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Environmental Tobacco Smoke Exposure and Child Behaviors

Yolton, Kimberly, PhD*; Khoury, Jane, PhD; Hornung, Richard, DrPH*; Dietrich, Kim, PhD; Succop, Paul, PhD; Lanphear, Bruce, MD, MPH*

Journal of Developmental & Behavioral Pediatrics: December 2008 - Volume 29 - Issue 6 - p 450-457
doi: 10.1097/DBP.0b013e31818d0c21
Original Article

Rationale: Emerging evidence suggests that exposure to environmental tobacco smoke (ETS) may be linked with behavior problems in childhood, but previous research has relied primarily on parent report of exposure, and results are inconclusive.

Objectives: To investigate the relationship between exposure to ETS and child behavior problems among children with asthma.

Methods: The sample included 220 children who were enrolled in an asthma intervention trial and regularly exposed to ETS at home. Serum cotinine was used to measure exposure to tobacco smoke, and behavior problems were assessed by parent report on the Behavior Assessment System for Children. Covariates in adjusted analyses included: sex, age, race, asthma severity, asthma medication, maternal education, prenatal tobacco exposure, maternal depression, and Home Observation for Measurement of the Environment score.

Results: Child behavior problems increased with increasing exposure to ETS. A stratified analysis of boys and girls separately indicated higher exposure among girls, but behavior problems were statistically significantly associated with exposure only in boys. Increasing behavior problems included externalizing behavior problems (β = 2.23, p = .02) such as hyperactivity and aggression, internalizing behavior problems (β = 2.19, p = .01) such as depression, and behavior symptoms (β = 2.55, p = .01).

Conclusions: Among children with asthma, exposure to ETS is related to increased child behavior problems among boys.

From the *Department of Pediatrics, Division of General and Community Pediatrics; †Department of Pediatrics, Center for Epidemiology and Biostatistics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; and ‡Department of Environmental Health, University of Cincinnati, Cincinnati, OH.

Received January 2008; accepted July 2008.

This project was supported by Grants from the National Institutes of Health: NIEHS R21 ES12952-01 and NHLBI R01 HL65731.

Address for reprints: Kimberly Yolton, Ph.D., Division of General and Community Pediatrics, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, ML 7035, Cincinnati, OH 45229-3039; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.