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Household Exposure to Secondhand Smoke is Associated with Decreased Physical and Mental Health of Mothers in the USA

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Abstract

Secondhand smoke is one of the most common toxic environmental exposures to children, and maternal health problems also have substantial negative effects on children. We are unaware of any studies examining the association of living with smokers and maternal health. To investigate whether non-smoking mothers who live with smokers have worse physical and mental health than non-smoking mothers who live in homes without smokers. Nationally representative data from the 2000–2004 Medical Expenditure Panel Survey were used. The health of non-smoking mothers with children <18 years (n = 18,810) was assessed, comparing those living with one or more smokers (n = 3,344) to those living in households with no adult smokers (n = 14,836). Associations between maternal health, household smoking, and maternal age, race/ethnicity, and marital, educational, poverty and employment status were examined in bivariable and multivariable analyses using SUDAAN software to adjust for the complex sampling design. Scores on the Medical Outcomes Short Form-12 (SF-12) Physical Component Scale (PCS) and Mental Component Scale (MCS) were used to assess maternal health. About 79.2% of mothers in the USA are non-smokers and 17.4% of them live with ≥1 adult smokers: 14.2% with 1 and 3.2% with ≥2 smokers. Among non-smoking mothers, the mean MCS score is 50.5 and mean PCS is 52.9. The presence of an adult smoker and increasing number of smokers in the home are both negatively associated with MCS and PCS scores in bivariable analyses (P < 0.001 for each). Non-smoking mothers with at least one smoker in the household had an 11% (95% CI = 0.80–0.99) lower odds of scoring at or above the mean MCS score and a 19% (95% CI = 0.73–0.90) lower odds of scoring at or above the mean PCS score compared to non-smoking mothers with no smokers in the household. There is an evidence of a dose response relationship with increasing number of smokers in the household for PCS (P < 0.001). These findings demonstrate a previously unrecognized child health risk: living with smokers is independently associated with worse physical and mental health among non-smoking mothers.

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References

  1. U.S. Department of Health, Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the surgeon general. Atlanta, GA: U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

    Google Scholar 

  2. Chou, S., Hsu, H., Kuo, H., & Kuo, H. (2008). Association between exposure to environmental tobacco smoke (ETS) and breastfeeding behaviour. Acta Paediatrica, 97(1), 76–80.

    Article  CAS  PubMed  Google Scholar 

  3. Collins, B., Wileyto, E., Murphy, M., & Munafò, M. (2007). Adolescent environmental tobacco smoke exposure predicts academic achievement test failure. Journal of Adolescent Health, 41(4), 363–370.

    Article  PubMed  Google Scholar 

  4. Jiang, X., Yuan, J., Skipper, P., Tannenbaum, S., & Yu, M. (2007). Environmental tobacco smoke and bladder cancer risk in never smokers of Los Angeles County. Cancer Research, 67(15), 7540–7545.

    Article  CAS  PubMed  Google Scholar 

  5. Wu, F., Wu, H., Yang, H., et al. (2007). Associations among genetic susceptibility, DNA damage, and pregnancy outcomes of expectant mothers exposed to environmental tobacco smoke. Science of the Total Environment, 386(1–3), 124–133.

    Article  CAS  PubMed  Google Scholar 

  6. Cutler-Triggs, C., Fryer, G., Miyoshi, T., & Weitzman, M. (2008). Increased rates and severity of child and adult food insecurity in households with adult smokers. Archives of Pediatrics and Adolescent Medicine, 162(11), 1056–1062.

    Article  PubMed  Google Scholar 

  7. Rahman, A., Iqbal, Z., Bunn, J., Lovel, H., & Harrington, R. (2004). Impact of maternal depression on infant nutritional status and illness: A cohort study. Archives of General Psychiatry, 61(9), 946–952.

    Article  PubMed  Google Scholar 

  8. Rahman, A., Patel, V., Maselko, J., & Kirkwood, B. (2008). The neglected ‘m’ in MCH programmes–why mental health of mothers is important for child nutrition. Tropical Medicine and International Health, 13(4), 579–583.

    Article  PubMed  Google Scholar 

  9. Grace, S., Evindar, A., & Stewart, D. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archives of Women’s Mental Health, 6(4), 263–274.

    Article  CAS  PubMed  Google Scholar 

  10. Lewinsohn, P., Olino, T., & Klein, D. (2005). Psychosocial impairment in offspring of depressed parents. Psychological Medicine, 35(10), 1493–1503.

