Abstract
The goal of the study was to examine the association between biomarkers and environmental measures of second hand smoke (SHS) with caregiver, i.e. parent or legal guardian, report of household smoking behavior and morbidity measures among children with asthma. Baseline data were drawn from a longitudinal intervention for 126 inner city children with asthma, residing with a smoker. Most children met criteria for moderate to severe persistent asthma (63%) versus mild intermittent (20%) or mild persistent (17%). Household smoking behavior and asthma morbidity were compared with child urine cotinine and indoor measures of air quality including fine particulate matter (PM2.5) and air nicotine (AN). Kruskal–Wallis, Wilcoxon rank-sum and Spearman rho correlation tests were used to determine the level of association between biomarkers of SHS exposure and household smoking behavior and asthma morbidity. Most children had uncontrolled asthma (62%). The primary household smoker was the child’s caregiver (86/126, 68%) of which 66 (77%) were the child’s mother. Significantly higher mean PM2.5, AN and cotinine concentrations were detected in households where the caregiver was the smoker (caregiver smoker: PM2.5 μg/m3: 44.16, AN: 1.79 μg/m3, cotinine: 27.39 ng/ml; caregiver non-smoker: PM2.5: 28.88 μg/m3, AN: 0.71 μg/m3, cotinine:10.78 ng/ml, all P ≤ 0.01). Urine cotinine concentrations trended higher in children who reported 5 or more symptom days within the past 2 weeks (>5 days/past 2 weeks, cotinine: 28.1 ng/ml vs. <5 days/past 2 weeks, cotinine: 16.2 ng/ml; P = 0.08). However, environmental measures of SHS exposures were not associated with asthma symptoms. Urban children with persistent asthma, residing with a smoker are exposed to high levels of SHS predominantly from their primary caregiver. Because cotinine was more strongly associated with asthma symptoms than environmental measures of SHS exposure and is independent of the site of exposure, it remains the gold standard for SHS exposure assessment in children with asthma.
Similar content being viewed by others
References
Schuster, M. A., Franke, T., & Pham, C. B. (2002). Smoking patterns of household members and visitors in home with children in the United States. Archives of Pediatric and Adolescent Medicine, 156(11), 1094–1100.
Winickoff, J. P., Berkowitz, A. B., & Brooks, K. (2005). Tobacco Consortium, Center for Child Health Research of the American Academy of Pediatrics. State-of-the-art interventions for office-based parental tobacco control. Pediatrics, 115(3), 750–760.
Delva, J., Tellez, M., & Finlayson, T. L. (2005). Cigarette smoking among low-income African Americans: A serious public health problem. American Journal of Preventive Medicine, 29(3), 218–220.
Oddoze, C., Dubus, J. C., Badier, M., Thirion, X., Pauli, A. M., Pastor, J., et al. (1999). Urinary cotinine and exposure to parental smoking in a population of children with asthma. Clinical Chemistry, 45(4), 505–509.
Centers for Disease Control and Prevention. (2009). Cigarette smoking among adults and trends in smoking cessation—United States, 2008. Morbidity and Mortality Weekly Report (MMWR), 54(44), 1227–1232.
Berman, B. A., Wong, G. C., Bastani, R., Hoang, T., Jones, C., Goldstein, D. R., et al. (2003). Household smoking behavior and ETS exposure among children with asthma in low-income, minority households. Addictive Behaviors, 28(1), 111–128.
Klepeis, N. E., Nelson, W. C., Ott, W. R., Robinson, J. P., Tsang, A. M., Switzer, P., et al. (2001). The National Human Activity Pattern Survey (NHAPS): A resource for assessing exposure to environmental pollutants. Journal of Exposure Analysis and Environmental Epidemiology, 11(3), 231–252.
Matt, G. E., Bernert, J. T., & Hovell, M. F. (2008). Measuring secondhand smoke exposure in children: An ecological measurement approach. Journal of Pediatric Psychology, 33(2), 156–175.
Moorman, J. E., Rudd, R. A., Johnson, C. A., King, M., Minor, P., Bailey, C., Scalia, M. R., & Akinbami, L. J. (2007). Centers for Disease Control and Prevention (CDC). National surveillance for asthma—United States, 1980–2004. Morbid Mortal Weekly Rep Surveillance Summary, 56:1–54.
