1. State Variation in Prevalence of Children Living in Households with Tobacco Smokers Kathleen Newton, BS, Oregon MPH Program & Child & Adolescent Health Measurement Initiative (CAHMI) Dongsoek Choi, PhD, Associate Professor, Biostatistics OHSU Public Health and Preventive Medicine

2. Environmental Exposure to Second Hand Tobacco Smoke Secondhand smoke contains at least 250 chemicals known to be toxic, including more than 50 that can cause cancer Most exposure to tobacco smoke occurs in homes and workplaces About 25% of children aged 3–11 years live with at least one smoker, compared to only about 7% of nonsmoking adults

3. Sudden Infant Death Syndrome (SIDS) Acute respiratory infections Slow lung growth Ear infections and middle ear effusion Increased frequency and severity of asthma attacks Increased cancer risk Passive Smoking Health Risks to Children

4. Explore state-level associations between the extent to which children might be exposed to second hand smoke in their homes and selected health issues among children ages 0 - 17 in the U.S. Study Objective

5. 2003 National Survey of Children’s Health Stratified random sample of 102,353 children CATI telephone interview with primary caregiver Weighted to represent the non-institutionalized population of children ages 0 -17 in each state Questions about a range of topics pertaining to children’s health, families and communities Methods

6. “Does anyone in the household use cigarettes, cigars, or pipe tobacco?” 19 NSCH child health indicators and questions Methods

7. Ecological study design State-level weighted prevalence estimates SPSS Complex Samples ESRI ArcMAP GIS software Analysis

8. Significant at α=.05 but very weak (R 2 <.20) Asthma-related health issues (0–17) Frequent or severe headaches (3–17) Risk of developmental delay (0–5) Correlations

9. Highly significant but still not strong (R 2 <.40) Elevated use or need of services (0-17) At risk for developmental delay (0-5) Repeated a grade in school (6-17) Problem behaviors (6-17) Above normal BMI (10-17)

10. Correlations Highly significant, moderate correlation (R 2 >.40) Use/need prescription medication (0-17) Frequent ear infections (3-17) Attention Deficit/Hyperactivity (2-17) Special Health Care Needs (0-17)

11. Smoking and 4 Child Health Outcomes

12. Significant association with % exposed to 2 nd hand smoke Prescription Medications

13. Ear Infections

14. ADD/ADHD

15. CSHCN

17. Local Moran’s I i

18. Local Gi* (as rendered)

19. Local Gi* by significance level

20. Ecological level analysis supports clinical studies connecting exposure to second hand smoke with a wide range of health problems among children in the U.S. Presence of a smoker in the household is positively associated with prevalence of Special Health Care Needs among children Regional clustering of state level prevalence of household smoke exposure can be identified Conclusions

21. Effective smoking cessation programs targeting parents will have a positive impact on related child health outcomes Attention to geographical clustering of high- exposure states could enhance the impact of public health resources. Public Health Implications

22. Second Hand Smoke  CDC Fact Sheet cdc.gov/tobacco/data_statistics/Factsheets/SecondhandSmoke.htm# cdc.gov/tobacco/data_statistics/Factsheets/SecondhandSmoke.htm#  National Cancer Institute www.cancer.gov/cancertopics/factsheet/Tobacco/ETS www.cancer.gov/cancertopics/factsheet/Tobacco/ETS  AAP www.aap.org/healthtopics/tobacco.cfm www.aap.org/healthtopics/tobacco.cfm National Survey of Children’s Health  www.nschdata.org www.nschdata.org  www.cahmi.org www.cahmi.org  www.cdc.gov/nchs/about/major/slaits/nsch.htm www.cdc.gov/nchs/about/major/slaits/nsch.htm Further information…