    Article  PubMed  Google Scholar 

  11. Patel, V., Rahman, A., Jacob, K., & Hughes, M. (2004). Effect of maternal mental health on infant growth in low income countries: New evidence from South Asia. BMJ, 328(7443), 820–823.

    Article  PubMed  Google Scholar 

  12. Pilowsky, D. J., Wickramaratne, P. J., Rush, A. J., et al. (2006). Children of currently depressed mothers: A STAR*D ancillary study. Journal of Clinical Psychiatry, 67(1), 126–136.

    Article  PubMed  Google Scholar 

  13. Warren, C., Jones, N., Peruga, A., et al. (2008). Global youth tobacco surveillance, 2000–2007. MMWR Surveillance Summaries, 57(1), 1–28.

    Google Scholar 

  14. Spence, S., Najman, J., Bor, W., O’Callaghan, M., & Williams, G. (2002). Maternal anxiety and depression, poverty and marital relationship factors during early childhood as predictors of anxiety and depressive symptoms in adolescence. Journal of Child Psychology and Psychiatry, 43(4), 457–469.

    Article  PubMed  Google Scholar 

  15. Clark, J. D., Wilkinson, J. D., LeBlanc, W. G., et al. (2008). Inflammatory markers and secondhand tobacco smoke exposure among US workers. American Journal of Industrial Medicine, 51(8), 626–632.

    Article  PubMed  Google Scholar 

  16. Stewart, R. (2007). Maternal depression and infant growth: A review of recent evidence. Maternal & Child Nutrition, 3(2), 94–107.

    Article  Google Scholar 

  17. Bartlett, S., Krishnan, J., Riekert, K., Butz, A., Malveaux, F., & Rand, C. (2004). Maternal depressive symptoms and adherence to therapy in inner-city children with asthma. Pediatrics, 113(2), 229–237.

    Article  PubMed  Google Scholar 

  18. Kavanaugh, M., Halterman, J. S., Montes, G., Epstein, M., Hightower, A. D., & Weitzman, M. (2006). Maternal depressive symptoms are adversely associated with prevention practices and parenting behaviors for preschool children. Ambulatory Pediatrics, 6(1), 32–37.

    Article  PubMed  Google Scholar 

  19. Kavanaugh, M., Halterman, J. S., Montes, G., Epstein, M., & Weitzman, M. (2004). Maternal depressive symptoms are adversely associated with parenting resources and skills and child prevention practices. Pediatric Research, 55(4), 228A.

    Google Scholar 

  20. Pachter, L., Auinger, P., Palmer, R., & Weitzman, M. (2006). Do parenting and the home environment, maternal depression, neighborhood, and chronic poverty affect child behavioral problems differently in different racial-ethnic groups? Pediatrics, 117(4), 1329–1338.

    Article  PubMed  Google Scholar 

  21. Elgar, F., McGrath, P., Waschbusch, D., Stewart, S., & Curtis, L. (2004). Mutual influences on maternal depression and child adjustment problems. Clinical Psychology Review, 24(4), 441–459.

    Article  PubMed  Google Scholar 

  22. Heneghan, A., Chaudron, L., Storfer-Isser, A., et al. (2007). Factors associated with identification and management of maternal depression by pediatricians. Pediatrics, 119(3), 444–454.

    Article  PubMed  Google Scholar 

  23. Korneluk, Y. G., & Lee, C. M. (1998). Children’s adjustment to parental physical illness. Clinical Child and Family Psychology Review, 1(3), 179–193.

    Article  CAS  PubMed  Google Scholar 

  24. Barkmann, C., Romer, G., Watson, M., & Schulte-Markwort, M. (2007). Parental physical illness as a risk for psychosocial maladjustment in children and adolescents: Epidemiological findings from a national survey in Germany. Psychosomatics, 48(6), 476–481.

    Article  PubMed  Google Scholar 

  25. Steck, B., Amsler, F., Grether, A., et al. (2007). Mental health problems in children of somatically ill parents, e.g. multiple sclerosis. European Child and Adolescent Psychiatry, 16(3), 199–207.

    Article  PubMed  Google Scholar 

  26. Nakata, A., Takahashi, M., Ikeda, T., Hojou, M., Nigam, J., & Swanson, N. (2008). Active and passive smoking and depression among Japanese workers. Preventive Medicine, 46(5), 451–456.

    Article  PubMed  Google Scholar 

  27. Cohen, S. (1997). Design and methods of the medical expenditure panel survey household component. MEPS methodology report no. 1. AHCPR pub. no. 97-0026. Rockville, MD: Agency for Health Care Policy and Research.

