Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

A cross sectional analysis of behaviors related to operating gas stoves and pneumonia in U.S. children under the age of 5

Authors: Eric S Coker, Ellen Smit, Anna K Harding, John Molitor, Molly L Kile

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Poorly ventilated combustion stoves and pollutants emitted from combustion stoves increase the risk of acute lower respiratory illnesses (ALRI) in children living in developing countries but few studies have examined these issues in developed countries. Our objective is to investigate behaviors related to gas stove use, namely using them for heat and without ventilation, on the odds of pneumonia and cough in U.S. children.

Methods

The National Health and Nutrition Examination Survey (1988–1994) was used to identify children < 5 years who lived in homes with a gas stove and whose parents provided information on their behaviors when operating their gas stoves and data on pneumonia (N = 3,289) and cough (N = 3,127). Multivariate logistic regression models were used to examine the association between each respiratory outcome and using a gas stove for heat or without ventilation, as well as, the joint effect of both behaviors.

Results

The adjusted odds of parental-reported pneumonia (adjusted odds ratio [aOR] = 2.08, 95% confidence interval [CI]: 1.08, 4.03) and cough (aOR = 1.66, 95% CI: 1.14, 2.43) were higher among children who lived in homes where gas stoves were used for heat compared to those who lived in homes where gas stoves were only used for cooking. The odds of pneumonia (aOR = 1.76, 95% CI: 1.04, 2.98), but not cough (aOR = 1.23, 95% CI: 0.87, 1.75), was higher among those children whose parents did not report using ventilation when operating gas stoves compared to those who did use ventilation. When considering the joint association of both stove operating conditions, only children whose parents reported using gas stoves for heat without ventilation had significantly higher odds of pneumonia (aOR = 3.06, 95% CI: 1.32, 7.09) and coughing (aOR = 2.07, 95% CI: 1.29, 3.30) after adjusting for other risk factors.

