Article Text
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.
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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.
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.
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Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.