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Epidemiological studies of asthma and allergic diseases in teenagers: methodological aspects and tobacco use
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. (OLIN-studierna ; Arcum)
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Parental reports are often used in studies of asthma and allergic diseases in children. A change in respondent from parent to index subject usually occurs during adolescence. Little is known about the effects this change in method might have on the outcomes of a longitudinal study. Smoking is a major cause of respiratory symptoms among adults and environmental tobacco smoke (ETS) is a risk factor for asthma among children. Less is known about these associations among teenagers. In order to improve prevention of smoking, it is important to identify populations at risk of becoming smokers.      

The aim of this thesis were to 1) evaluate the methodological change from parental to self-completion of a questionnaire about asthma and allergic diseases, and 2) to study determinants for, and respiratory health effects of ETS and personal smoking in teenagers.

In 1996, a longitudinal study of asthma and allergic diseases among schoolchildren started within the Obstructive Lung Disease in Northern Sweden (OLIN) studies. All children in first and second grades (aged 7-8 years) in three municipalities, Luleå, Kiruna and Piteå (n=3,525) were invited and 97% participated by parental completion of a questionnaire. The cohort has been followed with annual questionnaires until age 16-17 years and with high participation rates (>91%). From age 12-13 years, the teenagers were the respondents and questions about their tobacco use were included. In addition to the questionnaire completed by the teenagers at age 13-14 years, a questionnaire was also distributed to a random sample of 10% of the parents and 294 participated (84%).  

The parents and the teenagers reported a similar prevalence of asthma, respiratory symptoms, rhinitis, eczema and environmental factors. Two statistically significant differences were found: the teenagers reported a higher prevalence of wheezing during or after exercise (14% vs 8%, p<0.05), and having a dog in the home in the last 12 months (42% vs 29%, p<0.001). Answer agreement between parents and teenagers on questions about asthma was almost perfect with kappa values of 0.8-0.9. Corresponding kappa values for questions about respiratory symptoms and rhinitis were 0.3-0.6 and for eczema 0.5-0.6. Agreement about environmental factors varied from 0.2-0.9. Kappa values for parental smoking were 0.8-0.9. The risk factor pattern for allergic diseases was similar regardless of respondent, ie parent or teenager.

The prevalence of smoking increased from 3% at 12-13 years to 6% at 14-15 years. Smoking was more common among girls, while the use of snus was more common among boys. Significant risk factors related to smoking among teenagers were smoking family members, female sex and living in an apartment. Having physician-diagnosed asthma did not prevent the teenagers from becoming smokers. Factors related to using snus were a smoking mother and male sex. 

Daily smokers aged 16-17 years (9%) reported a significantly higher prevalence of wheezing and physician-diagnosed asthma compared to non-smokers. There was a significant dose-response association with higher prevalence of wheeze among those who smoked ≥11 cigarettes per day compared to those who smoked ≤10 per day. In multivariate analyses, maternal environmental tobacco smoke exposure was a significant risk factor for ever wheeze and physician-diagnosed asthma at age 16-17 years, while daily smoking was a risk factor for current wheeze.

In conclusion, the methodological change of questionnaire respondent from parent to index subject did not substantially alter the findings of this longitudinal study. There were significant sex differences in the tobacco use: smoking was more common among girls and snus was more common among boys. The most important factor related to tobacco use was presence of family members who smoke. Both maternal ETS exposure and personal smoking was associated with asthma and wheeze in adolescence. ETS was associated with lifetime symptoms but daily smoking was more strongly associated with current symptoms.

Place, publisher, year, edition, pages
2010. , 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1328
Keyword [en]
epidemiology, asthma, allergic diseases, wheeze, agreement, smoking, snus, teenagers
Identifiers
URN: urn:nbn:se:umu:diva-31292ISBN: 978-91-7264-943-9 (print)OAI: oai:DiVA.org:umu-31292DiVA: diva2:292168
Public defence
2010-02-26, Rum 135, Byggnad 9A, Umeå Universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-02-08 Created: 2010-02-04 Last updated: 2017-05-10Bibliographically approved
List of papers
1. Agreement between parental and self-completed questionnaires about asthma in teenagers
Open this publication in new window or tab >>Agreement between parental and self-completed questionnaires about asthma in teenagers
2005 (English)In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 16, 176-181 p.Article in journal (Refereed) Published
National Category
Environmental Health and Occupational Health
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-31289 (URN)10.1111/j.1399-3038.2005.00231.x (DOI)
Available from: 2010-02-05 Created: 2010-02-04 Last updated: 2011-09-16Bibliographically approved
2. Good agreement between parental and self-completed questionnaires about allergic diseases and environmental factors in teenagers
Open this publication in new window or tab >>Good agreement between parental and self-completed questionnaires about allergic diseases and environmental factors in teenagers
2010 (English)In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 63, no 7, 783-789 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To study whether the methodological change from parent to index subject as questionnaire respondent affected the prevalence estimates and risk factor patterns for allergic diseases in a longitudinal study.