Flores, G., Snowden-Bridon, C., Torres, S., Perez, R., Walter, T., Brotanek, J., et al. (2009). Urban minority children with asthma: Substantial morbidity, compromised quality and access to specialists, and the importance of poverty and specialty care. Journal of Asthma, 46(4), 392–398.
Halterman, J. S., Borrelli, B., Tremblay, P., Conn, K. M., Fagnano, M., Montes, G., et al. (2008). Screening for environmental tobacco smoke exposure among inner-city children with asthma. Pediatrics, 122(6), 1277–1283.
Kattan, M., Mitchell, H., Eggleston, P., Gergen, P., Crain, E., Redline, S., et al. (1997). Characteristics of inner-city children with asthma: The National Cooperative Inner-City Asthma Study. Pediatric Pulmonology, 24(4), 253–262.
Eggleston, P. A., Buckley, T. J., Wils-Karp, M., Kleeberger, S. R., & Jaakkola, J. J. (1999). The environment and asthma in US inner cities. Environmental Health Perspectives, 107(3), 439–450.
Swartz, L. J., Callahan, K. A., Butz, A. M., Rand, C. S., Kanchanaraksa, S., Diette, G. B., et al. (2004). Methods and issues in conducting a community based environmental randomized trial. Environmental Research, 95(2), 156–165.
Martinez, F. D., Wright, A. L., Taussig, L. M., Holberg, C. J., Morgan, W. J., & Group Health Medical Associates. (1995). Asthma and wheezing in the first six years of life. New England Journal of Medicine, 332(3), 133–138.
Henderson, F. W., Henry, M. M., Ivins, S. S., Morris, R., Neebe, E. C., Leu, S. Y., et al. (1995). The Physicians of Raleigh Pediatric Associates. Correlates of recurrent wheezing in school-age children. American Journal of Respiratory and Critical Care Medicine, 151(6), 1786–1793.
DiFranza, J. R., & Lew, R. A. (1996). Morbidity and mortality in children associated with the use of tobacco products by other people. Pediatrics, 97(4), 560–568.
Martinez, F. D., Antognoni, G., & Macri, F. (1988). Parental smoking enhances bronchial responsiveness in nine-year-old children. American Review of Respiratory Disease, 138(3), 518–523.
Morkjaroenpong, V., Rand, C. S., Butz, A. M., & Eggleston, P. A. (2002). Environmental tobacco smoke exposure and nocturnal symptoms among inner-city children with asthma. Journal of Allergy and Clinical Immunology, 110(1), 147–153.
Mannino, D. M., Homa, D. M., & Redd, S. C. (2002). Involuntary smoking and asthma severity in children. Chest, 122(2), 409–415.
Halterman, J. S., Szilagyi, P. G., Yoos, H. L., Conn, K. M., Kaczorowski, J. M., Holzhauer, R. J., et al. (2004). Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure. Archives of Pediatric and Adolescent Medicine, 158(5), 460–467.
Ehrlich, R., Jordan, E., Du, T. D., Potter, P., Volmink, J., Zwarenstein, M., et al. (2001). Household smoking and bronchial hyper responsiveness in children with asthma. Journal of Asthma, 38(3), 239–251.
Tarlo, S. M. (2003). Workplace irritant exposures: Do they produce true occupational asthma? Annals of Allergy, Asthma and Immunology, 90(suppl 2), 19–23.
US Department of Health and Human Services. (2007). National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Institutes of Health, Bethesda, MD. Full Report 2007, NIH Publication No. 07-4051.
Global Initiative for Asthma. (2006). GINA Workshop Report: Global Strategy for Asthma Management and Prevention.
US Department of Health and Human Services. (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: US Department of health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.
Emmons, K. M., Hammond, S. K., Fava, J. L., Velicer, W. F., Evans, J. L., & Monroe, A. D. (2001). A randomized trial to reduce passive smoke exposure in low-income households with young children. Pediatrics, 108(1), 18–24.
Winickoff, J. P., Park, E. R., Hipple, B. J., Berkowitz, A., Vieira, C., Friebely, J., et al. (2008). Clinical effort against secondhand smoke exposure: Development of framework and intervention. Pediatrics, 122(2), e363–e375.
Jaakkola, M. A., & Jaakkola, J. J. (1997). Assessment of exposure to environmental tobacco smoke. European Respiratory Journal, 10(10), 2384–2397.
Benowitz, N. L. (1996). Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiologic Reviews, 18(2), 188–204.
