Household Tobacco Use Research Articles

Secondhand Tobacco Exposure Assessed Using Urinary Cotinine Among 10-Year-Old Children in Japan: An 11-Year Repeated Cross-sectional Study

Abstract Introduction The emergence of heated tobacco products (HTPs) has made it important to monitor HTP-generated aerosols in addition to combustible cigarette (CC) smoke as a source of secondhand tobacco (SHT) exposure. We investigated the trend of SHT exposure in school-aged children and assessed whether SHT exposure depended on household tobacco use status. Aims and Methods This repeated cross-sectional study from 2011 to 2021 (15 927 participants) was based on data from an annual survey of fourth-grade students (aged 10 years) in Kumagaya City, Japan. In addition to a questionnaire which includes questions about household tobacco use status, we measured the urinary cotinine levels of each participant by their first-morning urine sample to objectively assess SHT exposure. We defined the participants with urinary cotinine levels ≥5.0 ng/mL as being exposed to SHT. Results The prevalence of SHT exposure decreased over the 11-year period from 18.6% in 2011 to 5.3% in 2021. It was significantly higher in households with tobacco users than without tobacco users (t-test p< .001). Prevalence of SHT exposure was 1.4% among the 68.1% of households not using tobacco, 22.9% among the 16.5% using only CC, 3.1% among the 12.3% using only HTP, and 27.6% among the 3.9% of households using CC and HTP. Conclusions While the prevalence of SHT exposure showed a decreasing trend from 2011 to 2021, the prevalence of SHT exposure was higher in children with household members using tobacco products, regardless of the type of tobacco product, than in those without tobacco users. Implications This study observed that the prevalence of SHT exposure was higher among children in households with tobacco users than among those without tobacco users, regardless of the type of tobacco product. Our findings highlight the importance of advocating that HTPs do not reduce the likelihood of SHT exposure to bystanders.

Tobacco and Nicotine Product Use Transitions by Race and Ethnicity: Results from a Latent Transition Analysis Using Data from the Truth Longitudinal Cohort (2020–2022)

Objective To examine use and frequency patterns across e-cigarettes, cigarettes, and little cigars, cigars, and cigarillos (LCCs) over time and determine whether patterns differ by race and ethnicity. Methods Data was obtained from the Truth Longitudinal Cohort of youth and young adults between September 2020 and June 2022. Latent class and transition analyses were used to classify participants (N = 4448) into subgroups, based on frequency of tobacco product use in the past 30 days, and to estimate the probability of use pattern transitions by race and ethnicity, adjusted for the effects of gender, financial situation, parental education, household tobacco use, and sensation seeking. Results Four latent classes were identified: former/noncurrent users, predominantly frequent to daily (FTD) e-cigarette users, predominantly FTD e-cigarette and LCC users, and predominantly FTD cigarette with polytobacco users. Use trajectories differed by race and ethnicity. A lower proportion of those who identified as non-Hispanic Black (60.0%) remained e-cigarette and LCC users, relative to those who identified as non-Hispanic White (86.0%), Hispanic or Latino (86.0%), and another race and ethnicity (79.0%). A lower proportion of those who identified as Hispanic or Latino (54.0%) and another race and ethnicity (59.9%) remained cigarette with polytobacco users, relative to those who identified as non-Hispanic White (76.0%) and non-Hispanic Black (72.0%). A greater proportion of non-Hispanic Black respondents transitioned from e-cigarette and LCC user to former/noncurrent user (40.0%) and polytobacco user to e-cigarette and LCC user (11.0%), relative to other racial/ethnic groups. Conclusion More research is needed to determine why tobacco use trajectories differ by race and ethnicity. Such research will be important in informing comprehensive approaches that promote evidence-based prevention policies and programs.

