被动吸烟儿童呼吸健康状况与血清免疫球蛋白含量的相关性

目的:探讨被动吸烟儿童呼吸健康状况与血清免疫球蛋白含量的相关性。方法:对泰安市6个县市区采用简单随机抽样的方式对3～6岁儿童进行调查,内容包括不同年龄儿童的被动吸烟量及吸烟年限;近1年呼吸道健康状况;血清免疫球蛋白含量。结果:被动吸烟儿童感冒、肺炎、支气管炎、哮喘发病率均高于无被动吸烟的儿童(P<0.01)。随被动吸烟量的增大、家庭成员吸烟年限的延长,儿童患呼吸系统疾病的次数逐渐增加(P<0.01)。被动吸烟组儿童血清免疫球蛋白低于无被动吸烟组,随被动吸烟量的增加,免疫球蛋白明显下降,各组有显著差异,而被动吸烟儿童免疫球蛋白含量降低者反复呼吸道感染的几率增高(P<0.01)。结论:被动吸烟对儿童呼吸健康及免疫功能有不良影响,应采取措施减少儿童被动吸烟的暴露。     

Indoor and outdoor smoking: impact on children's health

BACKGROUND: Many children are exposed to ETS (environmental tobacco smoke), which has both immediate and long-term adverse health effects. The aim was to determine the prevalence and nature of smoking among parents with infants and the association of indoor or outdoor smoking with the health of their children. METHODS: Mail-questionnaire study, which was performed in a county in the south-east of Sweden, as a retrospective cross-sectional survey including 1990 children, 12-24 months old. RESULTS: 20% of the children had at least one smoking parent; 7% had parents who smoked indoors and 13% parents who smoked only outdoors. Indoor smoking was most prevalent among single and blue-collar working parents. In the case of smoking cessation during pregnancy, smoking was usually resumed after delivery or at the end of the breast-feeding period. Coughing more than two weeks after a URI (upper respiratory infection), wheezing without a URI as well as pooled respiratory symptoms differed significantly between children of non-smokers and indoor smokers. CONCLUSION: Further research of the common belief that outdoor smoking is sufficient to protect infants from health effects due to ETS exposure is warranted.     

Ethnicity and smoking: differences in white, black, Hispanic, and Asian medical patients who smoke

To describe differences in the attitudes and behaviors of white, black, Hispanic, and Asian medical patients who smoke, we surveyed 2,835 patients of primary care physicians who participated in a controlled trial on smoking cessation. White smokers smoked more cigarettes per day, were more addicted to cigarettes, had more smoking-related symptoms and illnesses, and were more likely to relate smoking to their symptoms and illnesses. Black smokers found less pleasure in smoking, expressed the least concern about the health risks of smoking, but reported the greatest desire to quit and most confidence that they could quit. Hispanic and Asian smokers more often wanted to quit to keep their children from being exposed to smoking. We conclude that a single approach to helping patients quit smoking is less likely to be effective than one tailored to the ethnic differences among those patients.     

Cigarette smoking and self-reported health problems among U.S. high school seniors, 1982-1989

PURPOSE: To estimate the independent effect of cigarette smoking on respiratory tract symptoms and health status indicators among high school seniors. DESIGN: Consolidated data sets from one-time cross-sectional survey designs. SETTING: High schools in the United States, 1982-1989. SAMPLE: A total of 26,504 high school seniors, with an 83% response rate. MEASURES: Odds ratios for respiratory tract symptoms and health status indicators for cigarette smokers compared with nonsmokers, while controlling for sex, socioeconomic status, and use of other drugs. RESULTS: High school seniors who were regular cigarette smokers and who began smoking by grade nine were significantly more likely than never smokers to report shortness of breath when not exercising (adjusted odds ratio [OR] = 2.7), coughing spells (OR = 2.1), productive cough (OR = 2.4), and wheezing or gasping (OR = 2.6). These smokers were also more likely to have seen a doctor or other health professional for an emotional or psychologic complaint (OR = 3.0) and to rate their overall health as poorer than average (OR = 2.4). We found strong dose-response relationships for most outcome measures. CONCLUSIONS: Cigarette smoking among high school seniors is associated with respiratory tract symptoms and poorer overall physical health and may be a marker for underlying mental health problems. Smoking prevention activities directed at adolescents should include information on the early adverse health consequences of cigarette smoking.     

