Tobacco Smoke In Children Research Articles

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke.

Children's exposure to other people's tobacco smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children in child care or educational settings are also at risk of exposure to ETS. Preventing exposure to ETS during infancy and childhood has significant potential to improve children's health worldwide. To determine the effectiveness of interventions designed to reduce exposure of children to environmental tobacco smoke, or ETS. We searched the Cochrane Tobacco Addiction Group Specialised Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Education Resource Information Center (ERIC), and the Social Science Citation Index & Science Citation Index (Web of Knowledge). We conducted the most recent search in February 2017. We included controlled trials, with or without random allocation, that enrolled participants (parents and other family members, child care workers, and teachers) involved in the care and education of infants and young children (from birth to 12 years of age). All mechanisms for reducing children's ETS exposure were eligible, including smoking prevention, cessation, and control programmes. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions. Two review authors independently assessed studies and extracted data. Due to heterogeneity of methods and outcome measures, we did not pool results but instead synthesised study findings narratively. Seventy-eight studies met the inclusion criteria, and we assessed all evidence to be of low or very low quality based on GRADE assessment. We judged nine studies to be at low risk of bias, 35 to have unclear overall risk of bias, and 34 to have high risk of bias. Twenty-one interventions targeted populations or community settings, 27 studies were conducted in the well-child healthcare setting and 26 in the ill-child healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether visits were made to well- or ill-children, and another included visits to both well- and ill-children. Forty-five studies were reported from North America, 22 from other high-income countries, and 11 from low- or middle-income countries. Only 26 of the 78 studies reported a beneficial intervention effect for reduction of child ETS exposure, 24 of which were statistically significant. Of these 24 studies, 13 used objective measures of children's ETS exposure. We were unable to pinpoint what made these programmes effective. Studies showing a significant effect used a range of interventions: nine used in-person counselling or motivational interviewing; another study used telephone counselling, and one used a combination of in-person and telephone counselling; three used multi-component counselling-based interventions; two used multi-component education-based interventions; one used a school-based strategy; four used educational interventions, including one that used picture books; one used a smoking cessation intervention; one used a brief intervention; and another did not describe the intervention. Of the 52 studies that did not show a significant reduction in child ETS exposure, 19 used more intensive counselling approaches, including motivational interviewing, education, coaching, and smoking cessation brief advice. Other interventions consisted of brief advice or counselling (10 studies), feedback of a biological measure of children's ETS exposure (six studies), nicotine replacement therapy (two studies), feedback of maternal cotinine (one study), computerised risk assessment (one study), telephone smoking cessation support (two studies), educational home visits (eight studies), group sessions (one study), educational materials (three studies), and school-based policy and health promotion (one study). Some studies employed more than one intervention. 35 of the 78 studies reported a reduction in ETS exposure for children, irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure but rather sought to reduce symptoms of asthma, and found a significant reduction in symptoms among the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions. A minority of interventions have been shown to reduce children's exposure to environmental tobacco smoke and improve children's health, but the features that differentiate the effective interventions from those without clear evidence of effectiveness remain unclear. The evidence was judged to be of low or very low quality, as many of the trials are at a high risk of bias, are small and inadequately powered, with heterogeneous interventions and populations.

Clinical and morphological comparisons of the influence of tobacco smoke on the respiratory system of children and rats.

