Secondhand Tobacco Smoke Exposure and Severity of Influenza in Hospitalized Children

Published:August 06, 2012DOI:


      To assess whether children with influenza who are exposed to secondhand tobacco smoke (SHS) would have more severe illness than those not exposed.

      Study design

      We abstracted charts from pediatric inpatients with confirmed influenza from 2002-2009 for demographics, medical history, and smoke exposure. Severity indicators included intensive care, intubation, and length of stay (LOS) in the hospital; potential confounding factors included demographics and the presence of asthma or chronic conditions. All χ 2, t tests, and regression analyses were run using SPSS v. 18.0.


      Of 117 children, 40% were exposed to SHS, who had increased need for intensive care (30% vs 10%, P < .01) and intubation (13% vs 1%, P < .05), and had longer LOS (4.0 vs 2.4 days, P < .01). Children with chronic conditions and SHS exposure required more intensive care (53% vs 18%, P < .05) and had longer LOS (10.0 vs 3.5 days, P < .01) than children not exposed to SHS with chronic conditions. In multivariate analyses controlling for potential confounding factors, children with SHS exposure were 4.7 times more likely to be admitted to intensive care (95% CI 1.4-18.5) and had a 70% longer LOS (95% CI 12%-230%).


      Children with SHS exposure who are hospitalized with influenza have more severe illness. Efforts are needed to immunize this population against influenza, and eliminate children's exposure to SHS.
      ED ( Emergency Department), LOS ( Length of stay), PICU ( Pediatric Intensive Care Unit), SHS ( Secondhand tobacco smoke)
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      Linked Article

      • Secondhand Smoke and Influenza Severity in Children: Another Nail in the Coffin of the Tobacco Industry?
        The Journal of PediatricsVol. 162Issue 1
        • In Brief
          It is surely evident to all but the most blinkered advocate of the tobacco industry that secondhand smoke exposure is harmful to children's health, yet smoking rates remain obstinately high, particularly among adults of child-bearing age. The Centers for Disease Control estimated in 2010 that 45.3 million (19.3%) US adults were current smokers, with the highest rates in adults aged 25-44 years.1 Exposure to environmental tobacco smoke in the prenatal and postnatal periods is associated with a number of respiratory disorders in early childhood, including otitis media, recurrent wheezing, respiratory infections, asthma, and low lung function.
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