{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T17:00:04Z","timestamp":1768582804838,"version":"3.49.0"},"reference-count":45,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,2,1]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVE:<\/jats:title><jats:p>A better understanding of how poverty-related hardships affect child health could highlight remediable intervention targets. Tobacco smoke exposure may be 1 such consequence of family hardship. Our objective was to explore the relationship between family hardships and tobacco exposure, as measured by serum cotinine, a tobacco metabolite, among children hospitalized for asthma.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We prospectively enrolled a cohort of 774 children, aged 1 to 16 years, admitted for asthma or bronchodilator-responsive wheezing. The primary outcome was detectable serum cotinine. We assessed family hardships, including 11 financial and social variables, through a survey of the child\u2019s caregiver. We used logistic regression to evaluate associations between family hardship and detectable cotinine.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>We had complete study data for 675 children; 57% were African American, and 74% were enrolled in Medicaid. In total, 56% of children had detectable cotinine. More than 80% of families reported \u22651 hardship, and 41% reported \u22654 hardships. Greater numbers of hardships were associated with greater odds of having detectable cotinine. Compared with children in families with no hardships, those in families with \u22654 hardships had 3.7-fold (95% confidence interval, 2.0\u20137.0) greater odds of having detectable serum cotinine in adjusted analyses. Lower parental income and educational attainment were also independently associated with detectable serum cotinine.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>Family hardships are prevalent and associated with detectable serum cotinine level among children with asthma. Family hardships and tobacco smoke exposure may be possible targets for interventions to reduce health disparities.<\/jats:p><\/jats:sec>","DOI":"10.1542\/peds.2014-1748","type":"journal-article","created":{"date-parts":[[2015,1,13]],"date-time":"2015-01-13T03:26:31Z","timestamp":1421119591000},"page":"e416-e423","source":"Crossref","is-referenced-by-count":16,"title":["Family Hardships and Serum Cotinine in Children With Asthma"],"prefix":"10.1542","volume":"135","author":[{"given":"Adam J.","family":"Spanier","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Penn State Milton S. Hershey Children\u2019s Hospital, Hershey, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew F.","family":"Beck","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bin","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan E.","family":"McGrady","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis D.","family":"Drotar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy W. A.","family":"Peake","sequence":"additional","affiliation":[{"name":"Clinical Epidemiologic Research Laboratory, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark D.","family":"Kellogg","sequence":"additional","affiliation":[{"name":"Clinical Epidemiologic Research Laboratory, Boston Children\u2019s Hospital, Boston, Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert S.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Cincinnati Children\u2019s Hospital Medical Center, Ohio; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2015,2,1]]},"reference":[{"issue":"3 pt 2","key":"2021120907011583200_B1","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1542\/peds.112.S3.704","article-title":"Social, economic, and political determinants of child health.","volume":"112","author":"Spencer","year":"2003","journal-title":"Pediatrics"},{"issue":"4","key":"2021120907011583200_B2","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1542\/peds.2005-1647","article-title":"Cumulative social disadvantage and child health.","volume":"117","author":"Bauman","year":"2006","journal-title":"Pediatrics"},{"issue":"2","key":"2021120907011583200_B3","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1542\/peds.2007-0447","article-title":"Influence of multiple social risks on children\u2019s health.","volume":"121","author":"Larson","year":"2008","journal-title":"Pediatrics"},{"issue":"5","key":"2021120907011583200_B4","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2009-1078","article-title":"Cumulative hardship and wellness of