Article Text

Download PDFPDF
Spatial analysis of tobacco outlet density on secondhand smoke exposure and asthma health among children in Baltimore City
  1. Parisa Kaviany1,
  2. James Paul Senter2,
  3. Joseph Michael Collaco1,
  4. Anne E Corrigan3,
  5. Emily Brigham4,
  6. Megan Wood5,
  7. Han Woo4,
  8. Chen Liu4,
  9. Rachelle Koehl4,
  10. Panagis Galiatsatos6,
  11. Kirsten Koehler5,
  12. Nadia Hansel4,
  13. Meredith McCormack4
  1. 1Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  2. 2Pediatrics Residency Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  3. 3Spatial Science for Public Health Center, Johns Hopkins University, Baltimore, Maryland, USA
  4. 4Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Department of Environmental Health and Engineering, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  6. 6Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr Parisa Kaviany, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; pkavian1{at}jhmi.edu

Abstract

Rationale Tobacco outlets are concentrated in low-income neighbourhoods; higher tobacco outlet density is associated with increased smoking prevalence. Secondhand smoke (SHS) exposure has significant detrimental effects on childhood asthma. We hypothesised there was an association between higher tobacco outlet density, indoor air pollution and worse childhood asthma.

Methods Baseline data from a home intervention study of 139 children (8–17 years) with asthma in Baltimore City included residential air nicotine monitoring, paired with serum cotinine and asthma control assessment. Participant addresses and tobacco outlets were geocoded and mapped. Multivariable regression modelling was used to describe the relationships between tobacco outlet density, SHS exposure and asthma control.

Results Within a 500 m radius of each participant home, there were on average six tobacco outlets. Each additional tobacco outlet in a 500 m radius was associated with a 12% increase in air nicotine (p<0.01) and an 8% increase in serum cotinine (p=0.01). For every 10-fold increase in air nicotine levels, there was a 0.25-point increase in Asthma Therapy Assessment Questionnaire (ATAQ) score (p=0.01), and for every 10-fold increase in serum cotinine levels, there was a 0.54-point increase in ATAQ score (p<0.05).

Conclusions Increased tobacco outlet density is associated with higher levels of bedroom air nicotine and serum cotinine. Increasing levels of SHS exposure (air nicotine and serum cotinine) are associated with less controlled childhood asthma. In Baltimore City, the health of children with asthma is adversely impacted in neighbourhoods where tobacco outlets are concentrated. The implications of our findings can inform community-level interventions to address these health disparities.

  • secondhand smoke
  • cotinine
  • disparities
  • environment
  • nicotine

Data availability statement

Data are available upon reasonable request. Data relevant to the study question addressed in this manuscript are included in the article or uploaded as supplementary information. Additional data can be made available on request.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. Data relevant to the study question addressed in this manuscript are included in the article or uploaded as supplementary information. Additional data can be made available on request.

View Full Text

Footnotes

  • Contributors All authors have participated in the concept, design, analysis, writing and revision of the manuscript. MM acting as guarantor.

  • Funding This work was supported by the National Institute of Environmental Health Sciences (NIEHS) under grant number P50ES018176 and the US Environmental Protection Agency under grant number 83615201.

  • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.