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LJAS_A_783063 457..462 Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=ijas20 Journal of Asthma ISSN: 0277-0903 (Print) 1532-4303 (Online) Journal homepage: https://www.tandfonline.com/loi/ijas20 Correlates of Smoking During an Economic Recession Among Parents of Children with Asthma Tracy L. Jackson, Annie Gjelsvik, Aris Garro & Deborah N. Pearlman To cite this article: Tracy L. Jackson, Annie Gjelsvik, Aris Garro & Deborah N. Pearlman (2013) Correlates of Smoking During an Economic Recession Among Parents of Children with Asthma, Journal of Asthma, 50:5, 457-462, DOI: 10.3109/02770903.2013.783063 To link to this article: https://doi.org/10.3109/02770903.2013.783063 Published online: 01 May 2013. 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ISSN: 0277-0903 print/1532-4303 online DOI: 10.3109/02770903.2013.783063 ENVIRONMENTAL DETERMINANTS Correlates of Smoking During an Economic Recession Among Parents of Children with Asthma TRACY L. JACKSON, MPH,1,* ANNIE GJELSVIK, PH.D.,1 ARIS GARRO, MD, MPH,2 AND DEBORAH N. PEARLMAN, PH.D.1 1Department of Epidemiology, Brown University Warren Alpert Medical School, 121 South Main Street S 121-2, 02912 Providence, RI, USA. 2Department of Pediatrics and Emergency Medicine, Brown University Warren Alpert Medical School, 125 Whipple Street, 3rd floor, UEMF Suite, 02908 Providence, RI, USA. Objective.We describe the correlates of smoking among parents who have a child with asthma and examine whether the correlates changed from 2008 to 2010, when the United States experienced a severe recession and a sharp increase in unemployment, a stressor that could influence smoking behavior.Methods. Data are from the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative survey of U.S. adults age 18 and older. Separate logistic regressions estimated the association between unemployment and smoking in 2008 and 2010, adjusting for sociodemographic and other characteristics of parents of a child with asthma. Results. Being unemployedwas a significant predictor of smoking in 2010 (AOR ¼ 1.80; 95% CI: 1.24–2.61), but was not a significant predictor in 2008 (AOR ¼ 1.26, 95% CI: 0.82–1.95). One central component of well-being, as measured by being dissatisfied with one’s life, was significantly associated with parental smoking in 2010 (AOR ¼ 2.06, 95% CI: 1.00–4.27), but not in 2008 (AOR ¼ 1.62, 95% CI: 0.85–3.11). Several covariates had similar associations with parental smoking in both survey years, including low education, not being currently married, not having health insurance, and binge drinking. Conclusions. Our results support the idea that during hard economic times unemployment and related stressors may be strong determinants of parental smoking when a child in the home has asthma. Given that the BFRSS is a cross-sectional survey, definitive conclusions cannot be drawn regarding the causal pathway connecting unemployment, global well-being, and parental smoking. Keywords economic recession, education, employment, mental health, smoking, socioeconomic status, stressor The adverse health effects of exposure to environmental tobacco smoke (ETS) for children with asthma are well known (1–9). Exposure to ETS in children with asthma has been associated with poorer quality of life, reduced lung function, increased asthma-related emergency room visits and hospitalizations, and prolonged recovery after an asthma attack (2, 4, 8, 9). Because children with asthma are adversely affected by ETS exposure, one might expect that parents of children with asthma would be less likely to smoke, yet this is not the case. Parents of children with asthma continue to smoke at levels comparable to the general population of smokers (2, 8). To date, no studies have focused on whether the factors associated with cigar- ette smoking are unique to parents of a child with asthma as compared to the general U.S. adult population. Studies examining risk factors for smoking in the gen- eral adult U.S. population have found that smoking is associated with low socioeconomic status (SES), depres- sive symptoms, and parental and peer smoking (10–16). Low SES, either measured through educational attainment or income, is the strongest predictor (10–16). Another strong predictor of smoking is poor mental health, as smoking has been found to occur at higher rates among individuals with anxiety and depression (17–24). Unemployment has also been associated with increased smoking rates in both cross-sectional (25) and longitudinal studies (26, 27). This is consistent with previous literature suggesting that unemployment itself can be a stressor and may serve as a proxy measure for otherwise