low-income, young children: multisite surveillance study.","volume":"125","author":"Frank","year":"2010","journal-title":"Pediatrics"},{"issue":"5","key":"2021120907011583200_B5","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1093\/jpepsy\/jsl050","article-title":"Multiple urban and asthma-related risks and their association with asthma morbidity in children.","volume":"32","author":"Koinis-Mitchell","year":"2007","journal-title":"J Pediatr Psychol"},{"issue":"3","key":"2021120907011583200_B6","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1542\/peds.106.3.512","article-title":"Barriers to asthma care in urban children: parent perspectives.","volume":"106","author":"Mansour","year":"2000","journal-title":"Pediatrics"},{"issue":"5","key":"2021120907011583200_B7","doi-asserted-by":"crossref","first-page":"831s","DOI":"10.1378\/chest.07-1911","article-title":"Inner-city asthma: the role of the community.","volume":"132","author":"Persky","year":"2007","journal-title":"Chest"},{"key":"2021120907011583200_B8","doi-asserted-by":"crossref","first-page":"s174","DOI":"10.1542\/peds.2008-2233H","article-title":"Social determinants: taking the social context of asthma seriously.","volume":"123","author":"Williams","year":"2009","journal-title":"Pediatrics"},{"issue":"2","key":"2021120907011583200_B9","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/j.jpeds.2013.01.064","article-title":"Inequalities in neighborhood child asthma admission rates and underlying community characteristics in one US county.","volume":"163","author":"Beck","year":"2013","journal-title":"J Pediatr"},{"issue":"9","key":"2021120907011583200_B10","doi-asserted-by":"crossref","first-page":"e940","DOI":"10.1371\/journal.pone.0000940","article-title":"Children\u2019s health status: examining the associations among income poverty, material hardship, and parental factors.","volume":"2","author":"Ashiabi","year":"2007","journal-title":"PLoS ONE"},{"issue":"10","key":"2021120907011583200_B11","doi-asserted-by":"crossref","first-page":"842","DOI":"10.1136\/jech.2005.036301","article-title":"Maternal education, lone parenthood, material hardship, maternal smoking, and longstanding respiratory problems in childhood: testing a hierarchical conceptual framework.","volume":"59","author":"Spencer","year":"2005","journal-title":"J Epidemiol Community Health"},{"issue":"5","key":"2021120907011583200_B12","doi-asserted-by":"crossref","first-page":"679","DOI":"10.1111\/j.1365-2214.2010.01185.x","article-title":"From financial hardship to child difficulties: main and moderating effects of perceived social support.","volume":"37","author":"McConnell","year":"2011","journal-title":"Child Care Health Dev"},{"issue":"1","key":"2021120907011583200_B13","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1542\/peds.2010-2046","article-title":"Tobacco-smoke exposure in children who live in multiunit housing.","volume":"127","author":"Wilson","year":"2011","journal-title":"Pediatrics"},{"issue":"35","key":"2021120907011583200_B14","first-page":"1141","article-title":"Vital signs: nonsmokers\u2019 exposure to secondhand smoke\u2014United States, 1999\u20132008.","volume":"59","author":"Centers for Disease Control and Prevention (CDC)","year":"2010","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"35","key":"2021120907011583200_B15","first-page":"1135","article-title":"Vital signs: current cigarette smoking among adults aged &gt; or = 18 years\u2014United States, 2009.","volume":"59","author":"Centers for Disease Control and Prevention","year":"2010","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"2021120907011583200_B16","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2013-2422","article-title":"Cotinine in children admitted for asthma and readmission.","volume":"133","author":"Howrylak","year":"2014","journal-title":"Pediatrics"},{"issue":"2","key":"2021120907011583200_B17","doi-asserted-by":"crossref","DOI":"10.1542\/peds.101.2.e8","article-title":"The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third National Health and Nutrition Examination Survey, 1988 to 1994.","volume":"101","author":"Gergen","year":"1998","journal-title":"Pediatrics"},{"issue":"1","key":"2021120907011583200_B18","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1001\/archpedi.155.1.36","article-title":"Health effects related to environmental tobacco smoke exposure in children in the United States: data from the Third National Health and Nutrition Examination Survey.","volume":"155","author":"Mannino","year":"2001","journal-title":"Arch