Environmental tobacco smoke (ETS) and respiratory health in children

Early-life exposure to cigarette smoke primes lung function and DNA methylation changes at Cyp1a1 upon exposure later in life

Prenatal and early-life exposure to cigarette smoke (CS) has repeatedly been shown to induce stable, long-term changes in DNA methylation (DNAm) in offspring. It has been hypothesized that these changes might be functionally related to the known outcomes of prenatal and early-life CS exposure, which include impaired lung development, altered lung function, and increased risk of asthma and wheeze. However, to date, few studies have examined DNAm changes induced by prenatal CS in tissues of the lung, and even fewer have attempted to examine the specific influences of prenatal versus early postnatal exposures. Here, we have established a mouse model of CS exposure which isolates the effects of prenatal and early postnatal CS exposures in early life. We have used this model to measure the effects of prenatal and/or postnatal CS exposures on lung function and immune cell infiltration as well as DNAm and expression of Cyp1a1, a candidate gene previously observed to demonstrate DNAm differences on CS exposure in humans. Our study revealed that exposure to CS prenatally and in the early postnatal period causes long-lasting differences in offspring lung function, gene expression, and lung Cyp1a1 DNAm, which wane over time but are reestablished on reexposure to CS in adulthood. This study creates a testable mouse model that can be used to investigate the effects of prenatal and early postnatal CS exposures and will contribute to the design of intervention strategies to mediate these detrimental effects.NEW & NOTEWORTHY Here, we isolated effects of prenatal from early postnatal cigarette smoke and showed that exposure to cigarette smoke early in life causes changes in offspring DNA methylation at Cyp1a1 that last through early adulthood but not into late adulthood. We also showed that smoking in adulthood reestablished these DNA methylation patterns at Cyp1a1, suggesting that a mechanism other than DNA methylation results in long-term memory associated with early-life cigarette smoke exposures at this gene.

Evaluation of Exhaled Carbon Monoxide Levels in Individuals Exposed to Passive Tobacco Smoke in Indoor and Outdoor Environments: How Far Can We Getaway Under the Same Roof?

INTRODUCTION

Besides direct exposure, indirect contact with tobacco smoke significantly contributes to numerous health issues. Unfortunately, people are unaware that the precautions taken in closed environments are inadequate to deal with this issue. We conducted this study to assess carbon monoxide (CO) levels of people exposed to tobacco smoke indoors and outdoors.

METHODS

Our study between May and June 2023 included individuals exposed to tobacco smoke indoors (n=100) and outdoors (n=100). Our control group included 100 people who had never been exposed to healthy tobacco smoke and agreed to participate in our research. The amount of CO exhaled was measured by observing how long people were in contact with tobacco smoke and how close they were to it. Questionnaires were asked of the study participants about the harms and awareness of tobacco smoke exposure.

RESULTS

Exhaled CO levels were 1.46 ± 0.1 ppm in people exposed to tobacco smoke indoors, 1.1± 0.03 ppm in people exposed to smoke outside, and 1.1± 0.02 ppm in the control group. The statistical analysis revealed that individuals exposed to tobacco smoke in the indoor environment had significantly higher exhaled CO levels than those in the outdoor and the control groups (p=0.006). In the correlation analysis of time and distance in the indoor environment with the exhaled CO level, there was no statistically significant difference between time and space (r= -0.168, p=0.09, r=0.09, p=0.37, respectively). While less than half of both groups were aware of second-hand tobacco smoke, individuals exposed to tobacco smoke in the outdoor environment were more familiar (p<0.001).

CONCLUSION

Despite the precautions, indoor tobacco smoke exposure is severe because of second- and third-hand smoke. Raising individual awareness and enhancing the steps should be our top concern to prevent future health problems.

Nutrient Supplementation during the Prenatal Period in Substance-Using Mothers: A Narrative Review of the Effects on Offspring Development

Substance use during pregnancy increases the risk for poor developmental outcomes of the offspring, and for substance-dependent mothers, abstaining from substance use during pregnancy is often difficult. Given the addictive nature of many substances, strategies that may mitigate the harmful effects of prenatal substance exposure are important. Prenatal nutrient supplementation is an emerging intervention that may improve developmental outcomes among substance-exposed offspring. We provide a narrative review of the literature on micronutrient and fatty acid supplementation during pregnancies exposed to substance use in relation to offspring developmental outcomes. We first discuss animal models exposed to ethanol during pregnancy with supplementation of choline, zinc, vitamin E, iron, and fatty acids. We follow with human studies of both alcohol- and nicotine-exposed pregnancies with supplementation of choline and vitamin C, respectively. We identified only 26 animal studies on ethanol and 6 human studies on alcohol and nicotine that supplemented nutrients during pregnancy and reported offspring developmental outcomes. There were no studies that examined nutrient supplementation during pregnancies exposed to cannabis, illicit substances, or polysubstance use. Implementations and future directions are discussed.

Urinary cotinine and exposure to passive smoke in children and adolescents in Germany - Human biomonitoring results of the German Environmental Survey 2014-2017 (GerES V)

Passive smoking is a preventable and significant cause of many serious health problems, with children being particularly at risk. In the fifth German Environmental Survey (GerES V), conducted from 2014 to 2017, information reflecting the extent of passive smoke exposure in children and adolescents was collected by interview-based questionnaires and human biomonitoring (HBM) analyses of cotinine in urine from 2260 participants, aged 3-17 years. Based on these population-representative data, we describe current passive smoke exposure stratified by different subgroups and identify specific exposure determinants using multivariate logistic regression. The questionnaire data revealed that 42% of children and adolescents lived with at least one smoker in the household. Quantifiable concentrations of cotinine could be detected in 56% of the participants. The overall median concentration of cotinine was 0.2 μg/L, with children and adolescents of low socioeconomic status found to be a group particularly affected by passive smoke with higher cotinine concentrations (median = 1.2 μg/L). In the multiple analysis, the most significant predictor of cotinine levels derived from the questionnaire was passive smoking at home (odds ratio (OR) 13.07 [95CI: 4.65, 36.70]). However, parental smoking and passive smoking among friends and relatives could also be identified as independent factors influencing elevated cotinine levels. The comparison between the previous cycle GerES IV (2003-2006) on 3-14-year-olds and GerES V shows that tobacco smoke exposure of children decreased significantly. This decrease is likely an effect of extensive non-smoker protection laws being enforced 2007-2008 on federal and state level. This is reflected by a halving of urinary cotinine concentrations. Nevertheless, our results indicate that passive smoke is still a relevant source of harmful pollutants for many children and adolescents in Germany, and thus support the need for further efforts to reduce passive smoke exposure, especially in the private environment.

Developmental programming of macrophages by early life adversity

Macrophages are central elements of all organs, where they have a multitude of physiological and pathological functions. The first macrophages are produced during fetal development, and most adult organs retain populations of fetal-derived macrophages that self-maintain without major input of hematopoietic stem cell-derived monocytes. Their developmental origins make macrophages highly susceptible to environmental perturbations experienced in early life, in particular the fetal period. It is now well recognized that such adverse developmental conditions contribute to a wide range of diseases later in life. This chapter explores the notion that macrophages are key targets of environmental adversities during development, and mediators of their long-term impact on health and disease. We first briefly summarize our current understanding of macrophage ontogeny and their biology in tissues and consider potential mechanisms by which environmental stressors may mediate fetal programming. We then review evidence for programming of macrophages by adversities ranging from maternal immune activation and diet to environmental pollutants and toxins, which have disease relevance for different organ systems. Throughout this chapter, we contemplate appropriate experimental strategies to study macrophage programming. We conclude by discussing how our current knowledge of macrophage programming could be conceptualized, and finally highlight open questions in the field and approaches to address them.

