Tobacco smoking among asthmatic individuals has shown to influence the course and severity of the disease and its response to treatment.1-5 Specifically, ...
Tobacco Smoking among Adolescents with Asthma in the US Catalina Lopez-Quintero, Yehuda Neumark Braun School of Public Health and Community Medicine, Hebrew UniversityHadassah, Jerusalem, Israel Tobacco smoking among asthmatic individuals has shown to influence the course and severity of the disease and its response to treatment.1-5 Specifically, smoking may stimulate the production of eotaxins (potent eosinophil chemoattractant cytokines involved in the inflammatory response in asthma),3, 5 accelerate the decline in pulmonary function (FEV(1)/FVC is lower in smokers than nonsmokers with asthma),4, 6 reduce the effectiveness of inhaled corticosteroids by modifying their pharmacological properties,1, 4, 7 and increase the long-term mortality risk following a near-fatal asthma attack.3, 8 Moreover, the finding that children who smoke regularly are four times more likely to develop asthma within 8 years of follow than nonsmokers, suggests a causal link between smoking and asthma.9 Data from the 2007 National Youth Risk Behavior Survey (YRBS) was analyzed to estimate the prevalence of any cigarette smoking in the past 30 days (i.e., current tobacco smoking) in a nationally representative sample of American adolescent students who had been told by a doctor or nurse that they have asthma (n=1,438). We used logistic regression models to examine the associations between current tobacco smoking and several socio-demographic and health-related factors. Weighted proportions and variances accounting for the YRBS's complex sample design were estimated using the Taylor series linearization method in SUDAAN. Detailed information on survey methods is described elsewhere.10 Just over a quarter (26.9%) of asthmatic adolescents in the United States reported current tobacco smoking. Results of the multivariate logistic regression models indicate that male asthmatic children were 50% more likely to be current smokers than females [Adjusted Odds Ratio (AOR)=1.5; 95% Confidence Interval (95%C.I.):1.0-2.2]. Those in the oldest age group (≥18 years) were twice as likely as those in the youngest group (≤15 years) to be current smokers (AOR=2.0; 95%C.I.:1.2-3.3), as were White adolescents compared with African-Americans (AOR=2.0; 95%C.I.:1.4-3.0). No significant differences were found between AfricanAmericans and Hispanic adolescents (AOR=1.5; 95%C.I.:0.8-2.6) or between African-Americans and those in the "other" racial/ethnic category (AOR=1.7; 95%C.I.:0.9-3.4). Adolescents reporting a poor general health status were almost 3 times more likely to be currents smokers than those reporting fair general health status (AOR=2.7; 95%C.I.:1.7-4.2). Feeling sad over the past year also significantly increased the odds of being a current nicotine smoker (AOR=1.9; 95%C.I.:1.4-2.8). Based on these results, a significant proportion of U.S. high-school adolescents with asthma smoke, putting themselves (and others through second-hand smoke) at increased risk for deleterious health outcomes, and placing additional demands on the nation's health care system.8, 9, 11 More efforts on the part of health care providers, parents, and the educational system are needed to modify the tobacco risk perceptions and diminish knowledge gaps among asthmatic youth, reduce their likelihood of initiating tobacco use and increase the quit rate among smokers. Considering that the majority of individuals start smoking during their adolescence,12 school-based smoking prevention strategies should be encouraged. Messages must
address the mechanisms involved in delay discounting (i.e., the inability to resist temptation of a smaller immediate reward in lieu of receiving a larger reward at a later date)13 and first-order denial of health risks (i.e., denial of the primary facts of an illness)14. With an estimated 6 million (10% of the total number of high-school students in the US) asthmatic adolescents in the US,15 even limited success in these directions will translate into a considerable economic saving and a longer and better quality of life for those youth who avoid smoking as a result. References 1. Thomson NC, Spears M. The influence of smoking on the treatment response in patients with asthma. Current opinion in allergy and clinical immunology. 2005;5(1):57-63. 2. Krisiukeniene A, Babusyte A, Stravinskaite K, Lotvall J, Sakalauskas R, Sitkauskiene B. Smoking affects eotaxin levels in asthma patients. J Asthma. 2009;46(5):470-476. 3. Marquette CH, Saulnier F, Leroy O, Wallaert B, Chopin C, Demarcq JM, Durocher A, Tonnel AB. Long-term prognosis of near-fatal asthma. A 6-year follow-up study of 145 asthmatic patients who underwent mechanical ventilation for a near-fatal attack of asthma. The American review of respiratory disease. 1992;146(1):76-81. 4. Lange P, Parner J, Vestbo J, Schnohr P, Jensen G. A 15-year follow-up study of ventilatory function in adults with asthma. The New England journal of medicine. 1998;339(17):1194-1200. 5. Chalmers GW, MacLeod KJ, Thomson L, Little SA, McSharry C, Thomson NC. Smoking and airway inflammation in patients with mild asthma. Chest. 2001;120(6):1917-1922. 6. James AL, Palmer LJ, Kicic E, Maxwell PS, Lagan SE, Ryan GF, Musk AW. Decline in lung function in the Busselton Health Study: the effects of asthma and cigarette smoking. American journal of respiratory and critical care medicine. 2005;171(2):109-114. 7. Chalmers GW, Macleod KJ, Little SA, Thomson LJ, McSharry CP, Thomson NC. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax. 2002;57(3):226-230. 8. Mannino DM, Homa DM, Akinbami LJ, Moorman JE, Gwynn C, Redd SC. Surveillance for asthma--United States, 1980-1999. MMWR Surveill Summ. 2002;51(1):1-13. 9. Gilliland FD, Islam T, Berhane K, Gauderman WJ, McConnell R, Avol E, Peters JM. Regular smoking and asthma incidence in adolescents. American journal of respiratory and critical care medicine. 2006;174(10):1094-1100. 10. Brener ND, Kann L, Kinchen SA, Grunbaum JA, Whalen L, Eaton D, Hawkins J, Ross JG. Methodology of the youth risk behavior surveillance system. MMWR Recomm Rep. 2004;53(RR-12):1-13.
11. Baena-Cagnani CE, Gomez RM, Baena-Cagnani R, Canonica GW. Impact of environmental tobacco smoke and active tobacco smoking on the development and outcomes of asthma and rhinitis. Current opinion in allergy and clinical immunology. 2009;9(2):136-140. 12. U.S. Department of Health and Human Services. Preventing Drug Use among Children and Adolescents: A Research-Based Guide for Parents, Educators, and Community Leaders. In: (NIDA). NIoDA, ed. Second ed; 2003. 13. Reynolds B. A review of delay-discounting research with humans: relations to drug use and gambling. Behavioural pharmacology. 2006;17(8):651-667. 14. Weisman A. Denial, coping, and cancer. . In: Edelstein EL ND, Stone AM (eds), ed. Denial: A Clarification of Concepts and Research. New York: Plenum; 1989:251259. 15. Akinbami LJ, Schoendorf KC. Trends in childhood asthma: prevalence, health care utilization, and mortality. Pediatrics. 2002;110(2 Pt 1):315-322.
