文章基本信息

标题：Decrease in the Prevalence of Environmental Tobacco Smoke Exposure in the Home During the 1990s in Families With Children
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作者：Soheil Soliman ; Harold A. Pollack ; Kenneth E. Warner 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2004
卷号：94
期号：2
页码：314-320
语种：English
出版社：American Public Health Association
摘要：Objectives. This study explored correlates with and changes in the prevalence of environmental tobacco smoke (ETS) exposure of children in the home. Methods. We used multiple logistic regression to explore ETS exposures as reported in the 1992 and 2000 National Health Interview Survey. Results. ETS exposure in homes with children declined from 35.6% to 25.1% (P < .001) between 1992 and 2000, whereas smoking prevalence declined 26.5% to 23.3%. Home ETS exposures were more prevalent among non-Hispanic Whites than among African Americans (adjusted odds ratio [AOR] = 0.702; 95% confidence interval [CI] = 0.614, 0.802), Asian Americans (AOR = 0.534; 95% CI = 0.378, 0.754), and Hispanics (AOR = 0.388; 95% CI = 0.294, 0.389). Exposures declined across all groups, with greater gains in higher education and income groups. Conclusions. Home ETS exposure declined sharply between 1992 and 2000, more than would be predicted by the decline in adult smoking prevalence. Although the primary health risks associated with cigarette smoking accrue to the smoker, environmental tobacco smoke (ETS) is also a significant health concern. The Environmental Protection Agency has classified ETS as a group A carcinogen. 1 ETS has been shown to cause cancer and heart disease in nonsmokers. 1, 2 Children of smokers are particularly susceptible because many are exposed to ETS for extended periods in the home and because children have little recourse in removing themselves from such environments. Much research on childhood ETS exposure has demonstrated important links between ETS and asthma, respiratory infections, sudden infant death syndrome, the common cold, pneumonia, bronchitis, and other health outcomes, especially among children younger than 5 years. This age effect most likely results from the fact that young children spend the most time at home and are likely to be more vulnerable than older children to specific environmental health threats. 3– 5 Many studies have examined the validity of different measures of ETS exposure in the home, particularly among asthmatic children, and have concluded that survey questions give an accurate measure of ETS. 6 Some studies also have compared parental self-report and measured cotinine levels, finding that self-report accurately captures ETS exposure. 7 However, to date, only a handful of studies have measured the national and state-specific prevalence of home ETS exposures, with much of the available data collected during the late 1980s and early 1990s. Estimates exist as far back as 1970, 4, 8– 12 but only 1 study provides comparable data from the late 1990s. 13 Existing studies document significant declines in home ETS exposures over the past 3 decades. Data from the 1970 National Health Interview Survey (NHIS) indicate that 62% of children had at least 1 parent in the household who was a smoker. 4 Using data from the 1991 NHIS, Mannino et al. 4 found that 37% of children were exposed to ETS in the home. Some—but not all—of this decline in home ETS exposure can be attributed to an overall decline in smoking prevalence. Between 1970 and 1990, adult smoking prevalence fell from 37.4% to 25.5%. 14 Although some studies indicate continuing decline in the prevalence of home ETS exposure during the 1990s, 9– 11 estimates of the size of this reduction vary greatly. The estimated prevalence of home ETS was approximately 43% between 1988 and 1991, 8, 9 with 21.9% of children and adolescents younger than 18 years exposed in 1996. 11 In 2000, children’s home ETS exposure was explored in 20 states, with the percentage of adults reporting smoking in the home ranging from 39.2% in West Virginia to 21% in Colorado. 12 Although this study did not estimate the national prevalence of ETS in homes with children, it did estimate that between 1988–1991 and in 1999, home ETS exposure among children aged 3 years or younger decreased by 75% of the base rate. The current study builds on this research by comparing the national and regional prevalence of ETS exposure in homes with children younger than 18 years in 1992 and 2000. In addition to determining whether and how much home ETS exposure declined during the 1990s, we examined the relation between household characteristics and declines in home ETS exposure. Finally, we explored changing attitudes toward ETS among smokers as a potential protective factor in reducing home ETS exposure. This last concern is especially important, given the modest rate of decline in adult smoking prevalence over the 1990s. 14