Changes in parental smoking behavior and children's health status in Chile

Studies on parental smoking behavior have mostly been conducted for developed countries and show that current parental smoking is negatively associated with children's current health. Using four waves of a Chilean longitudinal survey (Encuesta de Protección Social), we estimate probit and ordinary least squares models relating parents' self-report of their children's current health status to several covariates, including current parental smoking status and change (transitions) in parental smoking status across the waves of the survey. The data were collected in the years 2004, 2006, 2009, and 2015. The working sample includes 25,052 observations. The study revealed that parents' self-report of their children's current health status is strongly associated with current and past parental smoking status. Parents who smoke have an increased 11.17% probability of reporting that their children are in fair, poor, or very poor health status, when compared to non-smoking parents. The effect is stronger if the smoker is the mother, and it is exacerbated if she is less educated or unemployed/inactive. In addition, quitting smoking has a significant positive effect on children's reported health status, which is greater if the mother quits smoking. Cessation among mothers who are unemployed or inactive is also associated with a more positive assessment of their children's health status. The findings suggest that cessation programs may have health benefits not only for smoking parents, but also for their children. Improving coverage or establishing a national cessation program may have important present and future effects on population health and well-being.

A retrospective analysis of oral and maxillofacial lesions in children and adolescents reported in two different services

BACKGROUND

Most epidemiological studies involving oral and maxillofacial lesions assess only data from histopathological analysis. This may lead to a poor notification of diseases whose diagnosis is predominantly clinical. Aim: To evaluate and to compare the frequency of oral and maxillofacial lesions in children and adolescents in two different types of services: Oral Medicine clinic service and laboratory service.

MATERIAL AND METHODS

The records of patients ≤ 19 years attending the Oral Medicine clinic service and records from the laboratory service in Oral and Maxillofacial Pathology of the Dental School of a university were analyzed.

RESULTS

828 records from the Oral Medicine clinic service and 2,409 records from the laboratory service were analyzed. The most common lesion group in both services was inflammatory/reactive lesions; however, infectious lesions and variations of normality were more frequently in the clinical service. Mucocele was the most common lesion in both services. The lips (28.9%) were the most affected region in the clinical service, while in the laboratory service, the bones (34.7%) were the most affected region.

CONCLUSIONS

Some differences may occur with respect to the frequency of oral and maxillofacial lesions among pediatric individuals when data from different sources are compared. Key words:Epidemiology, oral and maxillofacial pathology, oral medicine, oral and maxillofacial lesions, children, adolescents.

Changes in children's lung function over two decades in relation to socioeconomic, parental and household factors in Wuhan, China

Background

It is important to identify risk and beneficial factors for children's lung function. This study aims to ascertain potential changes in children's lung function in relation to changes in socioeconomic, parental and household factors, based on a comparison between two periods spanning 25 years in Wuhan, the largest metropolis in central China.

Methods

In two cross-sectional studies, lung function measurements and questionnaire surveys were conducted on school-age children in 1993-1996 (Period I) and in 2018 (Period II). Children of 6-12 years old from elementary schools were selected by a multistage sampling method. Demographic information, socioeconomic status, feeding methods, parental illness and behavior patterns, as well as household characteristics, were collected through a questionnaire survey. Spirometric lung function was measured, including forced vital capacity (FVC), forced expiratory volume in the first second (FEV₁), forced expiratory flow at 25% and 75% of the pulmonary volume (FEF25-75), and peak expiratory flow (PEF). Wilcoxon analysis of variances was used to assess the differences in lung function indexes between Period I and Period II. Multiple linear regression models were used to estimate the association of lung function with regard to socioeconomic, parental and household factors, respectively.

Results

Significant prevalence reductions were observed for household coal use, paternal smoking and maternal asthma, while the prevalence increased significantly for children sleeping in their own rooms or own beds and breastfeeding, ventilation use during cooking, and parental education level from Period I to Period II. When adjusted for age, height, weight, sex and other factors assessed in the study, children had significant lower values of FVC, FEV₁, and PEF in Period II than in Period I. Enclosed kitchen was significantly associated with lower lung function in children in Period I. Urban living condition and higher maternal education level were each associated with a higher FVC, while father having no fixed income was associated with a lower FVC and a lower FEV₁, respectively, in Period II. In comparison with Period I, the beneficial impact of urban living and that of breastfeeding were enhanced and the detrimental effect of poor household condition was weakened in Period II.

Conclusions

Lung function was lower in 2018 than in 1993-1996 in school-age children living in Wuhan. Although improvements in urban living and household environmental conditions as well as increased breastfeeding in Period II could have contributed to increased lung function, other unmeasured risk factors may have played a more dominant role in leading to a net decrease in lung function from Period I to Period II. Future studies are needed to identify these risk factors.

Exposure to environmental tobacco smoke during pregnancy and infancy increased the risk of upper respiratory tract infections in infants: A birth cohort study in Wuhan, China

We aimed to evaluate the association of the exposure to environmental tobacco smoke (ETS) during pregnancy and infancy with the risk of upper respiratory tract infections (URTI) in infants based on a Chinese birth cohort study. Among 4178 infants who constituted the final study population, 46.8% experienced URTI in their first year of life. The hazard ratios (HR) and 95% confidence intervals (CI) for the risk of URTI were assessed using Cox regression models. Compared with no ETS during pregnancy, continued ETS during pregnancy was independently associated with a higher risk of URTI (HR: 1.36, 95% CI: 1.13, 1.63) after adjustment for potential confounders and also associated with earlier occurrence of URTI (log-rank P = .002). The association remained consistent across the strata defined according to maternal age, number of siblings, sex, and breastfeeding. Exposure to ETS during infancy was associated with URTI only among infants who were breastfed for less than 12 months (P for interaction < 0.05).Furthermore, infants exposed to ETS during both pregnancy and infancy showed the highest HR of 1.46 (95% CI: 1.16, 1.85) for URTI. Efforts should be made to protect pregnant women and infants from the adverse effects of indoor and outdoor ETS.

The Triad Mother-Breast Milk-Infant as Predictor of Future Health: A Narrative Review

The benefits of human milk for both mother and infant are widely acknowledged. Human milk could represent a link between maternal and offspring health. The triad mother-breast milk-infant is an interconnected system in which maternal diet and lifestyle might have effects on infant's health outcome. This link could be in part explained by epigenetics, even if the underlining mechanisms have not been fully clarified yet. The aim of this paper is to update the association between maternal diet and human milk, pointing out how maternal diet and lifestyle could be associated with breast-milk composition, hence with offspring's health outcome.

Longitudinal association between environmental tobacco smoke exposure and behavioral problems in children from ages 5 to 9

Few studies have assessed the cumulative effects of exposure to environmental tobacco smoke (ETS¹) in relation to children's neurobehavioral problems over time. We assessed the longitudinal associations between ETS exposure at age 5 and behavioral problems at ages 5, 7, and 9 using the Ewha Birth and Growth Cohort, in Seoul, Korea. Children with available urinary cotinine levels at age 5 and one or more behavioral problem scores measured with the Korean Version of Child Behavior Checklist (CBCL²) at age 5, 7, and 9 were included in the study. Those whose mothers smoked during pregnancy were excluded, and a total of 179 children were included in the analysis. A linear mixed-model analysis using a REPEATED statement was conducted to assess whether ETS exposure was associated with the total, internalizing, and externalizing behavioral problem scores of the CBCL. The group with higher levels of cotinine showed continuously higher total and external behavioral problem scores from ages 5 to 9, which was seen after adjusting for preterm birth, father's education level, and television watching time. In addition, the difference in the total and external behavioral problem scores between the higher and lower cotinine groups at age 5 was statistically significant after a Bonferroni correction (p = 0.02 and 0.04, respectively), even though the fixed effect of cotinine level was almost but not statistically significant (p = 0.07 and 0.08, respectively). The results of this longitudinal cohort study provide evidence regarding the negative effects of ETS exposure in early childhood and their behavioral problems over time. This study supports the strengthening of anti-smoking policies used in educational interventions for parents, in order to reduce early ETS exposure in children.

