Ambulatory and emergency hospital visits on account of wheezing in children exposed to secondhand smoke in multi-unit dwellings, National Health and Nutrition E

摘要

INTRODUCTION: Among the approximately 79.2 million U.S residents in multi-unit housing (MUH), over half with smoke-free homes have experienced secondhand smoke (SHS) infiltration. This study assessed the effect of SHS exposure among children in MUH on wheezing-related hospital visits. METHODS: Data was analyzed from the 2001-2006 National Health and Nutrition Examination Survey for 11,657 non-smokers aged ＜15 years. Residence/housing was categorized as multi-unit or detached based on attachment to another housing unit. Household SHS exposure was defined as ＞1 smoker in the home. Number of ambulatory or emergency visits in the past year due to wheezing was self-reported. A multivariate Poisson regression model was fitted to assess the effect of household SHS exposure and housing type on hospital visits on account of wheezing, adjusting for pre-existing asthma, general health condition, sex, age, race/ethnicity, household reference-person education, and poverty index ratio. Household SHS exposure-housing type interaction was assessed using the likelihood-ratio test (P＜0.05). Data were weighted and analyzed with Stata, versionl2. RESULTS: Children exposed to household SHS had 1.89 times the rate of hospital visits due to wheezing compared to non-exposed children (P=0.009). The rate of hospital visits among children in MUH was 1.62 times that of children in detached houses (P=0.032). Household SHS exposure-housing type interaction was present (P=0.046). The effect of SHS exposure on hospital visits in children in MUH (Incidence rate ratio, IRR=2.48; 95% confidence interval, CI=1.44-4.28) was higher compared to children in detached houses (IRR=1.12; 95%CI: 0.30-4.22). CONCLUSION: The effect of household SHS exposure on hospital visits due to wheezing was significantly higher in MUH children compared to those in detached housing. Enhanced and sustained efforts are needed to reduce indoor SHS exposure.