Conclusions

Using gas stoves for heat without ventilation was associated with higher odds of pneumonia and cough among U.S. children less than five years old who live in homes with a gas stove. More research is needed to determine if emissions from gas stoves ventilation infrastructure, or modifiable behaviors contribute to respiratory infections in children.
Literature
1.
Rudan I, O’Brien KL, Nair H, Liu L, Theodoratou E, Qazi S, et al. Epidemiology and etiology of childhood pneumonia in 2010: estimates of incidence, severe morbidity, mortality, underlying risk factors and causative pathogens for 192 countries. J Glob Health. 2013;3:10401.CrossRef
2.
Centers for Disease Control and Prevention (CDC). VPD surveillance manual, 5th edition, pneumococcal disease: chapter 11–1. 12th edition. Atlanta, GA: Centers for Disease Control and Prevention; 2008.
3.
Centers for Disease Control and Prevention (CDC). Pneumonia hospitalizations among young children before and after introduction of pneumococcal conjugate vaccine--United States, 1997–2006. MMWR Morb Mortal Wkly Rep. 2009;58:1–4.
4.
Talan DA, Moran GJ, Pinner RW. Progress toward eliminating Haemophilus influenzae type b disease among infants and children–United States, 1987–1997. Ann Emerg Med. 1999;34:109–11.CrossRefPubMed
5.
Gern JE, Rosenthal LA, Sorkness RL, Lemanske Jr RF. Effects of viral respiratory infections on lung development and childhood asthma. J Allergy Clin Immunol. 2005;115:668–74. quiz 675.CrossRefPubMed
6.
7.
Sly PD, Kusel M, Holt PG. Do early-life viral infections cause asthma? J Allergy Clin Immunol. 2010;125:1202–5.CrossRefPubMed
8.
Jackson S, Mathews KH, Pulanić D, Falconer R, Rudan I, Campbell H, et al. Risk factors for severe acute lower respiratory infections in children – a systematic review and meta-analysis. Croat Med J. 2013;54:110–21.CrossRefPubMedPubMedCentral
9.
Dherani M, Pope D, Mascarenhas M, Smith KR, Weber M, Bruce N. Indoor air pollution from unprocessed solid fuel use and pneumonia risk in children aged under five years: a systematic review and meta-analysis. Bull World Health Organ. 2008;86:390–8C.CrossRefPubMedPubMedCentral
10.
Ezzati M, Kammen DM. The health impacts of exposure to indoor air pollution from solid fuels in developing countries: knowledge, gaps, and data needs. Environ Health Perspect. 2002;110:1057–68.CrossRefPubMedPubMedCentral
11.
Smith KR, Mehta S. The burden of diseae from indoor air pollution in developing countries: comparison of estimates. Int J Hyg Env Health. 2003;206:279–89.CrossRef
12.
Baxter LK, Clougherty JE, Laden F, Levy JI. Predictors of concentrations of nitrogen dioxide, fine particulate matter, and particle constituents inside of lower socioeconomic status urban homes. J Expo Sci Environ Epidemiol. 2006;17:433–44.CrossRefPubMed
13.
Hansel NN, Breysse PN, McCormack MC, Matsui EC, Curtin-Brosnan J, Williams DL, et al. A longitudinal study of indoor nitrogen dioxide levels and respiratory symptoms in inner-city children with asthma. Environ Health Perspect. 2008;116:1428–32.CrossRefPubMedPubMedCentral
14.
Loo CKJ, Foty RG, Wheeler AJ, Miller JD, Evans G, Stieb DM, et al. Do questions reflecting indoor Air pollutant exposure from a questionnaire predict direct measure of exposure in owner-occupied houses? Int J Environ Res Public Health. 2010;7:3270–97.CrossRefPubMedPubMedCentral
15.
Semple S, Garden C, Coggins M, Galea KS, Whelan P, Cowie H, et al. Contribution of solid fuel, gas combustion, or tobacco smoke to indoor air pollutant concentrations in Irish and Scottish homes: Indoor air pollutant concentrations in Irish and Scottish homes. Indoor Air. 2012;22:212–23.CrossRefPubMed
16.
Wallace LA, Emmerich SJ, Howard-Reed C. Source strengths of ultrafine and fine particles due to cooking with a gas stove. Environ Sci Technol. 2004;38:2304–11.CrossRefPubMed
17.