  28. Cohen, S. (1997). Sample design of the 1996 medical expenditure panel survey household component. MEPS methodology report no. 2. AHCPR pub. no. 97-0027. Rockville, MD: Agency for Health Care Policy and Research.

  29. Cohen, S. (2003). Design strategies and innovations in the medical expenditure panel survey. Medical Care, 41(7 Supplement), III-5–III-12.

  30. Ezzati-Rice, T., Rohde, F., & Greenblatt, J. (2008). Sample design of the medical expenditure panel survey household component, 1998–2007. Methodology report no. 22. March 2008. Rockville, MD: Agency for Healthcare Research and Quality. http://www.meps.ahrq.gov/mepsweb/data_files/publications/mr22/mr22.pdf.

  31. Fleishman, J. (2005). Demographic and clinical variations in health status. MEPS methodology report no. 14. AHRQ pub. no. 05-0022. Rockville, MD: Agency for Healthcare Research and Quality.

  32. Machlin, S. R., Hill, S. C., & Liang, L. (2006). Children living with adult smokers, United States, 2004. Statistical brief #147. Rockville, MD: Agency for Healthcare Research and Qualty.

  33. King, K., Martynenko, M., Bergman, M., Liu, Y., Winickoff, J., & Weitzman, M. (2009). Family composition and children`s exposure to adult smokers in their homes. Pediatrics (in press).

  34. Machlin, S. R., & Soget, M. W. (2005). Family health care expenses, by income level, 2002. Statistical brief #64. Rockville, MD: Agency for Healthcare Research and Quality. http://www.meps.ahrq.gov/papers/st64/stat64.pdf.

  35. Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    Article  PubMed  Google Scholar 

  36. Ware, J. E., Kosinski, M., & Keller, S. D. (1995). SF-12: How to score the SF-12 physical and mental health summary scales (2nd ed.). Boston, MA: The Health Institute, New England Medical Center.

    Google Scholar 

  37. Research Triangle Institute. (2001). SUDAAN user`s manual, release 8.0. Research Triangle Park, NC: Research Triangle Institute.

    Google Scholar 

  38. SAS Institute Inc. (2004). What`s new in SAS 9.0, 9.1, 9.1.2 and 9.1.3. Cary, NC: SAS.

    Google Scholar 

  39. Besaratinia, A., & Pfeifer, G. P. (2008). Second-hand smoke and human lung cancer. Lancet Oncology, 9(7), 657–666.

    Article  CAS  PubMed  Google Scholar 

  40. Bloch, M., Althabe, F., Onyamboko, M., et al. (2008). Tobacco use and secondhand smoke exposure during pregnancy: An investigative survey of women in 9 developing nations. American Journal of Public Health, 98(10), 1833–1840.

    Article  PubMed  Google Scholar 

  41. He, Y., Lam, T. H., Jiang, B., et al. (2008). Passive smoking and risk of peripheral arterial disease and ischemic stroke in Chinese women who never smoked. Circulation, 118(15), 1535–1540.

    Article  PubMed  Google Scholar 

  42. Teo, K., Ounpuu, S., Hawken, S., et al. (2006). Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: A case–control study. Lancet, 368(9536), 647–658.

    Article  PubMed  Google Scholar 

  43. American Academy of Pediatrics Commitee on Environmental Health. (1997). Environmental tobacco smoke: A hazard to children. Pediatrics, 99(4), 639–642.

    Article  Google Scholar 

  44. Forastiere, F., Mallone, S., Lo Presti, E., et al. (2000). Characteristics of nonsmoking women exposed to spouses who smoke: Epidemiologic study on environment and health in women from four Italian areas. Environmental Health Perspectives, 108(12), 1171–1177.

    CAS  PubMed  Google Scholar 

  45. Huttova, M., & Jurkovicova, J. (2001). The effects of smoking in pregnancy on mother and foetus. Prakt Gynek, 8(2), 60–64.

    Google Scholar 

  46. DiFranza, J. R., Aligne, C. A., & Weitzman, M. (2004). Prenatal and postnatal environmental tobacco smoke exposure and children’s health. Pediatrics, 113(4), 1007–1015.

    PubMed  Google Scholar 

  47. Aligne, C. A., Moss, M. E., Auinger, P., & Weitzman, M. (2003). Association of pediatric dental caries with passive smoking. JAMA—Journal of the American Medical Association, 289(10), 1258–1264.

