ENVIRONMENTAL TOBACCO SMOKE EXPOSURE AMONG CHILDREN HOSPITALIZED WITH PNEUMONIA

描述（由申请人提供）：本研究计划侧重于与儿童肺炎相关的环境风险因素，并将被纳入一项大型的、由cdc资助的、多中心的住院儿童和成人社区获得性肺炎（CAP）发病率和病因监测研究。本提案的主要目的是了解环境烟草烟雾（ETS）暴露与中田纳西州幼儿肺炎住院之间的关系。该项目的具体目标是：1。使用尼古丁生物标志物客观地确定肺炎住院幼儿队列中ETS暴露的程度2。比较肺炎住院儿童与肠胃炎住院儿童的ETS暴露情况。在住院肺炎队列中，ETS暴露与临床和功能性疾病严重程度之间的相关性先前发表的成人研究表明，ETS在肺炎易感性和临床严重程度中起着突出作用。因此，ETS极有可能在幼儿中发挥类似的作用。假设ETS暴露在这组因肺炎住院的幼儿中比因肠胃炎住院的对照组更常见和更广泛。此外，假设肺炎住院幼儿的ETS暴露程度会影响临床和功能疾病的严重程度，因此，ETS水平较高的儿童将需要更长的时间才能达到临床稳定和功能恢复。这项工作是独特和创新的，因为它测量了肺炎和肠胃炎住院儿童尿液中ETS暴露的实际生物标志物，而不是简单地依赖于父母的报告。如果这项工作证明了ETS暴露与肺炎负担和疾病严重程度之间的明确关联，那么这些发现将影响环境卫生政策的努力以及护理人员的吸烟预防和戒烟策略。该申请的长期目标是培养临床研究方面的职业，主要关注导致住院的儿科传染病的流行病学监测，以及环境因素在疾病负担中的重要作用。该提案将通过提供与高素质导师的密集指导培训经验，包括参与国家多中心研究，与研究团队的日常互动，每周和每月的研究会议，流行病学课程和重点职业发展活动，极大地促进这一职业道路。

DESCRIPTION (provided by applicant): This research proposal focuses on environmental risk factors associated with pediatric pneumonia, and will be nested within a large, CDC-funded, multi-center surveillance study of the incidence and etiology of community- acquired pneumonia (CAP) among hospitalized children and adults. The main objective of this proposal will be to understand the relationship between environmental tobacco smoke (ETS) exposure and pneumonia hospitalizations among young children in Middle Tennessee. The specific aims of the project are: 1. To objectively determine the extent of ETS exposure using biomarkers for nicotine in a cohort of young children hospitalized with pneumonia 2. To compare ETS exposure among children hospitalized with pneumonia with matched controls hospitalized with gastroenteritis 3. To correlate ETS exposure with clinical and functional disease severity among the hospitalized pneumonia cohort Previously published studies in adults demonstrate the prominent role that ETS has in the predisposition to and clinical severity of pneumonia. Thus, it is highly likely that a similar role of ETS can be established in young children. It is hypothesized that ETS exposure will be more common and more extensive among this group of young children hospitalized with pneumonia than among matched controls hospitalized with gastroenteritis. Furthermore, it is hypothesized that the extent of ETS exposure among young children hospitalized with pneumonia will impact clinical and functional disease severity, such that children with higher levels of ETS will require a longer time to achieve clinical stability and functional recovery. This work is unique and innovative because it measures actual biomarkers of ETS exposure in the urine of children hospitalized with pneumonia and gastroenteritis rather than simply relying on parental reports. If this work demonstrates a clear association between ETS exposure and pneumonia burden and disease severity, then these findings would impact environmental health policy efforts as well as smoking prevention and cessation strategies for caregivers. The long-term objective of this application is to foster a career in clinical investigation that centers on the epidemiologic surveillance of pediatric infectious diseases commonly leading to hospitalization and the important role that environmental factors have in disease burden. This proposal will greatly facilitate this career path by providing an intensive, mentored training experience with a highly qualified mentor that includes participation within a national, multicenter study and daily interaction with the study team, weekly and monthly research conferences, epidemiology coursework, and focused career development activities. PUBLIC HEALTH RELEVANCE: If this work establishes an important link between environmental tobacco smoke exposure (ETS) and childhood pneumonia burden and disease severity, it would add to the mounting evidence of the damaging effects of ETS on the respiratory health of children and would serve as an impetus for additional epidemiologic studies within this important area. Furthermore, it would inform health policy decisions such as comprehensive smoking bans in day care facilities and other public venues, and stimulate targeted smoking prevention and cessation strategies including hospital-based intervention programs for smoking parents.