Wallace L, Wang F, Howard-Reed C, Persily A. Contribution of gas and electric stoves to residential ultrafine particle concentrations between 2 and 64 nm: size distributions and emission and coagulation remission and coagulation rates. Environ Sci Technol. 2008;42:8641–7.CrossRefPubMed
18.
19.
Casas L, Tischer C, Tiesler C, Brüske I, Koletzko S, Bauer C-P, et al. Association of gas cooking with children’s respiratory health: results from GINIplus and LISAplus birth cohort studies: gas cooking and children’s respiratory health. Indoor Air. 2012;22:476–82.CrossRefPubMed
20.
Lin W, Brunekreef B, Gehring U. Meta-analysis of the effects of indoor nitrogen dioxide and gas cooking on asthma and wheeze in children. Int J Epidemiol. 2013;42:1724–37.CrossRefPubMed
21.
Moshammer H, Fletcher T, Heinrich J, Hoek G, Hruba F, Pattenden S, et al. Gas cooking is associated with small reductions in lung function in children. Eur Respir J. 2010;36:249–54.CrossRefPubMed
22.
Kile ML, Coker ES, Smit E, Sudakin D, Molitor J, Harding AK. A cross-sectional study of the association between ventilation of gas stoves and chronic respiratory illness in U.S. children enrolled in NHANESIII. Environ Health Glob Access Sci Source. 2014;13:71.
23.
Lanphear BP, Aligne CA, Auinger P, Weitzman M, Byrd RS. Residential exposures associated with asthma in US children. Pediatrics. 2001;107:505–11.CrossRefPubMed
24.
Aldous MB, Holberg CJ, Wright AL, Martinez FD, Taussig LM. Evaporative cooling and other home factors and lower respiratory tract illness during the first year of life. Group Health Medical Assoc Am J Epidemiol. 1996;143:423–30.
25.
Belanger K, Gent JF, Triche EW, Bracken MB, Leaderer BP. Association of indoor nitrogen dioxide exposure with respiratory symptoms in children with asthma. Am J Respir Crit Care Med. 2006;173:297–303.CrossRefPubMed
26.
Burr ML, Anderson HR, Austin JB, Harkins LS, Kaur B, Strachan DP, et al. Respiratory symptoms and home environment in children: a national survey. Thorax. 1999;54:27–32.CrossRefPubMedPubMedCentral
27.
Dockery DW, Speizer FE, Stram DO, Ware JH, Spengler JD, Ferris Jr BG. Effects of inhalable particles on respiratory health of children. Am Rev Respir Dis. 1989;139:587–94.CrossRefPubMed
28.
Holscher B, Heinrich J, Jacob B, Ritz B, Wichmann HE. Gas cooking, respiratory health and white blood cell counts in children. Int J Hyg Environ Health. 2000;203:29–37.CrossRefPubMed
29.
Marks GB, Ezz W, Aust N, Toelle BG, Xuan W, Belousova E, et al. Respiratory health effects of exposure to low-NOx unflued gas heaters in the classroom: a double-blind, cluster-randomized, crossover study. Environ Health Perspect. 2010;118:1476–82.CrossRefPubMedPubMedCentral
30.
Sunyer J. Nitrogen dioxide is not associated with respiratory infection during the first year of life. Int J Epidemiol. 2004;33:116–20.CrossRefPubMed
31.
Volkmer RE, Ruffin RE, Wigg NR, Davies N. The prevalence of respiratory symptoms in South Australian preschool children. II. Factors associated with indoor air quality. J Paediatr Child Health. 1995;31:116–20.CrossRefPubMed
32.
Ware JH, Dockery DW, Spiro 3rd A, Speizer FE, Ferris Jr BG. Passive smoking, gas cooking, and respiratory health of children living in six cities. Am Rev Respir Dis. 1984;129:366–74.PubMed
33.
Acevedo-Bolton V, Cheng K-C, Jiang R-T, Ott WR, Klepeis NE, Hildemann LM. Measurement of the proximity effect for indoor air pollutant sources in two homes. J Environ Monit. 2012;14:94.CrossRefPubMed
34.
Barnes BR, Mathee A, Shafritz LB, Krieger L, Zimicki S. A behavioral intervention to reduce child exposure to indoor air pollution: identifying possible target behaviors. Health Educ Behav Off Publ Soc Public Health Educ. 2004;31:306–17.CrossRef
35.
Cyrys J, Heinrich J, Richter K, Wölke G, Wichmann HE. Sources and concentrations of indoor nitrogen dioxide in Hamburg (west Germany) and Erfurt (east Germany). Sci Total Environ. 2000;250:51–62.CrossRefPubMed
36.
