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Thorax. Apr 1999; 54(4): 357–366.
PMCID: PMC1745458

Summary of effects of parental smoking on the respiratory health of children and implications for research

Abstract

BACKGROUND—Two recent reviews have assessed the effect of parental smoking on respiratory disease in children.
METHODS—The results of the systematic quantitative review published as a series in Thorax are summarised and brought up to date by considering papers appearing on Embase or Medline up to June 1998.The findings are compared with those of the review published recently by the Californian Environmental Protection Agency (EPA). Areas requiring further research are identified.
RESULTS—Overall there is a very consistent picture with odds ratios for respiratory illnesses and symptoms and middle ear disease of between 1.2 and 1.6 for either parent smoking, the odds usually being higher in pre-school than in school aged children. For sudden infant death syndrome the odds ratio for maternal smoking is about 2. Significant effects from paternal smoking suggest a role for postnatal exposure to environmental tobacco smoke. Recent publications do not lead us to alter the conclusions of our earlier reviews. While essentially narrative rather than systematic and quantitative, the findings of the Californian EPA review are broadly similar. In addition they have reviewed studies of the effects of environmental tobacco smoke on children with cystic fibrosis and conclude from the limited evidence that there is a strong case for a relationship between parental smoking and admissions to hospital. They also review data from adults of the effects of acute exposure to environmental tobacco smoke under laboratory conditions which suggest acute effects on spirometric parameters rather than on bronchial hyperresponsiveness. It seems likely that such effects are also present in children.
CONCLUSIONS—Substantial benefits to children would arise if parents stopped smoking after birth, even if the mother smoked during pregnancy. Policies need to be developed which reduce smoking amongst parents and protect infants and young children from exposure to environmental tobacco smoke. The weight of evidence is such that new prevalence studies are no longer justified. What are needed are studies which allow comparison of the effects of critical periods of exposure to cigarette smoke, particularly in utero, early infancy, and later childhood. Where longitudinal studies are carried out they should be analysed to look at the way in which changes in exposure are related to changes in outcome. Better still would be studies demonstrating reversibility of adverse effects, especially in asthmatic subjects or children with cystic fibrosis.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Strachan DP, Cook DG. Health effects of passive smoking. 1. Parental smoking and lower respiratory illness in infancy and early childhood. Thorax. 1997 Oct;52(10):905–914. [PMC free article] [PubMed]
  • Anderson HR, Cook DG. Passive smoking and sudden infant death syndrome: review of the epidemiological evidence. Thorax. 1997 Nov;52(11):1003–1009. [PMC free article] [PubMed]
  • Cook DG, Strachan DP. Health effects of passive smoking. 3. Parental smoking and prevalence of respiratory symptoms and asthma in school age children. Thorax. 1997 Dec;52(12):1081–1094. [PMC free article] [PubMed]
  • Strachan DP, Cook DG. Health effects of passive smoking. 4. Parental smoking, middle ear disease and adenotonsillectomy in children. Thorax. 1998 Jan;53(1):50–56. [PMC free article] [PubMed]