Prevalence and correlates of past 30-day dual-vaping of nicotine and cannabis among adolescents in five New England states

SignificanceAdolescent vaping behavior includes vaping of multiple substances, including both nicotine and cannabis (dual-vaping). This study describes the prevalence and the sociodemographic correlates of past 30-day dual-vaping. MethodsWe recruited adolescents ages 13–17 from five New England states (Massachusetts, Connecticut, Rhode Island, Vermont, New Hampshire) through the Prodege online survey panel from April 2021 to August 2022. Dual-vaping was defined as vaping both nicotine and cannabis (THC and/or CBD) in the past 30-days. We analyzed the prevalence of sole-nicotine, sole-cannabis, and dual-vaping of nicotine and cannabis and used multinomial logistic regression to examine associations between sociodemographic factors and sole- and dual-vaping of nicotine and cannabis. ResultsThe analytic sample included 2013 observations from 1858 participants (mean age 15.1 years, 46.2% female, 74.1% White, 82.2% heterosexual). Among these observations, 5.6% reported past 30-day sole-nicotine vaping, 5.5% reported sole-cannabis vaping, and 7.3% had dual-vaped. Correlates for higher odds of past 30-day dual-vaping included total social media sites used and household tobacco use, in contrast with sole-cannabis vaping, which included older age and self-reported depression (all p’s <0.05). DiscussionAdolescent past 30-day dual-vaping of nicotine and cannabis was more prevalent than past 30-day sole-vaping of either nicotine or cannabis alone. Future studies should continue to collect detailed data on the type of substances, besides nicotine, that adolescents are vaping.

Factors Associated with Use of Cigars, Little Cigars, Cigarillos, and Blunts among Hip Hop Youth in the United States

Objectives: Despite their wide use, little is known about risk and protective factors associated with cigar, little cigar, and cigarillo (CLCC) and blunt use among United States (US) youth, including youth in the Hip Hop peer crowd. Methods: Data come from a majority black and Hispanic cross-sectional sample of 2187 Hip Hop youth ages 12 to 18 recruited via address-based sampling and social media in 2015. We used multivariable logistic regressions with covariates entered in blocks to test which participant characteristics were associated with (1) CLCC use and (2) blunt use. Results: Several cultural/environmental, social/normative, and intrapersonal factors were positively associated with CLCC and blunt use, eg, older age, peer cigarette and marijuana use, and lower perceived smoking risks. There were also unique positive correlates of each, including being non-Hispanic black (vs Hispanic), smoking being allowed in the home, having friends that smoke CLCCs, and experiencing poor mental health for CLCC use, and household tobacco use and sensation seeking for blunt use. Conclusions: Factors associated with CLCC and blunt use may be important in designing interventions to prevent their use. The associations among household tobacco use, sensation seeking, and blunt use among the Hip Hop peer crowd warrant future investigation.

Prenatal Substance Use Among Young Pregnant Sexual Minority People.

Purpose: Sexual minority (SM) youth have higher rates of substance use and pregnancy but are absent from the prenatal substance use literature. We modeled the impact of SM identity and syndemic factors on prenatal substance use among 14- to 21-year-olds. Methods: Pregnant people completed an online survey (n = 357). Prenatal substance use was regressed on SM identity, controlling for other syndemic factors (e.g., depressive symptoms, intimate partner violence) and household substance use. Results: Pregnant SM participants (n = 125) were primarily bisexual and were more likely to use tobacco and illicit drugs than heterosexual participants (n = 232). The association between SM identity and prenatal tobacco use was not attenuated by syndemic factors, prenatal cannabis use, or household tobacco use. Conclusion: SM people need increased support for smoking cessation to redress health inequities in tobacco use, prevent prenatal exposures to tobacco, and limit the long-term consequences of tobacco use on health.

Assessment of the Smoke Free Families Tobacco Screening, Counseling, and Referral Program in Pediatric Primary Care Practices

ObjectiveThe Smoke Free Families (SFF) program trained pediatric providers to use an SFF tool during well-child visits (WCVs) of infants ≤12 months to “Ask” caregivers about tobacco use, “Advise” smokers to quit, and “Refer” smokers to cessation services (AAR). The primary objectives were to assess the prevalence and changes in caregiver tobacco use after being screened and counseled by providers using the SFF tool. A secondary objective was to examine providers’ AAR behavior facilitated by using the SFF tool. MethodsPediatric practices participated in 1 of 3 6–9-month SFF program waves. Over the 3 waves, all initial SFF tools completed on caregivers during their infant’s WCV were evaluated for the caregiver and household tobacco use and providers’ AAR rates. An infant’s first and next WCV was matched to determine changes in caregiver tobacco product use. ResultsIn total, the SFF tool was completed at 19,976 WCVs; 2081 (18.8%) infants were exposed to tobacco smoke. A total of 834 (74.1%) caregivers who smoked received counseling: 786 (69.9%) were advised to quit, 700 (62.2%) were given cessation resources, and 198 (17.6%) were referred to the Quitline. In total, 230 (27.6%) of caregivers who smoked had a second visit; 58 (25.2%) self-reported that they quit using tobacco. Among cigarette users (n = 183), 89 (48.6%) reported that they used fewer cigarettes or quit at their infants’ second WCV. ConclusionsSystematic use of the SFF AAR tool during infants’ WCVs could improve the health of caregivers and children, resulting in decreases in tobacco-related morbidity.

