• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxInstructions for authorsInstructions for authors
Thorax. Dec 2005; 60(12): 1052–1058.
Published online Aug 30, 2005. doi:  10.1136/thx.2005.042960
PMCID: PMC1414787

Childhood exposure to environmental tobacco smoke and chronic respiratory symptoms in non-smoking adults: The Singapore Chinese Health Study


Background: Childhood exposure to environmental tobacco smoke has been extensively associated with childhood respiratory illness; fewer studies have addressed the effects on adults.

Methods: Childhood environmental tobacco smoke exposure in relation to chronic cough, phlegm, and asthma diagnosis was studied in never smokers from a cohort of Singaporeans of Chinese ethnicity aged 45–74 years at enrolment from 1993 to 1998. From 1999 to 2004 subjects were interviewed regarding environmental tobacco smoke exposure before and after the age of 18 and the presence and duration of current symptoms of chronic cough and phlegm production and asthma diagnosis.

Results: Among 35 000 never smokers, fewer had smoking mothers (19%) than fathers (48%). Although few subjects currently lived (20%) or worked (4%) with smokers, 65% reported living with a daily smoker before the age of 18 years. Living with a smoker before the age of 18 increased the odds of chronic dry cough (149 cases, odds ratio 2.1, 95% CI 1.4 to 3.3) and, to a lesser extent, phlegm, after adjustment for age, sex, dialect group, and current and past exposure to smokers at home and at work after the age of 18. Associations strengthened with higher numbers of smokers in childhood. There was no association with asthma or chronic bronchitis. There was evidence to suggest a stronger association among subjects with a lower adult intake of fibre which has previously been found to be protective for respiratory symptoms.

Conclusions: In this large study of non-smokers, living with a smoker in childhood was associated with chronic dry cough and phlegm in adulthood, independent of later exposures to environmental tobacco smoke.

Full Text

The Full Text of this article is available as a PDF (105K).

Supplementary Material

[Web-only appendices]

