Household Cigarette Exposure and Functional Burden in Pediatric Epilepsy: Pooled Evidence from the 2016-2024 National Survey of Children's Health
Objective: to test whether household cigarette exposure is associated with worse outcomes among U.S. children with current epilepsy. Methods: we pooled the 2016-2024 National Survey of Children's Health topical public-use files and identified 2,371 children with current epilepsy. The primary exposure was household cigarette use; smoking inside the home was analyzed secondarily. Outcomes were parent-reported moderate/severe epilepsy, any emergency room visit, seven or more missed school days, activity limitation, and a composite burden endpoint defined as any ER visit, high absence, or activity limitation. Weighted logistic models adjusted for age, sex, race/ethnicity, poverty, food insecurity, and survey year. Results: household cigarette exposure was common in the epilepsy cohort (weighted 19.2%). It was associated with higher adjusted odds of composite burden (OR 1.85, 95% CI 1.35-2.54), seven or more missed school days (OR 1.38, 95% CI 1.04-1.81), and activity limitation (OR 1.34, 95% CI 1.07-1.68). Associations with parent-rated epilepsy severity and ER use were not clearly different from the null after adjustment. Indoor smoking estimates were less stable because relatively few children were exposed. Conclusions: among children with current epilepsy, household cigarette exposure tracks more strongly with functional burden than with parent-rated seizure severity. The finding is observational and cannot establish causality, but it identifies smoking exposure as a plausible marker of elevated burden in pediatric epilepsy care.