Maternal factors, obstetric history and smoking stage of change.

BACKGROUND: Maternal smoking is known to be associated with low educational status, low social class and younger age groups. The aim of this study was to determine if maternal smoking and stage of change relating to smoking is associated with other maternal variables such as intention to breastfeed and attend antenatal classes, having a planned pregnancy, previous obstetric history and child health problems. METHOD: A cross-sectional survey was carried out of all women who attended antenatal clinics at the Leicester Royal Infirmary NHS Trust over a two-week period. The data comprised 254 completed questionnaires. Results Intention to breastfeed was more common among non-smokers as shown by smoking status (p < 0.001) and smoking stage of change (p < 0.05). Having a planned pregnancy was more common among non-smokers as determined by smoking status (p < 0.001) and stage of change (p < 0.05). Intention to attend antenatal classes showed no significant relationship with smoking status but the majority of those planning to attend antenatal classes were in the action-maintenance stage (p< 0.05). Previous obstetric complications were not associated with either smoking status or stage of change. Smokers were more likely to have at least one child with asthma (p < 0.05) or respiratory infections (p < 0.001). Having at least one child with asthma or respiratory infections was more common among precontemplators (p < 0.05). CONCLUSION: Smoking stage of change should be assessed in antenatal care so that appropriate information can be offered to pregnant smokers. The development and evaluation of stage-specific smoking cessation materials should offer considerable benefits to maternal and infant health.     

Effects of environment and passive smoking on the respiratory health of children.

A cross-sectional survey was conducted to evaluate the possible effects of outdoor air pollution and of parental smoking on the respiratory health of children. A total of 3092 primary schoolchildren living in two polluted areas (an industrial town, Civitavecchia, and the city of Rome) and in a rural area, were chosen. A self-administered questionnaire was filled in by the parents of 2929 children (94.2%). A broad spectrum of respiratory symptoms and illnesses were taken as outcome variables. The frequency of most outcome variables was higher among children from the polluted areas than among those growing up in the non-polluted area (e.g. asthma: odds ratio (OR) = 1.4 for Civitavecchia, OR = 1.3 for Rome). Exposure to any passive smoking increased OR of having night cough (OR = 1.8), snoring (OR = 1.4), and respiratory infections during the first 2 years of life (OR = 1.3). A further increase in risk was observed in children whose mothers smoked or if both parents were smokers (asthma, OR = 1.5). When the separate and joint effects of the two exposures were studied, the patterns of OR did not suggest synergism between the two factors. The study indicates that both air pollution and passive smoking cause an increase in respiratory symptoms in children, although there would seem to be no additional effects of the two exposures together.     

Passive smoking,excretion of metabolites,and health effects: results of the Leipzig's Allergy Risk Study (LARS)

Over a 5-yr period, the Leipzig's Allergy Risk Study (LARS) investigated the influence of typical indoor-contaminant burdens on the development of allergies and upper respiratory tract infections in allergy-prone children. Typical indoor volatile organic compounds (VOCs) and excretion of certain VOC metabolites in urine were measured in children 3 yr of age. Data analyses were based on parent-completed questionnaires, exposure measurements, and medical examinations. Evaluation of passive smoking was of special interest. Generally, residences with a high burden of passive smoking had higher benzene concentrations than residences inhabited by nonsmokers. Obstructive bronchitis was observed more frequently in children exposed to increased concentrations of benzene, as well as toluene, styrene, and m,p-xylene. In addition, atopic symptoms were associated with excretion of certain VOC metabolites. For example, the authors found an association between eczema and exposure to toluene and between eczema and increased excretion of the toluene metabolite S-benzylmercapturic acid. The results suggest that if an association with certain health effects is to be demonstrated, evaluation of external exposures should be supplemented with evaluations of internal exposure.     