Secondhand tobacco smoke, does it have an impact on the neurobehavioral performance of the exposed children?

Secondhand tobacco smoke (SHS) is a significant public health problem for all ages worldwide. Children are more vulnerable to the health effects of SHS because of the inhalation of more air per body volume compared to adults. The study aimed to assess neurobehavioral performance among SHS exposed Egyptian basic school children (10-12 years) and its relationship with urinary cotinine levels. Multistage cluster sampling was carried out, where 181 children (80 exposed and 101 non-exposed children) were recruited. A questionnaire on SHS exposure was sent to students' parents/caregivers. Urine samples were taken for assessment of cotinine levels by enzyme immunoassay. A Neurobehavioral test battery was measured. The exposed children had significantly lower performance in tests of attention (PASAT) [5.22 ± 5.10 vs. 6.98 ± 5.87, p = 0.035], visuomotor speed (Digit Symbol and Trail making A) [41.40 ± 18.01 vs. 46.53 ± 15.89 and 107.92 ± 44.34 vs. 92.44 ± 37.09; respectively] than non-exposed subjects. The neurobehavioral effects were correlated with urinary cotinine levels among children exposed to SHS compared to unexposed children. The study revealed poor performance in neurobehavioral domains of attention and visuomotor skills among children exposed to SHS. This necessitates the implementation of antismoking media awareness programs on the harmful effects of SHS and how to protect children from it.

Perinatal smoking exposure and risk of asthma in the first three years of life: A prospective prebirth cohort study

BACKGROUND

There is limited evidence on the association between prenatal smoking exposure and the risk of asthma in children. The aim of this prebirth cohort study was to investigate the association between prenatal and postnatal tobacco smoke exposure and the risk of asthma in Japanese children.

METHODS

Study subjects were 1304 mother-child pairs. Information on the variables under study was obtained using repeated questionnaires that were completed by mothers, first prior to delivery, then shortly after birth and subsequently around 4, 12, 24, and 36 months after delivery. Ever asthma was defined as a maternal report of physician-diagnosed asthma at any time since birth. Current asthma was defined as the use of asthma medication at the time of the sixth survey.

RESULTS

Logistic regression models revealed that maternal active smoking, either before pregnancy or during pregnancy, was not associated with the risk of ever asthma or current asthma. Further, no association was observed between postnatally living with at least one household smoker and the risk of asthma. Among children whose mothers are never smokers, maternal second-hand smoke (SHS) exposure at work and/or at home during pregnancy increased the risk of ever asthma and current asthma in children; adjusted odds ratio (95% confidence intervals) for ever asthma and current asthma were 2.41 (1.13-5.05) and 4.82 (1.68-13.43), respectively.

CONCLUSIONS

Our findings suggest that maternal SHS exposure during pregnancy might be associated with an increased risk of ever asthma and current asthma in young children whose mothers have never smoked.

Exploring Volatile Organic Compound Exposure and Its Association with Wheezing in Children under 36 Months: A Cross-Sectional Study in South Lisbon, Portugal

Air quality and other environmental factors are gaining importance in public health policies. Some volatile organic compounds (VOCs) have been associated with asthma and symptoms of respiratory disease such as wheezing. The aim of this study was to measure the concentration of Total VOCs and assess their possible association with the occurrence of wheezing episodes in children under 36 months of age, in a region south of Lisbon, Portugal. A cross-sectional study was performed from October 2015 to March 2016. The sample of children under 36 months of age was selected by convenience, by inviting parents to take part in the study. A survey was applied to collect information on bedroom features, as well as to verify the occurrence of wheezing episodes. The indoor air quality parameters of bedrooms were measured using three 3M Quest^® EVM-7 environmental monitors. In total, 34.4% of infants had had wheezing episodes since birth, with 86.7% of these presenting at least one episode in the previous 12 months. Total VOC levels were above the reference values in 48% of the analyzed bedrooms. No significant association of VOC exposure in a domestic setting with episodes of wheezing was found. However, children living in households with smokers were 4 times more likely to develop wheezing episodes. Thus, this study provides relevant information that warrants further studies to assess infant exposure to indoor air pollution and parental smoking in a residential context.

Prenatal cigarette smoke exposure slightly alters neurobehavioral development in neonatal rats: Implications for developmental origins of health and disease (DoHAD)

Numerous studies indicate that smoking during pregnancy exerts harmful effects on fetal brain development. The aim of this study was to determine the influence of maternal smoking during pregnancy on the early physical and neurobehavioral development of newborn rats. Wistar rats were subjected to whole-body smoke exposure for 2 × 40 min daily from the day of mating until day of delivery. For this treatment, a manual closed-chamber smoking system and 4 research cigarettes per occasion were used. After delivery the offspring were tested daily for somatic growth, maturation of facial characteristics and neurobehavioral development until three weeks of age. Motor coordination tests were performed at 3 and 4 weeks of age. We found that prenatal cigarette smoke exposure did not alter weight gain or motor coordination. Critical physical reflexes indicative of neurobehavioral development (eyelid reflex, ear unfolding) appeared significantly later in pups prenatally exposed to smoke as compared to the control group. Prenatal smoke exposure also resulted in a delayed appearance of reflexes indicating neural maturity, including hind limb grasping and forelimb placing reflexes. In conclusion, clinically relevant prenatal exposure to cigarette smoke results in slightly altered neurobehavioral development in rat pups. These findings suggest that chronic exposure of pregnant mothers to cigarette smoke (including passive smoking) results in persisting alterations in the developing brain, which may have long-lasting consequences supporting the concept of developmental origins of health and disease (DoHAD).

Evaluation of hair cotinine and toxic metal levels in children who were exposed to tobacco smoke

Tobacco or tobacco products (TTP) are harmful because they contain nicotine and some heavy metals. In this study, it was aimed to evaluate whether the responses of parents to questionnaires were compatible with the hair cotinine levels of their children, and to investigate whether exposure to environmental tobacco smoke (ETS) and living conditions increased the levels of cotinine, lead (Pb), arsenic (As), and cadmium (Cd) in the hair samples of the children. Questionnaires were administered to the parents questioning household consumption of TTP and living conditions. Children were grouped as "exposed to ETS" (E-ETS) and "not exposed to ETS" (NE-ETS). This grouping was performed through a questionnaire-based evaluation, and a hair cotinine cut-off value-based evaluation. According to the questionnaire-based evaluation, there were no significant differences in hair Pb, As, and Cd levels between the groups (P-values: .337, .994, and .825, respectively). The hair cotinine of the E-ETS group was higher (0.24 ± 0.21 vs 0.22 ± 0.15 ng/mg), but the difference was not statistically significant (P = .317). According to the cotinine evaluation, cotinine, Pb, and As levels were statistically higher in the E-ETS group (P < .001, <.001, and .036, respectively), but there was no statistical difference between the groups in terms of Cd levels (P = .238). Our results showed that exposure to ETS increased the levels of cotinine, Pb, and As in the hair samples of children, and the questionnaire responses of the parents about their smoking habits might not be compatible with the hair cotinine levels of the children.

Malaysia: country report on children's environmental health

Children's environmental health (CEH) has become a main agenda in the National Environmental Health Action Plan (NEHAP) 2019 in Malaysia. Children are affected by exposure to many environmental hazards because they are uniquely vulnerable due to their immature immune systems and organs. This country report aims to review the environmental threats to CEH in Malaysia. There are a few key issues that have been identified, including air pollution, pesticides in food and water pollution. However, air pollution has been recognized as one of the major concerns in CEH, coming from both localized and transboundary sources. The localized sources include traffic-related air pollutants, industrial waste incinerators, land clearing and open burning. In addition, due to the tropical climate, children are exposed to fungal toxins, mycotoxins, endotoxins and allergens from classroom dust. Transboundary pollutants from neighboring countries result in recurring haze episodes in Malaysia, causing a negative impact on public health, especially in children. All in all, improving CEH in Malaysia requires all stakeholders and related agencies to recognize the issue as a problem, to develop a harmonized action plan and to work together to promote the protection of human health, specifically of children.

