Adolescent Tobacco Smoke Exposure, Respiratory Symptoms, and Emergency Department Use

Pediatrics. 2018 Sep;142(3):e20180266. doi: 10.1542/peds.2018-0266. Epub 2018 Aug 6.


Objectives: Our objective was to examine the relationship between distinct tobacco smoke exposure (TSE) measures and TSE-related symptoms and emergency department (ED) and/or urgent care (UC) use among nonsmoking adolescents without asthma diagnoses.

Methods: We performed a secondary analysis of 7389 adolescents who completed the Population Assessment of Tobacco and Health Study wave 2. Logistic regression and Poisson regression models were built.

Results: Adolescents with TSE were at increased risk of reporting: shortness of breath, finding it hard to exercise, wheezing during or after exercise, and dry cough at night. Adolescents who lived with a smoker and had home TSE were at increased odds of reporting wheezing or whistling in the chest, and only adolescents with home TSE were at increased risk of reporting wheezing that disturbed sleep. Adolescents with TSE were less likely to report very good or excellent overall health and physical health but were more likely to report they sometimes, often, or very often missed school because of illness. Participants who lived with a smoker and had TSE ≥1 hour were more likely to have had an ED and/or UC visit. Participants with any TSE were at increased risk of having a higher number of ED and/or UC visits.

Conclusions: Different TSE measures uniquely increased the risk of TSE-related symptoms, but any TSE increased the risk of having a higher number of ED and/or UC visits. The providers at these high-volume settings should offer interventions to adolescents who are exposed to tobacco smoke and their families to decrease these symptoms and related morbidity.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Ambulatory Care / statistics & numerical data*
  • Child
  • Cohort Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Respiratory Tract Diseases / epidemiology*
  • Respiratory Tract Diseases / etiology
  • Risk Factors
  • Tobacco Smoke Pollution / adverse effects*
  • United States / epidemiology


  • Tobacco Smoke Pollution