between the ages of 6 and 9 are atopic (9). In the CCAAPS
cohort, the frequency of SPT positivity to at least one aeroal-
lergen (15 evaluated) is approximately 45%. Hence, these
results are likely applicable to a large portion of children in the
United States presenting with allergic sensitization. This study
addresses the limitations of previous studies using question-
naire data rather than internal dose data for SHS exposure as
it controls for potential sources of bias and confounding asso-
ciated with parental reporting of smoking, passive smoking
outside of the child’s home, and exposure misclassiﬁcation. It
is acknowledged that prenatal exposure to SHS and other
sources of indoor/outdoor particulate matter is relevant to
lung function and may be potential confounders. However,
during univariate analyses, prenatal exposure to SHS, riding a
school bus, and the use of a gas stove in the home, all accord-
ing to parental report, were examined and were not associated
with the pulmonary function outcomes at age 7 and therefore
were not included in the models.
Based on our results, and those of others, gender and the
extent of allergic sensitization are signiﬁcant factors in sus-
ceptibility to SHS. Our study identiﬁed sensitized girls as
being a high-risk group for the damaging effects of SHS on
. The discordant results on lung function deﬁcits
presented in the literature, however, complicate and highlight
the complexity of the underlying mechanisms for gender dif-
ferences in children exposed to SHS. It is likely that the mul-
tifarious relationship between SHS and pulmonary function
loss among boys and girls is ultimately dependent on not
only timing of exposure but also the child’s ‘total load’ in
relationship to cumulative risks (i.e., exposures + allergic
sensitization + asthma status + genetic susceptibility + sex
hormones). Hence, it is overdue for researchers to extend
analyses to include these more complex interactions between
exposures and multiple simultaneous determinants to fully
understand a child’s risk for lung damage especially during
the early stages of lung development.
The authors thank Bridget Whitehead, Christopher Schaffer,
and the clinic staff for their efforts in study coordination,
recruitment, data management, and data collection. We
also thank all of the CCAAPS families for their time and
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