A strategy for assessing environmental influence on airway allergy using a regression binary tree-based method

OBJECTIVE: To clarify the living environment factors that increase the risk of allergic sensitization to house dust mites, we applied a regression binary tree-based method (CART, Classification & Regression Trees) to an epidemiological study on airway allergy. The utility of the tree map in personal sanitary guidance for preventing allergic sensitization was examined with respect to feasibility and validity. SUBJECTS AND METHODS: A questionnaire was given to 386 healthy adult women, asking them about their individual living environments. Also, blood samples were collected to measure Dermatophagoides pteronyssinus (Dp)-specific IgE, the presence/absence of Dp-sensitization being expressed as positive/negative. The questionnaire consisted of nine items on (1) home ventilation by keeping windows open, (2) personal or family smoking habits, (3) use of air conditioners in hot weather, (4) type of flooring (tatami/wooden/carpet) in the living room, (5) visible mold proliferation in the kitchen, (6) type of housing (concrete/wooden), (7) residential area (heavy or light traffic area) (8) heating system (use of unventilated combustion appliances), and (9) frequency of cleaning (every day or less often). There also were queries on the past history of airway allergic diseases, such as bronchial asthma and allergic rhinitis. CART and a multivariate logistic regression analysis (MLRA) were performed. The subjects were first classified into two groups, with and without a history of airway allergic diseases (Groups WPH and WOPH). In each group, the involvement of living environment factors in Dp-sensitization was examined using CART and MLRA. RESULTS: In the MLRA study, individual living environment factors showed promotional or suppressive effects on Dp-sensitization with differences between the two groups. With respect to the CART results, the two groups were first split by the factor that had the most significant odds ratio for MLRA. In Group WPH, which had a Dp-sensitization risk of 19.5%, the first split was by the factor of visible mold proliferation in the kitchen into the factor-present group with a risk value of 45.5% and the factor-absent group with 13.5%. The mold proliferation group was split with reference to frequent cleaning, and the risk rose to 75% in the factor-absent group and to 100% when family smoking habits were reported. Group WOPH (the risk: 10.8%) was first split into two groups according to the use of air conditioners in hot weather for more than 6 hours a day or less, which showed risk values of 16.7% and 6.9%, respectively. The risk of the group that intensively used air conditioners fell to 8.3% with tatami as flooring in the living room, and, if others, rose to 20.8%. The risk of the factor-lacking group fell to 4.0% without wooden flooring. CONCLUSIONS: CART analysis enables us to express complex relationships between living environment factors and Dp-sensitization simply by a binary regression tree, pointing to preventive strategies that can be flexibly changed according to the individual living environments of the subjects.     

Determinants of passive smoking in children in Edinburgh, Scotland.

OBJECTIVES. Using saliva cotinine as a quantitative marker, we examined the contribution of factors other than parental smoking to children's passive exposure to tobacco smoke. METHODS. Saliva specimens from a random sample of 734 7-year-old schoolchildren in Edinburgh, Scotland, were analyzed for cotinine. Their parents completed a questionnaire covering smoking habits and conditions in the home. RESULTS. A number of independent predictors of cotinine were identified in addition to the main one of smoking by household members. These predictors included home ownership, social class, day of the week, season of the year, number of parents present, crowding in the home, the number of children in the household, and sex. Cotinine was higher in children from less advantaged backgrounds, during winter, on Mondays, in girls, and when fewer other children were present. The effects were similar between children from nonsmoking and smoking homes. CONCLUSIONS. Questionnaire measures of parental smoking are insufficient to fully characterize young children's exposure to passive smoking. Because socioeconomic variables contribute to measured exposure, passive-smoking studies that treat class as a confounder and control for it may be overcontrolling.     