Indoor PM2.5, tobacco smoking and chronic lung diseases: A narrative review

The lung is one of the most important organs exposed to environmental agents. People spend approximately 90% of their time indoors, and risks to health may thus be greater from exposure to poor air quality indoors than outdoors. Multiple indoor pollutants have been linked to chronic respiratory diseases. Environmental tobacco smoke (ETS) is known as an important source of multiple pollutants, especially in indoor environments. Indoor PM_2.5 (particulate matter with aerodynamic diameter < 2.5 μm) was reported to be the most reliable marker of the presence of tobacco smoke. Recent studies have demonstrated that PM_2.5 is closely correlated with chronic lung diseases. In this paper, we reviewed the relationship of tobacco smoking and indoor PM_2.5 and the mechanism that underpin the link of tobacco smoke, indoor PM_2.5 and chronic lung diseases.

Associations of household environmental tobacco smoke exposure with respiratory symptoms and utilisation of medical services in healthy young children in Hong Kong

INTRODUCTION

Young children are especially vulnerable to environmental tobacco smoke (ETS) exposure. This study was carried out to determine whether household ETS exposure was associated with respiratory symptoms and medical service utilisation among Hong Kong healthy children in their first eighteen months of age.

METHODS

A secondary analysis was done on the data obtained from our previous cross-sectional territory-wide pneumococcal carriage surveillance study in Hong Kong in 2013–2014. All measures were reported by caregivers. Univariable and multivariable analyses were performed to examine the associations between ETS exposure and outcome measures. Covariates included children’s sex, age, body mass index z score, history of breastfeeding, gestational age at birth, birthweight, maternal age, living region, overcrowding of living area, household income, child care attendance, and presence of siblings. Additional adjustment for season and households’ respiratory symptoms were made to ascertain the association between ETS and children’s respiratory symptoms.

RESULTS

The analysis included 1541 children (mean age: 11.2 ± 6.4 months; males: 50.7%). Current household ETS exposure (AOR=1.30; 95% CI: 1.00– 1.66; p=0.050) and postnatal maternal smoking (AOR=2.21; 95% CI: 1.06–4.64; p=0.035) were independently and significantly associated with all-cause doctor consultation in the past 3 months. Children living with more than one household smoker were more likely to have all-cause doctor consultation compared with the non-exposed children (AOR=1.70; 95% CI: 1.04–2.77, p=0.028). Postnatal maternal smoking was associated with all-cause hospitalisation in the past 3 months (AOR=2.48; 95% CI: 1.05–5.86; p=0.039). Children living in a household, where the daily consumption by household smokers was more than 20 cigarettes, were more likely to have respiratory symptoms compared with non-exposed children (AOR=1.99; 95% CI: 1.12–3.52; p=0.016).

CONCLUSIONS

Household ETS exposure in young children was associated with respiratory symptoms and all-cause outpatient or inpatient medical service utilisation. The associations were potentially dose-dependent.

The relationship between second-hand smoke and wheezing in infants from Córdoba, Argentina

BACKGROUND

Wheezing constitutes a common respiratory symptom in children, and several risk factors have been associated with the prevalence of recurrent wheezing (RW) and its severity, especially viral respiratory infections and second-hand smoke (SHS) exposure.

OBJECTIVE

To analyze the relationship between smoking patterns in the home and wheezing, in infants from the city of Córdoba, Argentina, during their first year of life.

METHODS

Parents of infants were invited to complete a standardized questionnaire voluntarily and anonymously (WQ-P1-EISL). Wheezing in the first 12 months of life was classified as occasional wheezing (OW) when having one or two episodes during the first 12 months of life; recurrent wheezing (RW) if having three or more, and more frequent wheezing (MFW) ≥6 episodes.

RESULTS

409 infants (39.0%) had one or more episodes of wheezing in the first 12 months. Of these, 214 infants (52.3%) presented occasional wheezing (OW), 135 (33%) had recurrent wheezing (RW), and 60 (14.7%) more frequent wheezing (MFW). SHS was significantly related to MFW, especially if the mother smoked (OR=2.7; IC 95%: 1.4-5.18; p=0.0009) or if she smoked during pregnancy (OR=4; IC 95%: 1.8-8.5; p=0.0001). This group of MFW was also associated with SHS as well as having been to the emergency room for wheezing (40.87%, p=0.0056).

CONCLUSION

The results indicate that second-hand tobacco smoke is a significant risk factor for the presence of wheezing in infants, and for its severity. Our findings have significant implications for public health, as smoking is a modifiable behavior.

Exposure to secondhand smoke in vehicles among Canadian adolescents: Years after the adoption of smoke-free car laws

Exposure to secondhand smoke (SHS) can result in several adverse health consequences. SHS concentrations in vehicles can significantly exceed levels present in other enclosed spaces. Years after the adoption of smoke-free car laws, this study examined the prevalence of exposure to SHS in vehicles among adolescents. Data were utilized from the 2016-2017 Canadian Student Tobacco, Alcohol and Drugs Survey (n = 48,444). The prevalence of exposure to SHS in cars was estimated by grade level and demographic characteristics. The results showed a gradient by grade level in exposure to SHS with students in upper-grade levels reporting a higher prevalence of SHS in cars. SHS varied by province, with the lowest rate found in British Columbia (15.6%) and the highest in Saskatchewan (36.9%). The provinces with laws that extend protections to older children also had high rates of SHS exposure among students in upper-grade levels. Students exposed to SHS were more likely to engage in risky behaviors, including the use of marijuana, alcohol, cigarettes, and e-cigarettes. Despite laws prohibiting smoking in vehicles carrying children, SHS prevalence remains high. While enforcement of these laws may be challenging, persuasion campaigns highlighting that children are especially vulnerable to the health risks of SHS may be beneficial.

Further Insights on Predictors of Environmental Tobacco Smoke Exposure during the Pediatric Age

Background: The smoking ban in public places has reduced Environmental Tobacco Smoke (ETS) exposure for non-smokers, but despite this, domestic environments still remain places at high risk of exposure, and, today, about 40% of children worldwide are exposed to ETS at home. The aims of the study are to investigate the contribution of several factors on ETS exposure among a group of Italian children and to evaluate the changes in smoking precautions adopted at home when the smoker is the mother, the father, or both parents, respectively. Methods: A cross-sectional study was performed on a sample of 519 Italian schoolchildren. Information was collected via a questionnaire. Results: 41.4% of the participants lived with at least one smoker. Almost half of the children exposed to ETS lived with one or more smokers who do not observe any home smoking ban. Lower maternal or paternal educational levels significantly increase the risk of ETS exposure at home and the "worst case" is represented by both parents who smoke. Conclusions: More effective preventive interventions are needed to protect children from ETS exposure. Some interventions should be specifically dedicated to smokers with a low educational level and to mothers that smoke.

Adverse childhood experiences to adult adversity trends among parents: Socioeconomic, health, and developmental implications

Exposures to adverse childhood experiences compromise the early developmental foundation of people long before they become parents. These exposures partly take place within the family environment - a context tightly shared by parents and children. Despite considerable evidence regarding effects of adverse childhood experiences (ACEs), differential patterns of childhood and adulthood adversity accumulation among currently parenting adults is relatively less understood. The present study helps address this gap using the 2011 Behavioral Risk Factor Surveillance System Washington State data of respondents ages 18 and older who are currently parenting a minor child. Results demonstrate the proliferative nature of adversities, increasing risk of elevated life course stress, as well as parental socioeconomic, health and functioning outcomes that affect the family environment. Findings also suggest the resilience of some parents who, despite exposures to ACEs, were able to avoid heightened adversities in later life that could pose risk to their children's developmental environments.

