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. 2005 Oct;59(10):842–846. doi: 10.1136/jech.2005.036301

Maternal education, lone parenthood, material hardship, maternal smoking, and longstanding respiratory problems in childhood: testing a hierarchical conceptual framework

N Spencer 1
PMCID: PMC1732905  PMID: 16166356

Abstract

Background: Maternal smoking and low socioeconomic status are known to be associated with each other and with longstanding respiratory problems in childhood but their interrelation has received little attention. In this paper, the interrelations is studied using a conceptual hierarchical framework among children aged 0–11 years in a representative sample of British households with children.

Method: With data from the family and children study, this paper tested a conceptual hierarchical framework, in which maternal education acting through lone parenthood would influence material hardship and all three would have effects on maternal smoking increasing the risk of children's longstanding respiratory problems.

Results: Among children 0–2, maternal education and material hardship had indirect effects on respiratory problems mediated through more proximal variables. After adjustment for maternal education, the effect of lone parenthood was partially mediated through material hardship and maternal smoking. Adjustment for socioeconomic status variables attentuated but did not eliminate the effect of maternal smoking (odds ratio = 2.04, 95% confidence interval = 1.30, 3.20). Among children 3–11, the effect of maternal education was partially mediated through proximal variables. Lone parenthood and material hardship had indirect effects only. Adjustment for confounding eliminated the effect of maternal smoking (odds ratio = 1.06, 95% confidence interval = 0.88, 1.26).

Conclusions: Reducing childhood longstanding respiratory problems will require attention to background socioeconomic status factors in addition to maternal smoking.

