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Secondhand smoke heightens risk of child hospitalisation – Cincinnati study

Children in the United States who are exposed to tobacco have much higher rates of hospital admissions after visiting emergency departments or urgent care facilities, according to a study by University of Cincinnati researchers.

The study is set to be published in October in Pediatric Research and is currently available online, the university reports. It found that tobacco smoke exposure also increased the risk of paediatric patients having respiratory-related procedures performed while in the emergency department, as well as medications prescribed.

The study compared 380 children exposed to tobacco smoke with 1,140 children not exposed, matching the children in regards to age, sex, race and ethnicity, said study leader Ashley Merianos, an associate professor in the University of Cincinnati’s School of Human Services.

“We know that exposure to second hand smoke is related to substantial morbidity in children. In addition to exposed children having more health care visits, I was really interested in taking a closer look at the actual resource utilisation during their visits.

“For example, [I looked at whether] children who are exposed to tobacco smoke are more likely to have more infectious diagnostic, lab and radiologic tests during their emergency visit than children who are unexposed,” she explained.

Tobacco smoke exposure by the numbers

Merianos, who’s long conducted similar research in the field of children and tobacco smoke exposure, expected that children exposed to tobacco would be at higher risk, but even she was surprised by the numbers, she said.

Children exposed to tobacco smoke were 24 times more likely to be admitted to the hospital than unexposed children, which Merianos says emphasises that possible tobacco smoke exposure may contribute to related illness severity.

Children in the exposed group were also nearly eight times more likely to have suctioning performed with a BBG nasal aspirator and over seven times more likely to receive steroids during their visit.

Of children in both groups with asthma, kids exposed to tobacco smoke were 27 times more likely to receive steroids during their emergency department visit and over 15 times more likely to receive albuterol, a bronchodilator used to treat asthma attacks.

Children exposed to tobacco smoke were also at increased odds of having laboratory tests (5.72 times ordered), and radiologic tests (4.73 times), as well as various infectious diagnostic tests (2.68 times).

Children who were ages one or younger had the highest levels of exposure to tobacco smoke, likely due to their inability to leave environments in which tobacco is being smoked, explained Merianos. Socio-economic status was also a factor in a child’s likelihood of exposure, she said.

“Nearly three-quarters of children included in the present study were public insurance recipients, a proxy of low income,” said Merianos.

A 'teachable moment'

Despite the health implications of tobacco smoke exposure on children, Merianos says that most emergency departments don’t routinely screen for tobacco smoke exposure or provide tobacco cessation counselling services or resources to families.

Doing so would be to their benefit, as well as that of the children and families they serve, she points out.

“Standardised tobacco control initiatives may help overburdened health care facilities by decreasing resource utilisation attributed to tobacco smoke exposure,” she concludes in her study. “Targeting children with potential tobacco smoke exposure-related chief complaints (eg cough) and illnesses (eg asthma) may also help to reduce related morbidity and potentially preventable future health care visits.”

While emergency departments and urgent care facilities may provide what Merianos calls that “teachable moment” to promote smoking cessation resources for parents and caregivers, Merianos says she understands the constraints health care providers are under.

“The main reason why the resources aren’t routinely being offered is due to the need to medically stabilise ill children and also due to the lack of standardised efforts and resources in place,” she said.

“Emergency department providers might think that primary care is the more appropriate setting, but a lot of patients in the emergency care setting don’t regularly interact with their primary care provider.”

Merianos’ next steps are to take the data from this study and analyse it with plans to create standardised interventions and programmes to offer to health care providers that will be both clinically effective and feasible, as well as engaging and meaningful for parents and patients, she said.

“Even just being able to eliminate one child’s tobacco smoke exposure levels is a job well done on my part,” said Merianos. “It’s about bringing health promotion and disease prevention efforts to these vulnerable populations and making a positive change to the child’s health, as well as the family’s health.”


Child tobacco smoke exposure and healthcare resource utilisation patterns

The journal Pediatric Research.


Ashley L Merianos, Roman A Jandarov, Judith S Gordon, Michael S Lyons and 

E Melinda Mahabee-Gittens 


The objective was to examine the relationship between healthcare resource utilisation patterns in tobacco smoke-exposed children (TSE group) compared with unexposed children (non-TSE group).


We matched 380 children in the TSE group with 1,140 children in the non-TSE group based on child age, sex, race, and ethnicity using propensity scores. Healthcare resource utilization variables included respiratory-related procedures, diagnostic testing, disposition, and medications. Logistic and linear regression models were built.


Child mean age was 4.9 (SD = 0.1) years, 50.5% were female, 55.5% black, and 73.2% had public insurance/self-pay. Compared to the non-TSE group, the TSE group was at increased odds to have the following performed/obtained: nasal bulb suctioning, infectious diagnostic tests, laboratory tests, and radiologic tests.

The TSE group was more likely to be admitted to the hospital, and more likely to receive steroids and intravenous fluids during their visit. Among asthmatics, the TSE group was more likely to receive steroids, albuterol, or ipratropium alone, or a combination of all three medications during their visit, and be prescribed albuterol alone or steroids and albuterol.


Tobacco smoke-exposed children are more likely to have higher resource utilization patterns, highlighting the importance of screening and providing TSE prevention and remediation interventions.


  • Tobacco smoke exposure may affect the healthcare resource utilisation patterns of children.
  • Evidence is lacking concerning these associations among the highly vulnerable paediatric emergency department patient population.
  • This study examined the association between tobacco smoke exposure and healthcare resource utilisation patterns among paediatric emergency department patients.
  • Tobacco smoke exposure increased the risk of paediatric patients having respiratory-related procedures, respiratory-related and non-respiratory-related testing, medications administered during the paediatric emergency department visit, and medications prescribed for home administration.
  • Tobacco smoke-exposed patients were more likely to be admitted to the hospital compared to unexposed patients.


[link url="https://www.uc.edu/news/articles/2020/09/n20943607.html"]UC study: Second hand smoke sends more kids to the hospital[/link]


[link url="https://www.nature.com/articles/s41390-020-0997-0"]Child tobacco smoke exposure and healthcare resource utilization patterns[/link]


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