unmeasured social and economic strain. However, unemployment also has been associated with decreased cigarette consumption as smokers seek to balance their budgets when faced with job loss (28). In the present study, we examined mental health mea- sures, employment status, and SES in relation to parental smoking. We also were interested in investigating whether these factors differed at two points in time—in 2008 as the U.S. economy entered a recession, and in 2010 after the U.S. went through one of its longest and most severe recessions since the Great Depression of the 1930s (29). METHODS Study Design Data are from the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is a state-based random-digit-dialed telephone survey of the noninstitutiona- lized U.S. civilian population aged �18 years (30). The *Corresponding author: Tracy L. Jackson, MPH, Department of Epidemiology, Brown University Warren Alpert Medical School, 121 South Main Street S 121-2, 02912 Providence, RI, USA; Tel: (516) 557-3744; E-mail: [email protected] 457 sample obtained in 2010 was independent of the sample in 2008 as the BRFSS are serial cross-sectional surveys. The BRFSS Childhood Asthma optional module was utilized by 37 states/territories in 2008 and 35 states/terri- tories in 2010. Two asthma prevalence measures are asked about a randomly selected child in the household aged 17 years or younger. Current asthma is determined from the response, “Does the child still have [diagnosed] asthma?” Eligibility study criteria for the study included the fol- lowing: respondent was a parent/guardian of a child who lived in their home, the child in the home (one child was randomly selected if the parent reported having more than one) had current doctor-diagnosed asthma and was between 2 and 17 years of age, and the parent had valid information on smoking and employment status. The total number of BRFSS respondents in 2008 was 414,509, of which 69,814 were parents/guardians of a child who lived in their home. Of this sample of parents/guardians, 5811 reported that their randomly selected child had current doctor-diagnosed asthma (8.3%), 5426 of which were chil- dren 2–17 years of age. After respondents with missing data on smoking status and employment status were excluded, the final analytic sample for 2008 was 4244. The total number of BRFSS respondents in 2010 was 451,075, of which 78,619 were parents/guardians of a child who lived in their home. Of this sample of parents/ guardians, 5155 reported that their randomly selected child had current doctor-diagnosed asthma (6.6%), 4818 of which were children 2–17 years of age. The final analytic sample for 2010 was 3601, after excluding respondents with missing data on smoking and employment status. Measures Current smoking was measured by whether the parent or guardian of a child in the home with asthma currently smoked (yes/no). SES was measured according to parents’ educational level (<12th grade,="" high="" school="" graduate,="" some="" college="" or="" college="" graduate),="" rather="" than="" household="" income.="" income="" may="" be="" problematic="" as="" an="" indicator="" of="" ses,="" since="" income="" can="" fluctuate="" over="" the="" life="" course,="" unlike="" education,="" which="" is="" more="" stable="" beyond="" early="" adulthood="" (31).="" furthermore,="" brfss="" response="" rates="" tend="" to="" be="" higher="" for="" educational="" attainment="" (,99%),="" unlike="" household="" income,="" which="" typically="" has="" lower="" response="" rates="" (,93%)="" and="" consequently="" higher="" response="" bias.="" in="" addi-="" tion="" to="" educational="" status,="" health="" insurance="" was="" included="" as="" a="" proxy="" for="" access="" to="" care="" and="" potential="" tobacco="" cessation="" counseling.="" marital="" status="" was="" defined="" as="" either="" married="" or="" unmarried.="" we="" also="" included="" a="" measure="" of="" binge="" drinking,="" given="" that="" binge="" drinking="" is="" the="" most="" common="" pattern="" of="" excessive="" alcohol="" use="" in="" the="" united="" states="" (32),="" and="" alcohol="" and="" tobacco="" use="" often="" co-occur="" in="" the="" general="" adult="" u.s.="" population="" (33).="" binge="" drinkers="" were="" defined="" as="" men="" who="" reported="" consuming="" five="" or="" more="" drinks="" or="" females="" who="" reported="" consuming="" four="" or="" more="" drinks="" in="" one="" sitting="" on="" one="" or="" more="" occasions="" in="" the="" past="" 30="" days.="" psychosocial="" stress="" was="" assessed="" through="" self-reported="" global="" life="" satisfaction,="" receipt="" of="" emotional="" and="" social="" support,="" and="" frequency="" of="" mental="" distress.