    Article  Google Scholar 

  48. Kukla, L., Hrubá, D., & Tyrlík, M. (2004). Influence of prenatal and postnatal exposure to passive smoking on infants’ health during the first six months of their life. Central European Journal of Public Health, 12(3), 157–160.

    CAS  PubMed  Google Scholar 

  49. Barnoya, J., Bialous, S., & Glantz, S. (2005). Effective interventions to reduce smoking-induced heart disease around the world: Time to act. Circulation, 112(4), 456–458.

    Article  PubMed  Google Scholar 

  50. Grant, S. (2005). Qualitatively and quantitatively similar effects of active and passive maternal tobacco smoke exposure on in utero mutagenesis at the HPRT locus. BMC Pediatrics, 5, 20.

    Article  PubMed  Google Scholar 

  51. Zubor, P., Lasabova, Z., Hatok, J., Stanclova, A., & Danko, J. (2007). A polymorphism C3435T of the MDR-1 gene associated with smoking or high body mass index increases the risk of sporadic breast cancer in women. Oncology Reports, 18(1), 211–217.

    CAS  PubMed  Google Scholar 

  52. Herrmann, M., King, K., & Weitzman, M. (2008). Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment. Current Opinion in Pediatrics, 20(2), 184–190.

    Article  PubMed  Google Scholar 

  53. U.S. Department of Health, Human Services. (1986). The health consequences of involuntary smoking: A report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health.

    Google Scholar 

  54. U.S. Department of Health, Human Services. (2001). Women, smoking: A report of the surgeon general. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

    Google Scholar 

  55. Kavanaugh, M., McMillen, R., Pascoe, J., Hill Southward, L., Winickoff, J., & Weitzman, M. (2005). The co-occurrence of maternal depressive symptoms and smoking in a national survey of mothers. Ambulatory Pediatrics, 5(6), 341–348.

    Article  PubMed  Google Scholar 

  56. Munafò, M., Heron, J., & Araya, R. (2008). Smoking patterns during pregnancy and postnatal period and depressive symptoms. Nicotine & Tobacco Research, 10(11), 1609–1620.

    Article  Google Scholar 

  57. Pomerleau, C., Zucker, A., & Stewart, A. (2003). Patterns of depressive symptomatology in women smokers, ex-smokers, and never-smokers. Addictive Behaviors, 28(3), 575–582.

    Article  PubMed  Google Scholar 

  58. Annunziato, R., Rakotomihamina, V., & Rubacka, J. (2007). Examining the effects of maternal chronic illness on child well-being in single parent families. Journal of Developmental and Behavioral Pediatrics, 28(5), 386–391.

    Article  PubMed  Google Scholar 

  59. Poole-di Salvo, E., Fryer, E., Liu, Y. H., & Weitzman, M. (2008). Household smoking and children’s behavioral and emotional problems. Paper presented at the 2008 annual meeting of the pediatric academic societies, Honolulu, Hawaii.

  60. Centers for Disease Control and Prevention (CDC). (2006). Use of cigarettes and other tobacco products among students aged 13–15 years worldwide, 1999–2005. MMWR Morbidity and Mortality Weekly Report, 55(20), 553–556.

    Google Scholar 

  61. Warren, C., Jones, N., Eriksen, M., & Asma, S. (2006). Patterns of global tobacco use in young people and implications for future chronic disease burden in adults. Lancet, 367(9512), 749–753.

    Article  CAS  PubMed  Google Scholar 

  62. Rigotti, N., Lee, J., & Wechsler, H. (2000). US college students’ use of tobacco products: Results of a national survey. JAMA, 284(6), 699–705.

    Article  CAS  PubMed  Google Scholar 

  63. Rebagliato, M. (2002). Validation of self reported smoking. Journal of Epidemiology and Community Health, 56(3), 163–164.

    Article  CAS  PubMed  Google Scholar 

  64. Vartiainen, E., Seppala, T., Lillsunde, P., & Puska, P. (2002). Validation of self reported smoking by serum cotinine measurement in a community-based study. Journal of Epidemiology and Community Health, 56(3), 167–170.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was made possible by a grant from the Flight Attendant Medical Research Institute and by NIH grant #P60MD000538.

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Sobotova, L., Liu, YH., Burakoff, A. et al. Household Exposure to Secondhand Smoke is Associated with Decreased Physical and Mental Health of Mothers in the USA. Matern Child Health J 15, 128–137 (2011). https://doi.org/10.1007/s10995-009-0549-z

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