Burden of disease from exposure to secondhand smoke in children in Europe

Carreras, Giulia; Lachi, Alessio; Cortini, Barbara; Gallus, Silvano; López, María José; Nicolás, Ángel López; Lugo, Alessandra; Pastor, María Teresa; Soriano, Joan B.; Fernández, Esteve; Gorini, Giuseppe

doi:10.1038/s41390-020-01223-6

Cited by 13 publications

(11 citation statements)

References 39 publications

(36 reference statements)

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“…It has been estimated that 20% of pregnant women and 12% of children are regularly exposed to SHS at home in the EU [27], but this also varies widely between countries depending on the prevalence of smoking and the level of enforcement of smoke-free legislation. This is reflected in recent European data on exposure to SHS in restaurants.…”

Section: Tobacco Use In Europe: Facts and Figuresmentioning

confidence: 99%

European progress in working towards a tobacco-free generation

2021

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Children have the right to grow up free from the hazards associated with tobacco smoking. Tobacco smoke exposure can have detrimental effects on children’s health and development, from before birth and beyond. As a result of effective tobacco control policies, European smoking rates are steadily decreasing among adults, as is the proportion of adolescents taking up smoking. Substantial variation however exists between countries, both in terms of smoking rates and regarding implementation, comprehensiveness and enforcement of policies to address smoking and second-hand smoke exposure. This is important because comprehensive tobacco control policies such as smoke-free legislation and tobacco taxation have extensively been shown to carry clear health benefits for both adults and children. Additional policies such as increasing the legal age to buy tobacco, reducing the number of outlets selling tobacco, banning tobacco display and advertising at the point-of-sale, and introducing plain packaging for tobacco products can help reduce smoking initiation by youth. At societal level, health professionals can play an important role in advocating for stronger policy measures, whereas they also clearly have a duty to address smoking and tobacco smoke exposure at the patient level. This includes providing cessation advise and referring to effective cessation services.Conclusion: Framing of tobacco exposure as a child right’s issue and of comprehensive tobacco control as a tool to work towards the ultimate goal of reaching a tobacco-free generation can help accelerate European progress to curb the tobacco epidemic. What is Known:• Tobacco exposure is associated with a range of adverse health effects among babies and children.• Comprehensive tobacco control policies helped bring down smoking rates in Europe and benefit child health. What is New:• Protecting the rights and health of children provides a strong starting point for tobacco control advocacy.• The tobacco-free generation concept helps policy-makers set clear goals for protecting future generations from tobacco-associated harms.

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Section: Tobacco Use In Europe: Facts and Figuresmentioning

confidence: 99%

European progress in working towards a tobacco-free generation

2021

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“…Conversely, ETS exposure in private environments, particularly at home or in cars, cannot be regulated by any smoke-free legislation. Therefore, an unmet need for public health is to study the impact of ETS exposure in domestic ambientes on healthcare, mortality, and social welfare spending [ 5 , 6 , 7 , 8 , 9 ]. Several clinical studies have shown that ETS represents a risk factor for lung cancer [ 10 , 11 ] and induces the release of several cytokines involved in phlogistic processes [ 12 , 13 ], such as inflammatory airway diseases.…”

Section: Introductionmentioning

confidence: 99%

Short-Term Effects of Side-Stream Smoke on Nerve Growth Factor and Its Receptors TrKA and p75NTR in a Group of Non-Smokers

Stabile

Pistilli

Bartolini

et al. 2022

IJERPH

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Environmental tobacco smoke remains a major risk factor, for both smokers and non-smokers, able to trigger the initiation and/or the progression of several human diseases. Although in recent times governments have acted with the aim of banning or strongly reducing its impact within public places and common spaces, environmental tobacco smoke remains a major pollutant in private places, such as the home environment or cars. Several inflammatory and long-term biomarkers have been analysed and well-described, but the list of mediators modulated during the early phases of inhalation of environmental tobacco smoke needs to be expanded. The aim of this study was to measure the short-term effects after exposure to side-stream smoke on Nerve Growth Factor and its receptors Tropomyosin-related kinase A and neurotrophin p75, molecules already described in health conditions and respiratory diseases. Twenty-one non-smokers were exposed to a home-standardized level of SS as well as to control smoke-free air. Nerve Growth Factor and inflammatory cytokines levels, as well the expression of Tropomyosin-related kinase A and neurotrophin receptor p75, were analysed in white blood cells. The present study demonstrates that during early phases, side-stream smoke exposure induced increases in the percentage of neurotrophin receptor p75-positive white blood cells, in their mean fluorescent intensity, and in gene expression. In addition, we found a positive correlation between the urine cotinine level and the percentage of neurotrophin receptor-positive white blood cells. For the first time, the evidence that short-term exposure to side-stream smoke is able to increase neurotrophin receptor p75 expression confirms the very early involvement of this receptor, not only among active smokers but also among non-smokers exposed to SS. Furthermore, the correlation between cotinine levels in urine and the increase in neurotrophin receptor p75-positive white blood cells could represent a potential novel molecule to be investigated for the detection of SS exposure at early time points.