Pediatr Adolesc Med"},{"issue":"1","key":"2021120907011583200_B19","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1093\/eurpub\/ckn114","article-title":"Socioeconomic determinants of children\u2019s environmental tobacco smoke exposure and family\u2019s home smoking policy.","volume":"19","author":"Bolte","year":"2009","journal-title":"Eur J Public Health"},{"issue":"7","key":"2021120907011583200_B20","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1289\/ehp.0901232","article-title":"Childhood incident asthma and traffic-related air pollution at home and school.","volume":"118","author":"McConnell","year":"2010","journal-title":"Environ Health Perspect"},{"issue":"6","key":"2021120907011583200_B21","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.jaci.2009.02.043","article-title":"Addressing asthma health disparities: a multilevel challenge","volume":"123","author":"Canino","year":"2009","journal-title":"J Allergy Clin Immunol"},{"issue":"4","key":"2021120907011583200_B22","doi-asserted-by":"crossref","first-page":"702","DOI":"10.2105\/AJPH.2009.172676","article-title":"Financial strain and smoking cessation among racially\/ethnically diverse smokers.","volume":"100","author":"Kendzor","year":"2010","journal-title":"Am J Public Health"},{"key":"2021120907011583200_B23","unstructured":"Ouellette T, Burstein N, Long D, Beecroft E. Measures of material hardship: final report. US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. 2004. Available at: http:\/\/aspehhsgov\/hsp\/material-hardship04\/indexhtm. Accessed June 1, 2014"},{"issue":"1","key":"2021120907011583200_B24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1037\/0278-6133.22.1.12","article-title":"Predictors of repeat hospitalizations in children with asthma: the role of psychosocial and socioenvironmental factors.","volume":"22","author":"Chen","year":"2003","journal-title":"Health Psychol"},{"issue":"3\u20134","key":"2021120907011583200_B25","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1080\/13547500310012545","article-title":"Clinical considerations in study designs that use cotinine as a biomarker.","volume":"8","author":"Bramer","year":"2003","journal-title":"Biomarkers"},{"issue":"1","key":"2021120907011583200_B26","doi-asserted-by":"crossref","first-page":"88","DOI":"10.2307\/145934","article-title":"Poverty and the distribution of material hardship.","volume":"24","author":"Jencks","year":"1989","journal-title":"J Hum Resour"},{"issue":"1","key":"2021120907011583200_B27","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1111\/j.1745-6606.2000.tb00081.x","article-title":"Work, income, and material hardship after welfare reform.","volume":"34","author":"Danziger","year":"2000","journal-title":"J Consum Aff"},{"issue":"3","key":"2021120907011583200_B28","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1542\/peds.2013-2437","article-title":"Role of financial and social hardships in asthma racial disparities.","volume":"133","author":"Beck","year":"2014","journal-title":"Pediatrics"},{"issue":"7","key":"2021120907011583200_B29","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1111\/add.12143","article-title":"A life-course perspective on economic stress and tobacco smoking: a population-based study.","volume":"108","author":"Lindstr\u00f6m","year":"2013","journal-title":"Addiction"},{"issue":"1","key":"2021120907011583200_B30","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.biopsycho.2012.12.007","article-title":"Stress response dysregulation and stress-induced analgesia in nicotine dependent men and women.","volume":"93","author":"al\u2019Absi","year":"2013","journal-title":"Biol Psychol"},{"issue":"1","key":"2021120907011583200_B31","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1007\/s00213-010-2150-y","article-title":"Effect of social stress during acute nicotine abstinence.","volume":"218","author":"Wardle","year":"2011","journal-title":"Psychopharmacology (Berl)"},{"issue":"4","key":"2021120907011583200_B32","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1016\/j.healthplace.2007.03.001","article-title":"Disadvantaged mothers, young children and smoking in the home: mothers\u2019 use of space within their homes.","volume":"13","author":"Robinson","year":"2007","journal-title":"Health Place"},{"issue":"11","key":"2021120907011583200_B33","doi-asserted-by":"crossref","first-page":"1056","DOI":"10.1001\/archpediatrics.2008.2","article-title":"Increased rates and severity of child and adult food