Gilliland F D, Berhane K, Islam T, Wenten M, Rappaport E, Avol E, Gauderman W J, McConnell R, Peters J M
Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
Am J Epidemiol. 2003 May 15;157(10):861-9. doi: 10.1093/aje/kwg037.
Household environmental tobacco smoke (ETS) exposure accounts for substantial morbidity among young children, but the ETS-associated morbidity burden among school-age children is less well defined. Illness-related school absenteeism is a measure of a broad spectrum of adverse effects of ETS exposure in school-age children. The authors investigated the relations between ETS exposure, asthma status, and illness-related school absenteeism in a cohort of 1,932 fourth-grade schoolchildren from 12 southern California communities during January-June 1996. Incidence rates and adjusted relative risks of illness-related absences were determined by using an active surveillance system. The effects of ETS exposure on absenteeism were assessed by using stratified incidence rates and Poisson regression to adjust for sociodemographic factors. ETS exposure was associated with an increased risk of respiratory-illness-related school absences (relative risk (RR) = 1.27, 95% confidence interval (CI): 1.04, 1.56). Children living in a household with two or more smokers were at increased risk of such absences (RR = 1.75, 95% CI: 1.33, 2.30). Children's asthma status affected their response to ETS. Compared with unexposed children without asthma, children with asthma were at increased risk of respiratory-illness-related school absences when exposed to one (RR = 2.35, 95% CI: 1.49, 3.71) or two or more (RR = 4.45, 95% CI: 2.80, 7.07) household smokers. Children without asthma also had an increased risk if exposed to two or more smokers (RR = 1.44, 95% CI: 1.04, 2.00). Therefore, ETS exposure is associated with increased respiratory-related school absenteeism among children, especially those with asthma.
家庭环境烟草烟雾（ETS）暴露导致幼儿出现大量发病情况，但ETS相关的发病负担在学龄儿童中却不太明确。因病缺课是衡量ETS暴露对学龄儿童广泛不良影响的一个指标。作者于1996年1月至6月期间，在南加州12个社区的1932名四年级学童队列中，调查了ETS暴露、哮喘状况与因病缺课之间的关系。通过使用主动监测系统确定与疾病相关缺课的发病率和调整后的相对风险。采用分层发病率和泊松回归来评估ETS暴露对缺课的影响，以调整社会人口学因素。ETS暴露与因呼吸道疾病缺课的风险增加相关（相对风险（RR）=1.27，95%置信区间（CI）：1.04，1.56）。生活在有两名或更多吸烟者家庭中的儿童出现此类缺课的风险增加（RR = 1.75，95% CI：1.33，2.30）。儿童的哮喘状况影响了他们对ETS的反应。与未暴露且无哮喘的儿童相比，患有哮喘的儿童在暴露于一名（RR = 2.35，95% CI：1.49，3.71）或两名或更多（RR = 4.45，95% CI：2.80，7.07）家庭吸烟者时，因呼吸道疾病缺课的风险增加。如果未患哮喘的儿童暴露于两名或更多吸烟者，其风险也会增加（RR = 1.44，95% CI：1.04，2.00）。因此，ETS暴露与儿童尤其是哮喘儿童因呼吸道疾病缺课的增加有关。