Bernert, J. T., Turner, W. E., Pirkle, J. L., & Sosnoff, C. S. (1997). Development and validation of a sensitive method for determination of serum cotinine in smokers and nonsmokers by liquid chromatography/atmospheric pressure ionization tandem mass spectrometry. Clinical Chemistry, 43(12), 2281–2291.
Bernert, J. T., Harmon, T. L., Sosnoff, C. S., & McGuggey, J. E. (2005). Use of cotinine immunoassay test strips for preclassifying urine samples from smokers and nonsmokers prior to analysis by LC/MS/MS. Journal of Analytical Toxicology, 29(8), 814–818.
Caudill, S. P., Schleicher, R. L., & Pirkle, J. L. (2008). Multi-rule quality control for the age-related eye disease study. Statistics in Medicine, 27(20), 4094–4106.
US Environmental Protection Agency. (1997). National Ambient Air Quality for Particulate Matter. EPA/452/R-96-013.
Brunekreef, B., Leaderer, B. P., van Strien, R., Oldenwening, M., Smit, H., Koopman, L., et al. (2000). Using nicotine measurements and parental reports to assess indoor air: The Priama birth cohort study. Epidemiology, 11(3), 350–352.
Hammond, S. K., & Leaderer, B. P. (1987). A diffusion monitor to measure exposure to passive smoking. Environmental Science Technology, 21(5), 494–497.
Wakefield, M., Banham, D., Martin, J., Ruffin, R., McCaul, K., & Badcock, N. (2000). Restrictions on smoking at home and urinary cotinine levels among children with asthma. American Journal of Preventive Medicine, 19(3), 188–192.
Kumar, R., Curtis, L. M., Khiani, S., Moy, J., Shalowitz, M. U., Sharp, L., et al. (2008). A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago. Journal of Allergy and Clinical Immunology, 122(4), 754–759.
Liu, J. L., Box, M., Kalman, D., Kaufman, J., Koenig, J., & Larson, T. (2003). Exposure assessment of particulate matter for susceptible populations in Seattle. Environmental Health Perspectives, 111(7), 909–918.
Farber, H. J., Knowles, S. B., Brown, N. L., Caine, L., Luna, V., Qian, Y., et al. (2008). Secondhand tobacco smoke in children with asthma. Chest, 33(6), 1367–1374.
Delpisheh, A., Kelly, Y., Rizwan, S., & Brabin, B. J. (2008). Salivary cotinine, doctor-diagnosed asthma and respiratory symptoms in primary schoolchildren. Maternal and Child Health Journal, 12(2), 188–193.
Institute of Medicine (IOM). (2001). Clearing the smoke: Assessing the science base for tobacco harm reduction. Washington, DC: National Academy of Sciences. ISBN 978-0-309-07282-3.
Winickoff, J. P., Buckley, V. J., Palfrey, J. S., Perrin, J. M., & Rigotti, N. A. (2003). Intervention with parental smoking in an outpatient pediatric clinic using counseling and nicotine replacement. Pediatrics, 112(5), 1127–1133.
American Academy of Pediatrics. (2009). Policy statement-tobacco use: A pediatric disease. Pediatrics, 124(5), 1474–1487.
Fong, G. T., Cummings, K. M., & Shopland, D. R. (2006). Building the evidence based of effective tobacco control policies: The International Tobacco Control policy evaluation project (the ITC project). Tobacco Control, 15(Suppl 3), 1–2.
Moon, R. Y., Biliter, W. M., & Croskell, S. E. (2001). Examination of state regulations regarding infants and sleep in licensed child care centers and family child care settings. Pediatrics, 107(5), 1029–1036.
Acknowledgments
This work was supported by the National Institute of Environmental Health Science, NIH (E09606), the Environmental Protection Agency (P01 R-826724) and the Johns Hopkins Center for Childhood Asthma in the Urban Environment. We appreciate Heath Bradley, Craig Lewis, Rooti Lewis and Patrice Parham for the collection of the data and James E. McGuffey and Connie S. Sosnoff for performing the urine cotinine analyses and Jie Yuan for air nicotine analyses. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the United States Centers for Disease Control and Prevention.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Butz, A.M., Breysse, P., Rand, C. et al. Household Smoking Behavior: Effects on Indoor Air Quality and Health of Urban Children with Asthma. Matern Child Health J 15, 460–468 (2011). https://doi.org/10.1007/s10995-010-0606-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-010-0606-7