Indoor exposure to molds and allergic sensitization

Evidence that indoor dampness and mold growth are associated with respiratory health has been accumulating, but few studies have been able to examine health risks in relation to measured levels of indoor mold exposure. In particular, little is known about the contribution of indoor molds to the development of allergic sensitization. As a part of an ongoing study examining the effects of ambient air pollutants on respiratory health and atopic diseases in German school children, we examined the relation between viable mold levels indoors and allergic sensitization in 272 children. We examined whether allergic sensitization in children is associated with higher fungal spore count in settled house dust sampled from living room floors. Adjusting for age, sex, parental education, region of residency, and parental history of atopy, we found that mold spore counts for Cladosporium and Aspergillus were associated with an increased risk of allergic sensitization. Sensitized children exposed to high levels of mold spores (> 90th percentile) were more likely to suffer from symptoms of rhinoconjunctivitis. We conclude that elevated indoor concentrations of molds in wintertime might play a role in increasing the risk of developing atopic symptoms and allergic sensitization not only to molds but also to other common, inhaled allergens. These effects were strongest in the group of children who had lived in the same home since birth.     

Evaluating an early secondary smoking prevention intervention

Given the documented link between smoking and later debilitating health conditions, a need exists to investigate educational programs aimed at reducing rates of smoking among school-age children. The present study involved an entire class of ninth graders in a treatment condition featuring either role-playing and discussion, or only discussion. While both treatments effectively reduced levels of smoking among early smokers, few changes were noted for youngsters manifesting long-term, more entrenched habits. Levels of smoking for children monitored in a control school remained about the same. These data suggest that early preventive programs might be most efficacious in curtailing smoking among school-age children.     

Effects of environmental tobacco smoke on lower respiratory system of children under 5 years of age

OBJECTIVE: To determine the effects of second-hand smoke in the respiratory system of children under 5 years old. METHODS: A cross sectional study of a total of 1,104 children under 5 years old. Information about respiratory symptoms and illness, family history of respiratory diseases, smoking habits of household members and housing conditions were assessed by home interviews with the children's parents. RESULTS: We studied 546 boys and 558 girls. Among 611 children exposed to second-hand smoke, 82% had respiratory problems (odds ratio = 1.64; 95% confidence interval: 1.21-2.20). Children whose parents were smokers at the time of the survey were more likely to experience wheezing than children of nonsmoking parents (odds ratio = 1.66; 95% confidence interval: 1.21-2.27), shortness of breath (odds ratio = 1.91; 95% confidence interval: 1. 36-2.67), morning and day time or night coughs (odds ratio = 1.58; 95% confidence interval: 1.09-2.28). The odds ratio for asthma, bronchitis and pneumonia was greater for children exposed to second-hand smoke (odds ratio = 1.60; 95% confidence interval: 1. 11-2.31). CONCLUSIONS: Maternal smoking, paternal smoking, family history of respiratory diseases, and housing conditions are considered risk factors for respiratory diseases in children.     

安徽地区儿童暴露于农村生活环境对过敏性哮喘的影响

目的 研究暴露于农村生活环境对预防儿童哮喘及致敏的保护作用.方法 向2986名在校儿童父母发放哮喘标准调查表,采用放射性变应原荧光酶免疫吸附实验(RAST-FEIA)检测儿童血清中特异性IgE(sIgE)含量.结果 与在城镇生活的儿童相比,暴露于农村生活环境儿童的过敏性哮喘与非过敏性哮喘、过敏性哮鸣及特应性哮呜危险度显著性降低(OR=0.45,95%CI:0.13～0.96:OR=0.41,95%CI:0.15～0.95;OR=0.32,95% CI:0.11～0.62;OR=0.44,95% CI:0.13～0.91).1周岁内暴露与农村生活环境的儿童过敏性哮喘及特应性致敏危险度较低(OR=0.23,95% CI:0.04～0.91;OR=0.32,95%CI:0.17～0.78);若暴露持续至6周岁,过敏性哮喘及特应性致敏危险度更低(OR=0.21,95%CI:0.03～0.87;OR=0.31,95%CI:0.15～0.78).结论 暴露于农村环境对预防儿童过敏性哮喘及致敏的发生可能有保护作用,持续的暴露能加强此作用.     

