United States prevalence of pediatric asthma by environmental tobacco smoke exposure, 2016-2017

Objectives: We sought to update the prevalence estimates of parent-reported asthma diagnosis by Environmental Tobacco Smoke (ETS) exposure in the United States (US) pediatric population. Methods: This cross-sectional study included 71,811 families with children who participated in the 2016-2017 National Survey of Children's Health (NSCH). Weighted asthma prevalence estimates were calculated for ETS-exposed and non-exposed children. Chi-square analysis compared asthma prevalence between the two exposure groups and logistic regression analysis generated adjusted odds ratios (aORs) of asthma diagnosis by ETS exposure by sex, race/ethnicity, and household education and income level. Results: Asthma prevalence estimates were significantly higher in ETS-exposed vs. non-exposed children (10.7% vs. 7.8%, p < 0.001). Children with a smoker in the house are 30% more likely to have an asthma diagnosis vs. children with no smokers in the house (aOR 1.29, 95% Confidence Interval [CI] 1.09-1.52). Significant predictors for ETS exposure included < high school education and lower family income. Conversely, non-Hispanic black and Hispanic children were less likely to have ETS exposure vs. non-Hispanic white children. Conclusions: ETS exposure is a significant risk factor for asthma in the US pediatric population. Smoking cessation initiatives targeting non-Hispanic white parents from lower socioeconomic may improve children's chronic pulmonary health risk.