Background . Tobacco smoking is the most common bad habit on a global scale, which is one of the main risk factors of chronic bronchopulmonary pathology. Most sensitive to exposure to the components of tobacco smoke are children and teenagers, since their respiratory system is very vulnerable through age-related functional, anatomical and morphological features. Objective . To study the depth and dynamics of morphological changes in the bronchopulmonary system of adolescents under the influence of tobacco smoke based on the comparison of clinical data and experiment on rats. Methods . There was conducted a comparative study of the influence of tobacco smoke on the respiratory system of adolescents, who were divided into 3 groups: 1 group from the earliest age were exposed to passive exposure to tobacco smoke; group 2 consisted of teenagers, whose mother during pregnancy smoked, and after being born, they continued to be subjected to passive exposure to tobacco smoke from parents; 3 group – teenagers who were active smokers, however, had not been exposed to tobacco smoke at an early age. The examination included clinical, functional and instrumental methods. The experimental part of the work was to study the morphological changes in the respiratory system of Wistar rats that were in similar conditions, in terms of load and duration of the impact of the pathological factor. Results. It is established that the level of pathological load correlates with the depth of the morphological changes. Thus, the most evident changes in the functional parameters were shown by the second group of adolescents, which coincides with the depth of disorders of the morphological structure of lung tissue of rats that were in similar conditions. The comparison of the results of clinical and experimental studies also took place in other research groups, which allowed to confirm the damaging effect of tobacco smoke on respiratory system of children and adolescents. Conclusion . Studies have shown that tobacco smoke in children and adolescents leads to morphological changes in the bronchopulmonary system, the severity of which depends on age and the duration of its exposure.

Impact of advertisements promoting candy-like flavoured e-cigarettes on appeal of tobacco smoking among children: an experimental study

BackgroundThere are concerns that the marketing of e-cigarettes may increase the appeal of tobacco smoking in children. We examined this concern by assessing the impact on appeal of tobacco smoking...

Assessment of tobacco smoke exposure in the pediatric emergency department

ObjectiveTobacco smoke exposure causes significant childhood morbidity and is associated with a multitude of conditions. National organizations recommend tobacco smoke exposure screening at all pediatric clinical encounters. Data regarding tobacco smoke exposure screening in the pediatric emergency department is sparse, although children with tobacco smoke exposure-associated conditions commonly present to this setting. We aimed to determine the frequency and outcome of tobacco smoke exposure screening in the pediatric emergency department, and assess associated sociodemographic/clinical characteristics. MethodsThis retrospective review included pediatric patients presenting to a large pediatric emergency department in Cincinnati, Ohio between 2012 and 2013. Variables extracted included: age, sex, race/ethnicity, insurance, child's tobacco smoke exposure status, triage acuity, diagnosis, and disposition. Regression analyses examined predictors of tobacco smoke exposure screening and tobacco smoke exposure status. ResultsA total of 116,084 children were included in the analysis. Mean child age was 6.20years (SD±5.6); 52% were male. Nearly half of the children in the study did not undergo tobacco smoke screening; only 60% of children with tobacco smoke exposure-related illnesses were screened. Predictors of tobacco smoke exposure screening were: younger age, male, African American, non-commercial insurance, high acuity, tobacco smoke exposure-related diagnoses and non-intensive care admission. Of children screened for tobacco smoke exposure, 28% were positive. Children more likely to screen positive were non-Hispanic, had non-commercial insurance, and had tobacco smoke exposure-related diagnoses. NonAfrican American children triaged as low acuity were more likely to have tobacco smoke exposure, yet were less likely to be screened. ConclusionDespite national recommendations, current tobacco smoke exposure screening rates are low and fail to identify at-risk children. Pediatric emergency department visits for tobacco smoke exposure-associated conditions are common, thus further research is needed to develop and assess standardized tobacco smoke exposure screening tools/interventions in this setting.

Environmental Tobacco Smoke Exposure and Risk of Allergic Sensitisation in Children: A Systematic Review and Meta-analysis

W Feleszko, M Ruszczynski, J Jaworska, A Strzelak, BM Zalewski, M Kulus. Arch Dis Child. 2014;99:985–992 Environmental tobacco smoke (ETS) in children is associated with respiratory infections, impaired lung function, and increased risk of asthma. The association between ETS and total and specific immunoglobulin (Ig)E has not been extensively investigated. The meta-analysis included studies with participants aged 0 to 18 years from nonselected, random populations reporting the effects of postnatal ETS exposure on total IgE (tIgE) …

How does parental smoking affect nasal mucociliary clearance in children?

