Kumar Rajesh, Curtis Laura Marie, Khiani Sanjay, Moy James, Shalowitz Madeleine U, Sharp Lisa, Durazo-Arvizu Ramon A, Shannon John Jay, Weiss Kevin B
Division of Allergy, Children's Memorial Hospital, Chicago, Ill.
Institute for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Ill.
J Allergy Clin Immunol. 2008 Oct;122(4):754-759.e1. doi: 10.1016/j.jaci.2008.08.006.
Little is known about the level of tobacco exposure and the factors that influence exposure in children with persistent asthma.
We sought to measure tobacco smoke exposure and determine factors associated with exposure in a large urban sample of asthmatic children.
This cross-sectional study is based on a community-based cohort of 482 children (8-14 years old) with persistent asthma. Caregiver and household tobacco use were reported by the caregiver. Child tobacco smoke exposure was assessed by using salivary cotinine level. Multivariate linear regression of log-transformed salivary cotinine levels were used to characterize the relationship between smoke exposure and caregiver, household, and demographic characteristics. We used a multivariate logistic model to characterize associations with caregiver smoking.
Overall, 68.5% of children had tobacco smoke exposure. Compared with nonexposed children, those exposed to smoking by a caregiver or another household member had cotinine levels that were 1.68 (95% CI, 1.45-1.94) or 1.40 (95% CI, 1.22-1.62) times higher, respectively. Compared with Hispanic children, African American and white/other children had 1.55 (95% CI, 1.16-2.06) and 1.59 (95% CI, 1.18-2.14) times higher cotinine levels, respectively. Child exposure was also associated with caregiver depression symptoms (odds ratio, 1.01; 95% CI, 1.01-1.02), and higher household income was protective (odds ratio, 0.73; 95% CI, 0.56-0.95). Independent predictors of caregiver smoking included a protective effect of higher education (odds ratio, 0.35; 95% CI, 0.15-0.83) and a positive association with potential problematic drug/alcohol use (odds ratio, 2.30; 95% CI, 1.39-3.83).
Tobacco smoke exposure was high in this urban sample of asthmatic children. Caregiver smoking was strongly associated with child exposure and also was associated with lower socioeconomic status, non-Hispanic ethnicity, and depression symptoms.
关于持续性哮喘患儿的烟草暴露水平以及影响暴露的因素，我们了解甚少。
我们试图在一个大型城市哮喘儿童样本中测量烟草烟雾暴露情况，并确定与暴露相关的因素。
这项横断面研究基于一个以社区为基础的队列，该队列包含482名8至14岁的持续性哮喘儿童。照顾者报告其自身及家庭中的烟草使用情况。通过唾液可替宁水平评估儿童的烟草烟雾暴露。对经对数转换的唾液可替宁水平进行多元线性回归，以描述烟雾暴露与照顾者、家庭及人口统计学特征之间的关系。我们使用多元逻辑模型来描述与照顾者吸烟的关联。
总体而言，68.5%的儿童有烟草烟雾暴露。与未暴露儿童相比，那些暴露于照顾者或其他家庭成员吸烟环境中的儿童，其可替宁水平分别高出1.68倍（95%置信区间，1.45 - 1.94）或1.40倍（95%置信区间，1.22 - 1.62）。与西班牙裔儿童相比，非裔美国儿童和白人/其他儿童的可替宁水平分别高出1.55倍（95%置信区间，1.16 - 2.06）和1.59倍（95%置信区间，1.18 - 2.14）。儿童暴露还与照顾者的抑郁症状相关（比值比，1.01；95%置信区间，1.01 - 1.02），而较高的家庭收入具有保护作用（比值比，0.73；95%置信区间，0.56 - 0.95）。照顾者吸烟的独立预测因素包括高等教育的保护作用（比值比，0.35；95%置信区间，0.15 - 0.83）以及与潜在的药物/酒精使用问题呈正相关（比值比，2.30；95%置信区间，1.39 - 3.83）。
在这个城市哮喘儿童样本中，烟草烟雾暴露率很高。照顾者吸烟与儿童暴露密切相关，并且还与较低的社会经济地位、非西班牙裔种族以及抑郁症状相关。