Factors that influence passive smoking in infancy: a study among mothers of newborn babies in The Netherlands

BACKGROUND: The aim of this study was to assess the factors that influence smoking in the presence of the infant by mothers, partners, other family members, and friends. METHODS: An observational study using questionnaires was performed with smoking and nonsmoking parents of babies between 1 and 14 months old attending Dutch well-baby clinics between February and May 1996. The main measures were prevention of passive smoking in children by mothers and the relation with self-reported attitudes, social influence, and self-efficacy. RESULTS: A total of 1702 parents completed the questionnaire (63%). A total of 1551 questionnaires were completed by the mother. Sixty-five percent of the mothers prevented passive smoking by their child. This figure was 55% for smokers and 69% for nonsmokers. Attitude was the factor that most explained preventive behavior among both smokers and nonsmokers. Among the respondents, a lack of prevention of passive smoking was significantly related to (1) a negative attitude and 2) a negative social influence exerted by their partner, (3) lower self-efficacy in reducing passive smoking, and (4) increasing age of the child. (5) Finally, a lack of prevention is associated with the mother's self-efficacy in asking others not to smoke. This association strongly differs between smoking and nonsmoking mothers. CONCLUSION: The results suggest that health education efforts should focus on attitude and self-efficacy, assuming that these precede actual behavior, and in particular on the health consequences of the exposure of young children to tobacco smoke. The information should not be restricted to parents of newborn babies; it should also focus on parents with older children. Particular attention should be paid to smokers with a low educational level. The results also indicate that education should strengthen the ability of nonsmoking parents to deal with smokers and the ability of smoking parents to deal with their own smoking behavior.     

广州、佛山两地学龄期儿童家庭二手烟暴露及自我保护行为调查研究

目的 了解广州、佛山地区学龄期儿童家庭二手烟暴露情况及其面对暴露时的自我保护行为。方法 采用自行编制的学龄期儿童二手烟暴露及自我保护行为问卷,对广州、佛山两地共385名三年级以上的小学生进行问卷调查。结果 9.2%的小学生曾经尝试过吸烟,且男童显著高于女童(χ²=9.269,P=0.002);46.8%的学龄期儿童与1个或以上的吸烟者同住,且42.6%的吸烟者每天吸烟;学龄期儿童家庭二手烟暴露的来源除了家庭成员,还有客人,其中29.3%学龄期儿童在调查前一个月内曾暴露在客人的二手烟中,42.6%的家人会主动提供香烟给客人;暴露的场所除了家庭室内还有私家车;但90%以上的学龄期儿童不认可吸烟行为,且认为二手烟对自身有害;面对二手烟暴露,98.8%学龄期儿童会采取主动或者被动的自我保护行为,并且其中大部分会尝试劝家人戒烟,而女童更倾向于劝解家人戒烟(χ²=7.161,P= 0.012)。66.7%的吸烟家长被儿童劝解戒烟后会有积极的改变,其中有8.8%学龄期儿童报告吸烟者戒烟了。结论 广州、佛山地区学龄期儿童家庭二手烟暴露情况不容乐观,儿童对被动吸烟有一定的自我保护能力,在性别方面需要针对性的指导。控烟工作应注意将儿童与家长结合起来,共同创建无烟家庭。     

Cord serum cotinine as a biomarker of fetal exposure to cigarette smoke at the end of pregnancy

