Families living in poverty suffer from many hardships, including the increased likelihood of health problems. A new study evaluated the relationship between poverty and evidence of nicotine exposure in children with asthma. The findings were published in the journal Pediatrics by researchers at Penn State Milton S. Hershey Children’s Hospital, Hershey, Pennsylvania; Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and Boston Children’s Hospital, Boston, Massachusetts.
The study authors note that a better understanding of how poverty-related hardships affect child health could lead to interventions that could correct them. Tobacco smoke exposure may be one such consequence of family hardship. Therefore, the objective of the study was to examine the relationship between family hardships and tobacco exposure. This was accomplished by measuring the serum cotinine level among children hospitalized for asthma. Cotinine is a metabolic product of nicotine.
For the study, 774 children, aged 1 to 16 years who were admitted for asthma or bronchodilator-responsive wheezing. The primary outcome measurement was detectable serum cotinine. Family hardships, including 11 financial and social factors, were assessed through a survey of the child’s caregiver. The data was subjected to statistical analysis to determine associations between family hardship and detectable cotinine.
The investigators were able to obtain complete study data for 675 children (57%were African American and 74% were enrolled in Medicaid). They found that 56% of the children had detectable cotinine. More than 80% of families reported more than one hardship, and 41% reported four or more hardships. A high number of hardships was associated with a greater likelihood of having detectable cotinine. Compared to children in families with no hardships, those in families with four or more hardships had a 3.7-fold greater likelihood of having detectable serum cotinine. Moreover, lower parental income and educational level were also independently related to detectable serum cotinine.
The authors concluded that family hardships are commonplace and associated with detectable serum cotinine level among children with asthma. The noted that family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities among low income families.