STUDY DESIGN AND SETTING: A prospective study of asthma and allergic diseases among children was begun in 1996 within the Obstructive Lung Disease in Northern Sweden Study. In 2002, about 3,342 (95% of invited) teenagers (13 to 14 years) completed the annual questionnaire. A random sample of 294 (84% of invited) parents also completed the same extended International Study of Asthma and Allergies in Childhood questionnaire. Skin prick tests were performed in 1996 and 2000.

RESULTS: There were no significant differences in the prevalence of rhinitis, eczema, or related environmental factors between parental and self-reports, except for the question of having a dog at home. The absolute agreement was high, whereas the kappa values were fair or moderate. Kappa values of questions regarding parental smoking were 0.8-0.9. Allergic sensitization was the major risk factor for both rhinitis and eczema, and the odds ratios were similar regardless of who reported the condition.

CONCLUSION: The agreement between the parental and teenagers' reports was good, and the methodological change did not affect the study results.

Keyword
Agreement, Eczema, Parents, Questionnaires, Rhinitis, Teenager
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:umu:diva-30717 (URN)10.1016/j.jclinepi.2009.08.017 (DOI)000278412800015 ()19959330 (PubMedID)
Available from: 2010-01-14 Created: 2010-01-14 Last updated: 2017-05-09Bibliographically approved
3. Factors related to tobacco use among teenagers
Open this publication in new window or tab >>Factors related to tobacco use among teenagers
Show others...
2007 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 101, no 3, 496-502 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To examine tobacco use among teenagers, identify factors related to tobacco use, as well as evaluate the outcome of a smoking prevention program.

METHODS: From age 7/8 to 14/15, annual questionnaires about asthma and allergy have been completed in the OLIN paediatric study in Northern Sweden. From 12/13 years, questions about tobacco use, i.e. smoking and snuff, were added. A smoking prevention program was performed during 2 years.

RESULTS: Any tobacco use increased from 5.0% at age 12/13 years, to 14.4% at age 14/15. At age 14/15 years, the prevalence of tobacco use was significantly higher among boys than girls (16.7 and 12.0%, respectively). More girls than boys smoked (8.9 and 2.8%, respectively), while use of snuff was more common among the boys (15.6 and 4.2%, respectively). Significant risk factors for smoking were any of the family members currently smoking, OR 6.1 (95% CI 4.0-9.3) and a physician-diagnosed asthma at the age of 14/15 years, OR 1.9 (95% CI 1.2-3.0). A protective factor against tobacco use was participation in sports, OR 0.3 (95% CI 0.2-0.4). The prevention program did not result in less tobacco use, although it may have delayed smoking initiation.

CONCLUSION: The patterns of tobacco use differed significantly between boys and girls. Though any tobacco use was more common among boys, girls were more likely to smoke, and boys were more likely to use snuff. Having asthma did not prevent the teenagers from smoking. Since having a smoking family member was the major risk factor for tobacco use, prevention programs should be directed at smoking families in addition to the individuals.

Identifiers
urn:nbn:se:umu:diva-19102 (URN)10.1016/j.rmed.2006.07.001 (DOI)16914300 (PubMedID)
Available from: 2009-03-04 Created: 2009-03-04 Last updated: 2016-03-11Bibliographically approved
4. Both environmental tobacco smoke and personal smoking are associated to asthma and wheeze among adolescents
Open this publication in new window or tab >>Both environmental tobacco smoke and personal smoking are associated to asthma and wheeze among adolescents
Show others...
(English)Manuscript (preprint) (Other academic)
Keyword
Asthma, wheeze, adolescents, smoking, environmental tobacco smoke
Research subject
Epidemiology
Identifiers
urn:nbn:se:umu:diva-31290 (URN)
Available from: 2010-02-04 Created: 2010-02-04 Last updated: 2016-03-11Bibliographically approved

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