Factors Associated with Increased Passive Cigarette Smoke Exposure in Inner City Asthmatic Children

Abstract

RATIONALE: Cigarette smoking is higher among people living in poverty, with less education, and depressive symptoms. Children exposed to passive cigarette smoke experience poorer asthma outcomes. Our objective is to identify the home and caretaker characteristics that associate with higher passive smoke exposure in inner-city asthmatic children. METHODS: The study sample was derived from the Chicago Initiative to Raise Asthma Health Equity study. A questionnaire queried caregivers of asthmatic children regarding demographics, symptoms of depression, and exposure to tobacco smoke in their households. Depression score was measured using the Clinical Epidemiological Survey-Depression. Saliva samples were tested for cotinine. RESULTS: Saliva was collected from 504 children. Forty-eight percent had smokers living in the home(range =1-5). Cotinine levels in smoke-exposed children were significantly higher than non-exposed children (geometric means 2.4 ng/ml and 1.1 ng/ml, respectively, p<0.0001). Of the exposed children, 37% of their caregivers did not smoke, 21% smoked some days, and 42% smoked daily. Multivariate analysis revealed no association between cotinine levels and child's age, number of smokers or rooms in the home. Cotinine levels for girls were 1.3 times higher than for boys(p=0.021), 1.98 times higher for daily caregiver smoking compared to not smoking(p<0.001), and 1.01 times higher for every 1 unit increase in depression score(p=0.018). CONCLUSIONS: These findings support the accuracy of caregivers' reports of their children's cigarette smoke exposure. The caregivers' smoking habits are more important in the level of smoke exposure than the number of smokers in the home. The relationship between caregiver's depression and smoking deserves additional attention.