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Tobacco smoke exposure and respiratory morbidity in young children

Tobacco smoke exposure and respiratory morbidity in young children
Tobacco smoke exposure and respiratory morbidity in young children
OBJECTIVE:Secondhand smoke exposure is a potentially preventable cause of significant respiratory morbidity in young children. Our study aimed to quantify respiratory morbidity in young children exposed to secondhand smoke to identify potentially modifiable factors.

MATERIALS AND METHODS:This study was embedded in a prospective birth cohort study of pregnant women and their children from fetal life onwards in Singapore (Growing Up in Singapore Towards healthy Outcomes, or GUSTO). Data on prenatal, antenatal and postnatal active and secondhand tobacco smoke exposure were obtained by an investigator-administered questionnaire for the periods before pregnancy, at 26-28?weeks' gestation and 24?months after delivery. Data on respiratory morbidity (wheezing episodes, croupy cough, nebuliser use, snoring) and other morbidity (fever, hospitalisation, ear infection) of the child was collected at week 3 and at months 3, 6, 9, 12, 15, 18 and 24 after delivery. Information on parental atopy and potential confounders such as socioeconomic status and maternal educational level were also obtained. Statistical analysis of the data was performed to quantify any significant differences in incidence of respiratory morbidity in children exposed to tobacco smoke in utero and postdelivery, compared with those in smoke-free environments.

RESULTS:Women who smoked regularly prior to pregnancy comprised 12.5% (n=155) of the study population; this number fell to 2.3% (n=29) during pregnancy. Mothers exposed to secondhand smoke in the household before pregnancy comprised 35.7% of the study population (n=441) and 31.5% (n=389) were exposed during pregnancy. Postnatally, the prevalence of secondhand tobacco smoke exposure from birth to 2?years of age was 29% (n=359). Participants of Malay ethnicity (p<0.001), mothers with no or primary level education (p<0.001) and mothers with low socioeconomic status (p<0.001) had the highest exposure to tobacco smoke. Offspring secondhand smoke exposure at home by 12?months and by 24?months of age was associated with an increase in hospital admissions due to respiratory disease (RR 1.89, 95% CI 1.02 to 3.50, p=0.04 by 12?months and RR 1.64, 95% CI 1.05 to 2.55, p=0.03 by 24?months) as well as all-cause hospitalisation (RR 1.57, 95% CI 1.14 to 2.17, p=0.01 by 12?months and RR 1.49, 95% CI 1.17 to 1.90, p=0.001 by 24?months), adjusting for parental atopy and child atopic dermatitis. Participants exposed to secondhand smoke by 12?months postdelivery had a significantly increased risk of having at least one wheezing episode (RR 1.71, 95% CI 1.38 to 2.11, p<0.001).

CONCLUSIONS:Secondhand smoke exposure during the prenatal and postnatal periods is associated with increased respiratory morbidity in children. Opportunistic screening and targeted smoking cessation counselling for parents at child hospital admissions and well-child outpatient visits, as well as preconception smoking cessation counselling for future pregnancies, may be beneficial to protect the child from negative health impacts.
0964-4563
Snodgrass, A.M.
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Tan, P.T.
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Soh, S.E.
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Goh, A.
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Shek, L.P.
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van Bever, H.P.
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Gluckman, P.D.
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Godfrey, K.M.
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Chong, Y.S.
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Saw, S.M.
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Kwek, K.
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Teoh, O.H.
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Snodgrass, A.M.
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Tan, P.T.
eeb2aa4a-5b3f-4b0f-b53c-4ea5a8d5c8b0
Soh, S.E.
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Goh, A.
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Shek, L.P.
eb7d2e42-ed76-42a5-8649-06657984882b
van Bever, H.P.
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Gluckman, P.D.
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Godfrey, K.M.
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Chong, Y.S.
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Saw, S.M.
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Kwek, K.
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Teoh, O.H.
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Snodgrass, A.M., Tan, P.T., Soh, S.E., Goh, A., Shek, L.P., van Bever, H.P., Gluckman, P.D., Godfrey, K.M., Chong, Y.S., Saw, S.M., Kwek, K. and Teoh, O.H. (2015) Tobacco smoke exposure and respiratory morbidity in young children. Tobacco Control. (doi:10.1136/tobaccocontrol-2015-052383). (PMID:26502739)

Record type: Article

Abstract

OBJECTIVE:Secondhand smoke exposure is a potentially preventable cause of significant respiratory morbidity in young children. Our study aimed to quantify respiratory morbidity in young children exposed to secondhand smoke to identify potentially modifiable factors.