Home Smoke Exposure and Health-Related Quality of Life in Children with Acute Respiratory Illness

OBJECTIVE

This study aims to assess whether secondhand smoke (SHS) exposure has an impact on health-related quality of life (HRQOL) in children with acute respiratory illness (ARI).

METHODS

This study was nested within a multicenter, prospective cohort study of children (two weeks to 16 years) with ARI (emergency department visits for croup and hospitalizations for croup, asthma, bronchiolitis, and pneumonia) between July 1, 2014 and June 30, 2016. Subjects were surveyed upon enrollment for sociodemographics, healthcare utilization, home SHS exposure (0 or ≥1 smoker in the home), and child HRQOL (Pediatric Quality of Life Physical Functioning Scale) for both baseline health (preceding illness) and acute illness (on admission). Data on insurance status and medical complexity were collected from the Pediatric Hospital Information System database. Multivariable linear mixed regression models examined associations between SHS exposure and HRQOL.

RESULTS

Home SHS exposure was reported in 728 (32%) of the 2,309 included children. Compared with nonexposed children, SHS-exposed children had significantly lower HRQOL scores for baseline health (mean difference -3.04 [95% CI -4.34, -1.74]) and acute illness (-2.16 [-4.22, -0.10]). Associations were strongest among children living with two or more smokers. HRQOL scores were lower among SHS-exposed children for all four conditions but only significant at baseline for bronchiolitis (-2.94 [-5.0, -0.89]) and pneumonia (-4.13 [-6.82, -1.44]) and on admission for croup (-5.71 [-10.67, -0.75]).

CONCLUSIONS

Our study demonstrates an association between regular SHS exposure and decreased HRQOL with a dose-dependent response for children with ARI, providing further evidence of the negative impact of SHS.

Passive smoking is associated with cognitive and emotional impairment in adolescent girls

It is well established that smoking is associated with impaired mental health and sleep problems. However, the possible effects of passive smoking on cognitive and emotional characteristics have not previously been evaluated in adolescents. We investigated the association between passive smoking and cognitive and emotional function, and sleep patterns in 940 adolescent girls. The girls were divided into two groups [305 exposed subjects and 635 non-exposed subjects (the controls)]. The passive smokers had a significantly lower cognitive function and higher depression, aggression, and insomnia scores compared to the control group (P < 0.05). No significant difference was detected with respect to day-time sleepiness and sleep apnea. Logistic regression analyses showed that the passive smokers were more likely than the controls to have cognitive impairments, depressive mood, aggressive behavior, and insomnia. Adolescent passive smokers had significant differences in their cognitive abilities and emotional function.

Passive exposure to pollutants from conventional cigarettes and new electronic smoking devices (IQOS, e-cigarette) in passenger cars

Smoking in car interiors is of particular concern because concentrations of potentially harmful substances can be expected to be high in such small spaces. To assess the potential exposure for occupants, especially children, we performed a comprehensive evaluation of the pollution in 7 passenger cars while tobacco cigarettes and new electronic smoking products (IQOS, e-cigarette) were being smoked. We collected data on the indoor climate and indoor air pollution with fine and ultrafine particles and volatile organic compounds while the cars were being driven. Smoking of an IQOS had almost no effect on the mean number concentration (NC) of fine particles (>300 nm) or on the PM_2.5 concentration in the interior. In contrast, the NC of particles with a diameter of 25-300 nm markedly increased in all vehicles (1.6-12.3 × 10⁴/cm³). When an e-cigarette was vaped in the interior, 5 of the 7 tested cars showed a strong increase in the PM_2.5 concentration to 75-490 μg/m³. The highest PM_2.5 levels (64-1988 μg/m³) were measured while tobacco cigarettes were being smoked. With the e-cigarette, the concentration of propylene glycol increased in 5 car interiors to 50-762 μg/m³, whereby the German indoor health precaution guide value for propylene glycol was exceeded in 3 vehicles and the health hazard guide value in one. In 4 vehicles, the nicotine concentration also increased to 4-10 μg/m³ while the e-cigarette was being used. The nicotine concentrations associated with the IQOS and e-cigarette were comparable, whereas the highest nicotine levels (8-140 μg/m³) were reached with tobacco cigarettes. Cigarette use also led to pollution of the room air with formaldehyde (18.5-56.5 μg/m³), acetaldehyde (26.5-141.5 μg/m³), and acetone (27.8-75.8 μg/m³). Tobacco cigarettes, e-cigarettes, and the IQOS are all avoidable sources of indoor pollutants. To protect the health of other non-smoking passengers, especially that of sensitive individuals such as children and pregnant women, these products should not be used in cars.

Correlation between Domestic Cigarette Smoke Exposure and Respiratory Complaints, Hospitalization and School Absence due to Respiratory Complains in the Indonesian Elementary School-Aged Children

Background:

Over 43 million Indonesian children who are exposed to cigarette smoke are at risk of having health hazard and morbidities.

Aims:

The aim of this study is to identify the correlation between cigarette smoke exposure and respiratory complaints, hospitalization, as well as school absence due to respiratory complaints in elementary school-aged Indonesian children.

Materials and Methods:

A cross-sectional study was conducted in nonsmoking elementary school-aged children. Participants were categorized into the exposed and unexposed groups based on the report of their parents. Questionnaire-retrieved data were analyzed to identify the correlation between cigarette smoke exposure and respiratory complaints, hospitalization, as well as school absence due to respiratory complaints in elementary school-aged children.

Results:

A total of 128 study participants of nonsmoking children aged 6–12 years (mean 9.8 ± standard deviation 1.6 years) were categorized into 64 children exposed and 64 children unexposed to domestic cigarette smoking. There was a significant correlation between smoking exposure and cough episodes as well as upper respiratory infection in children within the past 12 months. A cough episode of ≥3 times/year was found more prevalent in exposed children compared to the unexposed children (26.6% vs. 9.4%; P < 0.05). Cough ≥3 times/year was found in 50% of children exposed to cigarette smoke of a smoker with a smoking habit of >10 cigarettes/day. There was a correlation between cigarette smoke exposure and hospitalization frequency of ≥1 time(s)/year due to respiratory complaints in children (P < 0.05).

Conclusion:

Cigarette smoke exposure is correlated with complaints of cough, upper respiratory tract infection, and hospitalization due to respiratory complaints in children.

Prenatal and postnatal tobacco smoke exposure and risk of severe bronchiolitis during infancy

BACKGROUND

Maternal prenatal smoking has adverse effects on the growing fetus including those of respiratory nature. Although postnatal smoke exposure is a risk factor for respiratory infections, the effects of prenatal smoking independent of postnatal smoke exposure are less established. We hypothesized that both maternal prenatal smoking, and postnatal smoke exposure are risk factors for severe bronchiolitis during infancy.

METHODS

We performed a case-control study of 1353 children born between 1996 and 2011 at a single teaching hospital. Cases were admitted to the same hospital for bronchiolitis during infancy. Maternal prenatal smoking was collected from birth records. Postnatal smoke exposure was collected from review of electronic health records. Multivariable logistic regression was used to evaluate the independent associations of the two smoking variables with severe bronchiolitis.

RESULTS

6% of cases were exposed to maternal prenatal smoking, compared with 4% of controls (P = 0.10). Postnatal smoke exposure was present in the households of 17% of cases compared with 3% of controls (P < 0.001). In a multivariable model with both smoking variables and adjustment for 10 covariates, maternal prenatal smoking was not a significant risk factor for severe bronchiolitis (adjusted OR = 1.02, 95%CI 0.56-1.84). By contrast, postnatal smoke exposure was associated with >300% increased odds (adjusted OR 4.19, 95%CI 2.51-6.98).

CONCLUSIONS

Although maternal prenatal smoking has many known adverse effects, it was not associated with increased odds of severe bronchiolitis in either unadjusted or multivariable analyses. Postnatal smoke exposure was a consistently strong risk factor. Our findings support ongoing efforts to decrease infant exposure to ambient smoke.

