B98-01 Parent-Reported Household Tobacco and E-Cigarette Exposure and Asthma Control in Children: A Cross-Sectional Study

Abstract Rationale Tobacco use remains a leading cause of disease and death in the US globally. Secondhand smoke exposure worsens respiratory illnesses in children, particularly asthma. The impact of combined combustible tobacco and e-cigarette exposure on pediatric asthma control remains poorly understood. Objective To examine associations between parent-reported household tobacco and e-cigarette use and parent-reported asthma control among children with asthma. Methods In this cross-sectional study, we used electronic health record data from an urban, 330,000 pediatric patient primary care network (July 2023-2025). We included visits where parents of children aged ≥1 year with an asthma diagnosis completed both a parent tobacco treatment platform (PTTP) and asthma control tool (ACT). The PTTP assessed household tobacco/e-cigarette use through questions asking who in the family smoked combustible tobacco and/or e-cigarettes. The ACT included 11 questions covering asthma symptoms, control, medication use, and healthcare utilization. Exposure was categorized as: both tobacco and e-cigarettes, tobacco only, e-cigarettes only, or none (reference). We used multivariable logistic regression to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI), adjusting for payor and Childhood Opportunity Index (COI). Results Among 35,229 encounters (48% aged 6-12 years, 42% female, 34% Non-Hispanic Black, 43% Medicaid insured, 29% from very low COI neighborhoods), household use of both tobacco and e-cigarette was reported in 5%, tobacco only in 9%, and e-cigarette only in 3% of encounters. After adjusting for payor and COI, combined tobacco and e-cigarette exposure was associated with nighttime symptoms (aOR 1.3, 95% CI 1.1-1.4), worse parent rating of asthma control (aOR 1.3, 1.1-1.4), and lower parental comfort with asthma management (aOR 1.3, 1.1-1.5; Table 1). E-cigarette-only exposure was associated with more asthma flares (aOR 1.4, 1.2-1.6) and activity-related symptoms (aOR 1.4, 1.2-1.6), with effect sizes comparable to or exceeding combined exposure. Tobacco-only exposure showed more modest associations. Healthcare utilization outcomes were not significantly associated with any exposure type after adjustment. Conclusion Household tobacco and e-cigarette use, as reported by parents, is associated with worse parent-reported asthma control among children with asthma, even after adjusting for socioeconomic factors. E-cigarette-only exposure showed associations with asthma symptoms comparable to combined exposure, challenging assumptions that e-cigarette exposure poses minimal risk to children with asthma. These findings underscore the importance of comprehensive tobacco cessation counseling for families, addressing both combustible tobacco products and electronic products. This abstract is funded by: None