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“…Environmental tobacco smoke exposure (TSE) resulting from second-hand smoke (ie, inhalation of emitted smoke) and potentially from third-hand smoke (ie, the uptake of tobacco smoke residuals from polluted surfaces) is known to be a major burden on children's health. [1][2][3] Each year, second-hand smoke is responsible for an estimated 56 000 deaths globally in children younger than 10 years 1 and for 35 633 disability-adjusted life-years among children in the EU. 2 TSE has been linked to various adverse respiratory health outcomes in children, including respiratory tract infec tions, wheezing, and asthma.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Each year, second-hand smoke is responsible for an estimated 56 000 deaths globally in children younger than 10 years 1 and for 35 633 disability-adjusted life-years among children in the EU. 2 TSE has been linked to various adverse respiratory health outcomes in children, including respiratory tract infec tions, wheezing, and asthma. 4,5 Governmental action to protect children from these deleterious effects of TSE is urgently needed, given that children are not able to control their degree of exposure.…”

Section: Introductionmentioning

confidence: 99%

Effect of smoke-free policies in outdoor areas and private places on children's tobacco smoke exposure and respiratory health: a systematic review and meta-analysis

Radó

Mölenberg

Westenberg

et al. 2021

The Lancet Public Health

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Background Smoke-free policies in outdoor areas and semi-private and private places (eg, cars) might reduce the health harms caused by tobacco smoke exposure (TSE). We aimed to investigate the effect of smoke-free policies covering outdoor areas or semi-private and private places on TSE and respiratory health in children, to inform policy. MethodsIn this systematic review and meta-analysis, we searched 13 electronic databases from date of inception to Jan 29, 2021, for published studies that assessed the effects of smoke-free policies in outdoor areas or semi-private or private places on TSE, respiratory health outcomes, or both, in children. Non-randomised and randomised trials, interrupted time series, and controlled before-after studies, without restrictions to the observational period, publication date, or language, were eligible for the main analysis. Two reviewers independently extracted data, including adjusted test statistics from each study using a prespecified form, and assessed risk of bias for effect estimates from each study using the Risk of Bias in Non-Randomised Studies of Interventions tool. Primary outcomes were TSE in places covered by the policy, unplanned hospital attendance for wheezing or asthma, and unplanned hospital attendance for respiratory tract infections, in children younger than 17 years. Random-effects meta-analyses were done when at least two studies evaluated policies that regulated smoking in similar places and reported on the same outcome. This study is registered with PROSPERO, CRD42020190563. FindingsWe identified 5745 records and assessed 204 full-text articles for eligibility, of which 11 studies met the inclusion criteria and were included in the qualitative synthesis. Of these studies, seven fit prespecified robustness criteria as recommended by the Cochrane Effective Practice and Organization of Care group, assessing smoke-free cars (n=5), schools (n=1), and a comprehensive policy covering multiple areas (n=1). Risk of bias was low in three studies, moderate in three, and critical in one. In the meta-analysis of ten effect estimates from four studies, smoke-free car policies were associated with an immediate TSE reduction in cars (risk ratio 0•69, 95% CI 0•55-0•87; 161 466 participants); heterogeneity was substantial (I² 80•7%; p<0•0001). One additional study reported a gradual TSE decrease in cars annually. Individual studies found TSE reductions on school grounds, following a smoke-free school policy, and in hospital attendances for respiratory tract infection, following a comprehensive smoke-free policy. Interpretation Smoke-free car policies are associated with reductions in reported child TSE in cars, which could translate into respiratory health benefits. Few additional studies assessed the effect of policies regulating smoking in outdoor areas and semi-private and private places on children's TSE or health outcomes. On the basis of these findings, governments should consider including private cars in comprehensive smoke-free policies to protect child health.

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Burden of disease from exposure to secondhand smoke in children in Europe

Cited by 13 publications

References 39 publications

European progress in working towards a tobacco-free generation

European progress in working towards a tobacco-free generation

Short-Term Effects of Side-Stream Smoke on Nerve Growth Factor and Its Receptors TrKA and p75NTR in a Group of Non-Smokers

Effect of smoke-free policies in outdoor areas and private places on children's tobacco smoke exposure and respiratory health: a systematic review and meta-analysis

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