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8.A. - Page 29
<br />Tobacco -Smoke Exposure in Children Who Live in
<br />Multiunit Housing
<br />AUTHORS: Karen M. Wilson, MD, MPH, 8,b Jonathan D.
<br />Klein, MD, MPH,a.b Aaron K. Blumkin, MS,a Mark Gottlieb,
<br />JD,bc and Jonathan P. Winickoff, MD, MPHb•d
<br />aDepartment of Pediatrics, University of Rochester, Rochester,
<br />New York; °Julius B. Richmond Center of Excellence, American
<br />Academy of Pediatrics, Elk Grove Village, Illinois; 'Public Health
<br />Advocacy Institute, Northeastern University School of Law,
<br />Boston, Massachusetts; and aDepartment of Pediatrics,
<br />Massachusetts General Hospital for Children, Harvard Medical
<br />School, Boston, Massachusetts
<br />KEY WORDS
<br />secondhand smoke, passive smoking, environmental tobacco
<br />smoke, multiunit housing, apartment
<br />ABBREVIATION
<br />NHANES—National Health and Nutrition Examination Survey
<br />or Wilson participated in all aspects of the study, including
<br />study conception and design, interpretation of data, drafting
<br />and revising of the manuscript, and supervising the statistical
<br />analysis; Or Klein made substantial contributions in the design
<br />of the study, interpretation of the data, critical revision of the
<br />manuscript, and supervision; Mr Blumkin provided the
<br />statistical analyses for the study, acquired the data, and
<br />assisted with the drafting and revision of the manuscript; or
<br />Gottlieb provided important information on the medicolegal and
<br />policy implications of the study, assisted in the interpretation of
<br />the data from the policy perspective, contributed to the revision
<br />of the manuscript, and supervision; and or Winickoff provided
<br />overall supervision for the direction of the manuscript and was
<br />involved in the conception and design, analysis and
<br />interpretation of data, and critical review of the manuscript.
<br />www.pediatrics.org/cgi/doi/10.1542/peds.2010-2046
<br />do i:10.1542/peds.2010-2046
<br />Accepted for publication Sep 29, 2010
<br />Address correspondence to Karen M. Wilson, MD, MPH,
<br />University of Rochester, 601 Elmwood Ave, Box 777, Rochester,
<br />NY 14642. E-mail: karen—wilson@urmc.rochester.edu
<br />PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
<br />Copyright @ 2011 by the American Academy of Pediatrics
<br />FINANCIAL DISCLOSURE: The authors have indicated they have
<br />no financial relationships relevant to this article to disclose.
<br />WHAT'S KNOWN ON THIS SUBJECT: Exposure to secondhand
<br />tobacco smoke is an important cause of morbidity and mortality
<br />among children, even at low levels of exposure. In a recent
<br />national sample, 54% of children who did not live with a smoker
<br />showed measureable amounts of cotinine.
<br />66 WHAT THIS STUDY ADDS: Children who live in homes in which no
<br />one smokes inside have a 45% increase in cotinine levels if they
<br />live in apartments compared with detached homes. Multiunit
<br />housing may be a significant source of secondhand tobacco-
<br />, smnkp pvnnsnrp fnr childrpn at Ipvpls assnciatprl with mnrhirlit
<br />abstract
<br />OBJECTIVE: There is no safe level of secondhand tobacco -smoke expo-
<br />sure, and no previous studies have explored multiunit housing as a
<br />potential contributor to secondhand tobacco -smoke exposure in chil-
<br />dren. We hypothesized that children who live in apartments have
<br />higher cotinine levels than those who live in detached homes, when
<br />controlling for demographics.
<br />METHODS: We analyzed data from the 2001-2006 National Health and Nu-
<br />trition Examination Survey. The housing types we included in our study
<br />were detached houses (including mobile homes), attached houses, and
<br />apartments. Our study subjects were children between the ages of 6 and
<br />18 years. Cotinine levels were used to assess secondhand tobacco -smoke
<br />exposure, and those living with someone who smoked inside the home
<br />were excluded. X2 tests, ttests, and Tobit regression models were used in
<br />Stata. Sample weights accounted for the complex survey design.
<br />RESULTS: Of 5002 children in our study, 73% were exposed to second-
<br />hand tobacco smoke. Children living in apartments had an increase in
<br />cotinine of 45% overthose living in detached houses. This increase was
<br />212% (P < .01) for white residents and 46% (P < .03) for black resi-
<br />dents, but there was no significant increase for those of other races/
<br />ethnicities. At every cutoff level of cotinine, children in apartments had
<br />higher rates of exposure. The exposure effect of housing type was most
<br />pronounced at lower levels of cotinine.
<br />CONCLUSIONS: Most children without known secondhand tobacco -
<br />smoke exposure inside the home still showed evidence of tobacco -smoke
<br />exposure. Children in apartments had higher mean cotinine levels than
<br />children in detached houses. Potential causes for this result could be
<br />seepage through walls or shared ventilation systems. Smoking bans in
<br />multiunit housing may reduce children's exposure to tobacco smoke.
<br />Pediatrics 2011;127:85-92
<br />PEDIATRICS Volume 127, Number 1 January 2011 85
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