This study investigated the association between biomarkers of fetal exposure to cigarette smoke at the end of pregnancy, cotinine in cord serum and in maternal and newborn urine samples, and quantitative measurement of smoking intake and exposure evaluated by maternal self-reported questionnaire. Study subjects were 429 mothers and their newborns from a hospital in Barcelona, Spain. A questionnaire including smoking habits was completed in the third trimester of pregnancy and on the day of delivery. Cotinine concentration in cord serum was associated with daily exposure to nicotine in nonsmokers and with daily nicotine intake in smokers. The geometric mean of cotinine concentration in cord serum statistically discriminated between newborns from nonexposed and exposed nonsmoking mothers, and between these two classes and smokers, and furthermore was able to differentiate levels of exposure to tobacco smoke and levels of intake stratified in tertiles. Urinary cotinine levels in newborns from nonsmoking mothers exposed to more than 4 mg nicotine daily were statistically different from levels in two other categories of exposure. Cotinine concentration in urine from newborns and from mothers did not differentiate between exposure and nonexposure to environmental tobacco smoke (ETS) in nonsmoking mothers. Cord serum cotinine appeared to be the most adequate biomarker of fetal exposure to smoking at the end of pregnancy, distinguishing not only active smoking from passive smoking, but also exposure to ETS from nonexposure.     

Prevalence of asthma and wheeze in relation to passive smoking in Japanese children

PURPOSE: Evidence remains inconclusive as to whether environmental tobacco smoke is a risk factor for allergic disorders in childhood. The present large-scale cross-sectional study examined the relationship between passive smoking at home and the prevalence of allergic disorders in Japanese schoolchildren. METHODS: Study subjects were 23,044 children aged 6 to 15 years in Okinawa. Outcomes were based on diagnostic criteria from the International Study of Asthma and Allergies in Childhood. Adjustment was made for sex, age, region of residence, number of siblings, paternal and maternal history of asthma, atopic eczema, or allergic rhinitis, as well as paternal and maternal educational level. RESULTS: The prevalence of wheeze, asthma, atopic eczema, and allergic rhinoconjunctivitis in the previous 12 months was 10.7%, 7.6%, 6.8%, and 7.7%, respectively. Current heavy passive smoking and 7.0 or more pack-years of smoking in the household were independently related to an increased prevalence of wheeze and asthma, especially in children 6 to 10 years of age and children with a positive parental allergic history. There was no dose-response relationship between pack-years of smoking in the household and atopic eczema or allergic rhinoconjunctivitis. CONCLUSIONS: Our findings suggested that environmental tobacco smoke might be associated with an increased prevalence of wheeze and asthma in Japanese children.     

The exposure of nonsmoking and smoking mothers to environmental tobacco smoke during different gestational phases and fetal growth

We studied the impact of maternal exposure to environmental tobacco smoke (ETS) on birth weight (BW), low birth weight (LBW), and intrauterine growth retardation (IUGR) according to self-reported maternal smoking habits in a sample of 6,866 singleton births. We obtained data about parental characteristics and maternal active smoking (AS) and passive smoking at delivery via maternal questionnaires and medical records. We used three categories of smoking habits (nonsmokers and those who smoked 1-10 or >10 cigarettes per day) and defined ETS exposure as greater than or equal to 5 cigarettes per day smoked by others in the mother's presence. We used multiple regression and logistic regression procedures with adjustment for many associated covariates. We observed a significant reduction of the mean BW in infants of AS mothers. This reduction was only marginal for mothers who stopped smoking after recognizing their pregnancy. ETS exposure in 1,797 of 5,507 nonsmoking mothers reduced the mean BW of their infants by 53 g [95% confidence interval (CI), 24-82 g]. ETS exposure also significantly reduced BW in babies of AS mothers by 92 g (CI, 21-113 g) compared with BW of ETS-nonexposed AS mothers. The adjusted odds ratio (AOR) of LBW for ETS-exposed AS mothers was two times the LBW risk of ETS-nonexposed AS mothers(2.02; CI, 1.11-3.67); the AOR of ETS-exposed nonsmoking mothers was 1.51 (CI, 1.02-2.26). The AOR of IUGR for this group did not differ from unity (1.08; CI, 0.82-1.43). However, ETS exposure increased the AOR of IUGR for AS mothers from 1.64 (CI, 1.06-2.53) to 2.13 (CI, 1.70-2.67). ETS exposure reduced the BW of infants of nonsmoking mothers and contributed to additional BW reduction in infants of AS mothers. ETS exposure increased the risk of LBW but not that of IUGR in babies of nonsmoking mothers.     