The smoking and dietary behaviour of lambeth schoolchildren II. the relationship between knowledge, attitudes and behaviour

As part of a study designed to examine the effect of a health education programme on 10-year-old schoolchildren, information was obtained on the children's knowledge, attitudes and behaviour concerning two health hazards, namely smoking and obesity. Cross sectional analyses showed that children who smoked were as aware of the health hazards of smoking as non-smokers but were less likely to hold anti-smoking attitudes. They were also more likely to think of themselves as “naughty” and “silly”. Conversely, children who subsequently adopted smoking were less aware of the health hazards of smoking than those who remained non-smokers. There was good evidence that obese children possessed more nutritional knowledge than the non-obese, and their attitudes to diet differed little. No relationship was demonstrated between reported energy intake and obesity, either cross sectionally or longitudinally. Relationships between knowledge and attitudes towards nutrition and the development of obesity were investigated, but there was only one significant finding, namely that boys identifying correct statements about nutrition put on less fat than other boys.     

Cigarette smoking: knowledge, attitudes and behaviour in an adult population in Italy

The study explores knowledge, attitudes, and behaviour regarding cigarette smoking and related factors in an adult population. A total of 935 parents of children attending the eighth class of ten randomly selected primary schools in Catanzaro (Italy) received a questionnaire consisting of questions on demographic and socioeconomic characteristics, knowledge, behaviour and attitudes about cigarette smoking. Six hundred and sixty-nine parents returned the questionnaire, with a response rate of 71.5%. Knowledge of risk associated to smoking was significantly higher in more educated subjects and in past smokers compared to current. Current and past smokers were respectively 39.6% and 17.2%, and current smokers were younger, not married, less prone to consider smoking as a major risk for their health and more likely to live with other smokers compared to past and never smokers. Females of higher education were more likely to be current smokers, whereas male current smokers were more likely to be less educated compared to past or never smokers. The results strongly recommend the provision of accurate information about the health consequences related to smoking, with a more intensive involvement of health care providers, particularly targeted to women and younger age groups.     

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.     

The health of Travellers' children in Northern Ireland.

A study was carried out to examine aspects of the health status of children from a group of 'travelling people' in Northern Ireland. A total of 350 children, aged under 16 years, were included in the study. Data were gathered by community health doctors and health visitors using a standardised questionnaire. The study revealed that this community has a high degree of consanguinity and points to higher levels of congenital abnormalities than in the settled community. Uptake of immunisation was less than the settled community and hospital admissions in the younger age group were particularly due to infectious diseases. The authors conclude that provision of health services for travelling people in Northern Ireland should be urgently reviewed with consideration of the needs and lifestyle of this group. The provision of suitable sites for travelling people with adequate water and sewage facilities to reduce potential risks to health is also advocated.     

Stage of change is associated with assessment of the health risks of maternal smoking among pregnant women

This study explored pregnant women's assessment of the health risks associated with maternal smoking. The aim was to determine if stage of change relating to smoking is associated with risk assessment. A cross-sectional survey (employing a self-completion questionnaire) was conducted of all women who attended antenatal clinics at Leicester Royal Infirmary, National Health Service Trust, UK over a 2 week period. Questionnaires were completed by 254 respondents. Twenty seven percent of non-smokers agreed with more than 75% of a series of statements about the dangers of maternal smoking compared to 5% of smokers and 44% of women in social class I (highest social class) agreed with more than 75% of the statements compared with only 10% of women in social classes IV and V (lower social class groups). Married women were twice as likely to concur with more than 75% of the health risks compared to single or cohabiting women and 29% of women intending to breastfeed agreed with more than 75% of the statements compared with only 8.7% of women not intending to breastfeed. There was no significant effect of age, whether the pregnancy was planned, previous obstetric complications or whether the woman had a child with asthma or respiratory infections. A multiple regression analysis indicated that smokers were much less likely to agree with the health risks than their non-smoking counterparts (p = 0.034). Stage of change was related to both the number of health risks agreed with and the level of conviction. A woman's stage of change could be assessed at the start of antenatal care so that appropriate smoking cessation advice can be offered.     

