Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma

Arlene Manns Butz, Mona Tsoukleris, Mary Elizabeth Bollinger, Mandeep S Jassal, Melissa H. Bellin, Joan Kub, Shawna S Mudd, Jean Ogborn, Cassia Lewis-Land, Richard Thompson

Research output: Contribution to journalArticle

Abstract

Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.

Original languageEnglish (US)
JournalJournal of Asthma
DOIs
StateAccepted/In press - Jan 1 2018

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Tobacco Smoke Pollution
Caregivers
Asthma
Psychological Stress
Cotinine
Smoking
Medicaid
African Americans
Odds Ratio
Morbidity
Delivery of Health Care
Control Groups

Keywords

  • Pediatric; asthma; second hand smoke exposure; caregiver stress

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine

Cite this

Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma. / Butz, Arlene Manns; Tsoukleris, Mona; Elizabeth Bollinger, Mary; Jassal, Mandeep S; Bellin, Melissa H.; Kub, Joan; Mudd, Shawna S; Ogborn, Jean; Lewis-Land, Cassia; Thompson, Richard.

In: Journal of Asthma, 01.01.2018.

Research output: Contribution to journalArticle

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AU - Bellin, Melissa H.

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N2 - Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.

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