Akinbami Lara J, Kit Brian K, Simon Alan E
Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD; United States Public Health Service, Rockville, MD.
Acad Pediatr. 2013 Nov-Dec;13(6):508-16. doi: 10.1016/j.acap.2013.07.003. Epub 2013 Sep 8.
Given widespread interventions to reduce environmental tobacco smoke (ETS) exposure and improve asthma control, we sought to assess the current impact of ETS exposure on children with asthma.
We analyzed 2003-2010 data for nonsmoking children aged 6 to 19 years with asthma from the National Health and Nutrition Examination Survey. Outcomes (sleep disturbance, missed school days, health care visits, activity limitation, and wheezing with exercise) were compared between ETS exposed children (serum cotinine levels 0.05 to 10 ng/mL) and unexposed children (<0.05 ng/mL) using ordinal regression adjusted for demographic characteristics. We also assessed whether associations were observable with low ETS exposure levels (0.05 to 1.0 ng/mL).
Overall, 53.3% of children aged 6 to 19 years with asthma were ETS exposed. Age-stratified models showed associations between ETS exposure and most adverse outcomes among 6- to 11-year-olds, but not 12- to 19-year-olds. Even ETS exposure associated with low serum cotinine levels was associated with adverse outcomes for 6- to 11-year-olds. Race-stratified models for children aged 6 to 19 years showed an association between ETS exposure and missing school, health care visits, and activity limitation due to wheezing among non-Hispanic white children, and disturbed sleep among non-Hispanic white and Mexican children. Among non-Hispanic black children, there was no elevated risk between ETS exposure and the assessed outcomes: non-Hispanic black children had high rates of adverse outcomes regardless of ETS exposure.
Among children with asthma 6 to 11 years of age, ETS exposure was associated with most adverse outcomes. Even ETS exposure resulting in low serum cotinine levels was associated with risks for young children with asthma.
鉴于为减少环境烟草烟雾（ETS）暴露及改善哮喘控制而广泛采取的干预措施，我们试图评估ETS暴露对哮喘儿童目前的影响。
我们分析了来自美国国家健康与营养检查调查的2003 - 2010年数据，这些数据涉及6至19岁患哮喘的非吸烟儿童。使用经人口统计学特征调整的有序回归，比较了ETS暴露儿童（血清可替宁水平为0.05至10 ng/mL）和未暴露儿童（<0.05 ng/mL）的结局（睡眠障碍、缺课天数、医疗就诊、活动受限以及运动时喘息）。我们还评估了低ETS暴露水平（0.05至1.0 ng/mL）是否存在关联。
总体而言，6至19岁患哮喘的儿童中有53.3%暴露于ETS。年龄分层模型显示，ETS暴露与6至11岁儿童的大多数不良结局相关，但与12至19岁儿童无关。即使是与低血清可替宁水平相关的ETS暴露，也与6至11岁儿童的不良结局相关。6至19岁儿童的种族分层模型显示，ETS暴露与非西班牙裔白人儿童缺课、医疗就诊以及因喘息导致的活动受限相关，与非西班牙裔白人和墨西哥儿童的睡眠障碍相关。在非西班牙裔黑人儿童中，ETS暴露与评估的结局之间不存在风险升高的情况：无论是否暴露于ETS，非西班牙裔黑人儿童的不良结局发生率都很高。
在6至11岁的哮喘儿童中，ETS暴露与大多数不良结局相关。即使是导致血清可替宁水平较低的ETS暴露，也与哮喘幼儿的风险相关。