Tobacco Smoke Induces and Alters Immune Responses in the Lung Triggering Inflammation, Allergy, Asthma and Other Lung Diseases: A Mechanistic Review

Many studies have been undertaken to reveal how tobacco smoke skews immune responses contributing to the development of chronic obstructive pulmonary disease (COPD) and other lung diseases. Recently, environmental tobacco smoke (ETS) has been linked with asthma and allergic diseases in children. This review presents the most actual knowledge on exact molecular mechanisms responsible for the skewed inflammatory profile that aggravates inflammation, promotes infections, induces tissue damage, and may promote the development of allergy in individuals exposed to ETS. We demonstrate how the imbalance between oxidants and antioxidants resulting from exposure to tobacco smoke leads to oxidative stress, increased mucosal inflammation, and increased expression of inflammatory cytokines (such as interleukin (IL)-8, IL-6 and tumor necrosis factor α ([TNF]-α). Direct cellular effects of ETS on epithelial cells results in increased permeability, mucus overproduction, impaired mucociliary clearance, increased release of proinflammatory cytokines and chemokines, enhanced recruitment of macrophages and neutrophils and disturbed lymphocyte balance towards Th2. The plethora of presented phenomena fully justifies a restrictive policy aiming at limiting the domestic and public exposure to ETS.

Self-Reported Environmental Tobacco Smoke Exposure and Avoidance Compared with Cotinine Confirmed Tobacco Smoke Exposure among Pregnant Women and Their Infants

BACKGROUND

Exposure to environmental tobacco smoke (ETS) presents substantial health risks for pregnant women and newborn infants. Measurements of ETS include invasive and expensive biochemical tests, as well as less invasive and lower-cost, self-reported exposure and avoidance measures. Better understanding of self-report measures will help to select ETS assessments for evaluation.

METHODS

This analysis was conducted within the context of a tailored video intervention to reduce tobacco smoking and ETS exposure during pregnancy and after delivery in the control group sample of 147 nonsmoking women. Measurements of salivary cotinine concentration, self-reported ETS exposure, and avoidance behaviors were captured at 32 weeks’ gestation and 6 months postpartum.

RESULTS

Salivary cotinine concentration was significantly related to ETS avoidance among pregnant nonsmokers at 32 weeks’ gestation, but not ETS exposure. At 6 months postpartum, both the reported ETS exposure of the infant and maternal avoidance behaviors to reduce her infant’s exposure were associated with the infant’s salivary cotinine concentration. At 32 weeks’ gestation and 6 months postpartum, avoidance behaviors decreased as exposure increased.

DISCUSSION

This study suggests that for nonsmoking women during pregnancy, reports of tobacco smoke avoidance are more valid than reports of exposure. After delivery, self-reported ETS exposure or avoidance are associated with each other and the biochemical measurement of salivary cotinine. These results provide researchers and clinicians with evidence to support the inclusion of avoidance behaviors in the selection of ETS measures.

Maternal Smoking during Pregnancy and Early Childhood and Development of Asthma and Rhinoconjunctivitis - a MeDALL Project

BACKGROUND

The role of tobacco smoke exposure in the development and persistence of asthma and rhinoconjunctivitis through childhood into adolescence is unclear.

OBJECTIVES

We assessed the associations of parental smoking from fetal life through adolescence with asthma and rhinoconjunctivitis during childhood and adolescence.

METHODS

We analyzed data for 10,860 participants of five European birth cohort studies from the Mechanisms of the Development of Allergy (MeDALL) consortium. Parental smoking habits and health outcomes (early transient, persistent, and adolescent-onset asthma and rhinoconjunctivitis) were based on questionnaires covering the period from pregnancy to 14-16 y of age. Data were combined and analyzed using a one-stage and two-stage individual participant data meta-analysis.

RESULTS

Overall, any maternal smoking during pregnancy tended to be associated with an increased odds of prevalent asthma [adjusted odds ratio (aOR)=1.19 (95% CI: 0.98, 1.43)], but not prevalent rhinoconjunctivitis [aOR=1.05 (95% CI: 0.90, 1.22)], during childhood and adolescence. In analyses with phenotypes related to age of onset and persistence of disease, any maternal smoking during pregnancy was associated with early transient asthma [aOR=1.79 (95% CI: 1.14, 2.83)]. Maternal smoking of ≥10 cigarettes/day during pregnancy was associated with persistent asthma [aOR=1.66 (95% CI: 1.29, 2.15)] and persistent rhinoconjunctivitis [aOR=1.55 (95% CI, 1.09, 2.20)]. Tobacco smoke exposure during fetal life, infancy, childhood, and adolescence was not associated with adolescent-onset asthma or rhinoconjunctivitis.

CONCLUSIONS

Findings from this combined analysis of five European birth cohorts strengthen evidence linking early exposure to tobacco smoke with asthma during childhood and adolescence. Children with high early-life exposure were more likely than unexposed children to have early transient and persistent asthma and persistent rhinoconjunctivitis. https://doi.org/10.1289/EHP2738.

Prenatal tobacco smoke exposure predisposes offspring mice to exacerbated allergic airway inflammation associated with altered innate effector function

Background

Epidemiological studies suggest that prenatal and early life environmental exposures have adverse effects on pulmonary function and are important contributors in the development of childhood asthma and allergic disease. The mechanism by which environmental tobacco smoke (ETS) exposure in utero promotes the development of allergic asthma remains unclear. In this study, we investigated the immunological consequences of prenatal exposure to ETS in order to understand events responsible for the development or exacerbation of allergic asthma.

Methods

Pregnant C57BL/6 mice were exposed to either ETS or filtered air throughout gestation and the effect on pulmonary inflammation in the offspring were examined and compared. Specifically, the effects on eosinophilic inflammation, airway hyperreactivity, goblet cell hyperplasia, properties of pulmonary natural killer (NK) cells and type 2 cytokines elicited in response to inhaled house dust mite (HDM) allergen were investigated in the progeny.

Results

Exposure to ETS prenatally significantly exacerbated HDM-induced airway eosinophilic inflammation, hyperreactivity, mucus secretion, cysteinyl leukotriene biosynthesis and type 2 cytokine production in the offspring. Consistently, lung mononuclear cells from ETS-exposed offspring secreted higher levels of IL-13 when stimulated in vitro with anti-αβ TCR antibody or HDM allergen. Moreover, offspring from ETS-exposed dams exhibited a higher frequency of CD11b⁺ dendritic cells and CD3⁺CD4⁺ T lymphocytes in the lungs following allergen inhalation compared to air-exposed mice. Unexpectedly, the exacerbated allergic inflammation in the ETS-exposed offspring was associated with a reduction in CD3⁻CD19⁻NK1.1⁺CD94⁺ NK cell numbers and their IFN-γ production, highlighting a role for altered innate immunity in the enhanced allergic response.

Conclusion

Our results reveal that prenatal exposure to ETS predisposes offspring to an exacerbated allergic airway inflammation that is associated with a reduction in pulmonary NK cell function, suggesting that NK cells play a key role in controlling asthma severity.

The association between environmental tobacco smoke exposure and childhood respiratory disease: a review

INTRODUCTION

Childhood respiratory illness is a major cause of morbidity and mortality particularly in low and middle-income countries. Environmental tobacco smoke (ETS) exposure is a recognised risk factor for both acute and chronic respiratory illness. Areas covered: The aim of this paper was to review the epidemiology of ETS exposure and impact on respiratory health in children. We conducted a search of 3 electronic databases of publications on ETS and childhood respiratory illness from 1990-2015. Key findings were that up to 70% of children are exposed to ETS globally, but under-reporting may mask the true prevalence. Maternal smoking and ETS exposure influence infant lung development and are associated with childhood upper and lower respiratory tract infection, wheezing or asthma. Further, exposure to ETS is associated with more severe respiratory disease. ETS exposure reduces lung function early in life, establishing an increased lifelong risk of poor lung health. Expert commentary: Urgent and effective strategies are needed to decrease ETS exposure in young children to improve child and long-term lung health in adults especially in low and middle income countries where ETS exposure is increasing.