  • Strachan DP, Cook DG. Health effects of passive smoking .5. Parental smoking and allergic sensitisation in children. Thorax. 1998 Feb;53(2):117–123. [PMC free article] [PubMed]
  • Strachan DP, Cook DG. Health effects of passive smoking. 6. Parental smoking and childhood asthma: longitudinal and case-control studies. Thorax. 1998 Mar;53(3):204–212. [PMC free article] [PubMed]
  • Cook DG, Strachan DP. Parental smoking, bronchial reactivity and peak flow variability in children. Thorax. 1998 Apr;53(4):295–301. [PMC free article] [PubMed]
  • Cook DG, Strachan DP, Carey IM. Health effects of passive smoking. 9. Parental smoking and spirometric indices in children. Thorax. 1998 Oct;53(10):884–893. [PMC free article] [PubMed]
  • Margolis PA, Keyes LL, Greenberg RA, Bauman KE, LaVange LM. Urinary cotinine and parent history (questionnaire) as indicators of passive smoking and predictors of lower respiratory illness in infants. Pediatr Pulmonol. 1997 Jun;23(6):417–423. [PubMed]
  • Nafstad P, Kongerud J, Botten G, Hagen JA, Jaakkola JJ. The role of passive smoking in the development of bronchial obstruction during the first 2 years of life. Epidemiology. 1997 May;8(3):293–297. [PubMed]
  • Maier WC, Arrighi HM, Morray B, Llewellyn C, Redding GJ. Indoor risk factors for asthma and wheezing among Seattle school children. Environ Health Perspect. 1997 Feb;105(2):208–214. [PMC free article] [PubMed]
  • Lam TH, Chung SF, Betson CL, Wong CM, Hedley AJ. Respiratory symptoms due to active and passive smoking in junior secondary school students in Hong Kong. Int J Epidemiol. 1998 Feb;27(1):41–48. [PubMed]
  • Rönmark E, Lundbäck B, Jönsson E, Platts-Mills T. Asthma, type-1 allergy and related conditions in 7- and 8-year-old children in northern Sweden: prevalence rates and risk factor pattern. Respir Med. 1998 Feb;92(2):316–324. [PubMed]
  • Saraçlar Y, Sekerel BE, Kalayci O, Cetinkaya F, Adalioğlu G, Tuncer A, Tezcan S. Prevalence of asthma symptoms in school children in Ankara, Turkey. Respir Med. 1998 Feb;92(2):203–207. [PubMed]
  • Butland BK, Strachan DP, Anderson HR. The home environment and asthma symptoms in childhood: two population based case-control studies 13 years apart. Thorax. 1997 Jul;52(7):618–624. [PMC free article] [PubMed]
  • Dales RE, White J, Bhumgara C, McMullen E. Parental reporting of childrens' coughing is biased. Eur J Epidemiol. 1997 Jul;13(5):541–545. [PubMed]
  • Jedrychowski W, Flak E. Maternal smoking during pregnancy and postnatal exposure to environmental tobacco smoke as predisposition factors to acute respiratory infections. Environ Health Perspect. 1997 Mar;105(3):302–306. [PMC free article] [PubMed]
  • Hu FB, Persky V, Flay BR, Zelli A, Cooksey J, Richardson J. Prevalence of asthma and wheezing in public schoolchildren: association with maternal smoking during pregnancy. Ann Allergy Asthma Immunol. 1997 Jul;79(1):80–84. [PubMed]
  • Forsberg B, Pekkanen J, Clench-Aas J, Mårtensson MB, Stjernberg N, Bartonova A, Timonen KL, Skerfving S. Childhood asthma in four regions in Scandinavia: risk factors and avoidance effects. Int J Epidemiol. 1997 Jun;26(3):610–619. [PubMed]
  • Siersted HC, Boldsen J, Hansen HS, Mostgaard G, Hyldebrandt N. Population based study of risk factors for underdiagnosis of asthma in adolescence: Odense schoolchild study. BMJ. 1998 Feb 28;316(7132):651–656. [PMC free article] [PubMed]
  • Wennergren G, Amark M, Amark K, Oskarsdóttir S, Sten G, Redfors S. Wheezing bronchitis reinvestigated at the age of 10 years. Acta Paediatr. 1997 Apr;86(4):351–355. [PubMed]