Diette GB, Hansel NN, Buckley TJ, Curtin-Brosnan J, Eggleston PA, Matsui EC, et al. Home indoor pollutant exposures among inner-city children with and without asthma. Environ Health Perspect. 2007;115:1665–9.CrossRefPubMedPubMedCentral
37.
García Algar O, Pichini S, Basagaña X, Puig C, Vall O, Torrent M, et al. Concentrations and determinants of NO2 in homes of Ashford, UK and Barcelona and Menorca, Spain. Indoor Air. 2004;14:298–304.CrossRefPubMed
38.
Linaker CH, Chauhan AJ, Inskip H, Frew A, Sillence A, Coggon D. Holgate: Distribution and determinants of personal exposure to nitrogen dioxide in school children. Occup Environ Med. 1996;53:200–3.CrossRefPubMedPubMedCentral
39.
40.
Wong TW, Yu TS, Liu HJ, Wong AHS. Household gas cooking: a risk factor for respiratory illnesses in preschool children. Arch Dis Child. 2004;89:631–6.CrossRefPubMedPubMedCentral
41.
Zhang Q, Gangupomu RH, Ramirez D, Zhu Y. Measurement of ultrafine particles and other Air pollutants emitted by cooking activities. Int J Environ Res Public Health. 2010;7:1744–59.CrossRefPubMedPubMedCentral
42.
Clougherty JE, Houseman EA, Levy JI. Source apportionment of indoor residential fine particulate matter using land use regression and constrained factor analysis: indoor-source apportionment using LUR and factor analysis. Indoor Air. 2011;21:53–66.CrossRefPubMed
43.
Dassen WG, Matsuki H, Kasuga H, Misawa K, Yokoyama H, Shimizu Y. Determinants of indoor NO2-concentration and the personal exposures of children and their mothers in Japanese homes. Tokai J Exp Clin Med. 1987;12:83–95.PubMed
44.
Matsuki H, Kasuga H, Osaka F, Yanagisawa Y, Nishimura H. A comparative study on the health effects of smoking and indoor air pollution in summer and winter. Tokai J Exp Clin Med. 1985;10:427–37.PubMed
45.
Rim D, Wallace L, Nabinger S, Persily A. Reduction of exposure to ultrafine particles by kitchen exhaust hoods: the effects of exhaust flow rates, particle size, and burner position. Sci Total Environ. 2012;432:350–6.CrossRefPubMed
46.
Zota A, Adamkiewicz G, Levy JI, Spengler JD. Ventilation in public housing: implications for indoor nitrogen dioxide concentrations. Indoor Air. 2005;15:393–401.CrossRefPubMed
47.
Logue JM, Klepeis NE, Lobscheid AB, Singer BC. Pollutant exposures from natural gas cooking burners: a simulation-based assessment for southern California. Environ Health Perspect. 2013;122:43–50.PubMedPubMedCentral
48.
Centers for Disease Control and Prevention (CDC). Use of unvented residential heating appliances--United States, 1988–1994. MMWR Morb Mortal Wkly Rep. 1997;46:1221–4.
49.
50.
Chantry CJ. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006;117:425–32.CrossRefPubMed
51.
Quraishi SA, Bittner EA, Christopher KB, Camargo CA. Vitamin D status and community-acquired pneumonia: results from the third national health and nutrition examination survey. PLoS One. 2013;8:e81120.CrossRefPubMedPubMedCentral
52.
53.
Neuman MI, Shah SS, Shapiro DJ, Hersh AL. Emergency department management of childhood pneumonia in the United States prior to publication of national guidelines. Acad Emerg Med. 2013;20:240–6.CrossRefPubMed
54.
Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988–2004. Clin Infect Dis. 2010;50:1439–47.CrossRefPubMed
55.
Jin Y, Ma X, Chen X, Cheng Y, Baris E, Ezzati M. Exposure to indoor air pollution from household energy use in rural China: the interactions of technology, behavior, and knowledge in health risk management. Soc Sci Med. 2006;62:3161–76.CrossRefPubMed
56.
Behrens T, Maziak W, Weiland SK, Rzehak P, Siebert E, Keil U. Symptoms of asthma and the home environment. The ISAAC I and III cross-sectional surveys in Münster, Germany. Int Arch Allergy Immunol. 2005;137:53–61.CrossRefPubMed
57.
Belanger K. Symptoms of wheeze and persistent cough in the first year of life: associations with indoor allergens, Air contaminants, and maternal history of asthma. Am J Epidemiol. 2003;158:195–202.CrossRefPubMed
58.
