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

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.