  • Olesen AB, Ellingsen AR, Olesen H, Juul S, Thestrup-Pedersen K. Atopic dermatitis and birth factors: historical follow up by record linkage. BMJ. 1997 Apr 5;314(7086):1003–1008. [PMC free article] [PubMed]
  • Butland BK, Strachan DP, Lewis S, Bynner J, Butler N, Britton J. Investigation into the increase in hay fever and eczema at age 16 observed between the 1958 and 1970 British birth cohorts. BMJ. 1997 Sep 20;315(7110):717–721. [PMC free article] [PubMed]
  • Schäfer T, Dirschedl P, Kunz B, Ring J, Uberla K. Maternal smoking during pregnancy and lactation increases the risk for atopic eczema in the offspring. J Am Acad Dermatol. 1997 Apr;36(4):550–556. [PubMed]
  • Burr ML, Merrett TG, Dunstan FD, Maguire MJ. The development of allergy in high-risk children. Clin Exp Allergy. 1997 Nov;27(11):1247–1253. [PubMed]
  • Lødrup Carlsen KC, Jaakkola JJ, Nafstad P, Carlsen KH. In utero exposure to cigarette smoking influences lung function at birth. Eur Respir J. 1997 Aug;10(8):1774–1779. [PubMed]
  • Oyen N, Markestad T, Skaerven R, Irgens LM, Helweg-Larsen K, Alm B, Norvenius G, Wennergren G. Combined effects of sleeping position and prenatal risk factors in sudden infant death syndrome: the Nordic Epidemiological SIDS Study. Pediatrics. 1997 Oct;100(4):613–621. [PubMed]
  • Schellscheidt J, Ott A, Jorch G. Epidemiological features of sudden infant death after a German intervention campaign in 1992. Eur J Pediatr. 1997 Aug;156(8):655–660. [PubMed]
  • Brooke H, Gibson A, Tappin D, Brown H. Case-control study of sudden infant death syndrome in Scotland, 1992-5. BMJ. 1997 May 24;314(7093):1516–1520. [PMC free article] [PubMed]
  • Mitchell EA, Tuohy PG, Brunt JM, Thompson JM, Clements MS, Stewart AW, Ford RP, Taylor BJ. Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics. 1997 Nov;100(5):835–840. [PubMed]
  • MacDorman MF, Cnattingius S, Hoffman HJ, Kramer MS, Haglund B. Sudden infant death syndrome and smoking in the United States and Sweden. Am J Epidemiol. 1997 Aug 1;146(3):249–257. [PubMed]
  • Adair-Bischoff CE, Sauve RS. Environmental tobacco smoke and middle ear disease in preschool-age children. Arch Pediatr Adolesc Med. 1998 Feb;152(2):127–133. [PubMed]
  • Stenström C, Ingvarsson L. Otitis-prone children and controls: a study of possible predisposing factors. 2. Physical findings, frequency of illness, allergy, day care and parental smoking. Acta Otolaryngol. 1997 Sep;117(5):696–703. [PubMed]
  • Saim A, Saim L, Saim S, Ruszymah BH, Sani A. Prevalence of otitis media with effusion amongst pre-school children in Malaysia. Int J Pediatr Otorhinolaryngol. 1997 Jul 18;41(1):21–28. [PubMed]
  • Salazar JC, Daly KA, Giebink GS, Lindgren BR, Liebeler CL, Meland M, Le CT. Low cord blood pneumococcal immunoglobulin G (IgG) antibodies predict early onset acute otitis media in infancy. Am J Epidemiol. 1997 Jun 1;145(11):1048–1056. [PubMed]
  • Paradise JL, Rockette HE, Colborn DK, Bernard BS, Smith CG, Kurs-Lasky M, Janosky JE. Otitis media in 2253 Pittsburgh-area infants: prevalence and risk factors during the first two years of life. Pediatrics. 1997 Mar;99(3):318–333. [PubMed]
  • Gilljam H, Stenlund C, Ericsson-Hollsing A, Strandvik B. Passive smoking in cystic fibrosis. Respir Med. 1990 Jul;84(4):289–291. [PubMed]
  • Rubin BK. Exposure of children with cystic fibrosis to environmental tobacco smoke. N Engl J Med. 1990 Sep 20;323(12):782–788. [PubMed]
  • Campbell PW, 3rd, Parker RA, Roberts BT, Krishnamani MR, Phillips JA., 3rd Association of poor clinical status and heavy exposure to tobacco smoke in patients with cystic fibrosis who are homozygous for the F508 deletion. J Pediatr. 1992 Feb;120(2 Pt 1):261–264. [PubMed]
