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The Diverging Trend in Exposure to Environmental Tobacco Smoke Among US Children

Journal of Racial and Ethnic Health Disparities (2023)Cite this article

Abstract

Objective

Environmental tobacco smoke exposure (ETSE) was race/ethnicity-specific, but how the race/ethnicity-specific ETSE has changed over time, diverging or converging, remains unclear. We examined ETSE trends by race/ethnicity in US children aged 3–11 years.

Methods

We analyzed the data of 9678 children who participated in the biennial National Health and Nutrition Examination Surveys, 1999–2018. ETSE was defined as serum cotinine ≥ 0.05 ng/ml, with ≥ 1 ng/ml as heavy exposure. For trend description, adjusted biennial prevalence ratios (abiPR: the ratio associated with a 2-year increase in time) were estimated by race/ethnicity. The prevalence ratios between races/ethnicities were used to quantify ethnoracial differences in different survey periods. Analyses were performed in 2021.

Results

The overall ETSE prevalence was cut by almost half, from 61.59% (95% confidence interval = 56.55%, 66.62%) in the 1999–2004 survey to 37.61% (33.90%, 41.31%) in 2013–2018, exceeding the national 2020 health target (47.0%). However, the decrease occurred unequally between races/ethnicities. Heavy ETSE declined significantly in white [abiPR = 0.80 (0.74, 0.86)] and Hispanic children [0.83 (0.74, 0.93)], but insignificantly in black children [0.97 (0.92, 1.03)]. Consequently, the adjusted prevalence ratio between black children and white children increased from 0.82 (0.47, 1.44) in 1999–2004 to 2.73 (1.51, 4.92) in 2013–2018 for heavy ETSE. Hispanic children remained at the lowest risk throughout the study period.

Conclusion

Overall ETSE prevalence was cut by half between 1999 and 2018. However, due to uneven declines, the gaps between black children and others have expanded in heavy ETSE. Special vigilance is needed in preventive medicine practice with black children.

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Data Availability

The deidentified participant's data used for this study are publicly available NHANES data from the National Center for Health Statistics, Centers for Disease Control and Prevention, United States at https://wwwn.cdc.gov/nchs/nhanes/Default.aspx.

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Acknowledgements

The NHANES has been developed and funded by multiple federal agencies and is run by the National Center for Health Statistics. Westat, Inc. conducted the fieldwork under contract with the National Center for Health Statistics.

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Authors and Affiliations

  1. Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, 30460, USA

    Felix Twum, Joana Tome, Erica Ledel, Victoria Roy, Arshpreet Kaur Mallhi, Diana Aguirre & Jian Zhang

  2. The Dr. Lynn Cook Hartwig Public Health Program, School of Health Professions, The University of Southern Mississippi, Hattiesburg, MS, 39406, USA

    Felix Twum

  3. Department of Community Medicine, Mercer University School of Medicine, Macon, GA, 31207, USA

    Yudan Wei

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What is new:

The gaps in environmental tobacco smoke exposure between races have widened, especially in heavy exposure in children. The prevalence of heavy exposure decreased by roughly 10% annually for both white and Hispanic children but remained unchanged for black children.

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Twum, F., Tome, J., Ledel, E. et al. The Diverging Trend in Exposure to Environmental Tobacco Smoke Among US Children. J. Racial and Ethnic Health Disparities (2023). https://doi.org/10.1007/s40615-023-01645-y

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