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Selected References

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  1. Baker D., Taylor H., Henderson J. Inequality in infant morbidity: causes and consequences in England in the 1990s. ALSPAC Study Team. Avon Longitudinal Study of Pregnancy and Childhood. J Epidemiol Community Health. 1998 Jul;52(7):451–458. doi: 10.1136/jech.52.7.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Barbeau Elizabeth M., Krieger Nancy, Soobader Mah-Jabeen. Working class matters: socioeconomic disadvantage, race/ethnicity, gender, and smoking in NHIS 2000. Am J Public Health. 2004 Feb;94(2):269–278. doi: 10.2105/ajph.94.2.269. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Bornehag C-G, Sundell J., Sigsgaard T. Dampness in buildings and health (DBH): Report from an ongoing epidemiological investigation on the association between indoor environmental factors and health effects among children in Sweden. Indoor Air. 2004;14 (Suppl 7):59–66. doi: 10.1111/j.1600-0668.2004.00274.x. [DOI] [PubMed] [Google Scholar]
  4. Burr M. L., Miskelly F. G., Butland B. K., Merrett T. G., Vaughan-Williams E. Environmental factors and symptoms in infants at high risk of allergy. J Epidemiol Community Health. 1989 Jun;43(2):125–132. doi: 10.1136/jech.43.2.125. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Cavelaars A. E., Kunst A. E., Geurts J. J., Crialesi R., Grötvedt L., Helmert U., Lahelma E., Lundberg O., Mielck A., Rasmussen N. K. Persistent variations in average height between countries and between socio-economic groups: an overview of 10 European countries. Ann Hum Biol. 2000 Jul-Aug;27(4):407–421. doi: 10.1080/03014460050044883. [DOI] [PubMed] [Google Scholar]
  6. Cesaroni G., Farchi S., Davoli M., Forastiere F., Perucci C. A. Individual and area-based indicators of socioeconomic status and childhood asthma. Eur Respir J. 2003 Oct;22(4):619–624. doi: 10.1183/09031936.03.00091202. [DOI] [PubMed] [Google Scholar]
  7. Cook D. G., Strachan D. P. Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999 Apr;54(4):357–366. doi: 10.1136/thx.54.4.357. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Cook D. G., Strachan D. P. Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children. Thorax. 1997 Dec;52(12):1081–1094. doi: 10.1136/thx.52.12.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Dales R. E., Choi B., Chen Y., Tang M. Influence of family income on hospital visits for asthma among Canadian school children. Thorax. 2002 Jun;57(6):513–517. doi: 10.1136/thorax.57.6.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Elliott M. R., Wang Y., Lowe R. A., Kleindorfer P. R. Environmental justice: frequency and severity of US chemical industry accidents and the socioeconomic status of surrounding communities. J Epidemiol Community Health. 2004 Jan;58(1):24–30. doi: 10.1136/jech.58.1.24. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Graham H., Der G. Patterns and predictors of tobacco consumption among women. Health Educ Res. 1999 Oct;14(5):611–618. doi: 10.1093/her/14.5.611. [DOI] [PubMed] [Google Scholar]
  12. Graham H. Women's smoking and family health. Soc Sci Med. 1987;25(1):47–56. doi: 10.1016/0277-9536(87)90206-1. [DOI] [PubMed] [Google Scholar]
  13. Hoek G., Wypij D., Brunekreef B. Self-reporting versus parental reporting of acute respiratory symptoms of children and their relation to pulmonary function and air pollution. Int J Epidemiol. 1999 Apr;28(2):293–299. doi: 10.1093/ije/28.2.293. [DOI] [PubMed] [Google Scholar]
  14. Jaakkola N., Ruotsalainen R., Jaakkola J. J. What are the determinants of children's exposure to environmental tobacco smoke at home? Scand J Soc Med. 1994 Jun;22(2):107–112. doi: 10.1177/140349489402200205. [DOI] [PubMed] [Google Scholar]
  15. Kaplan G. A. Where do shared pathways lead? Some reflections on a research agenda. Psychosom Med. 1995 May-Jun;57(3):208–212. doi: 10.1097/00006842-199505000-00002. [DOI] [PubMed] [Google Scholar]
  16. Koupilová I., Vågerö D., Leon D. A., Pikhart H., Príkazský V., Holcík J., Bobák M. Social variation in size at birth and preterm delivery in the Czech Republic and Sweden, 1989-91. Paediatr Perinat Epidemiol. 1998 Jan;12(1):7–24. doi: 10.1111/j.1365-3016.1998.00075.x. [DOI] [PubMed] [Google Scholar]
  17. Krieger N., Williams D. R., Moss N. E. Measuring social class in US public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18:341–378. doi: 10.1146/annurev.publhealth.18.1.341. [DOI] [PubMed] [Google Scholar]
  18. Mielck A., Reitmeir P., Wjst M. Severity of childhood asthma by socioeconomic status. Int J Epidemiol. 1996 Apr;25(2):388–393. doi: 10.1093/ije/25.2.388. [DOI] [PubMed] [Google Scholar]
  19. Patrick D. L., Cheadle A., Thompson D. C., Diehr P., Koepsell T., Kinne S. The validity of self-reported smoking: a review and meta-analysis. Am J Public Health. 1994 Jul;84(7):1086–1093. doi: 10.2105/ajph.84.7.1086. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Pearce N., Sunyer J., Cheng S., Chinn S., Björkstén B., Burr M., Keil U., Anderson H. R., Burney P. Comparison of asthma prevalence in the ISAAC and the ECRHS. ISAAC Steering Committee and the European Community Respiratory Health Survey. International Study of Asthma and Allergies in Childhood. Eur Respir J. 2000 Sep;16(3):420–426. doi: 10.1183/9031936.00.16337700. [DOI] [PubMed] [Google Scholar]
  21. Power Chris, Graham Hilary, Due Pernille, Hallqvist Johan, Joung Inez, Kuh Diana, Lynch John. The contribution of childhood and adult socioeconomic position to adult obesity and smoking behaviour: an international comparison. Int J Epidemiol. 2005 Jan 19;34(2):335–344. doi: 10.1093/ije/dyh394. [DOI] [PubMed] [Google Scholar]
  22. Riley Anne W., Forrest Christopher B., Starfield Barbara, Rebok George W., Robertson Judith A., Green Bert F. The Parent Report Form of the CHIP-Child Edition: reliability and validity. Med Care. 2004 Mar;42(3):210–220. doi: 10.1097/01.mlr.0000114909.33878.ca. [DOI] [PubMed] [Google Scholar]
  23. Spencer N., Coe C. Parent reported longstanding health problems in early childhood: a cohort study. Arch Dis Child. 2003 Jul;88(7):570–573. doi: 10.1136/adc.88.7.570. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Spencer Nick. Does material disadvantage explain the increased risk of adverse health, educational, and behavioural outcomes among children in lone parent households in Britain? A cross sectional study. J Epidemiol Community Health. 2005 Feb;59(2):152–157. doi: 10.1136/jech.2004.020248. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Stewart M. J., Brosky G., Gillis A., Jackson S., Johnston G., Kirkland S., Leigh G., Pawliw-Fry B. A., Persaud V., Rootman I. Disadvantaged women and smoking. Can J Public Health. 1996 Jul-Aug;87(4):257–260. [PubMed] [Google Scholar]
  26. Strachan D. P., Anderson H. R., Limb E. S., O'Neill A., Wells N. A national survey of asthma prevalence, severity, and treatment in Great Britain. Arch Dis Child. 1994 Mar;70(3):174–178. doi: 10.1136/adc.70.3.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Strachan D. P., Cook D. G. Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood. Thorax. 1997 Oct;52(10):905–914. doi: 10.1136/thx.52.10.905. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Séguin Louise, Xu Qian, Gauvin Lise, Zunzunegui Maria-Victoria, Potvin Louise, Frohlich Katherine L. Understanding the dimensions of socioeconomic status that influence toddlers' health: unique impact of lack of money for basic needs in Quebec's birth cohort. J Epidemiol Community Health. 2005 Jan;59(1):42–48. doi: 10.1136/jech.2004.020438. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Varni James W., Burwinkle Tasha M., Rapoff Michael A., Kamps Jodi L., Olson Nancy. The PedsQL in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory generic core scales and asthma module. J Behav Med. 2004 Jun;27(3):297–318. doi: 10.1023/b:jobm.0000028500.53608.2c. [DOI] [PubMed] [Google Scholar]
  30. Victora C. G., Huttly S. R., Fuchs S. C., Olinto M. T. The role of conceptual frameworks in epidemiological analysis: a hierarchical approach. Int J Epidemiol. 1997 Feb;26(1):224–227. doi: 10.1093/ije/26.1.224. [DOI] [PubMed] [Google Scholar]
  31. White I. R., Blane D., Morris J. N., Mourouga P. Educational attainment, deprivation-affluence and self reported health in Britain: a cross sectional study. J Epidemiol Community Health. 1999 Sep;53(9):535–541. doi: 10.1136/jech.53.9.535. [DOI] [PMC free article] [PubMed] [Google Scholar]

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