  • Smyth A, O'Hea U, Williams G, Smyth R, Heaf D. Passive smoking and impaired lung function in cystic fibrosis. Arch Dis Child. 1994 Oct;71(4):353–354. [PMC free article] [PubMed]
  • Egger M, Schneider M, Davey Smith G. Spurious precision? Meta-analysis of observational studies. BMJ. 1998 Jan 10;316(7125):140–144. [PMC free article] [PubMed]
  • Shapiro S. Meta-analysis/Shmeta-analysis. Am J Epidemiol. 1994 Nov 1;140(9):771–778. [PubMed]
  • Colley JR. Respiratory symptoms in children and parental smoking and phlegm production. Br Med J. 1974 Apr 27;2(5912):201–204. [PMC free article] [PubMed]
  • Colley JR, Holland WW, Corkhill RT. Influence of passive smoking and parental phlegm on pneumonia and bronchitis in early childhood. Lancet. 1974 Nov 2;2(7888):1031–1034. [PubMed]
  • Coultas DB. Health effects of passive smoking. 8. Passive smoking and risk of adult asthma and COPD: an update. Thorax. 1998 May;53(5):381–387. [PMC free article] [PubMed]
  • Cook DG, Whincup PH, Jarvis MJ, Strachan DP, Papacosta O, Bryant A. Passive exposure to tobacco smoke in children aged 5-7 years: individual, family, and community factors. BMJ. 1994 Feb 5;308(6925):384–389. [PMC free article] [PubMed]
  • Cook DG, Whincup PH, Papacosta O, Strachan DP, Jarvis MJ, Bryant A. Relation of passive smoking as assessed by salivary cotinine concentration and questionnaire to spirometric indices in children. Thorax. 1993 Jan;48(1):14–20. [PMC free article] [PubMed]
  • Strachan DP, Jarvis MJ, Feyerabend C. The relationship of salivary cotinine to respiratory symptoms, spirometry, and exercise-induced bronchospasm in seven-year-old children. Am Rev Respir Dis. 1990 Jul;142(1):147–151. [PubMed]
  • Corbo GM, Agabiti N, Forastiere F, Dell'Orco V, Pistelli R, Kriebel D, Pacifici R, Zuccaro P, Ciappi G, Perucci CA. Lung function in children and adolescents with occasional exposure to environmental tobacco smoke. Am J Respir Crit Care Med. 1996 Sep;154(3 Pt 1):695–700. [PubMed]
  • Chen Y, Li WX. The effect of passive smoking on children's pulmonary function in Shanghai. Am J Public Health. 1986 May;76(5):515–518. [PMC free article] [PubMed]
  • Chen Y, Li WX, Yu SZ, Qian WH. Chang-Ning epidemiological study of children's health: I: Passive smoking and children's respiratory diseases. Int J Epidemiol. 1988 Jun;17(2):348–355. [PubMed]
  • Jin C, Rossignol AM. Effects of passive smoking on respiratory illness from birth to age eighteen months, in Shanghai, People's Republic of China. J Pediatr. 1993 Oct;123(4):553–558. [PubMed]
  • Chen Y. Environmental tobacco smoke, low birth weight, and hospitalization for respiratory disease. Am J Respir Crit Care Med. 1994 Jul;150(1):54–58. [PubMed]
  • Blair PS, Fleming PJ, Bensley D, Smith I, Bacon C, Taylor E, Berry J, Golding J, Tripp J. Smoking and the sudden infant death syndrome: results from 1993-5 case-control study for confidential inquiry into stillbirths and deaths in infancy. Confidential Enquiry into Stillbirths and Deaths Regional Coordinators and Researchers. BMJ. 1996 Jul 27;313(7051):195–198. [PMC free article] [PubMed]
  • Anderson HR, Cook DG. Passive smoking and sudden infant death syndrome: review of the epidemiological evidence. Thorax. 1997 Nov;52(11):1003–1009. [PMC free article] [PubMed]
  • Strachan DP, Cook DG. Health effects of passive smoking .5. Parental smoking and allergic sensitisation in children. Thorax. 1998 Feb;53(2):117–123. [PMC free article] [PubMed]
  • Ownby DR, Johnson CC, Peterson EL. Maternal smoking does not influence cord serum IgE or IgD concentrations. J Allergy Clin Immunol. 1991 Oct;88(4):555–560. [PubMed]

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