Berkey CS, Ware JH, Dockery DW, Ferris BG, Speizer FE. Indoor air pollution and pulmonary function growth in preadolescent children. Am J Epidemiol. 1986;123:250–60.PubMed
59.
Corbo GM, Forastiere F, Agabiti N, Dell’Orco V, Pistelli R, Aebischer ML, et al. Effect of gas cooking on lung function in adolescents: modifying role of sex and immunoglobulin E. Thorax. 2001;56:536–40.CrossRefPubMedPubMedCentral
60.
De Bilderling G, Chauhan AJ, Jeffs JAR, Withers N, Johnston SL, Holgate ST, et al. Gas cooking and smoking habits and the risk of childhood and adolescent wheeze. Am J Epidemiol. 2005;162:513–22.CrossRefPubMed
61.
Garrett MH, Hooper MA, Hooper BM, Abramson MJ. Respiratory symptoms in children and indoor exposure to nitrogen dioxide and gas stoves. Am J Respir Crit Care Med. 1998;158:891–5.CrossRefPubMed
62.
Jarvis D, Chinn S, Luczynska C, Burney P. Association of respiratory symptoms and lung function in young adults with use of domestic gas appliances. Lancet. 1996;347:426–31.CrossRefPubMed
63.
Pershagen G, Rylander E, Norberg S, Eriksson M, Nordvall SL. Air pollution involving nitrogen dioxide exposure and wheezing bronchitis in children. Int J Epidemiol. 1995;24:1147–53.CrossRefPubMed
64.
MacIntyre EA, Gehring U, Mölter A, Fuertes E, Klümper C, Krämer U, et al. Air pollution and respiratory infections during early childhood: an analysis of 10 European birth cohorts within the ESCAPE project. Environ Health Perspect. 2014;1:107–13.
65.
Paulin LM, Diette GB, Scott M, McCormack MC, Matsui EC, Curtin-Brosnan J, et al. Home interventions are effective at decreasing indoor nitrogen dioxide concentrations. Indoor Air. 2014;24:416–24.CrossRefPubMedPubMedCentral
66.
Fabian MP, Stout NK, Adamkiewicz G, Geggel A, Ren C, Sandel M, et al. The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model. Environ Health Glob Access Sci Source. 2012;11:66.
67.
Fabian MP, Adamkiewicz G, Stout NK, Sandel M, Levy JI. A simulation model of building intervention impacts on indoor environmental quality, pediatric asthma, and costs. J Allergy Clin Immunol. 2014;133:77–84.CrossRefPubMed
68.
Aguilera I, Pedersen M, Garcia-Esteban R, Ballester F, Basterrechea M, Esplugues A, et al. Early life exposure to outdoor air pollution and respiratory health, ear infections, and eczema in infants from the INMA study. Environ Health Perspect. 2012;3:387–92.CrossRef
69.
Fusco D, Forastiere F, Michelozzi P, Spadea T, Ostro B, Arcà M, et al. Air pollution and hospital admissions for respiratory conditions in Rome, Italy. Eur Respir J Off J Eur Soc Clin Respir Physiol. 2001;17:1143–50.
70.
Neas LM, Dockery DW, Ware JH, Spengler JD, Speizer FE, Ferris Jr BG. Association of indoor nitrogen dioxide with respiratory symptoms and pulmonary function in children. Am J Epidemiol. 1991;134:204–19.PubMed
71.
Ngo L, Mehta S, Do D, Thach T. The effects of short-term exposure on hospital admissions for acute lower respiratory infections in young children of Ho Chi Minh City, Viet Nam. Epidemiology. 2011;22:S228–9.CrossRef
72.
Speizer FE, Ferris Jr B, Bishop YM, Spengler J. Respiratory disease rates and pulmonary function in children associated with NO2 exposure. Am Rev Respir Dis. 1980;121:3–10.PubMed
73.
Tramuto F, Cusimano R, Cerame G, Vultaggio M, Calamusa G, Maida CM, et al. Urban air pollution and emergency room admissions for respiratory symptoms: a case-crossover study in Palermo, Italy. Environ Health. 2011;10:31.CrossRefPubMedPubMedCentral
74.
Wong TW, Lau TS, Yu TS, Neller A, Wong SL, Tam W, et al. Air pollution and hospital admissions for respiratory and cardiovascular diseases in Hong Kong. Occup Environ Med. 1999;56:679–83.CrossRefPubMedPubMedCentral
75.
Wong C-M, Thach TQ, Chau PYK, Chan EKP, Chung RY, Ou C-Q, et al. Part 4. Interaction between air pollution and respiratory viruses: time-series study of daily mortality and hospital admissions in Hong Kong. Res Rep Health Eff Inst. 2010;154:283–362.
76.