Respiratory symptoms and lung function effects of domestic exposure to tobacco smoke and cooking by gas in non-smoking women in Singapore.

STUDY OBJECTIVES--To investigate the effects of passive exposure to tobacco smoke and gas cooking at home on respiratory symptoms and lung function of non-smoking women. SETTING--Evidence on the effects of passive smoking and exposure to nitrogen dioxide from gas cooking on the respiratory health of adults is limited and variable. Over 97% of women in Singapore do not smoke, and a principal source of indoor air pollution for housewives is passive smoking and gas cooking. DESIGN--This was a cross sectional (prevalence) study of a population based sample of 2868 adults aged 20 to 74 years in Singapore. A structured questionnaire administered by trained interviewers was used to collect data on passive smoking, gas cooking, respiratory symptoms, and other relevant variables. Passive smoking was defined as exposure to cigarette smoke from one or more members of the household who had ever smoked. Gas cooking was defined in terms of the weekly frequency of gas cooking, as well as the frequency with which the respondent's kitchen was filled with heavy cooking fumes (rarely, occasionally, often). Forced expiratory volume in one second (FEV1) was measured by using a portable Micro-spirometer. Multivariate analyses were used to estimate relative odds of association for respiratory symptoms and FEV1 effect, with adjustment for potential confounding variables. PARTICIPANTS--Of a total of 1438 women in the sample, 1282 women who had never smoked provided questionnaire data and 1008 women provided acceptable readings of FEV1 for analysis. MAIN RESULTS--Passive smoking was significantly associated with greater relative odds of usual or chronic cough and phlegm, wheezing, and breathlessness on exertion, as well as lower FEV1. Greater relative odds of respiratory symptoms were also associated with the weekly frequency of gas cooking, although these results were statistically insignificant. Chronic cough and phlegm and breathlessness on exertion, however, were significantly associated with the frequency with which the kitchen was filled with heavy cooking fumes. A lower FEV1 was found in women who cooked frequently (more than thrice a week). CONCLUSION--Domestic exposure to cigarette smoke and gas cooking is associated with increased risks of respiratory symptoms and impairment of lung function in non-smoking women in Singapore.     

Housing Environments and Child Health Conditions Among Recent Mexican Immigrant Families: A Population-Based Study

The influx of immigrants to urban areas throughout the United States has raised concerns about accessibility of safe, affordable housing and the health consequences of poor-quality housing, particularly among immigrant children. We conducted a population-based study of home environmental conditions among recently immigrated Mexican families (weighted n = 473), generally of low socioeconomic status, and the health conditions of their children, in an urban industrial area north of Denver, Colorado. The majority of recent immigrants had low socioeconomic status; virtually all had household incomes below the Colorado median ($50,841). Approximately one quarter of homes were overcrowded. Adverse environmental conditions were present across recent immigrant homes. These conditions include dampness or mold (44%), pests (28%), and minimal to no ventilation potential (26%), all of which are associated with asthma and atopic diseases. At least one of these three environmental hazards was found in 67% of homes; multiple hazards were present in 27% of homes. Children of recent immigrant families had active symptoms within the past 12 months suggestive of asthma (4%) and atopic disorders (10%); however, fewer than 2% had been diagnosed with these conditions. The prevalence of asthma and atopic symptoms among Mexican immigrant children, albeit lower than in other low income and minority communities, is partially explained by housing conditions. Many of the conditions identified (e.g., pest infestation, mold resulting from plumbing leaks, and lack of exhaust fans) are amenable to low cost interventions. Solutions to address unhealthy housing conditions among recent immigrants must be multi-faceted and include strategies that target household-level improvements and access to health care.     