Correlation between passive smoking and nasal mucociliary clearance (MCC) in pediatric population has not been reported before. Therefore, in this study, we aimed to investigate the relationship between environmental tobacco smoke and nasal MCC in children whose parents smoke in or outside the house. Three groups of subjects were evaluated: control group (group 1) with 18 children who were not exposed to environmental smoke, 15 passive smokers living with at least one adult household member smoking outside the house (group 2), 17 passive smokers living with at least one adult household member smoking inside the house (group 3). Parents of children were asked to answer our questions regarding their smoking history, and nasal MCC time was assessed for all individuals of the 3 groups. The mean MCC value in control group, group 2 and group 3 were 7.33 ± 2.91, 10.00 ± 4.78 and 12.41 ± 3.44, respectively. Differences between the mean nasal MCC values of the groups were statistically significant (p < 0.01). The comparison of MCC values between control group and group 2 did not reveal significant difference, but since p value was very close to significance level, in larger series it could be significant. (p = 0.067). Also, when we compared the MCC values between group 2 and group 3, there was no significant difference (p = 0.173). But, the difference between MCC values of control group and group 3 was statistically significant (p < 0.001). Parental smoking both inside or outside the house seemed to increase nasal mucociliary clearance time when they are compared with healthy controls. Further studies with larger study groups also measuring direct quantitative doses of smoking are needed to verify this important issue.

Parents' experiences of participating in an intervention on tobacco prevention in Child Health Care.

BackgroundChild health care is an important arena for tobacco prevention in Sweden. The aim of this study was to describe parents’ experiences from participating in a nursebased tobacco prevention intervention.MethodsEleven parents were interviewed using semi-structured interviews. The material was analysed in a qualitative content analysis process.ResultsThe analysis emerged four categories; Receiving support, Respectful treatment, Influence on smoking habits and Receiving information. The parents described how the CHC nurses treated them with support and respect. They described the importance of being treated with respect for their autonomy in their decisions about smoking. They also claimed that they had received little or no information about health consequences for children exposed to environmental tobacco smoke (ETS). The findings also indicate that both the questionnaire used and the urine-cotinine test had influenced parents’ smoking.ConclusionThe clinical implication is that CHC is an important arena for preventive work aiming to minimize children’s tobacco smoke exposure. CHC nurses can play an important role in tobacco prevention but should be more explicit in their communication with parents about tobacco issues. The SiCET was referred to as an eye-opener and can be useful in the MI dialogues nurses perform in order to support parents in their efforts to protect their children from ETS.

Biologic Mechanisms of Environmental Tobacco Smoke in Children with Poorly Controlled Asthma: Results from a Multicenter Clinical Trial

Environmental tobacco smoke (ETS) negatively affects children with asthma. The prevalence of ETS exposure among children with poor asthma control may be changing. Importantly, the mechanisms by which ETS worsens asthma control are poorly understood. We describe how ETS affects gastroesophageal reflux (GER), respiratory infections, and leukotriene production among children with poor asthma control. We analyzed data from 306 children between 6 and 17 years of age with poorly controlled asthma enrolled in a 6-month clinical trial. We evaluated prevalence and determinants of ETS exposure by interview, questionnaire, and urinary cotinine and the association of ETS exposure on leukotriene production, respiratory infections, GER, lung function, and asthma control. We used multivariable linear, logistic, and Poisson regressions to assess outcomes. ETS prevalence estimates ranged from 6% to 30%. Children with domestic indoor exposure had worse asthma control (c-Asthma Control Test, 17.8 vs 21.5; P = .04), worse FEV1 % predicted (84.1 vs 90.7; P = .02), and a trend for increased mean urinary leukotriene E4. ETS from any setting was associated with increased symptomatic respiratory infections (adjusted incidence rate ratio: 1.30; P = .02). However, children exposed to ETS did not have symptoms or pH probe results, suggestive of heightened GER. Domestic smoking exposure was associated with both higher rates of symptomatic respiratory infection and poorer asthma control despite generally intensive controller therapy. ETS exposure is common among asthmatic children with poor control and may worsen asthma control by promoting respiratory infections. Further investigation is required to elucidate ETS mechanisms in poor asthma control.