Predictors of E-cigarette and Cigarette Use Trajectory Classes from Early Adolescence to Emerging Adulthood Across Four Years (2013-2017) of the PATH Study.

This study examines predictors of trajectories of cigarette and e-cigarette use among a cohort of US adolescents transitioning into young adulthood. Comparing trajectories of each tobacco product is important to determine if different intervention targets are needed to prevent progression to daily use. Latent trajectory class analyses identified cigarette and e-cigarette use (never, ever excluding past 12-month, past 12-month (excluding past 30-day (P30D)), P30D 1-5 days, P30D 6+ days) trajectory classes, separately, among US youth (12-17; N = 10,086) using the first 4 waves (2013-2017) of data from the nationally representative PATH Study. Weighted descriptive analyses described the class characteristics. Weighted multinomial logistic regression analyses examined demographic, psychosocial, and behavioral predictors of class membership. Younger adolescents 12-15 years had lower tobacco use compared to 16-17 year olds and less stable classes. In the 16-17 year group, there were five unique trajectories of cigarette smoking, including a Persistent High Frequency class. Four e-cigarette use trajectories were identified; but not a persistent use class. Shared predictors of class membership for cigarettes and e-cigarettes included mental health problems, other tobacco use, marijuana use, and poorer academic achievement. Male sex and household tobacco use were unique e-cigarette trajectory class predictors. There was no evidence that initiation with e-cigarettes as the first product tried was associated with cigarette progression (nor cigarettes as first product and e-cigarette progression). Interventions should focus on well-established risk factors such as mental health and other substance use to prevent progression of use for both tobacco products. Using nationally representative data and definitions of use that take into account frequency and recency of use, longitudinal 4-year trajectories of e-cigarette and cigarette use among US adolescents transitioning into young adulthood were identified. Results among 16-17-year olds revealed a class of persistent high frequency cigarette smoking that was not identified for e-cigarette use. Cigarette use progression was not associated with e-cigarettes as the first product tried. Risk factors for progression of use of both products included mental health and other substance use, which are important prevention targets for both tobacco products.

Assessment of sociodemographic indicators of Tobacco expenditure: an application of the censored regression model

ABSTRACT Background The high level of tobacco use in Turkey and across the world, causes a high number of health problems. This study explores the indicators of tobacco expenditure of households, the smallest unit of a society. In this context, the sociodemographic factors affecting household tobacco use were examined, and recommendations are made to reduce tobacco product impact in terms of users and those who are exposed to smoke. Methods This study uses the dataset acquired from the Household Budget Survey. The factors affecting household expenditure on tobacco products were evaluated using the Tobit model. Results Gender, age, educational status, marital status, income level, and social variables were found to be effective indicators of tobacco product expenditure. Conclusion The study aims to bring the following issues to the attention of decision-makers and policymakers: Priority should be given to tobacco control programs, particularly for young, single, male, and lowly educated individuals; raise tobacco taxes in a way that does not adversely affect the financial situation of low-income smokers who use such products; and encourage the implementation of evidence-based smoking cessation methods.

