ADULT HOUSEHOLD SMOKING IS ASSOCIATED WITH INCREASED CHILD EMOTIONAL AND BEHAVIORAL PROBLEMS

Context: While maternal smoking has been associated with child emotional and behavioral problems, to our knowledge, no study has evaluated the association between overall household smoking and such problems. Objectives: To investigate whether children who live with smokers are more likely than children who do not live with smokers to have emotional and behavioral problems, and to explore this association in households with non-smoking mothers. Design, Setting, and Participants: Nationally representative data from the 2000-2004 Medical Expenditure Panel Surveys, involving 30 668 children aged 5-17 years, were utilized. Associations between child emotional and behavioral problems, household smoking, child, maternal and family characteristics, were examined. SUDAAN software was used to adjust for complex sampling design. Main Outcome Measures: Overall score on the Columbia Impairment Scale (CIS), a 13 item parent-report measure of child emotional and behavioral functioning (range, 0-52). Results: Children in smoking vs. non-smoking households had significantly higher mean total CIS scores (7.78 vs.5.75, P<0.001), as well as higher mean scores on each of the 13 CIS items, indicating worse behavioral and emotional functioning. After adjusting for all covariates, male sex, older age of child, younger age of mother, un- married mother, maternal depression, below average maternal physical and mental health each were independently associated with increased likelihood of emotional and behavioral problems (CIS?16), as was the presence of one or more adult smokers in the household (Adjusted OR 1.42; 95% CI:1.26-1.60). The odds of CIS?16 increased with increasing number of smokers in the household, even among children whose mothers did not smoke. Conclusion: Children living with smokers are at increased risk for emotional and behavioral problems, and rates of such problems increase with increasing numbers of smokers in the household, even in the absence of maternal smoking.

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