Environmental Tobacco Smoke
Exposure and Respiratory Health in
Children:
An Updated Critical Review and
Analysis of the Epidemiological
Literature

Hood, Ronald D.; Wu, Joseph M.; Witorsch, Raphael J.; Witorsch, Philip

doi:10.1159/000463405

Cited by 12 publications

(34 citation statements)

References 34 publications

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“…Exposure of children to environmental tobacco smoke (ETS) has been implicated in the development of respiratory symptoms and illnesses, impaired pulmonary function or lung growth and middle ear effusion (Environmental Protection Agency, 1992;Hood et al, 1992;Thornton and Lee, 1999). A correct and practical assessment of the exposure dose is required in order to elucidate the role of ETS exposure in the development of these diseases.…”

Section: Introductionmentioning

confidence: 99%

Determinants of children's exposure to environmental tobacco smoke (ETS): A study in Southern Germany

Scherer

Krämer

Meger-Kossien

et al. 2004

J Expo Sci Environ Epidemiol

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Maternal smoking has been repeatedly found to be the most important determinant of children's exposure to environmental tobacco smoke (ETS). Here, we further investigated predictors for the urinary cotinine/creatinine ratio (CCR, ng/mg) in 1220 preschool children for the year 1996. Children from smoking homes (35.1%) had significantly higher CCR than children from nonsmoking homes (mean: 55.5 vs. 14.9 ng/mg). The level of education of the parents was a strong predictor for CCRs even after adjusting for number of cigarettes smoked, maternal smoking and dwelling space. Additionally, dwelling space was inversely related to children's urinary cotinine level. The CCR-levels in children investigated in 1996 and 1998 were significantly correlated (Pearson's r ¼ 0.67). The parents of 806 children agreed for a visit to their homes. In 79 of the 536 (14.7%) of the self-reported, nonsmoking households, smoking was admitted during the visit. The mean urinary CCR of these children was 25.2 ng/mg. We conclude that in addition to parental smoking behaviour, other variables such as dwelling space and social and educational status predict the children's exposure to ETS. Our data also revealed that a considerable percentage of parents denied the ETS exposure of their children at home.

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Section: Introductionmentioning

confidence: 99%

Determinants of children's exposure to environmental tobacco smoke (ETS): A study in Southern Germany

Scherer

Krämer

Meger-Kossien

et al. 2004

J Expo Sci Environ Epidemiol

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“…The authors concluded that there was no evidence of an inflammatory effect from acute ETS exposure. Gurk et al [74], who exposed subjects to levels of ETS usually higher than most of the preceding studies (CO level of 35-40 ppm) reported a 4% decrease in mean FEV 1 and a 13% increase in specific airway resistance postexposure compared to pre-exposure (table 3). Since these statistically significant differences were within the range of reported individual variability of these parameters [43], they are probably neither physiologically significant nor clinically relevant.…”

Section: Witorschmentioning

confidence: 95%

“…refers to statistically significant increase. 1 Number in parentheses indicates magnitude of change (in %) when available. 2 Magnitudes estimated from graphs.…”

Section: Nrmentioning

confidence: 99%

“…On the other hand, the suggestion that abnormalities in FEF are indicative of disease and dysfunction of small bronchioles (under 2- In subjects reporting respiratory symptoms, no significant negative association (RR) between ETS exposure at work and length of intervals without asthma symptoms (wheeze, dyspnoea, or chest tightness apart from cold) (1.1); significant negative association between ETS exposure at work and intervals without bronchitis symptoms (cough, phlegm apart from colds) (1.31); n = 1,492 RR = Relative risk; OR = odds ratio; CI = confidence intervals. 1 Those studies dealing with asthma symptoms, incidence or exacerbation. 2 Magnitude of risk not reported.…”

Section: Witorschmentioning

confidence: 99%

“…A relatively large series of studies have attempted to relate ETS exposure in children and pulmonary function and respiratory symptoms and diseases. These have been previously reviewed by us [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

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Effects of Environmental Tobacco Smoke Exposure on Pulmonary Function and Respiratory Health in Adults: Update 1997

Witorsch¹

1998

Indoor Built Environ

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Eighteen epidemiology studies have examined the relationship between chronic environmental tobacco smoke (ETS) exposure and pulmonary function. A statistically significant relationship between chronic ETS exposure and a specific spirometric endpoint was reported in 5 of 17 studies that measured forced expiratory volume in 1 s (FEV₁), 2 of 9 studies that measured forced vital capacity (FVC) and 3 of 5 studies that measured mean forced expiratory flow during the middle half of the FVC. Fourteen of 24 epidemiological studies report a statistically significant association between chronic ETS exposure and a clinical endpoint, although there is little consistency from one report to the next when a specific endpoint is considered. A statistically significant association was reported in 2 of 9 studies for cough, 3 of 9 studies for phlegm and expectoration, 6 of 10 studies for dyspnea and shortness of breath, 3 of 6 studies for bronchitis, and 8 of 18 studies dealing with asthma incidence, exacerbation, or symptoms. The inconsistency of association in the foregoing functional and clinical epidemiology studies could either reflect absence of such an association or methodology problems such as reliability of spirometric measurement, lack of verification of clinical endpoint, errors in classification of smoking and ETS exposure status and inappropriate control of confounding variables. The effects of acute ETS exposure (at levels equivalent to or exceeding real-life smoke-polluted environments) have been examined in experimental studies in which spirometric measures were obtained prior to, during, and after exposure of subjects to machine-generated tobacco smoke. Six of seven studies suggest that acute ETS exposure, while serving as an irritant to the upper respiratory tract, fails adversely to affect pulmonary function of normal adults. The effect of acute ETS exposure in asthmatic subjects has been examined in 15 studies. These studies suggest that acute exposure to ETS does not consistently evoke adverse pulmonary effects in most asthmatics. Several studies from a single research group suggest that a small sub-set of asthmatics may respond to acute ETS exposure with a ≥20% decrement in FEV₁ as well as an increased responsiveness to bronchoconstrictors. The mechanism for this responsiveness does not appear to be allergic in nature and is subject to speculation.

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Wheeze, cough, atopy, and indoor environment in the Scottish Highlands

Austin

Russell

1997

Archives of Disease in Childhood

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A questionnaire which included items on wheeze, cough, eczema, hay fever, and indoor environment, including parental smoking habits, pet ownership, heating and cooking methods, home insulation, damp, mould, and years lived in their houses, was given to 1801 children, aged 12 and 14 from the Highland Region in Scotland. Of the 1537 (85%) who replied, 267 (17%) reported current wheeze, 135 (9%) cough for three months in the year, 272 (18%) eczema, and 317 (21%) hay fever. There was no consistent relationship between respiratory symptoms and indoor environment although cough was associated with damp, double glazing, and maternal smoking. The prevalence of wheeze, cough, and atopy was higher in children who had lived in more than one house during their lifetime. These results suggest that increasing mobility of families in recent years may be more important in the aetiology of asthma than exposure to any one individual allergen or pollutant. (Arch Dis Child 1997;76:22-26)

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Environmental Tobacco Smoke Exposure and Respiratory Health in Children: An Updated Critical Review and Analysis of the Epidemiological Literature

Cited by 12 publications

References 34 publications

Determinants of children's exposure to environmental tobacco smoke (ETS): A study in Southern Germany

Determinants of children's exposure to environmental tobacco smoke (ETS): A study in Southern Germany

Effects of Environmental Tobacco Smoke Exposure on Pulmonary Function and Respiratory Health in Adults: Update 1997

Wheeze, cough, atopy, and indoor environment in the Scottish Highlands

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