Association of Peer Influence and Access to Tobacco Products With U.S. Youths' Support of Tobacco 21 Laws, 2015

PurposeTobacco 21 (T21) is a population-based strategy to prevent tobacco initiation. A majority of U.S. youths support T21; however, the extent to which individual, interpersonal, and community factors influence T21 support is uncertain. This study explored predictors of T21 support among U.S. youth. MethodsWe analyzed data from the 2015 National Youth Tobacco Survey (n = 17,683) to assess the association of peer influence and access to tobacco products on T21 support. We used multivariable logistic regression to calculate adjusted odds ratios (aORs) with 95% confidence intervals for T21 support. For tobacco nonusers, the model included peer influence along with covariates including sex, age, race/ethnicity, household tobacco use, and perceived harm. For tobacco users, the model included tobacco access sources (direct purchase, social sources, and other means), the aforementioned covariates, and tobacco product type. ResultsAmong nonusers, students least receptive to peer influence (aOR = 2.5), those youngest in age (11–14 years, aOR = 2.3), and those who believe tobacco is dangerous (aOR = 2.5) had higher odds of T21 support. Among users, lower odds of T21 support were observed among those who purchased tobacco (aOR = .3) and accessed tobacco through social sources (aOR = .7) or other means (aOR = .6) in the past 30 days. Younger tobacco users (11–14 years, aOR = 2.2), black, non-Hispanic users (aOR = 3.8), e-cigarette users (aOR = 2.5), and users who believe that tobacco is dangerous (aOR = 2.8) had higher odds of T21 support. ConclusionsLow receptivity to peer influence and lack of access to tobacco products are associated with T21 support. Results underscore that T21 implementation may require a social-ecological approach.

You can have your breastmilk and safe sleep too: a preliminary analysis of infant safe sleep data in a Midwestern home visiting program

BackgroundSudden unexpected infant death (SUID) accounted for approximately 3700 infant deaths in the US in 2015. SUID risk factors include prone sleeping, bed-sharing, soft bedding use, and maternal smoking. Infant safe sleep data in at-risk communities are difficult to obtain and home visiting programs can add to what we know. This study’s purpose is to determine how often caregivers enrolled in home visiting programs provide safe sleep environments for their infants in relation to breastfeeding status and tobacco use.MethodsFemale caregivers in at-risk communities were prospectively enrolled in Midwestern home visiting programs. Those that had infants < 365 days old and completed a safe sleep survey between October 1, 2016 and May 18, 2017 were included. Caregivers’ responses (always, sometimes, or never) to three safe sleep questions were compared by breastfeeding status, caregiver tobacco use, and household tobacco use using Pearson’s chi-squared or Fisher’s exact test.ResultsThe characteristics of the 289 eligible female caregivers included 120 (42%) ≤ 21 years old, 137 (47%) black, 77 (27%) breastfeeding, and 60 (22%) with household tobacco use. Two hundred forty-six (85%) caregivers always placed infants in the supine position, 148 (51%) never bed-shared, and 186 (64%) never used soft bedding. Ongoing breastfeeding caregivers never bed-shared more often than those who never breastfed or weaned (66% vs. 53% vs. 39%, p = 0.003). Households with tobacco use placed infants in the supine position less (75% vs. 88%, p = 0.03), bed-shared more (62% vs. 44%, p = 0.04), and used soft bedding more (50% vs. 32%, p = 0.004) relative to those without tobacco use.ConclusionsIn this group of at-risk young mothers, those who breastfed bed-shared less than mothers who were not breastfeeding; this finding has implications toward reducing the SUID risk in similar populations. This study also demonstrated that infants living with a tobacco user are less likely to be sleeping safely. This suggests that a multifaceted approach to safe sleep counseling may be needed.

The Role of Poverty Status and Obesity on School Attendance in the United States

PurposeSeveral studies have shown that obesity influences school performance. Little is known about the joint effect of poverty and obesity associated with school attendance. MethodsData are from the National Survey of Children's Health (N = 93,151), a nationally representative sample of U.S. youth aged 10–17 years. Our dependent variable was ≥11 days of school days missed per year. Body mass index was classified as normal, overweight, and obese using age- and sex-specific criteria. Federal poverty level (FPL) was classified as <200%, 200%–399%, and ≥400% (high income). Covariates included gender, age, child's race or ethnicity, maternal physical and mental health, child's health, family composition, and household tobacco use. Logistic regression models and prevalence ratios were estimated, accounting for the complex survey design. ResultsThe odds of missing ≥11 days of school among overweight youth was 1.5 times that of normal-weight youth (95% confidence interval (CI) = 1.22–1.85) and 1.7 (95% CI = 1.35–2.13) times among obese youth in fully adjusted models. In joint effects models, the probability of missing school was significantly greater for obese youth in both the <200% FPL group (prevalence ratio = 1.78, CI = 1.36–2.34) and the ≥400% FPL group (prevalence ratio = 2.88, CI = 1.91–4.35), when compared with their normal-weight, higher income peers. Predicted probabilities revealed sharper gradients for higher income youth. ConclusionsObesity influences school absenteeism across all income categories. Nonetheless, there may be distinct reasons for missing school for lower and higher income youth, and the long-term consequences of school absences may also differ for these populations.

