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.
Conference Paper: Healthcare Costs of Secondhand Smoke Exposure at Home in Rural China[Show abstract] [Hide abstract]
ABSTRACT: Objective: The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure at home among nonsmoking adults (age≥19) in rural China. Methods: We analyzed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalization expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach. Findings: The total healthcare costs of SHS exposure at home in rural China amounted to $1.2 billion in 2011, including $559.0 million for outpatient visits and $612.4 million for inpatient hospitalizations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure at home in rural China accounted for 0.3% of China’s national healthcare expenditures in 2011. Conclusion: The adverse health effects of SHS exposure at home result in a large economic burden in rural China. Tobacco control policies that reduce SHS exposure at home could have an impact on reducing healthcare costs in China.142nd APHA Annual Meeting and Exposition 2014; 11/2014
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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
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ABSTRACT: To investigate the attention-deficit/hyperactivity disorder (ADHD) status among preschool-aged children in Guiyu, an electronic waste (e-waste) recycling town in Guangdong, China. Two hundred and forty-three parents were surveyed regarding ADHD behaviors in their children (aged 3-7 years) based solely on the DSM-IV criteria. The peripheral blood samples were taken from these children to measure blood lead levels (BLLs) and blood cadmium levels (BCLs). 12.8% of children met the criteria for ADHD, of which the inattentive, hyperactive/impulsive and combined subtypes were 4.5%, 5.3% and 2.9% respectively. Of all children, 28.0% had BLLs ≥ 10 ug/dL and only 1.2% had BCLs ≥ 2 ug/L, levels conventionally considered high. Either modeled by univariate or multivariable analysis, the three ADHD scores (inattentive, hyperactive/impulsive and total scores) calculated from the Parent Rating Scale showed strong positive correlations with BLLs but not with BCLs. Furthermore, children with high BLLs had 2.4 times higher risk of ADHD than those with low BLLs (OR: 2.4 [95% CI: 1.1-5.2]). When each of the 18 categories on the Parent Rating Scale was separately analyzed, children with high BLLs had significant higher risks for positive ADHD symptoms than those with low BLLs in 12 of the 18 categories (ORs ranged from 2.1 [95% CI: 1.1-3.9] to 3.6 [95% CI: 1.7-7.5]). This study suggests that environmental lead contamination due to e-waste recycling has an impact on neurobehavioral development of preschool children in Guiyu.BMC Pediatrics 05/2015; 15(1):51. DOI:10.1186/s12887-015-0368-x