insecurity in households with adult smokers.","volume":"162","author":"Cutler-Triggs","year":"2008","journal-title":"Arch Pediatr Adolesc Med"},{"key":"2021120907011583200_B34","first-page":"CD000214","article-title":"Training health professionals in smoking cessation.","volume":"5","author":"Carson","year":"2012","journal-title":"Cochrane Database Syst Rev"},{"key":"2021120907011583200_B35","first-page":"CD001188","article-title":"Nursing interventions for smoking cessation.","volume":"8","author":"Rice","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"issue":"1","key":"2021120907011583200_B36","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1542\/peds.2010-3209","article-title":"Parental smoking cessation to protect young children: a systematic review and meta-analysis.","volume":"129","author":"Rosen","year":"2012","journal-title":"Pediatrics"},{"issue":"1","key":"2021120907011583200_B37","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/1747-597X-8-12","article-title":"Factors associated with self-assessed increase in tobacco consumption among over-indebted individuals in Germany: a cross-sectional study.","volume":"8","author":"Rueger","year":"2013","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"2021120907011583200_B38","article-title":"Does social support buffer the effect of financial strain on the trajectory of smoking in older Japanese? A 19-year longitudinal study","author":"Murayama","journal-title":"J Gerontol B Psychol Sci Soc Sci"},{"issue":"6","key":"2021120907011583200_B39","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1007\/s10865-009-9226-3","article-title":"Pathways between socioeconomic status and modifiable risk factors among African American smokers.","volume":"32","author":"Kendzor","year":"2009","journal-title":"J Behav Med"},{"issue":"2","key":"2021120907011583200_B40","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1177\/1745691612436694","article-title":"\u201cShift-and-persist\u201d strategies: why being low in socioeconomic status isn\u2019t always bad for health.","volume":"7","author":"Chen","year":"2012","journal-title":"Perspect Psychol Sci"},{"issue":"7","key":"2021120907011583200_B41","doi-asserted-by":"crossref","DOI":"10.1007\/s10826-012-9663-4","article-title":"SHS-related pediatric sick visits are linked to maternal depressive symptoms among low-income African American smokers: an opportunity for intervention in pediatrics.","volume":"22","author":"Collins","year":"2013","journal-title":"J Child Fam Stud"},{"issue":"1","key":"2021120907011583200_B42","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1177\/2150131912442898","article-title":"Testing of a web-based program to facilitate parental smoking cessation readiness in primary care.","volume":"4","author":"Gillaspy","year":"2013","journal-title":"J Prim Care Community Health"},{"issue":"2","key":"2021120907011583200_B43","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1097\/PSY.0b013e31824206fd","article-title":"Protective factors for adults from low-childhood socioeconomic circumstances: the benefits of shift-and-persist for allostatic load.","volume":"74","author":"Chen","year":"2012","journal-title":"Psychosom Med"},{"issue":"7","key":"2021120907011583200_B44","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1056\/NEJMsa0806819","article-title":"A randomized, controlled trial of financial incentives for smoking cessation.","volume":"360","author":"Volpp","year":"2009","journal-title":"N Engl J Med"},{"issue":"4","key":"2021120907011583200_B45","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.cbpra.2011.11.001","article-title":"Motivation and problem solving (MAPS): motivationally based skills training for treating substance use.","volume":"20","author":"Vidrine","year":"2013","journal-title":"Cognit Behav Pract"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/135\/2\/e416\/1058381\/peds_2014-1748.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/135\/2\/e416\/1058381\/peds_2014-1748.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T17:29:58Z","timestamp":1650994198000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/135\/2\/e416\/33443\/Family-Hardships-and-Serum-Cotinine-in-Children"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,2,1]]},"references-count":45,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2015,2,1]]},"published-print":{"date-parts":[[2015,2,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2014-1748","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,2,1]]}}}