Passive smoking: an environmental health risk

The supposed health risks of passive smoking are leading to increasingly restrictive legislation on smoking. Tobacco smoke is undoubtedly irritating to the eyes, nose and throat of non-smokers, but politicians wanted more spectacular facts. There is some evidence of fatal consequences of passive smoking, particularly increases in lung cancer and heart-disease mortality among non-smokers exposed to tobacco smoke. Most studies compare the non-smoking partners of smokers and non-smokers. The observed relative risks are too small to be ascertained reliably. The more than twentyfold increased risk of lung cancer among smokers and the presence of tobacco-related metabolites in non-smokers' body fluids lend support to the hypothesis that passive smoking causes lung cancer. The less than twofold increased risk of heart disease among smokers and the documented social-risk factors cast doubt on the validity of the increased risk of heart disease in non-smokers, associated with having a smoking partner. The precautionary principle regulates potential environmental health hazards: the suspicion and the hazard must be sufficiently serious to take legislative action. There is ample evidence of tobacco smoke's carcinogenicity and the accumulated knowledge strongly suggests that the legal threshold of an acceptable environmental health risk has been exceeded.     

Accounting for risk and responsibility associated with smoking among mothers of children with respiratory illness

Contemporary public health discourses construct individuals as rational, responsible and knowledgeable, and thus promote a self-controlled prudent response to risk. In the context of evidence emphasising risks to children's health associated with passive smoking, mothers of children with respiratory illness may knowingly place their children at increased risk should they continue to smoke in their presence. Drawing on an analysis of depth qualitative interview accounts with mothers who smoke and whose young child was recently admitted to hospital with respiratory illness, this study describes mothers' constructions of risk and responsibility associated with their smoking. Three forms of accounting style were identified: 'stories of acceptability'; 'denial of agency'; and 'reflections of guilt'. 'Stories of acceptability' either positioned the risk of passive smoking as contained and controlled to an acceptable level, or disputed the level of risk that passive smoke posed. 'Denial of agency' drew on discourses of addiction and shared responsibility to exonerate the mother of responsibility or blame. 'Reflections of guilt' were presented when contradictions arose within accounts, particularly in relation to discussions of agency and rationality in decision-making. The study illustrates how constructions of moral responsibility, especially in relation to being a 'good mother', framed mothers' accounts of smoking in the face of risk. The study concludes that far greater consideration be given to the way in which mothers rationalise their smoking to others if paediatric doctors are to foster risk reduction practices associated with passive smoking more effectively.     

Adverse health effects in children associated with moisture and mold observations in houses

This work was conducted to study the health effects in children associated with observations of moisture or mold in their homes. A random sample of 310 houses in Finland was studied during the years 1993-1994. In all, 204 children 15 years old or younger were living in 110 houses. The houses were investigated for visual signs of moisture by a surveyor, and observations of mold were reported by the parents. Thus, two different definitions of exposure were used in the analysis. Health data was collected by a postal questionnaire. Exposure to moisture or mold significantly increased the risk of respiratory infections and respiratory symptoms as well as non-respiratory symptoms in both the preschool and schoolchildren. In preschool children, exposure to moisture significantly increased the risk of hoarseness and in the schoolchildren, the risks were significantly increased of cough without phlegm, nocturnal cough, sore throat and rhinitis. Preschool children exposed to mold had significantly increased risks of nocturnal cough and eczema, and they also had significantly more episodes of common cold than the non-exposed children. If schoolchildren had been exposed to mold, this significantly increased their risk of nausea and led to difficulties in concentration. They also had a significantly higher number of doctor visits than the non-exposed children.     