Secondhand smoke exposure and risk of wheeze in early childhood: a prospective pregnancy birth cohort study

Background

Evidence regarding the independent and additive effects of both pre- and postnatal smoking exposure on the risk of wheeze in children is limited. The purpose of this prospective pregnancy birth cohort study was to examine the association between prenatal and postnatal tobacco smoke exposure during the first year of life and the risk of wheeze in Japanese children aged 23 to 29 months.

Methods

Study subjects were 1354 Japanese mother-child pairs. Information on the variables under study was obtained using repeated questionnaires that were completed by mothers, first prior to delivery, then shortly after birth and subsequently around 4, 12, and 24 months after delivery. Wheeze was defined according to the criteria of the International Study of Asthma and Allergies in Childhood.

Results

Compared with no maternal smoking during pregnancy, maternal smoking throughout pregnancy was significantly associated with an increased risk of wheeze in children, yet there were no associations between maternal smoking in the first trimester only or in the second and/or third trimesters and the risk of wheeze. No association was observed between postnatally living with at least one household smoker and the risk of wheeze. An analysis to assess the additive effect of prenatal and postnatal smoking exposure revealed that, compared with children not exposed to maternal smoking during pregnancy and not postnatally living with at least one household smoker, those who were both exposed to maternal smoking during pregnancy and postnatally living with at least one household smoker had twofold odds of developing wheeze.

Conclusions

Our findings suggest that maternal smoking throughout pregnancy might be associated with an increased risk of wheeze in children. There is also the possibility of a positive additive effect of pre- and postnatal smoking exposure on the risk of childhood wheeze.

Electronic supplementary material

The online version of this article (doi:10.1186/s12971-017-0138-7) contains supplementary material, which is available to authorized users.

In utero and early childhood exposure to secondhand smoke in Taiwan: a population-based birth cohort study

OBJECTIVES

This study provides secondhand smoke (SHS) exposure data in utero and after birth when children were at 18 months, 36 months and 66 months old, and it identifies risk factors for the early childhood SHS among 18-month-old infants living in smoker and non-smoker households.

STUDY DESIGN

The data come from the Taiwan Birth Cohort Study, a longitudinal survey of a birth cohort born in 2005. This study used the survey wave when children were 18 months old (n=18 845) for statistical analysis of early childhood SHS exposure. Logistic regression was used to identify the risk factors of the SHS exposure.

RESULTS

Approximately 62% of the 18-month-old infants lived in a household with at least one smoker, with the father being the smoker in 84% of those households. Among these infants living in a smoker household, 70% were exposed to SHS and 36% were exposed to heavy SHS in utero, and the prevalence was approximately 66% and 17% after birth for SHS and heavy SHS, respectively. The number and the existence of smokers in the household, parents' smoking status, father's educational attainment and being a first-born baby are strong predictors of early childhood heavy SHS exposure.

CONCLUSIONS

Encouraging families to have a smoke-free home environment, empowering women to ensure their perspectives and rights are embedded into tobacco control efforts and educating families about the health risks from childhood SHS exposure, especially among people living in households with smokers, will protect non-smoking adults and children from SHS exposure.

Wood Stove Pollution in the Developed World: A Case to Raise Awareness Among Pediatricians

Use of wood for residential heating is regaining popularity in developed countries. Currently, over 11 million US homes are heated with a wood stove. Although wood stoves reduce heating costs, wood smoke may adversely impact child health through the emission of gaseous and particulate air pollutants. Our purpose is to raise awareness of this environmental health issue among pediatricians. To summarize the state of the science, we performed a narrative review of articles published in PubMed and Web of Science. We identified 36 studies in developed countries that reported associations of household wood stove use and/or community wood smoke exposure with pediatric health outcomes. Studies primarily investigated respiratory outcomes, with no evaluation of cardiometabolic or neurocognitive health. Studies found community wood smoke exposure to be consistently associated with adverse pediatric respiratory health. Household wood stove use was less consistently associated with respiratory outcomes. However, studies of household wood stoves always relied on participant self-report of wood stove use, while studies of community wood smoke generally assessed air pollution exposure directly and more precisely in larger study populations. In most studies, important potential confounders, such as markers of socioeconomic status, were unaccounted for and may have biased results. We conclude that studies with improved exposure assessment, that measure and account for confounding, and that consider non-respiratory outcomes are needed. While awaiting additional data, pediatricians can refer patients to precautionary measures recommended by the US Environmental Protection Agency (EPA) to mitigate exposure. These include replacing old appliances with EPA-certified stoves, properly maintaining the stove, and using only dry, well-seasoned wood. In addition, several studies have shown mechanical air filters to effectively reduce wood stove pollution exposure in affected homes and communities.

Cross-sectional study about impact of parental smoking on rhinitis symptoms in children

OBJECTIVE

Assess the prevalence of rhinitis and exposure to environmental tobacco smoke (ETS) of children in our community and its relationship with symptoms of rhinitis METHODS (DESIGN, SETTING, PARTICIPANTS, MAIN OUTCOME MEASURES): Cross-sectional study using questionnaire on rhinitis of the International Study of Asthma and Allergies in Childhood, in children (6-7 years) and adolescents (13-14 years). Categories: "rhinitis ever", "recent rhinitis", "recent rhinoconjunctivitis", "severe rhinoconjunctivitis". Parental smoking: (i) neither parent smokes; (ii) only the mother smokes; (iii) only the father smokes; and (iv) both parents smoke. Odds ratio of the prevalence of symptoms of rhinitis according to ETS exposure was calculated using logistic regression.

RESULTS

10 690 children and 10 730 adolescents. The prevalence of "rhinitis ever" in children: 29.4%, "recent rhinitis" 24%, "recent rhinoconjunctivitis" 11.5% and "severe rhinoconjunctivitis" 0.1%. In adolescents: 46.2%, 34.5%, 16.2% and 0.2%, respectively. Environmental tobacco smoke exposure in the home occurred in 51% of cases. Parental smoking was associated with a higher prevalence of forms of rhinitis in adolescents when only the mother was a smoker. In children when both parents were smokers.

CONCLUSION

Rhinitis is highly prevalent in our community. Environmental tobacco smoke exposure is still very common. The relationship between ETS and rhinitis symptoms in children of this community is not as robust as that found for asthma.

Family-Based Smoking Cessation Intervention for Smoking Fathers and Nonsmoking Mothers with a Child: A Randomized Controlled Trial

OBJECTIVE

To examine whether a family-based intervention targeting both smoking fathers and nonsmoking mothers in well-child health clinics is effective in increasing fathers' abstinence from cigarette smoking.

STUDY DESIGN

This parallel 2-arm randomized controlled trial recruited a total of 1158 families with a daily-smoking father, a nonsmoking mother, and a child aged 0-18 months from the 22 maternal and child health centers in Hong Kong. The intervention group received the family-based intervention, including 6 nurse-led individual face-to-face and telephone counseling sessions within 1 month after recruitment and a voluntary face-to-face family counseling session (FCS). The control group received a leaflet, a self-help booklet, and brief quitting advice only. Father-reported 7-day and 6-month abstinence, smoking reduction, quit attempts, mother-reported help and support, and child salivary cotinine level were assessed at 12 months. Generalized estimating equation models were used to compare these outcomes between the 2 study groups.

RESULTS

Compared with the control group, the intervention group reported a greater prevalence of 7-day (13.7% vs 8.0%; OR, 1.92; 95% CI, 1.16-3.17; P < .01) and 6-month self-reported abstinence (13.4% vs. 7.5%; OR, 2.10; 95% CI, 1.30-3.40; P < .01). Within the intervention group, compared with receipt of individual counseling only, participation in the FCS was associated with increases in fathers' self-reported abstinence (20.2% vs 12.3%; P = .02), mothers' help (66.1% vs 43.8%; P < .01), and support to the fathers (55.0% vs 45.4%; P < .01).