Ciencewicki J, Jaspers I. Air pollution and respiratory viral infection. Inhal Toxicol. 2007;19:1135–46.CrossRefPubMed
77.
Devalia JL, Bayram H, Rusznak C, Calderón M, Sapsford RJ, Abdelaziz MA, et al. Mechanisms of pollution-induced airway disease: in vitro studies in the upper and lower airways. Allergy. 1997;52(38 Suppl):45–51. discussion 57–58.CrossRefPubMed
78.
Spannhake EW, Reddy SPM, Jacoby DB, Yu X-Y, Saatian B, Tian J. Synergism between rhinovirus infection and oxidant pollutant exposure enhances airway epithelial cell cytokine production. Environ Health Perspect. 2002;110:665–70.CrossRefPubMedPubMedCentral
79.
Becker S, Soukup JM. Effect of nitrogen dioxide on respiratory viral infection in airway epithelial cells. Environ Res. 1999;81:159–66.CrossRefPubMed
80.
Rose RM, Fuglestad JM, Skornik WA, Hammer SM, Wolfthal SF, Beck BD, et al. The pathophysiology of enhanced susceptibility to murine cytomegalovirus respiratory infection during short-term exposure to 5 ppm nitrogen dioxide. Am Rev Respir Dis. 1988;137:912–7.CrossRefPubMed
81.
Becker S, Soukup JM. Exposure to urban air particulates alters the macrophage-mediated inflammatory response to respiratory viral infection. J Toxicol Environ Health A. 1999;57:445–57.CrossRefPubMed
82.
Jakab GJ. Modulation of pulmonary defense mechanisms against viral and bacterial infections by acute exposures to nitrogen dioxide. Res Rep Health Eff Inst. 1988;20:1–38.
83.
Djuardi Y, Wibowo H, Supali T, Ariawan I, Bredius RGM, Yazdanbakhsh M, et al. Determinants of the relationship between cytokine production in pregnant women and their infants. PLoS One. 2009;4:e7711.CrossRefPubMedPubMedCentral
84.
Neuzil KM, Tang YW, Graham BS. Protective Role of TNF-alpha in respiratory syncytial virus infection in vitro and in vivo. Am J Med Sci. 1996;311:201–4.PubMed
85.
Duramad P, Harley K, Lipsett M, Bradman A, Eskenazi B, Holland NT, et al. Early environmental exposures and intracellular Th1/Th2 cytokine profiles in 24-month-old children living in an agricultural area. Environ Health Perspect. 2006;114:1916–22.PubMedPubMedCentral
86.
Hassan MA, Eldin AME, Ahmed MM. T - helper2 /T - helper1 imbalance in respiratory syncytial virus bronchiolitis in relation to disease severity and outcome. Egypt J Immunol Egypt Assoc Immunol. 2008;15:153–60.
87.
Kang C-I, Rouse MS, Patel R, Kita H, Juhn YJ. Allergic airway inflammation and susceptibility to pneumococcal pneumonia in a murine model with real-time in vivo evaluation. Clin Exp Immunol. 2009;156:552–61.CrossRefPubMedPubMedCentral
88.
89.
Klug V, Lobscheid AB, Singer BC. Cooking appliance use in California homes—data collected from a Web-based survey. Berkeley, California: Lawrence Berkeley National Laboratory; 2011. p. 1–39.CrossRef
Metadata
Title
A cross sectional analysis of behaviors related to operating gas stoves and pneumonia in U.S. children under the age of 5
Authors
Eric S Coker
Ellen Smit
Anna K Harding
John Molitor
Molly L Kile
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1425-y

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Validation of PIN 3 physical activity survey in low-income overweight and obese young mothers

Research article

Prevalence of high-risky behaviors in transmission of HIV among high school and college student MSM in China: a meta-analysis

Research article

Recovery from post-traumatic stress disorder after a flood in China: a 13-year follow-up and its prediction by degree of collective action

Research article

Demographic and clinical characteristics of deaths associated with influenza A(H1N1) pdm09 in Central America and Dominican Republic 2009–2010

Research article

Lifestyle, chronic diseases and self-rated health among Malaysian adults: results from the 2011 National Health and Morbidity Survey (NHMS)

Research article

A cross-sectional analysis of the relationship between tobacco and alcohol outlet density and neighbourhood deprivation