="" the="" centers="" for="" disease="" control="" and="" prevention="" (cdc)="" assesses="" global="" well-="" being="" with="" two="" valid="" measures—life="" satisfaction="" and="" emo-="" tional="" support="" received.="" the="" cdc="" also="" supports="" frequency="" of="" mental="" distress="" as="" a="" measure="" of="" health-related="" quality="" of="" life="" with="" acceptable="" criterion="" validity="" and="" test–retest="" reliability="" (34–36).="" questions="" measuring="" psychosocial="" stress="" in="" the="" 2008="" and="" 2010="" brfss="" included="" the="" following:="" “in="" general,="" how="" satisfied="" are="" you="" with="" your="" life?”="" (very="" satisfied,="" satis-="" fied,="" dissatisfied/very="" dissatisfied),="" “howoften="" do="" you="" get="" the="" social="" and="" emotional="" support="" you="" need?”="" (always/often,="" sometimes/rarely/never),="" and="" “now="" thinking="" about="" your="" mental="" health,="" which="" includes="" stress,="" depression,="" and="" pro-="" blems="" with="" emotions,="" for="" how="" many="" days="" during="" the="" past="" 30="" days="" was="" your="" mental="" health="" not="" good?”="" (0="" days,="" 1–13="" days,="" 14="" or="" more="" days).="" cdc="" measures="" the="" prevalence="" of="" poor="" mental="" health="" based="" on="" number="" of="" mentally="" unhealthy="" days.="" respondents="" who="" report�14="" mentally="" unhealthy="" days="" over="" the="" past="" month="" are="" defined="" as="" having="" frequent="" mental="" distress="" (34,="" 35,="" 37).="" the="" 14-day="" minimum="" period="" also="" was="" used="" because="" clinicians="" and="" researchers="" often="" use="" this="" period="" as="" a="" marker="" for="" clinical="" depression.="" adopting="" this="" precedent="" ensured="" comparability="" with="" other="" studies="" looking="" at="" poor="" mental="" health="" based="" on="" frequent="" mental="" distress="" (�14="" days)="" in="" relation="" to="" health="" outcomes.="" unemployment="" can="" be="" a="" significant="" source="" of="" stress.="" financial="" strain,="" stigma="" of="" job="" loss,="" and="" uncertainty="" about="" the="" future="" may="" be="" particularly="" prevalent="" during="" an="" eco-="" nomic="" recession.="" in="" the="" current="" study,="" employment="" status="" was="" defined="" as="" either="" employed="" or="" unemployed.="" respondents="" who="" were="" homemakers,="" retired,="" students,="" or="" unable="" to="" work="" were="" excluded="" from="" both="" sample="" years.="" statistical="" analysis="" sampling="" weights="" that="" correct="" for="" unequal="" probabilities="" of="" sample="" selection="" and="" adjust="" for="" nonresponse="" and="" telephone="" noncoverage="" were="" applied="" to="" the="" brfss="" adult="" samples="" to="" obtain="" a="" nationally="" representative="" sample="" of="" parents="" with="" a="" child="" in="" the="" home="" with="" asthma="" (38).="" separate="" logistic="" regressions="" estimated="" the="" associations="" between="" unemployment="" and="" smoking="" in="" 2008="" and="" 2010,="" adjusting="" for="" the="" same="" covariates="" in="" each="" model.="" an="" inter-="" action="" term="" between="" current="" smoking="" and="" survey="" year="" assessed="" statistically="" significant="" differences="" in="" unemploy-="" ment="" by="" time="" period.="" since="" the="" interaction="" term="" was="" not="" significant="" in="" the="" logistic="" regressions="" in="" either="" survey="" year,="" it="" was="" dropped="" from="" each="" model.="" results="" the="" rates="" of="" smoking="" among="" parents="" of="" children="" with="" asthma="" were="" similar="" across="" the="" two="" study="" years.="" in="" 2008,="" 20.0%="" of="" parents="" were="" smokers,="" compared="" to="" 17.8%="" in="" 2010="" (table="" 1).="" there="" were="" no="" significant="" differences="" between="" the="" two="" sample="" populations="" by="" socio-="" demographic="" and="" health="" characteristics="" or="" in="" rates="" of="" unem-="" ployment.="" the="" only="" significant="" difference="" between="" the="" two="" periods="" was="" the="" substantial="" increase="" in="" the="" proportion="" of="" 458="" t.="" l.="" jackson="" et="" al.