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cook DG, Strachan DP. Health effects of passive smoking-10: Summary of effects of parental smoking on the respiratory health of children and implications for research. Thorax. 1999 Apr;54(4):357–366. [PMC free article] [PubMed]
  • Jaakkola Maritta S, Jaakkola Jouni J K. Effects of environmental tobacco smoke on the respiratory health of adults. Scand J Work Environ Health. 2002;28 (Suppl 2):52–70. [PubMed]
  • de Marco Roberto, Pattaro Cristian, Locatelli Francesca, Svanes Cecilie. Influence of early life exposures on incidence and remission of asthma throughout life. J Allergy Clin Immunol. 2004 May;113(5):845–852. [PubMed]
  • Hu FB, Persky V, Flay BR, Richardson J. An epidemiological study of asthma prevalence and related factors among young adults. J Asthma. 1997;34(1):67–76. [PubMed]
  • Jenkins MA, Hopper JL, Bowes G, Carlin JB, Flander LB, Giles GG. Factors in childhood as predictors of asthma in adult life. BMJ. 1994 Jul 9;309(6947):90–93. [PMC free article] [PubMed]
  • Larsson ML, Frisk M, Hallström J, Kiviloog J, Lundbäck B. Environmental tobacco smoke exposure during childhood is associated with increased prevalence of asthma in adults. Chest. 2001 Sep;120(3):711–717. [PubMed]
  • Robbins AS, Abbey DE, Lebowitz MD. Passive smoking and chronic respiratory disease symptoms in non-smoking adults. Int J Epidemiol. 1993 Oct;22(5):809–817. [PubMed]
  • Sears Malcolm R, Greene Justina M, Willan Andrew R, Wiecek Elizabeth M, Taylor D Robin, Flannery Erin M, Cowan Jan O, Herbison G Peter, Silva Phil A, Poulton Richie. A longitudinal, population-based, cohort study of childhood asthma followed to adulthood. N Engl J Med. 2003 Oct 9;349(15):1414–1422. [PubMed]
  • Strachan DP, Butland BK, Anderson HR. Incidence and prognosis of asthma and wheezing illness from early childhood to age 33 in a national British cohort. BMJ. 1996 May 11;312(7040):1195–1199. [PMC free article] [PubMed]
  • Svanes C, Omenaas E, Jarvis D, Chinn S, Gulsvik A, Burney P. Parental smoking in childhood and adult obstructive lung disease: results from the European Community Respiratory Health Survey. Thorax. 2004 Apr;59(4):295–302. [PMC free article] [PubMed]
  • Upton MN, Watt GC, Davey Smith G, McConnachie A, Hart CL. Permanent effects of maternal smoking on offsprings' lung function. Lancet. 1998 Aug 8;352(9126):453–453. [PubMed]
  • Masi MA, Hanley JA, Ernst P, Becklake MR. Environmental exposure to tobacco smoke and lung function in young adults. Am Rev Respir Dis. 1988 Aug;138(2):296–299. [PubMed]
  • Henley S Jane, Flanders W Dana, Manatunga Amita, Thun Michael J. Leanness and lung cancer risk: fact or artifact? Epidemiology. 2002 May;13(3):268–276. [PubMed]
  • Butler Lesley M, Koh Woon-Puay, Lee Hin-Peng, Yu Mimi C, London Stephanie J. Dietary fiber and reduced cough with phlegm: a cohort study in Singapore. Am J Respir Crit Care Med. 2004 Aug 1;170(3):279–287. [PubMed]
  • Yuan Jian-Min, Stram Daniel O, Arakawa Kazuko, Lee Hin-Peng, Yu Mimi C. Dietary cryptoxanthin and reduced risk of lung cancer: the Singapore Chinese Health Study. Cancer Epidemiol Biomarkers Prev. 2003 Sep;12(9):890–898. [PubMed]
  • Hankin JH, Stram DO, Arakawa K, Park S, Low SH, Lee HP, Yu MC. Singapore Chinese Health Study: development, validation, and calibration of the quantitative food frequency questionnaire. Nutr Cancer. 2001;39(2):187–195. [PubMed]
  • Pirkle JL, Flegal KM, Bernert JT, Brody DJ, Etzel RA, Maurer KR. Exposure of the US population to environmental tobacco smoke: the Third National Health and Nutrition Examination Survey, 1988 to 1991. JAMA. 1996 Apr 24;275(16):1233–1240. [PubMed]
  • Vartiainen E, Seppälä T, Lillsunde P, Puska P. Validation of self reported smoking by serum cotinine measurement in a community-based study. J Epidemiol Community Health. 2002 Mar;56(3):167–170. [PMC free article] [PubMed]
  • Ferris BG. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1–120. [PubMed]
  • Emmanuel SC, Chen AJ, Phe A. Cigarette smoking in Singapore. Singapore Med J. 1988 Apr;29(2):119–124. [PubMed]
  • Emmanuel SC, Phe A, Chen AJ. The impact of the anti-smoking campaign in Singapore. Singapore Med J. 1988 Jun;29(3):233–239. [PubMed]
  • Elliot J, Vullermin P, Robinson P. Maternal cigarette smoking is associated with increased inner airway wall thickness in children who die from sudden infant death syndrome. Am J Respir Crit Care Med. 1998 Sep;158(3):802–806. [PubMed]
  • Elliot John G, Carroll Neil G, James Alan L, Robinson Philip J. Airway alveolar attachment points and exposure to cigarette smoke in utero. Am J Respir Crit Care Med. 2003 Jan 1;167(1):45–49. [PubMed]
  • Moreno RH, Hogg JC, Paré PD. Mechanics of airway narrowing. Am Rev Respir Dis. 1986 Jun;133(6):1171–1180. [PubMed]
  • Bonham AC, Chen CY, Mutoh T, Joad JP. Lung C-fiber CNS reflex: role in the respiratory consequences of extended environmental tobacco smoke exposure in young guinea pigs. Environ Health Perspect. 2001 Aug;109 (Suppl 4):573–578. [PMC free article] [PubMed]
  • Leuenberger P, Schwartz J, Ackermann-Liebrich U, Blaser K, Bolognini G, Bongard JP, Brandli O, Braun P, Bron C, Brutsche M, et al. Passive smoking exposure in adults and chronic respiratory symptoms (SAPALDIA Study). Swiss Study on Air Pollution and Lung Diseases in Adults, SAPALDIA Team. Am J Respir Crit Care Med. 1994 Nov;150(5 Pt 1):1222–1228. [PubMed]
  • Rautalahti M, Virtamo J, Haukka J, Heinonen OP, Sundvall J, Albanes D, Huttunen JK. The effect of alpha-tocopherol and beta-carotene supplementation on COPD symptoms. Am J Respir Crit Care Med. 1997 Nov;156(5):1447–1452. [PubMed]
  • Zemp E, Elsasser S, Schindler C, Künzli N, Perruchoud AP, Domenighetti G, Medici T, Ackermann-Liebrich U, Leuenberger P, Monn C, et al. Long-term ambient air pollution and respiratory symptoms in adults (SAPALDIA study). The SAPALDIA Team. Am J Respir Crit Care Med. 1999 Apr;159(4 Pt 1):1257–1266. [PubMed]
  • Dalphin JC, Dubiez A, Monnet E, Gora D, Westeel V, Pernet D, Polio JC, Gibey R, Laplante JJ, Depierre A. Prevalence of asthma and respiratory symptoms in dairy farmers in the French province of the Doubs. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1493–1498. [PubMed]
  • Upton MN. Effects of parental smoking on the respiratory health of adults. Thorax. 2004 Apr;59(4):274–276. [PMC free article] [PubMed]
  • Lee SC, Prosky L. International survey on dietary fiber: definition, analysis, and reference materials. J AOAC Int. 1995 Jan-Feb;78(1):22–36. [PubMed]
  • Walter Robert E, Beiser Alexa, Givelber Rachel J, O'Connor George T, Gottlieb Daniel J. Association between glycemic state and lung function: the Framingham Heart Study. Am J Respir Crit Care Med. 2003 Mar 15;167(6):911–916. [PubMed]
  • Eliraz A, Sternfeld M, Madar Z. Glycaemic and insulinaemic index of meals in stable obstructive pulmonary disease subjects. Eur J Clin Nutr. 1994 Jul;48(7):522–524. [PubMed]
  • Davis Wendy A, Knuiman Matthew, Kendall Peter, Grange Valerie, Davis Timothy M E. Glycemic exposure is associated with reduced pulmonary function in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care. 2004 Mar;27(3):752–757. [PubMed]
  • Liu Simin, Manson JoAnn E, Buring Julie E, Stampfer Meir J, Willett Walter C, Ridker Paul M. Relation between a diet with a high glycemic load and plasma concentrations of high-sensitivity C-reactive protein in middle-aged women. Am J Clin Nutr. 2002 Mar;75(3):492–498. [PubMed]
  • Eastwood MA. Interaction of dietary antioxidants in vivo: how fruit and vegetables prevent disease? QJM. 1999 Sep;92(9):527–530. [PubMed]
  • Godtfredsen Nina S, Prescott Eva, Osler Merete. Effect of smoking reduction on lung cancer risk. JAMA. 2005 Sep 28;294(12):1505–1510. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles
  • Substance
    PubChem Substance links

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...