Environmental Risk Factors for Respiratory Infections

In this study, the authors investigated the possible relationship between environmental—including dietary—factors and respiratory and ear infections in children. A sample of 304 children, aged 4-5 y, in Geneva, Switzerland, was studied. Mothers filled out a questionnaire that the authors provided. The questionnaire included items on food frequency, infections, and background factors (e.g., education, housing conditions, parents' smoking habits). Allergy was a risk factor for all infections, and mother's age was a protective factor. Humid conditions at home was a significant risk factor for cold, sore throat, and otitis (odds ratios = 2.71, 3.03, and 2.77, respectively); mold in the home was a significant risk factor for otitis (odds ratio = 2.80); and attending day-care centers was a significant risk factor for cold and bronchitis (odds ratios = 1.36 and 1.89, respectively). Dietary factors were not related to disease risk nor were environmental tobacco smoke or housing conditions generally related to an increased risk.     

Environmental risk factors for respiratory infections

In this study, the authors investigated the possible relationship between environmental-including dietary-factors and respiratory and ear infections in children. A sample of 304 children, aged 4-5 y, in Geneva, Switzerland, was studied. Mothers filled out a questionnaire that the authors provided. The questionnaire included items on food frequency, infections, and background factors (e.g., education, housing conditions, parents' smoking habits). Allergy was a risk factor for all infections, and mother's age was a protective factor. Humid conditions at home was a significant risk factor for cold, sore throat, and otitis (odds ratios = 2.71, 3.03, and 2.77, respectively); mold in the home was a significant risk factor for otitis (odds ratio = 2.80); and attending day-care centers was a significant risk factor for cold and bronchitis (odds ratios = 1.36 and 1.89, respectively). Dietary factors were not related to disease risk nor were environmental tobacco smoke or housing conditions generally related to an increased risk.     

农村留守儿童膳食多样化评价及其影响因素分析

  目的  评价学龄期留守儿童的膳食多样化得分及其影响因素,为指导留守儿童合理膳食提供参考依据。  方法  2019年8月对2009年在江苏射阳建立的儿童出生队列中501名9~10岁儿童进行调查,问卷询问儿童留守情况与其他基本信息,24 h膳食回顾法收集膳食资料。根据联合国粮食与农业组织(Food and Agriculture Organization, FAO)的标准计算膳食多样化得分(dietary diversity score, DDS₁₀和DDS)和食物多样性得分(food variety score, FVS);测量儿童的体格发育指标并评估肥胖情况,应用多变量回归分析留守情况与膳食多样化得分关系及影响因素。  结果  留守儿童的比例为40.9%,3种膳食多样化得分(DDS₁₀、DDS、FVS)分别为(5.69±1.31)(6.55±1.44)(13.48±4.23)分,均低于非留守儿童(5.99±1.29,6.79±1.40,14.15±4.22)分,留守儿童与非留守儿童的DDS₁₀评分差异有统计学意义(P=0.01)。广义线性模型回归结果显示,性别、被动吸烟、家庭教育水平、家庭年收入、留守情况与膳食多样化得分相关均有统计学意义(P值均 < 0.05)。  结论  留守儿童的膳食多样化程度较低,膳食多样化与儿童性别、被动吸烟、家庭教育水平和家庭年收入等有关。应注重留守儿童膳食多样化,改善儿童饮食。     

The extent of passive smoking in the federal republic of Germany

A representative survey of 1,670 persons between 14 and 65 years of age was conducted in order to obtain current data on active and passive smoking in the Federal Republic of Germany. Overall, 36.7% were smokers, 21.3% were former smokers, and 42.0% were nonsmokers. These rates vary for sociodemographic subgroups and for states, cities, and rural areas. The time pattern during the 24 hr preceding the interview is identical in shape for active as well as passive smoking. The exposed maximum time for passive smoking varies with age and sex. It lies somewhere between 2 and 15% of the observed 24 hr; the best estimates seem to be 5% for nonsmoking men and 3-4% for nonsmoking women. It consistently compares with our preliminary definition of passive smoking. A reconstruction of Hirayama's definition reveals parallel results in terms of maximum exposure time when compared with our preliminary definition. A direct comparison between both definitions showed inconsistencies to an extent that could jeopardize the results of a case-control study. Data demonstrate a massive effect of measuring techniques on study results with regard to the frequency and extent of passive smoking. They also show the vulnerability of the calculation of equivalence of actively smoked cigarettes.     

