Health Impact Assessment of Environmental Tobacco Smoke in European Children: Sudden Infant Death Syndrome and Asthma Episodes

Abstract

This article by Boldo et al. demonstrates that in Europe, exposure to environmental tobacco smoke (ETS) caused an estimated 24% to 32% of sudden infant death syndrome (SIDS) cases and increased the number of asthma episodes by 7% to 11% in children younger than 14 years of age. The major source of exposure to ETS among children is smoking by parents and other household members. The European countries in this study included wealthy countries such as Austria, Denmark, Germany, and the United Kingdom as well as those with struggling economies such as Bulgaria, Croatia, Estonia, and Macedonia. This diversity of wealth across the 27 countries included in the study provided a range of exposures when correlated with the smoking rates. The levels of exposure to ETS for the children in the study ranged from one-fifth to one-half. Using the data from the 27 countries and applying the methods used by others to look at the association of ETS to both SIDS and asthma, the authors make a compelling case for recommending to governmental and ministerial officials that their countries follow the World Health Organization (WHO) recommendations to develop and implement enforceable smoke-free policies to avoid the ETS impact on children's health. Such a recommendation is logical, progressive, and highly protective of the most vulnerable members of the population. 1 This study also demonstrates the need for countries, as well as WHO and the European Union, to develop educational programs for parents and children to recognize the dangers of smoking, ETS, and other tobacco-related diseases.

Disease burdens from environmental tobacco smoke in Korean adults

“…We also could not estimate the disease burden in infants because we could not obtain data on the prevalence of exposure to maternal smoking in utero. Exposure to maternal smoking in utero is suspected to be associated with low birth weight, sudden infant death syndrome, asthma, and lower respiratory tract infections in children (Anderson & Cook 1997;Cook & Strachan 1997;Boldo et al 2010). In a previous study, the proportion of deaths in infants among all AD ets in white non-smokers was approximately 1.6 %, with a maternal smoking exposure prevalence rate in utero of 2.8 % in the United States in 2006 (Max et al 2012).…”

“…According to summary reports of several expert agency panels, including the US Surgeon General and the California Environmental Protection Agency, ETS has been proven to be associated with a higher risk of coronary heart disease, stroke, lung cancer, and respiratory diseases in adults (California Environmental Protection Agency: Air Resources Board 2005; General 2006). The US Surgeon General also suggested that exposure to ETS might be causally associated with various health effects in children, including low birth weight, sudden infant death syndrome, asthma, and lower respiratory tract infections (General 2006;Boldo et al 2010).…”

Increasing prevalence of smoke-free homes and decreasing rates of sudden infant death syndrome in the United States: an ecological association study

“…The sizeable lower 95% CI estimate underscores the significance of SHS exposure as an environmental risk factor for infant health. The assumed pooled OR used associating SHS in the home with SIDS (OR=3.15) is based on postnatal maternal smoking and has been validated as a proxy for all infant exposure to SHS 34. The RCP-UK meta-analysis, and resulting pooled OR, was inclusive of studies reviewed by the US Surgeon General in 2006 as well as 75 additional studies including studies from the USA; as such, it was appropriate to apply this OR to US SIDS data.…”

Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke

“…[6][7][8][9][10][11][12][13][14][15] In utero tobacco exposure increases risk of adverse fetal outcomes and can have long-lasting adverse health effects for the child. [16][17][18][19][20][21][22][23][24][25][26][27][28] Although sorting out in utero from postnatal effects is challenging, emerging data points to secondhand tobacco smoke exposure as an independent risk factor for neurobehavioral disorders (including attention-deficit/hyperactivity disorder, learning disabilities, and conduct disorders), [29][30][31] decreased glomerular filtration rate in adolescents, 32 and preclinical atherosclerosis in adolescents.…”