ETS exposure in children.
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Affiliation(s)
- Bomi Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea; National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Republic of Korea.
| | - Bohyun Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea.
| | - Eui-Jung Kim
- Department of Psychiatry, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea.
| | - Young Ju Kim
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea.
| | - Hwayoung Lee
- Department of Anatomy, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea.
| | - Eun-Hee Ha
- Department of Occupational and Environmental Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea.
| | - Hyesook Park
- Department of Preventive Medicine, College of Medicine, Ewha Womans University, 25, Magokdong-ro 2-gil, Gangseo-gu, Seoul, Republic of Korea.
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Nadhiroh SR, Djokosujono K, Utari DM, Hasugian AR. Questionnaire-Based Environmental Tobacco Smoke Exposure and Hair Nicotine Levels in 6-month-old Infants: A Validation Study in Indonesia. Glob Pediatr Health 2020; 7:2333794X20969287. [PMID: 33195749 PMCID: PMC7605031 DOI: 10.1177/2333794x20969287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 08/28/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives. Using hair nicotine as the gold standard, this study aimed to establish cutoff points and validate the questionnaire-based environmental tobacco smoke (ETS) exposure and ETS statuses of Indonesian infants. Methods. A cross-sectional study design was conducted among families who were participants of the Peer Health Cohort Study in Jakarta, Indonesia. Households with 6-month-old infants joined this study. The presence and amount of ETS exposure were assessed by both questionnaire and hair sampling for nicotine determination. Head hair samples were collected from 102 infants and measured by optimized gas chromatography-mass spectrometry (GC/MS). Infants were grouped as ETS-exposed if they lived with at least 1 smoker at home. We used the receiver operating characteristic (ROC) curve to assess the sensitivity and specificity of cutoff values of hair nicotine. Results. There were 78 (76.5%) infants exposed to ETS based on the questionnaire. The nicotine concentrations in hair were significantly higher in infants with ETS exposure than in those without ETS exposure (P < .001). The area under the curve for nicotine was 0.774. A hair nicotine cutoff value of 2.37 ng/mg, with a sensitivity of 67.95% and specificity of 83.33%, was identified as the optimal cutoff value for separating exposed from non-exposed to ETS in infants. Conclusion. The hair nicotine value of infants aged 6 months is useful in confirming the questionnaire on smoking in the household and exposure to ETS. Moreover, it also could be used to distinguish ETS-exposed from non-ETS-exposed infants.
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Affiliation(s)
| | | | | | - Armedy Ronny Hasugian
- National Institutes of Health Research and Development, Ministry of Health, Jakarta, Indonesia
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Child tobacco smoke exposure and healthcare resource utilization patterns. Pediatr Res 2020; 88:571-579. [PMID: 32505125 PMCID: PMC7529841 DOI: 10.1038/s41390-020-0997-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The objective was to examine the relationship between healthcare resource utilization patterns in tobacco smoke-exposed children (TSE group) compared with unexposed children (non-TSE group). METHODS We matched 380 children in the TSE group with 1140 children in the non-TSE group based on child age, sex, race, and ethnicity using propensity scores. Healthcare resource utilization variables included respiratory-related procedures, diagnostic testing, disposition, and medications. Logistic and linear regression models were built. RESULTS Child mean age was 4.9 (SD = 0.1) years, 50.5% were female, 55.5% black, and 73.2% had public insurance/self-pay. Compared to the non-TSE group, the TSE group was at increased odds to have the following performed/obtained: nasal bulb suctioning, infectious diagnostic tests, laboratory tests, and radiologic tests. The TSE group was more likely to be admitted to the hospital, and more likely to receive steroids and intravenous fluids during their visit. Among asthmatics, the TSE group was more likely to receive steroids, albuterol, or ipratropium alone, or a combination of all three medications during their visit, and be prescribed albuterol alone or steroids and albuterol. CONCLUSION Tobacco smoke-exposed children are more likely to have higher resource utilization patterns, highlighting the importance of screening and providing TSE prevention and remediation interventions. IMPACT Tobacco smoke exposure may affect the healthcare resource utilization patterns of children. Evidence is lacking concerning these associations among the highly vulnerable pediatric emergency department patient population. This study examined the association between tobacco smoke exposure and healthcare resource utilization patterns among pediatric emergency department patients. Tobacco smoke exposure increased the risk of pediatric patients having respiratory-related procedures, respiratory-related and non-respiratory-related testing, medications administered during the pediatric emergency department visit, and medications prescribed for home administration. Tobacco smoke-exposed patients were more likely to be admitted to the hospital compared to unexposed patients.
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Protano C, Cammalleri V, Antonucci A, Ungureanu AS, Santilli F, Martellucci S, Mattei V, Vitali M. Further Insights on Predictors of Environmental Tobacco Smoke Exposure during the Pediatric Age. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214062. [PMID: 31652694 PMCID: PMC6861986 DOI: 10.3390/ijerph16214062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/20/2019] [Accepted: 10/21/2019] [Indexed: 12/24/2022]
Abstract
Background: The smoking ban in public places has reduced Environmental Tobacco Smoke (ETS) exposure for non-smokers, but despite this, domestic environments still remain places at high risk of exposure, and, today, about 40% of children worldwide are exposed to ETS at home. The aims of the study are to investigate the contribution of several factors on ETS exposure among a group of Italian children and to evaluate the changes in smoking precautions adopted at home when the smoker is the mother, the father, or both parents, respectively. Methods: A cross-sectional study was performed on a sample of 519 Italian schoolchildren. Information was collected via a questionnaire. Results: 41.4% of the participants lived with at least one smoker. Almost half of the children exposed to ETS lived with one or more smokers who do not observe any home smoking ban. Lower maternal or paternal educational levels significantly increase the risk of ETS exposure at home and the "worst case" is represented by both parents who smoke. Conclusions: More effective preventive interventions are needed to protect children from ETS exposure. Some interventions should be specifically dedicated to smokers with a low educational level and to mothers that smoke.
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Affiliation(s)
- Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
| | - Arianna Antonucci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
| | | | - Francesa Santilli
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", 02100 Rieti, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy.
| | - Stefano Martellucci
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", 02100 Rieti, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy.
| | - Vincenzo Mattei
- Biomedicine and Advanced Technologies Rieti Center, "Sabina Universitas", 02100 Rieti, Italy.
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy.
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy.
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