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J Hosp Med. 2019 Apr;14(4):212-217. doi: 10.12788/jhm.3164.

Home Smoke Exposure and Health-Related Quality of Life in Children with Acute Respiratory Illness.

Author information

Division of Hospital Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt, Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee.
Division of General Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai, New York, New York.
Department of Pediatrics, University of Washington and the Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington.
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia and the Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.
Division of General Pediatrics and Hospital Medicine, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington.
Section of Pediatric Hospital Medicine, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.



This study aims to assess whether secondhand smoke (SHS) exposure has an impact on health-related quality of life (HRQOL) in children with acute respiratory illness (ARI).


This study was nested within a multicenter, prospective cohort study of children (two weeks to 16 years) with ARI (emergency department visits for croup and hospitalizations for croup, asthma, bronchiolitis, and pneumonia) between July 1, 2014 and June 30, 2016. Subjects were surveyed upon enrollment for sociodemographics, healthcare utilization, home SHS exposure (0 or ≥1 smoker in the home), and child HRQOL (Pediatric Quality of Life Physical Functioning Scale) for both baseline health (preceding illness) and acute illness (on admission). Data on insurance status and medical complexity were collected from the Pediatric Hospital Information System database. Multivariable linear mixed regression models examined associations between SHS exposure and HRQOL.


Home SHS exposure was reported in 728 (32%) of the 2,309 included children. Compared with nonexposed children, SHS-exposed children had significantly lower HRQOL scores for baseline health (mean difference -3.04 [95% CI -4.34, -1.74]) and acute illness (-2.16 [-4.22, -0.10]). Associations were strongest among children living with two or more smokers. HRQOL scores were lower among SHS-exposed children for all four conditions but only significant at baseline for bronchiolitis (-2.94 [-5.0, -0.89]) and pneumonia (-4.13 [-6.82, -1.44]) and on admission for croup (-5.71 [-10.67, -0.75]).


Our study demonstrates an association between regular SHS exposure and decreased HRQOL with a dose-dependent response for children with ARI, providing further evidence of the negative impact of SHS.


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