The Impact of Tobacco Control Policies on Disparities in Children’s Secondhand Smoke Exposure: A Comparison of Methods

To examine the impact of cigarette excise taxes and smoke-free legislation on tobacco use among households with school-age children and adolescents as well as disparities in children's secondhand smoke exposure. We compare the results from models using causal inference techniques to those from cross-sectional models. We linked families of 6-17-year-olds from the 2003 (N = 67,607) and 2007 (N = 62,768) contacts of the National Survey of Children's Health with state-level cigarette excise taxes and smoke-free legislation total score (0 [none]-32 [very strong]) in 2001 and 2005. Parents reported whether anyone in the household used tobacco products. In adjusted causal inference models every $1.00 increase in cigarette excise tax between 2001 and 2005 was associated with a 4 percentage point decrease in household tobacco use between 2003 and 2007 (p = 0.008); however, there was no effect of smoke-free legislation on household tobacco use. Significant interactions revealed that cigarette tax increases were only associated with reductions in household tobacco use for parents of white children and, separately, lower income households. In contrast, in adjusted cross-sectional models, a higher smoke-free legislation total score was associated with a lower prevalence of household tobacco use. Stronger cigarette excise taxes decrease tobacco use among households with school-age children and adolescents, but smoke-free legislation at the state level does not change parental smoking. Since cross-sectional models cannot assess the direction of causality, evaluations should employ causal inference methods to help inform policy decisions to reduce disparities in adult smoking and, ultimately, protect children from secondhand smoke.

Increased Tobacco Exposure in Older Children and Its Effect on Asthma and Ear Infections

To examine selected social determinants of children's exposure to household tobacco use and smoking inside the home and to assess the effect of second-hand smoke exposure on asthma and ear infections across children's age groups. A total of 90,961 parents of children aged 0-17 years from the 2007 National Survey of Children's Health were included in the study. In all, 26.2% of parents reported that anyone in the household used tobacco products. Parents of children aged 6-11 and 12-17 years were 1.97 (adjusted OR; 95% CI, 1.65-2.36) and 2.93 (2.46-3.49) times more likely, respectively, to report that someone smoked inside the house than parents of younger children. Second-hand smoke exposure varied by children's race/ethnicity, and children from more disadvantaged circumstances were more likely to be exposed. For all children, they were more likely to ever have asthma if someone in their household used tobacco. Although young children's likelihood of recurrent ear infections did not increase with household tobacco use, children aged 12-17 were 1.67 (1.02-2.72) times more likely to have recurrent ear infections if someone smoked inside their home. Family members are increasingly likely to smoke indoors as children age, which may increase adolescents' vulnerability to ear infections. Parents and health professionals should monitor second-hand smoke exposure at home and encourage a smoke-free environment.

Tobacco use patterns in traditional and shared parenting families: a gender perspective.

BackgroundAlthough researchers have focused on women's smoking during pregnancy and the postpartum period and the influence of household interactions on their tobacco reduction efforts, little attention has been given to parents' efforts to regulate smoking during the child-rearing years. The objective of this study was to examine how parenting young children and gender relations reflected in couple dynamics influence household tobacco use patterns and, specifically, women's tobacco reduction efforts.MethodsAs part of a longitudinal, grounded-theory study with 28 couples to examine the place of tobacco in the lives of new parents, each parent participated in one or two individual, semi-structured interviews during the first three years postpartum. Grounded theory methods and a gender relations framework were used to analyze transcribed data.ResultsTwo different parenting styles that couples adhered to were identified. These parenting styles reflected performances of femininities and masculinities, and were associated with particular smoking patterns. Traditional parenting reinforced by women's alignment with emphasized femininities and men's alignment with hegemonic masculinities placed women with smoking partners at risk for relapse. Women's actions to be supportive partners facilitated couples' continued smoking. In shared parenting dyads, egalitarian practices tended to support successful transitions to smoke-free homes. Women's ability to exert more influence around family decision making, and the acceptance of new masculine identities associated with fatherhood were influential. In non-smoking dyads where the mother, father, or both reduced or stopped smoking, we observed a subtext of potential conflict in the event either the mother or father relapsed.ConclusionsDecisions about tobacco use are made within relationships and social contexts that vary based on each individual's relationship to tobacco, divisions of domestic labour and childcare, and other activities that impact tobacco use. Sensitive approaches to tobacco reduction for women and men must be developed building on greater understanding of gender relations and how tobacco use is integrated in spousal and parental roles.