Relationship between Exhaled Nitric Oxide and Exposure to Low-Level Environmental Tobacco Smoke in Children with Asthma on Inhaled Corticosteroids

Objectives. The relationship between exhaled nitric oxide (FeNO) and asthma severity or control is inconsistent. Active smoking lowers FeNO, but the relationship between passive smoking and FeNO is less clear. Children may be exposed to low-level environmental tobacco smoke (ETS) or thirdhand smoke, even if parents avoid smoking in the presence of their children. Our hypothesis was that FeNO is lower in children with asthma exposed to low-level ETS when compared with those who are not exposed. Methods. Children with stable asthma, 8–18 years of age, on low- or medium-dose inhaled corticosteroids (ICS) were enrolled. Spirometry, Asthma Control Questionnaire (ACQ), FeNO, exhaled breath condensate pH (EBC pH), and EBC ammonia were compared between children with and without ETS exposure as determined by urinary cotinine. Results. Thirty-three subjects were enrolled, of which 10 (30%) had urinary cotinine levels ≥1 ng/ml. There were no significant differences between the two groups in age, sex, BMI percentile, atopy status, FEV1, EBC pH, or EBC ammonia. Median ACQ was 0.29 (IQR: 0.22–0.57) for those with cotinine levels <1 ng/ml and 0.64 (IQR: 0.57–1.1) for those with cotinine levels of ≥1 ng/ml, p = .02. Median FeNO (ppb) was 23.9 (IQR: 15.2–34.5) for unexposed subjects and 9.6 (IQR: 5.1–15.8) for exposed subjects, p = .008. Conclusions: Children with asthma on low to medium doses of ICS and recent low-level ETS exposure have lower FeNO levels when compared with non-ETS-exposed subjects. Exposure to low-level ETS or thirdhand smoke may be an important variable to consider when interpreting FeNO as a biomarker for airway inflammation.

Tobacco Smoke Exposure Before, During, and After Pregnancy and Risk of Overweight at Age 6

Maternal smoking during pregnancy has been associated with overweight and obesity in childhood and is strongly correlated with children's tobacco smoke exposure before and after pregnancy. We investigated the independent association of tobacco smoke exposure at various pre- and postnatal periods and overweight at age 6. A total of 1,954 children attending the 2001-2002 school entrance health examination in the city of Aachen, Germany, were included into this study. Height and weight were measured, BMI was calculated. Tobacco smoke exposure at various periods, other lifestyle and sociodemographic factors were ascertained by questionnaire. Multiple logistic regression models were used to assess the association between tobacco smoke exposure and overweight. Prevalence of overweight was 8.9%. Significant positive associations were found with maternal smoking before and during pregnancy and during the first and sixth year of life. When all smoking periods were included into one logistic model simultaneously, secondhand smoke exposure after birth remained positively associated with overweight at age 6 at either one of the two time periods (first year only: odds ratio (OR) (95% confidence interval (CI)): 2.94 (1.30-6.67), sixth year only: 2.57 (1.64-4.04), respectively) or at both (4.43 (2.24-8.76)). Exposure to tobacco smoke during the first years of life appears to be a key risk factor for development of childhood overweight.

Tobacco Smoking and Suicidal Ideation in School-Aged Children 12–15 Years Old: Impact of Cultural Differences

ABSTRACT This cross-sectional study examined the association between tobacco smoking and suicidal ideation in school-aged children from 9 countries in Africa, the Americas, and the Western Pacific region. Data were collected through the Global school-based Student Health Survey, a collaborative surveillance project between the World Health Organization, the United Nations, UNICEF, UNESCO, UNAIDS, and the U.S. Centers for Disease Control and Prevention. Suicidal ideation, tobacco smoking, and drug and alcohol use were included in loglinear models to analyze higher order interactions among suicidality and regional and country differences separately for boys and girls. School-aged children who reported suicidal ideation had a higher risk of smoking tobacco even after controlling for drug and alcohol misuse. Furthermore, analyses indicated higher order interactions between suicidal ideation and countries belonging to different regions with different exposure to tobacco smoking among school-aged children. Future studies analyzing the mechanism and sequencing of the relationship among suicidal ideation and tobacco smoking should explore cultural factors.

