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Income inequality and U.S. Children's secondhand smoke exposure: Distinct associations by race-ethnicity
Shenassa ED , Rossen LM , Cohen J , Morello-Frosch R , Payne-Sturges DC . Nicotine Tob Res 2016 19 (11) 1292-1299 INTRODUCTION: Prior studies have found considerable racial and ethnic disparities in second-hand smoke exposure. Although a number of individual-level determinants of this disparity have been identified, contextual determinants of racial and ethnic disparities in second-hand smoke exposure remain unexamined. The objective of this study was to examine disparities in serum cotinine in relation to area-level income inequality among 14,649 children from the National Health and Nutrition Examination Survey (NHANES). METHODS: We fit log-normal regression models to examine disparities in serum cotinine in relation to Metropolitan Statistical Areas (MSA) level income inequality among 14,649 non-smoking children aged 3-15 from the NHANES (1999-2012). RESULT: Non-Hispanic black children had significantly lower serum cotinine than non-Hispanic white children (-0.26; 95% CI: -0.38, -0.15) in low income inequality areas, but this difference was attenuated in areas with high income inequality (0.01; 95% CI: -0.16, 0.18). Serum cotinine declined for non-Hispanic white and Mexican American children with increasing income inequality. Serum cotinine did not change as a function of the level of income inequality among non-Hispanic black children. CONCLUSIONS: We have found evidence of differential associations between SHS exposure and income inequality by race and ethnicity. Further examination of environments which engender SHS exposure among children across various racial/ethnic subgroups can foster a better understanding of how area-level income inequality relates to health outcomes such as levels of SHS exposure and how those associations differ by race/ethnicity. IMPLICATIONS: In the US, the association between children's risk of secondhand smoke exposure and income inequality is modified by race/ethnicity in a manner that is inconsistent with theories of income inequality. In overall analysis this association appears to be as predicted by theory. However, race-specific analyses reveal that higher levels of income inequality are associated with lower levels of SHS exposure among white children, while levels of secondhand smoke exposure among non-Hispanic black children are largely invariant to area-level income inequality. Future examination of the link between income inequality and smoking related health outcomes should consider differential associations across racial and ethnic subpopulations. |
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