Body Mass Index and Pediatric Asthma Outcomes

The purpose of this study was to determine the association between body mass index (BMI), a measure of obesity, with emergency department admission rate in children with asthma. This was a prospective study in a tertiary care, urban pediatric emergency department. Treating physicians and academic associates enrolled subjects during June 2005 to April 2008. Eligible subjects with documented weight and height were between ages 6 and 18 years with chief complaint of wheezing. We compared admission rates between overweight children (BMI, > or = 85% percentile) and nonoverweight children (BMI, < 85% percentile). Data were expressed as mean (SD). Group comparisons were made by Student t test or Fisher exact test, as appropriate. All tests were 2-tailed with an alpha set at 0.05. We studied 183 children, where 108 children were classified overweight. Demographic differences (mean age, male sex, and African-American race) between overweight and nonoverweight children were not statistically significant. In addition, changes in asthma outcome measures (inpatient admissions during the previous year, asthma visits in the last 30 days, and missed school days in the last 30 days) were not statistically significant. Only household tobacco use approached statistical significance (P = 0.07). The admission rate for nonoverweight children was 9.3% (95% confidence interval [CI], 4.3-18.3) compared with the 10.2% (95% CI, 5.6-17.5) for overweight children; a P = 1.0 was equivalent. Body mass index, a method to quantify overweight children, failed to predict admission of children with ambulatory asthma who presented to the pediatric emergency department.

Tobacco-Related Documentation in Pediatric Practice

The goal of this study was to evaluate tobacco-related documentation in children's medical records. A cross-sectional, consecutive sample of 4216 parents at 13 primary care practices was surveyed on demographics, health habits, and smoking status of household members. The medical records of 2085 children from a subsample of 1149 families (all households with smokers and a sample of nonsmoking households) were reviewed for tobacco-related documentation at the first visit to the practice and visits in the 14 months preceding recruitment. Relationships of documentations with visit type, household smoking status, and use of charting prompts were examined. Most children (93%) had > or =1 visit during the reviewed period (77% had a health supervision visit), 23% were aged > or =11 years, 52% were Medicaid/uninsured, and 70% lived with smokers; 30.6% of children had family tobacco use status documented at a first visit to the practice and 15.4% had prenatal tobacco use status documented. Among children with a visit in the reviewed period, 39.3% with a health supervision visit and 9.6% without had a tobacco-related notation at a visit (P < .001). Overall, 15.2% of children living with a smoker had a visit notation indicating that someone in the household smoked. In households with smokers, documentation of household tobacco use status often disagreed with parent survey. Charting prompts significantly increased rates of identification of family tobacco use history and prenatal tobacco use history. Correct identification of household smoking status was absent for most children living with smokers. Improved documentation systems may facilitate tobacco-related surveillance and counseling.

A community-based study of tobacco smoke exposure among inner-city children with asthma in Chicago

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.

Characteristics related to the incidence and prevalence of acute respiratory tract infection in young children in Kenya.

Acute respiratory tract infection (ARI) in children is a prevalent condition that results in substantial morbidity and consumes large portions of health care resources in developing countries. We examined factors associated with the reported incidence and prevalence of ARI in a 3-year longitudinal study of 485 children < 5 years of age in rural Kenya. A large number of environmental factors, household and family characteristics, and child-specific factors were examined with use of multivariable methods. Few variables that may play a role in the incidence and prevalence of ARI (e.g., household tobacco use and weight z-score) were found to be related to such rates. Several factors related to ARI incidence and prevalence (e.g., mother's age, number of children, and community) were found to be associated with only mild ARI episodes. Evidence is presented to support the hypothesis that these factors are related to differential reporting of mild ARI episodes. The impact of such differential reporting on health care utilization and health education is discussed.