Passive smoking and behavioural problems in children: Results from the LISAplus prospective birth cohort study

ObjectiveTo analyse the association between pre- and postnatal exposure to tobacco smoke and child behavioural problems and to further investigate the influence of trimester-specific exposure to maternal smoking and the impact of paternal smoking at home on the same outcome. MethodsData of 3097 German children recruited at birth for a population-based, prospective study were used. Detailed information on children's tobacco smoke exposure was collected by self-administered questionnaires at each follow-up. Behavioural outcomes were measured by the Strengths and Difficulties Questionnaire applied at 10-year follow-up. ResultsChildren exposed to environmental tobacco smoke at home showed increased risks of hyperactivity/inattention problems. Only smoking during the entire pregnancy increased the risk for conduct and hyperactivity/inattention problems (proportional odds ratio (pOR)=1.58, 95% confidence interval (CI)=1.06–2.37 and pOR=1.67, CI=1.03–2.72). Pre- and postnatal exposure to paternal smoking was associated with hyperactivity/inattention problems in children of non-smoking mothers (pOR=1.97, CI=1.06–3.65). Effect estimates were adjusted for study centre, sex, parental educational level, mother's age at birth, having a single parent and time spent in front of a screen. ConclusionsNot only maternal smoking during pregnancy but also paternal smoking at home should be considered as a risk for hyperactivity/inattention problems in children.

Effect of environmental exposure to lead and tobacco smoke on inattentive and hyperactive symptoms and neurocognitive performance in children

The present study assessed the association between blood lead and urinary cotinine levels and inattentive and hyperactive symptoms and neurocognitive performance in children. A total of 667 children (age range 8-11) were recruited from nine schools in five Korean cities. The teachers and parents completed the Korean version of the Attention-deficit/hyperactivity disorder Rating Scales (K-ARS), and the children performed neurocognitive tests. Blood lead and urinary cotinine levels were then measured. The inattentive, hyperactive, and total scores of the teacher-rated K-ARS were positively associated with blood lead level, and the results of the continuous performance test (CPT), Stroop Color-Word Test, and Children's Color Trails Test were inversely associated with urinary cotinine level when controlled for age, gender, father's educational level, maternal IQ, child's IQ, residential area, birth weight, and cotinine (for lead) or lead (for cotinine). The association between blood lead level and commission errors score on the CPT disappeared when the effect of urinary cotinine level was controlled. These findings indicate that environmental exposure to tobacco smoke in children is associated with poor neurocognitive performance, and low levels of lead are associated with inattention and hyperactivity symptoms.

Advances in environmental and occupational disorders in 2008

Substantial progress in understanding the role of environmental factors in allergic disease and asthma has been made in the past year. A number of new allergens have been described, and the impact of exposure to indoor allergens in the development of allergic respiratory disease is further confirmed. Exposures to environmental pollutants, particularly tobacco smoke in children, have furthered our knowledge of the detrimental effects of these exposures. This review highlights key advances in environmental and occupational exposures that contribute to the burden of allergic respiratory disease.

Occurrence of respiratory symptoms resulting from exposure to house dust mites in early childhood