Effects of pre- and postnatal exposure to parental smoking on early childhood respiratory health

Compelling evidence suggests a causal relation between parental smoking during and after pregnancy and adverse effects on respiratory health in the offspring. The authors' aim in this study was to disentangle the effects of prenatal and postnatal smoking on early childhood respiratory health. Most parents who smoke during pregnancy continue to smoke postpartum, and it is difficult to identify sufficiently large subgroups of children who were exclusively exposed in utero or after birth. This study was based on the first 22,390 children born between 2000 and 2004 in the Norwegian Mother and Child Cohort, a pregnancy cohort designed to eventually include 100,000 pregnancies. Data were collected through detailed questionnaires administered at various stages of pregnancy, starting in early pregnancy. Because of the large study population, the authors were able to disentangle the pre- and postnatal effects of parental smoking on wheeze and lower respiratory tract infection in the children's first 18 months of life. They found maternal smoking in pregnancy to be an independent risk factor for wheeze and respiratory infection. Postnatal paternal smoking was also associated with these outcomes, independently of maternal smoking in pregnancy.     

Cigarette smoking behavioral distinctions between experimental nonadopters and adopters in children and adolescents--a consideration of transitional smoking experience: the Bogalusa Heart Study

A cigarette-smoking questionnaire to examine behavior, attitudes, and beliefs related to cigarette use was administered to children, ages 8-17, in a biracial community. Children who experimented with cigarettes but did not adopt the habit (experimental nonadopters) and children who continued to smoke (adopters) were identified and characterized. Follow-up behavior was examined 2 years later. Adopters were more likely to have smokers as friends and family members, more likely to have purchased their first cigarettes, more likely to believe smoking to be pleasurable for themselves and others, and less likely to consider smoking harmful. Adopters who maintained smoking behavior 2 years later had, during the initial survey, reported having more friends who also smoked and were more likely to believe smoking to be enjoyable. Experimental nonadopters were more likely to try the first cigarette alone, reported having fewer friends and family members who smoked, and believed greater health risks to be associated with cigarette use. Experimental nonadopters who maintained nonsmoking behavior 2 years later, especially in the older cohort, exhibited higher agreement with the negative consequences of cigarette smoking (health beliefs) and theories concerning smoking behavior of others.     

Air pollution, cigarette smoking, and the production of respiratory health

Previous studies of the determinants of respiratory health have treated both smoking and air pollution as being exogenous. Using an instrumental variables approach, we estimate a simple production technology in which smoking is treated as being endogenously determined. Doing so, we find, increases the predicted absolute effects of smoking on respiratory health; relative to air pollution, smoking becomes a more important determinant when it is treated as an endogenous variable.     

Smoking and health: the association between smoking behaviour, total mortality, and cardiorespiratory disease in west central Scotland.

The relationship of smoking to total mortality and to the prevalence of cardiorespiratory symptoms has been studied in three prospective surveys in west central Scotland in which 18 786 people attended a multiphasic screening examination. The prevalence of respiratory symptoms, and to a lesser extent cardiovascular symptoms, increased with the number of cigarettes smoked, with inhalation, and with a younger age of starting to smoke. A lower prevalence of respiratory symptoms in both sexes was observed in smokers of filter cigarettes than in smokers of plain cigarettes, and in those who smoked cigarettes with lower tar levels, irrespective of whether these were filtered or plain. In general, the relationships found between smoking and mortality were similar to those reported by other workers. Current cigarette smokers had a death rate from all causes which was twice that of those who had never smoked. No difference was found between the mortality rates of smokers of plain and filter cigarettes.