News & Analysis

Tobacco Smoke Exposure

Among Children

compared with 43.6% of those without

asthma. No significant difference was reported among boys.
Among racial and ethnic groups, the only
disparity reported was in Mexican-American children: 38.2% of those with asthma
were exposed to ETS compared with 27.4%
without asthma. By age group, the only difference reported was in children 6 to 11 years
old. More than half, 58.8%, of those with
asthma were exposed compared with 44.7%
without asthma By age group, the only difference reported was in children 6 to 11 years
old. More than half, 58.8%, of those with
asthma were exposed compared with 44.7%
without asthma. More in-depth analysis may
explain the differences among these subgroups (http://1.usa.gov/14O7ZWR).

More children with asthma are exposed to

environmental tobacco smoke (ETS) in the
United States than are children who dont
have the chronic lung disease.
The National Center for Health Statistics (NCHS) reported that from 1999 to 2010,
the percentage of children without asthma
who were exposed to ETS decreased to
44.2% from 57.3%. But no similar change occurred in children with asthma, about 54%
of whom are exposed to ETS.
Exposure to ETS increases childrens risk
of developing middle ear infections, bronchitis and pneumonia, coughing and wheezing,
compromised lung function, and asthma. The
US Surgeon Generals office has reported that
children with asthma whose parents smoke
have more severe symptoms and more frequent exacerbations. In 2007 the National
Asthma Education and Prevention Program
issued guidelines recommending that ETS exposure among people with asthma be minimized. The condition is common among children in the United Statesin 2007 to 2010,
about 1 in 10 had asthma.
The highest prevalence of ETS exposure among children with asthma was in
families with incomes below 185% of the
poverty level67.7% compared with 58.9%
of children without asthma in households at
the same income level. Among girls, 57.6%
of those with asthma were exposed to ETS

News Media and Electronic Alerts

Aided Cyclospora Outbreak Efforts
News media, Twitter, and an electronic
health department newsletter mobilized
health professionals to help quell a recent
Cyclospora outbreak in Iowa.
Beforethisyear,only10infectionswiththe
coccidian parasite had ever been reported in
the state. So when 6 cases were reported in a
matter of days in late June and early July, the
Iowa Department of Public Health (IDPH) released a special alert through its electronic
newsletter, EPI Update. In addition to public
health officials and health care professionals,

Percentage of Children Aged 3 to 19 Years Exposed to

Environmental Tobacco Smoke, by Asthma Status, 1999-2010
Children with asthma
60

57.9

55.1

Percentage

57.3

54.0

54.3

40

44.2
Children without asthmaa

20

0
1999-2002

2003-2006

Year

2007-2010

aSignificant decreasing trend.

Source: US Dept of Health and Human Services. NCHS Data Brief. 2013;126.
Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and
Nutrition Examination Survey.

1218

newsletter readers included news media,

which reported the story statewide.
On July 8, a press release on the outbreak
was emailed to nearly 400 members of the
news media and the first of 14 updates went
outto5282Twitterfollowers.Dailyupdateson
the IDPH website started the next day.
The first 2 cases were diagnosed at Iowas State Hygienic Laboratory. In June, before the electronic communications and
news accounts began, the laboratory was
asked for 271 stool tests for ova and parasites, but none specifically for Cyclospora.
During the first 23 days of July, the laboratory received 762 requests for general ova
and parasite stool tests; specific Cyclospora
testing was requested on 1460 specimens.
Iowa public health officials said news reporting and electronic communications led to
improved diagnosis and treatment. For example, a patient with severe vomiting and
diarrhea was discharged without a diagnosis
after a 5-day hospital stay and extensive laboratory testing, only to relapse a few days later.
But after reading the EPI Update alert, the
patients physician ordered Cyclospora testing for the patient. The result was positive,
the patient received trimethoprim-sulfamethoxazole, and the symptoms resolved.
Without electronic communications and
news coverage, Iowa public health officials
said Cyclospora might not otherwise have
been considered by health-care providers or
their patients as a cause of the outbreak
(http://1.usa.gov/142SIyS).

JAMA September 25, 2013 Volume 310, Number 12

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