CONCLUSIONS

The family-based smoking cessation intervention for the families in the well-child healthcare setting was effective in increasing the fathers' self-reported abstinence. Additional participation in the FCS increased mothers' help and support to the fathers.

TRIAL REGISTRATION

Controlled-trials.com: ISRCTN99111655; Hkuctr.com: HKUCTR-465.

Exposure to tobacco smoke and childhood rhinitis: a population-based study

Exposure to tobacco smoke has been associated with harmful effects on child health. The association between tobacco smoke exposure and childhood rhinitis has not been established in developed or developing countries. We investigated the association between serum cotinine levels and rhinitis in a population sample of 1,315 Asian children. Serum cotinine levels were positively associated with rhinitis ever (adjusted odds ratio [AOR] = 2.95; 95% confidence interval [CI]: 1.15–7.60) and current rhinitis (AOR = 2.71; 95% CI: 1.07–6.89), while the association for physician-diagnosed rhinitis approaching borderline significance (AOR = 2.26; 95% CI: 0.88–5.83). Stratified analyses demonstrated significant association of serum cotinine levels with current rhinitis among children without allergic sensitization (AOR = 6.76; 95% CI: 1.21–37.74), but not among those with allergic sensitization. Serum cotinine levels were positively associated with rhinitis ever (AOR = 3.34; 95% CI: 1.05–10.61) and current rhinitis (AOR = 4.23; 95% CI: 1.28–13.97) among adolescents but not in children aged less than 10 years. This population-based study demonstrates supportive evidence for positive association of tobacco smoke exposure with rhinitis, while the effect is mainly confined to non-allergic rhinitis and more pronounced in adolescents than in young children, highlighting the need for raising public health awareness about the detrimental effects of tobacco smoke exposure on children’s respiratory health.

Family-based social determinants and child health: Cross-sectional study

BACKGROUND

The aim of this study was to evaluate the association between urbanization of residential area, parent education level, employment status, overweight/obesity, physical activity, and exposure to environmental tobacco smoke (ETS), in a sample of healthy Italian school-age children (5-11 years).

METHODS

A cross-sectional study was conducted on 432 children resident, respectively, in a highly urban and in a rural area (Latium Region) in 2014. Information on children and families were obtained via questionnaire.

RESULTS

One-third of children were overweight or obese, 15% did not participate in any sport outside school, and more than one-third were exposed to ETS in the domestic environment. Living in a rural area (adjusted OR, 2.55; 95%CI: 1.18-5.52) and lower maternal education (adjusted OR, 2.32; 95%CI: 1.03-5.27) were significant predictors of overweight/obese status. Moreover, lower maternal education level (adjusted OR, 2.74; 95%CI: 1.40-5.33) and paternal education level (adjusted OR, 3.06; 95%CI: 1.54-6.07) were significant predictors of ETS exposure.

CONCLUSIONS

It is essential to investigate the reasons underlying the higher frequency of overweight/obesity in children living in rural environments compared with those in urban areas; and preventative actions should be designed to be easily understood by those with lower education levels.

Recurrent Pneumonia in Children: A Reasoned Diagnostic Approach and a Single Centre Experience

Recurrent pneumonia (RP), i.e., at least two episodes of pneumonia in one year or three episodes ever with intercritical radiographic clearing of densities, occurs in 7.7%–9% of children with community-acquired pneumonia. In RP, the challenge is to discriminate between children with self-limiting or minor problems, that do not require a diagnostic work-up, and those with an underlying disease. The aim of the current review is to discuss a reasoned diagnostic approach to RP in childhood. Particular emphasis has been placed on which children should undergo a diagnostic work-up and which tests should be performed. A pediatric case series is also presented, in order to document a single centre experience of RP. A management algorithm for the approach to children with RP, based on the evidence from a literature review, is proposed. Like all algorithms, it is not meant to replace clinical judgment, but it should drive physicians to adopt a systematic approach to pediatric RP and provide a useful guide to the clinician.

The Effect of a Pilot Pediatric In-Patient Department-Based Smoking Cessation Intervention on Parental Smoking and Children's Secondhand Smoke (SHS) Exposure in Guangxi, China

Children's exposure to secondhand smoke (SHS) at home has numerous adverse health effects. This study evaluated the effects of a pediatric in-patient department-based pilot smoking cessation intervention for household members to reduce children's SHS exposure and encourage smoking cessation. A pre-post test design study was designed to assess the effectiveness of a telephone counseling intervention on household members of hospitalized children in pediatric departments. Data were collected with a standardized Chinese language questionnaire. At the three-month follow-up survey, the proportions of household members who reported adopting complete smoking restriction at home (55%), did not smoke at home at all (37%), did not allow others to smoke in the car (70%), or did not allow others to smoke around the child (57%) were significantly higher than the self-reported responses at the baseline survey. The proportions of household members who reported smoking at home (49%) and in the car (22%) were significantly lower than the baseline survey. Overall, 7% of the participants had reported quitting smoking after three months. Pediatric in-patient department-based telephone counseling for smoking cessation was found to be acceptable to Chinese parents. The intervention encouraged few parents to quit smoking, but encouraged more parents to take measures to reduce children's SHS exposure.

A tailored video intervention to reduce smoking and environmental tobacco exposure during and after pregnancy: Rationale, design and methods of Baby's Breath

Low-cost interventions to decrease environmental tobacco smoke (ETS) exposure of pregnant women and their newborns are needed to lower health risks of exposed fetuses and infants. Baby's Breath is a tailored video intervention developed and tested in a randomized controlled trial. The study aimed to test the efficacy of tailored video versus usual care approaches to reduce the ETS exposure of fetuses of low-income women during and after pregnancy; and to assess this intervention separately among non-smoking and smoking women. Participating women, recruited early in pregnancy, who spoke English, were at least 18years old, smoke exposed (current smokers, quit smoking on their own, or were exposed to smoke of others), pregnant with only one baby, and had access to a telephone and video player, were randomized to experimental or control conditions. Intervention participants received newsletters containing content aimed at smoking cessation and avoidance (5 during and 3 after pregnancy), in addition to videos (3 during and 2 after pregnancy) individually tailored on behavioral theory-based survey questions. Comparison participants received newsletters and videos on healthy pregnancy topics. Outcomes included salivary cotinine of both mother and baby (32weeks gestation and 6months postpartum) as well as self-reported ETS exposure and avoidance behaviors. This study may demonstrate the efficacy of a low-cost intervention to decrease ETS exposure, and will fill an important gap in describing the utility of this innovative intervention technology, as well as demonstration of potential benefits to this type of intervention.

Household air pollution and its effects on health

Household air pollution is a leading cause of disability-adjusted life years in Southeast Asia and the third leading cause of disability-adjusted life years globally. There are at least sixty sources of household air pollution, and these vary from country to country. Indoor tobacco smoking, construction material used in building houses, fuel used for cooking, heating and lighting, use of incense and various forms of mosquito repellents, use of pesticides and chemicals used for cleaning at home, and use of artificial fragrances are some of the various sources that contribute to household air pollution.

Household air pollution affects all stages of life with multi-systemic health effects, and its effects are evident right from pre-conception to old age. In utero exposure to household air pollutants has been shown to have health effects which resonate over the entire lifetime. Exposures to indoor air pollutants in early childhood also tend to have repercussions throughout life. The respiratory system bears the maximum brunt, but effects on the cardiovascular system, endocrine system, and nervous system are largely underplayed. Household air pollutants have also been implicated in the development of various types of cancers.

Identifying household air pollutants and their health implications helps us prepare for various health-related issues. However, the real challenge is adopting changes to reduce the health effects of household air pollution and designing innovative interventions to minimize the risk of further exposure.

This review is an attempt to understand the various sources of household air pollution, the effects on health, and strategies to deal with this emergent risk factor of global mortality and morbidity.