The aim of the study was to describe the distribution of house dust mite (HDM) allergens within homes of three‐year‐old children, to identify factors responsible for its variation and to test the hypothesis whether the content of HDM allergens exceeding 2 µg/g dust may be regarded as a risk level of sensitization possibly affecting respiratory health in early childhood. House dust samples were collected in 279 dwellings from the mattresses, children’s bedroom and kitchen floors. In the laboratory, dust samples were analyzed for Der f 1 and Der p 1 using monoclonal antibody enzyme‐linked immunosorbent assays. At the time of the house dust collection, interviews with mothers on the household characteristics and child’s respiratory health were performed. Respiratory outcome variables included running or stuffed nose, cough, barking cough, difficult (puffed) breathing and wheezing or whistling in the chest irrespective of respiratory infection. For each of the symptoms the number of the episodes and duration in days over the past six months were recorded in the questionnaire. In the multivariate Poisson regression analysis, a set of potential confounders has been taken into account such as gender of child, season, maternal education, maternal atopy, older siblings and environmental tobacco smoke. The adjusted rate ratio for episodes of running nose among those exposed to higher HDM exposure was 1.09 (95% confidence interval (CI): 0.98–1.20), for episodes of cough 1.11 (95% CI: 0.99–1.24), barking cough 1.44 (95% CI: 0.99–2.09) difficult breathing 1.31 (95% CI: 0.91–1.92) and for wheezing 1.42 (95% CI: 1.00–2.02). In contrast, rate ratios for the duration of all respiratory symptoms were significantly higher in children exposed to higher HDM level. The corresponding rate ratios for duration of symptoms (in days) were 1.10 (95% CI: 1.06–1.14), 1.06 (95% CI: 1.02–1.11), 1.64 (95% CI; 1.42–1.90), 2.05 (95% CI: 1.79–2.35) and 1.40 (95% CI: 1.21–1.62). The children with positive history of maternal atopy showed a higher risk of wheezing than those without the maternal atopy. The rate ratios for number of wheezing episodes in children of mothers without atopy was insignificant 1.11 (95% CI: 0.94–1.30) while in the group with maternal atopy the risk ratio amounted to 1.47 (95% CI: 1.09–1.96); the corresponding rate ratio estimates for the duration of wheezing were 1.12 (95% CI: 1.04–1.20) and 1.46 (95% CI: 1.29–1.66). The data support the view that exposure to higher level of HDM allergens may affect susceptibility of the bronchi to environmental factors and increase the burden of respiratory diseases in early childhood.

&lt;emph type="ital"&gt;JAMA&lt;/emph&gt; Classics: Celebrating 125 Years of Publication

THIS ISSUE MARKS THE 125TH ANNIVERSARY OR quasquicentennial (we dare you to say that 3 times without getting tongue-tied) of JAMA, which began publication in 1883. In that year, Chester A. Arthur was the US president and the first telephone line connected New York and Chicago. In the 1883 world of biology and medicine, Robert Koch discovered the cholera bacillus and Georgios N. Papanikolaou, pioneer in cervical cytology, was born. The first issue of JAMA, published on July 14, 1883 (FIGURE), included a wide range of articles that apparently were selected to be of interest to a general medical readership. These reports covered a wide range of topics, including tobacco smoking in children, blunt chest trauma, and neurological disorders. Other articles in that issue described therapeutic interventions, such as treatment of otorrhea and diabetes and surgical techniques. All of this information was available for 10 cents per issue ($5 for an annual subscription), with costs probably at least partially defrayed with advertisements (mostly for schools and books, but also for medicinal products) that also appeared in that issue. Some things change little over time. Over the past 125 years, JAMA has published many important groundbreaking and practice-changing articles, some of which we now refer to as JAMA Classics. To celebrate our quasquicentennial, over the next year we will republish 24 of those classic articles online accompanied in print by a JAMA Classics Commentary that provides a brief summary of the original article and an update of the topic covered in the classic article. Whenever possible the Commentary will be written by individuals from the same institution as the authors of the classic article. To start this series, with this issue of JAMA we are publishing online the full text of the classic article “The Surgical Treatment of Malformations of the Heart in Which There Is Pulmonary Stenosis or Pulmonary Atresia” authored by Alfred Blalock, MD, and Helen B. Taussig, MD. The accompanying Commentary in this issue of JAMA is authored by Anne Murphy, MD, and Duke Cameron, MD; all 4 authors are from Johns Hopkins University School of Medicine. Both women were/are pediatric cardiologists and both men were/are pediatric surgeons. One difference is that, unlike the original article, the Commentary has the woman as first author. We hope you will enjoy the JAMA Classics series as much as we have in choosing the articles and collaborating with the authors of the Commentaries. Read, learn, and enjoy.