Latent factors aggravating airway allergic symptom in urban population: the involvement of urban living environments]

The involvement of urban living environments in IgE-increase (atopy) and ECP-increase (enhanced eosinophil activity), the inter-relationship of IgE-increase and ECP-increase, and their involvement in developing airway allergic symptoms were studied on a population of adult nonsmoking women, in order to elucidate the latent factors aggravating airway allergic symptoms in an urban population. In our earlier study on child asthma in 1994, we examined the relationship between living environments and mite proliferation in asthma and non-asthma groups and the involvement of mite proliferation in developing atopy in the non-asthma group. The asthma group consisted of 190 children under 12 years old who had been recently diagnosed as having bronchial asthma and under the care of Osaka Prefectural Habikino Hospital. The non-asthma group consisted of 78 children under 12 years old who had been under care at Osaka Prefectural Hospital but had no present history of allergic symptom. The adult woman group consisted of 423 non-smoking women who had been diagnosed as having no allergic disease by the medical examination done at Yao City, Osaka, each March from 1995 to 1997. Individual living environments such as housing and heating styles were surveyed by questionnaire. Also, the amount of mite allergen (Dp: Dermatophagoides pteronyssinus, Df: Dermatophagoides farinae) in room and bedding dust (only in the case of children) and the concentration of continine in urine were examined as objective indicators for the load of environmental allergen and the indoor air pollution by tobacco smoke, respectively. Atopy was diagnosed according to whether Dp-specific immunoglobulin E (Dp-IgE) was present/absent (positive/negative), and ECP-increase was defined as serum ECP concentration over 10 ng/ml. The results were as follows: 1. An environment of higher humidity (dampness) causing a room to become moldy appeared to enhance mite proliferation, while heating only with an electric heater or kotatsu appeared to suppress it. 2. Living environments were involved in the development of atopy in children and adult women through the effects on mite proliferation. In the case of children, heating with oil or gas heater appeared to have a positive effect while reinforced concrete housing a negative effect, probably by effects on the immune system. However, in the case of adult women, such modification was not observed. 3. Passive smoking in adult women was related to ECP-increase. 4. IgE-increase and ECP-increase appeared to be involved in each other. 5. Among airway allergic symptoms such as cough, sputum and wheeze, atopy was involved in wheeze, and ECP-increase in cough.     

Maternal smoking and medical expenditures for childhood respiratory illness.

OBJECTIVES: This study sought to assess the association between environmental tobacco smoke exposure from maternal smoking and health care expenditures for respiratory conditions among US children. METHODS: Multivariate analysis of the 1987 National Medical Expenditure Survey was undertaken with a sample that included 2624 children 5 years of age and under. RESULTS: After analysis that controlled for various sociodemographic factors associated with health care usage, respiratory-related health care expenditures among children whose mothers smoke were found to be significantly higher than those expenditures for children of nonsmoking mothers. Truncated regression techniques were used to estimate that maternal smoking was associated with increased health care expenditures averaging (in 1995 dollars) $120 per year for children aged 5 years and under and $175 per year for children aged 2 years and under. Our analysis indicates that passive smoking was associated with $661 million in annual medical expenditures in 1987, representing 19% of all expenditures for childhood respiratory conditions. CONCLUSIONS: Maternal smoking is associated with significantly increased child health expenditures and contributes significantly to the overall cost of medical care.