="" parents="" without="" health="" insurance,="" from="" 12.0%="" in="" 2008="" to="" 16.6%="" in="" 2010="" (p="">< .01; table 1). there was no significant difference in the proportion of children with current asthma by age, sex, or race/ethnicity across the two study periods (data not shown). the average age of children in 2008 was 10.3 years (95% confidence interval (ci): 10.1– 10.5) and 10.2 years in 2010 (95% ci: 9.9–10.5). in 2008, unemployment was not significantly asso- ciated with parental smoking [adjusted odds ratios (aor) ¼ 1.26, 95% ci: 0.82–1.95], but in 2010 this association was significant (aor ¼ 1.80, 95% ci: 1.24– 2.61). dissatisfaction with one’s life was not a significant predictor of smoking in 2008. in 2010, parents who reported being either satisfied with life or dissatisfied with life were more likely to smoke compared to those who reported being very satisfied with life (table 2). several covariates had similar associations with paren- tal smoking in both survey years. the aor for smoking among those with less than a high school level of education were 4.10 (95% ci: 2.46–6.84) in 2008 and 4.81 (95% ci: 2.82–8.22) in 2010. reporting frequent mental distress (14 or more days of poor mental health in the last month), not being currently married, and being a binge drinker also were positively associated with smoking in both study years. hispanic ethnicity was negatively associated with parental smoking in both 2008 and 2010. there were no significant associations between smoking and not getting social and emotional support needed in either study year. discussion the results of this study confirm previous findings in the literature regarding the relationship between unemployment and smoking in cross-sectional and longitudinal studies where the unemployed were more likely to smoke than the employed or the general population of adults (25–27, 39–42). the study adds to the previous literature by showing that a table 2.—adjusted odds ratio in logistic regressionmodel for predictors of current smoking .01;="" table="" 1).="" there="" was="" no="" significant="" difference="" in="" the="" proportion="" of="" children="" with="" current="" asthma="" by="" age,="" sex,="" or="" race/ethnicity="" across="" the="" two="" study="" periods="" (data="" not="" shown).="" the="" average="" age="" of="" children="" in="" 2008="" was="" 10.3="" years="" (95%="" confidence="" interval="" (ci):="" 10.1–="" 10.5)="" and="" 10.2="" years="" in="" 2010="" (95%="" ci:="" 9.9–10.5).="" in="" 2008,="" unemployment="" was="" not="" significantly="" asso-="" ciated="" with="" parental="" smoking="" [adjusted="" odds="" ratios="" (aor)="" ¼="" 1.26,="" 95%="" ci:="" 0.82–1.95],="" but="" in="" 2010="" this="" association="" was="" significant="" (aor="" ¼="" 1.80,="" 95%="" ci:="" 1.24–="" 2.61).="" dissatisfaction="" with="" one’s="" life="" was="" not="" a="" significant="" predictor="" of="" smoking="" in="" 2008.="" in="" 2010,="" parents="" who="" reported="" being="" either="" satisfied="" with="" life="" or="" dissatisfied="" with="" life="" were="" more="" likely="" to="" smoke="" compared="" to="" those="" who="" reported="" being="" very="" satisfied="" with="" life="" (table="" 2).="" several="" covariates="" had="" similar="" associations="" with="" paren-="" tal="" smoking="" in="" both="" survey="" years.="" the="" aor="" for="" smoking="" among="" those="" with="" less="" than="" a="" high="" school="" level="" of="" education="" were="" 4.10="" (95%="" ci:="" 2.46–6.84)="" in="" 2008="" and="" 4.81="" (95%="" ci:="" 2.82–8.22)="" in="" 2010.="" reporting="" frequent="" mental="" distress="" (14="" or="" more="" days="" of="" poor="" mental="" health="" in="" the="" last="" month),="" not="" being="" currently="" married,="" and="" being="" a="" binge="" drinker="" also="" were="" positively="" associated="" with="" smoking="" in="" both="" study="" years.="" hispanic="" ethnicity="" was="" negatively="" associated="" with="" parental="" smoking="" in="" both="" 2008="" and="" 2010.="" there="" were="" no="" significant="" associations="" between="" smoking="" and="" not="" getting="" social="" and="" emotional="" support="" needed="" in="" either="" study="" year.="" discussion="" the="" results="" of="" this="" study="" confirm="" previous="" findings="" in="" the="" literature="" regarding="" the="" relationship="" between="" unemployment="" and="" smoking="" in="" cross-sectional="" and="" longitudinal="" studies="" where="" the="" unemployed="" were="" more="" likely="" to="" smoke="" than="" the="" employed="" or="" the="" general="" population="" of="" adults="" (25–27,="" 39–42).="" the="" study="" adds="" to="" the="" previous="" literature="" by="" showing="" that="" a="" table="" 2.—adjusted="" odds="" ratio="" in="" logistic="" regressionmodel="" for="" predictors="" of="" current="">
Answered 3 days AfterNov 17, 2022

Answer To: LJAS_A_ XXXXXXXXXXFull Terms & Conditions of access and use can be found...

Banasree answered on Nov 21 2022
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