MATERIALS AND METHODS:This study was embedded in a prospective birth cohort study of pregnant women and their children from fetal life onwards in Singapore (Growing Up in Singapore Towards healthy Outcomes, or GUSTO). Data on prenatal, antenatal and postnatal active and secondhand tobacco smoke exposure were obtained by an investigator-administered questionnaire for the periods before pregnancy, at 26-28?weeks' gestation and 24?months after delivery. Data on respiratory morbidity (wheezing episodes, croupy cough, nebuliser use, snoring) and other morbidity (fever, hospitalisation, ear infection) of the child was collected at week 3 and at months 3, 6, 9, 12, 15, 18 and 24 after delivery. Information on parental atopy and potential confounders such as socioeconomic status and maternal educational level were also obtained. Statistical analysis of the data was performed to quantify any significant differences in incidence of respiratory morbidity in children exposed to tobacco smoke in utero and postdelivery, compared with those in smoke-free environments.

RESULTS:Women who smoked regularly prior to pregnancy comprised 12.5% (n=155) of the study population; this number fell to 2.3% (n=29) during pregnancy. Mothers exposed to secondhand smoke in the household before pregnancy comprised 35.7% of the study population (n=441) and 31.5% (n=389) were exposed during pregnancy. Postnatally, the prevalence of secondhand tobacco smoke exposure from birth to 2?years of age was 29% (n=359). Participants of Malay ethnicity (p<0.001), mothers with no or primary level education (p<0.001) and mothers with low socioeconomic status (p<0.001) had the highest exposure to tobacco smoke. Offspring secondhand smoke exposure at home by 12?months and by 24?months of age was associated with an increase in hospital admissions due to respiratory disease (RR 1.89, 95% CI 1.02 to 3.50, p=0.04 by 12?months and RR 1.64, 95% CI 1.05 to 2.55, p=0.03 by 24?months) as well as all-cause hospitalisation (RR 1.57, 95% CI 1.14 to 2.17, p=0.01 by 12?months and RR 1.49, 95% CI 1.17 to 1.90, p=0.001 by 24?months), adjusting for parental atopy and child atopic dermatitis. Participants exposed to secondhand smoke by 12?months postdelivery had a significantly increased risk of having at least one wheezing episode (RR 1.71, 95% CI 1.38 to 2.11, p<0.001).

CONCLUSIONS:Secondhand smoke exposure during the prenatal and postnatal periods is associated with increased respiratory morbidity in children. Opportunistic screening and targeted smoking cessation counselling for parents at child hospital admissions and well-child outpatient visits, as well as preconception smoking cessation counselling for future pregnancies, may be beneficial to protect the child from negative health impacts.

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More information

Accepted/In Press date: 7 October 2015
Published date: 26 October 2015
Organisations: Faculty of Medicine

Identifiers

Local EPrints ID: 387193
URI: http://eprints.soton.ac.uk/id/eprint/387193
ISSN: 0964-4563
PURE UUID: 3303da94-8aa2-4dda-bdf4-26e95fadb299
ORCID for K.M. Godfrey: ORCID iD orcid.org/0000-0002-4643-0618

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Date deposited: 16 Feb 2016 14:49
Last modified: 07 Oct 2020 01:35

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Contributors

Author: A.M. Snodgrass
Author: P.T. Tan
Author: S.E. Soh
Author: A. Goh
Author: L.P. Shek
Author: H.P. van Bever
Author: P.D. Gluckman
Author: K.M. Godfrey ORCID iD
Author: Y.S. Chong
Author: S.M. Saw
Author: K. Kwek
Author: O.H. Teoh

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