Attention deficit hyperactivity disorder among children exposed to secondhand smoke: A logistic regression analysis of secondary data.
ABSTRACT BACKGROUND: A growing body of literature examines the association of postnatal secondhand smoke exposure with attention deficit hyperactivity disorder (ADHD) in children, but the findings are mixed. OBJECTIVE: We compare prevalence of ADHD in children aged 4-15 years who were exposed to postnatal secondhand smoke with prevalence in those who were not exposed, and examine the association of postnatal secondhand smoke exposure with ADHD using both reported and cotinine-measured secondhand smoke exposure. DESIGN AND SETTING: We analyze secondary data from the 1999-2004 U.S. National Health and Nutrition Examination Surveys. PARTICIPANTS: Analyses using reported secondhand smoke exposure and cotinine-measured exposure included 6283 and 6033 children aged 4-15 respectively, including 419 and 404 children who either had a reported physician diagnosis of ADHD or were taking stimulant medications. METHODS: The association of secondhand smoke exposure with ADHD was examined by two multiple logistic regression models that differ in the secondhand smoke measurement used. RESULTS: After controlling for maternal smoking during pregnancy, gender, age, race/ethnicity, preschool attendance, health insurance coverage, and exposure to lead, children with reported secondhand smoke exposure at home were more likely to have ADHD (adjusted odds ratio=1.5, 95% confidence interval: 1.1-2.0) than those who were not exposed. After controlling for these covariates, children with detectable cotinine levels were more likely to have ADHD (adjusted odds ratio=1.8, 95% confidence interval: 1.3-2.5) than those with non-detectable levels. CONCLUSIONS: Our findings suggest that secondhand smoke exposure in children is strongly associated with ADHD independent of other risk factors and this association is robust using both measurements of secondhand smoke exposure. Further research is needed to understand the mechanism underlying this association. Nurses and other healthcare professionals can play an important role in encouraging parents to quit smoking to reduce children's exposure to secondhand smoke and their risk of ADHD.
- International journal of nursing studies 04/2013; 50(6). DOI:10.1016/j.ijnurstu.2013.03.007 · 2.25 Impact Factor
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ABSTRACT: Background Cigarette smoking and attention-deficit/hyperactivity disorder (ADHD) are highly co-morbid. One explanation is that individuals with ADHD use cigarettes as ‘self-medication’ to alleviate their attention problems. However, animal studies reported that exposure to nicotine during adolescence influences the developing brain and negatively affects attention. This is the first human study exploring the effects of smoking during adolescence on attention problems. Methods Longitudinal data on smoking and attention problems were available for 1,987 adult and 648 adolescent monozygotic (MZ) twin pairs from the Netherlands Twin Register. Twin pairs were classified as concordant/discordant for smoking and compared on attention problems. Within adult discordant pairs, the difference in attention problems between the smoking and never smoking twins was first assessed cross-sectionally. In longitudinal analyses, the increase in attention problems from adolescence, when neither twin smoked, to adulthood was compared within discordant pairs. In subgroups with longitudinal data from childhood and adolescence, changes in smoking concordance and subsequent changes in attention problems were explored. Results Adult twins who ever smoked, reported significantly more attention problems than their never smoking co-twin. Longitudinal analyses showed a larger increase in attention problems from adolescence to adulthood in smoking twins than their never smoking co-twin (p<0.05). In childhood/adolescence, smoking twins had more attention problems than their never smoking co-twin, while scores were similar before smoking was initiated or after both twins started smoking (not significant in all groups). Conclusions Results from this genetically informative study suggest smoking during adolescence leads to higher attention problem scores, lasting into adulthood.Biological Psychiatry 07/2014; DOI:10.1016/j.biopsych.2014.06.019 · 10.25 Impact Factor
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ABSTRACT: Objectives: To assess the costs of the health effects of cigarette smoking and secondhand smoke (SHS) exposure to society. Design: Prevalence-based, disease-specific cost-of-illness study. We used an epidemiological population-attributable risk method to determine the costs that can be attributed to smoking and SHS exposure. Setting: Taiwan. Participants: All adult population aged 35 and older. Primary outcome measures: Direct costs of healthcare expenditures spent for treating tobacco-related diseases, indirect mortality costs measured by the value of lost productivity due to tobacco-related premature deaths and indirect morbidity costs measured by the value of time lost from work due to tobacco-related illness. Results: In 2010, direct costs of smoking and SHS exposure amounted to US$828 million, accounting for 3.4% of Taiwan's total personal healthcare expenditures. Smoking and SHS exposure also contributed to 15 555 premature deaths-corresponding to a loss of 284 765 years of life and US$820 million in productivity-and US$22 million in indirect morbidity costs. These direct and indirect costs totalled US$1670 million, representing 0.4% of Taiwan's gross domestic product and averaging about US$720/adult smoker. The share of the total costs was greater from active smoking (92%) than SHS exposure (8%), and greater for men (92%) than women (8%). Conclusions: Smoking and SHS exposure impose a huge financial loss in Taiwan. Sustained tobacco control efforts to encourage people to quit smoking, prevent smoking uptake by children and young adults and protect all people from SHS exposure are needed.BMJ Open 07/2014; 4(7):e005199. DOI:10.1136/bmjopen-2014-005199 · 2.06 Impact Factor