State Variation in Prevalence of Children Living in

Households with Tobacco Smokers

Kathleen Newton, BS, Oregon MPH Program & Child & Adolescent Health Measurement Initiative (CAHMI)

Dongsoek Choi, PhD, Associate Professor, BiostatisticsOHSU Public Health and Preventive Medicine

Environmental Exposure to Second Hand Tobacco Smoke

Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can cause cancer

Most exposure to tobacco smoke occurs in homes and workplaces

About 25% of children aged 3–11 years live with at least one smoker, compared to only about 7% of nonsmoking adults

Sudden Infant Death Syndrome (SIDS) Acute respiratory infections Slow lung growth Ear infections and middle ear effusion Increased frequency and severity of

asthma attacks Increased cancer risk

Passive Smoking Health Risks to Children

Explore state-level associations between the extent to which children might be exposed to second hand smoke in their homes and selected health issues among children ages 0 - 17 in the U.S.

Study Objective

2003 National Survey of Children’s Health Stratified random sample of 102,353 children CATI telephone interview with primary

caregiver Weighted to represent the non-institutionalized

population of children ages 0 -17 in each state Questions about a range of topics pertaining to

children’s health, families and communities

Methods

“Does anyone in the household use cigarettes, cigars, or pipe tobacco?”

19 NSCH child health indicators and questions

Methods

Ecological study design State-level weighted prevalence

estimates SPSS Complex Samples ESRI ArcMAP GIS software

Analysis

Significant at α=.05 but very weak (R2<.20) Asthma-related health issues (0–17) Frequent or severe headaches (3–17) Risk of developmental delay (0–5)

Correlations

Correlations

Highly significant but still not strong (R2<.40) Elevated use or need of services (0-17) At risk for developmental delay (0-5) Repeated a grade in school (6-17) Problem behaviors (6-17) Above normal BMI (10-17)

Correlations

Highly significant, moderate correlation (R2>.40) Use/need prescription medication (0-17) Frequent ear infections (3-17) Attention Deficit/Hyperactivity (2-17) Special Health Care Needs (0-17)

Smoking and 4 Child Health Outcomes

Significant association with % exposed to 2nd hand smoke

Prescription Medications

Linear Regression

20.00 30.00 40.00

% Children living in household with smoker (ages 0-17)

10.00

12.00

14.00

16.00

18.00

% CSHCN rxmeds = 6.22 + 0.24 * ind6_4PR-Square = 0.49

Ear Infections

Linear Regression

20.00 30.00 40.00

% Living in household with smoker (ages 0-17)

3.00

4.00

5.00

6.00

7.00

% F

req

uen

t ea

r in

fect

ion

s (a

ges

3-1

7)

% 3 or more ear infections in past 12 months (ages 3-17) = 0.39 + 0.14 * ind6_4PR-Square = 0.48

ADD/ADHDLinear Regression

20.00 30.00 40.00

% Living in household with smoker (ages 0-17)

5.00

6.00

7.00

8.00

9.00

10.00

% A

DD

/AD

HD

(ag

es 2

-17)

% Ever been told child has ADD/ADHD (ages 2-17) = 2.19 + 0.16 * ind6_4PR-Square = 0.45

CSHCN

Linear Regression

20.00 30.00 40.00

% Living in household with smoker (ages 0-17)

14.00

16.00

18.00

20.00

22.00

% C

SH

CN

all

% CSHCN all = 10.43 + 0.24 * ind6_4PR-Square = 0.41

Local Moran’s Ii

Local Gi* (as rendered)

Local Gi* by significance level

Ecological level analysis supports clinical studies connecting exposure to second hand smoke with a wide range of health problems among children in the U.S.

Presence of a smoker in the household is positively associated with prevalence of Special Health Care Needs among children

Regional clustering of state level prevalence of household smoke exposure can be identified

Conclusions

Effective smoking cessation programs targeting parents will have a positive impact on related child health outcomes

Attention to geographical clustering of high-exposure states could enhance the impact of public health resources.

Public Health Implications

Second Hand SmokeCDC Fact Sheet

cdc.gov/tobacco/data_statistics/Factsheets/SecondhandSmoke.htm#

National Cancer Institute

www.cancer.gov/cancertopics/factsheet/Tobacco/ETS

AAP www.aap.org/healthtopics/tobacco.cfm

National Survey of Children’s Healthwww.nschdata.org www.cahmi.org www.cdc.gov/nchs/about/major/slaits/nsch.htm

Further information…