Secondhand Tobacco Smoke in Children With Asthma: Sources of and Parental Perceptions About Exposure in Children and Parental Readiness To Change

Secondhand smoke triggers childhood asthma. Understanding sources of exposure, parental beliefs about exposure, and readiness to change that exposure are important for designing smoke exposure reduction interventions.As part of screening for a clinical trial of a smoke exposure reduction intervention, 519 smoke-exposed children 3 to 12 years old with asthma provided urine specimens for cotinine testing, and their primary caregivers completed questionnaires.The urine cotinine to creatinine ratio (CCR) was lowest if neither the primary caregiver nor day-care provider smoked (mean CCR, 14.0; SD, 14.4), greater if either smoked (mean CCR, 22.2; SD, 21.3; and mean, CCR, 26.3; SD, 22.2, respectively), and greatest if both smoked (mean CCR, 39.6; SD, 27.5; p < 0.01). Parental perception of their child's exposure was weakly associated with the child's CCR (r(2) = 0.11, p < 0.001). Most parents (58.3%) reported that tobacco smoke exposure had small/no negative effect on their child's asthma. Substantial proportions of those for whom a specific exposure reduction action was relevant were classified as contemplating, preparing, or had recently taken action to reduce their child's exposure, including smoking cessation (61.3%), keeping the child out of smoke-exposed places (72.7%), and making the child's home (49.2%) and areas out of the home smoke free (66.9%).Smoking by the primary caregiver and day-care provider are important sources of exposure for children with asthma. Parental assessment of their child's exposure is associated with biologically confirmed exposure but cannot be relied on to assess that exposure. Although the harm of smoke exposure was frequently underestimated, many parents appeared receptive to considering action to reduce their child's exposure.(Clinicaltrials.gov). Identifier: NCT00217958.

Parental smoking behaviour and effects of tobacco smoke on children's health in Finland and Russia

There is little information on potential differences in smoking behaviour of parents between Finland and Russia and on the effects of environmental tobacco smoke (ETS) exposure on allergic and respiratory diseases among Finnish and Russian children. The aim of the study was to compare the smoking behaviour of parents and school children and to assess the relations of tobacco smoke exposure during pregnancy and childhood with occurrence of allergic diseases and respiratory infections among school children. We conducted a population-based cross-sectional study in the neighbour towns across the border of Imatra in Finland and Svetogorsk in Russia. The study population consisted of 512 Finnish and 581 Russian school children aged 7-16 years (response rate 79%). Children's tobacco smoke exposure differed markedly between Finland and Russia. The risk of asthma was particularly related to high maternal smoking exposure during pregnancy (adjusted OR 3.51, 95% CI 1.00-12.3), infancy (3.34, 1.23-9.07) and currently (3.27, 1.26-8.48), and the risk of common cold was related to high combined parental smoking during infancy (1.83, 1.06-3.17) in Finnish children. Among Russian children allergic conjunctivitis was related to maternal smoking during infancy (4.53, 1.49-13.8) and currently (2.82, 1.07-7.44). Smoking behaviour of parents and ETS exposure during childhood differed markedly between Finland and Russia. Asthma was particularly increased in relation to high exposure to maternal smoking in Finland. The results suggest that more efforts should be directed to reducing tobacco smoke exposure of children in both Finland and Russia. (250 words).

Impact of repeated lifestyle counselling in an atherosclerosis prevention trial on parental smoking and children's exposure to tobacco smoke

Abstract Aim: To determine whether repeated infancy‐onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke. Methods: In 1990, 1062 healthy infants were recruited to a randomized, ongoing atherosclerosis prevention trial (STRIP). Intervention families received at least twice a year individualized nutrition and lifestyle counselling. By 1999, 652 8‐y‐old children continued participation. Exposure to tobacco smoke was evaluated using serum cotinine concentration. Parents' smoking was also assessed using questionnaires and interviews. Results: Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8‐y‐old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non‐smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers. Conclusion: Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.

Impact of repeated lifestyle counselling in an atherosclerosis prevention trial on parental smoking and children's exposure to tobacco smoke

To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke. In 1990, 1062 healthy infants were recruited to a randomized, ongoing atherosclerosis prevention trial (STRIP). Intervention families received at least twice a year individualized nutrition and lifestyle counselling. By 1999, 652 8-y-old children continued participation. Exposure to tobacco smoke was evaluated using serum cotinine concentration. Parents' smoking was also assessed using questionnaires and interviews. Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8-y-old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non-smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers. Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.