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Tobacco
Health Effects of Exposure to
Environmental Tobacco Smoke

TABLE 4.1
SUDDEN INFANT DEATH SYNDROME (SIDS)
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

 

Authors (year)

Study Size

Exposure Group Comparison

Comments

Location

 

Exposure Group1

Odds Ratio
(95% CI)

 
Bergman & Wiesner
(1976)
56 cases,
86 controls
•Any vs. no MS
during pregnancy
2.2 (1.0-4.5) Matched on sex, race. Poor study participation. Virtually all mothers who
United States

(King County,

  *Any vs. no MS after
pregnancy
2.4 (1.2-4.8) smoked in pregnancy also smoked afterwards.
Washington)   *Any vs. no PS 1.5 (0.7-3.2)  
McGlashan (1989)
Tasmania
167 cases,
334 controls
•Any vs. no MS
during pregnancy
1.9 (1.2-2.9) Matched on sex; no other adjustment. ORs were calculated from table; author
    *Any vs. no MS in
child's first year
1.9 (1.2-2.9) presented results of a matched analysis that were different. Virtually all mothers who
    *Any vs. no PS "significantly increased" smoked in pregnancy also smoked afterwards.
Mitchell et al. (1991)
New Zealand
128 cases,
503 controls (subset of
•Any vs. no MS during pregnancy (from medical records) 2.7 (crude) Controlled for many demographic and social factors, breastfeeding, season, and sleeping position. Strong dose-response
  Mitchell et al.
(1993))
*Any vs. no recent
MS (from interview)
3.0 (crude)
1.8 (1.0-3.3; adj)
noted in crude analysis. Virtually all mothers who smoked in pregnancy also smoked afterwards.
Nicholl & O'Cathain
(1992)

United Kingdom

242 cases,
251 controls
•Any vs. no MS
during pregnancy
2.1 (1.5-3.1)

Matched for date and place of birth. Controlled for spousal smoking only. Effect of PS increased as infants' ages increased.

  *Any vs. no PS
1.6 (1.1-2.4)  

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure.

 

TABLE 4.1 (continued)
SUDDEN INFANT DEATH SYNDROME (SIDS)
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

 

Authors (year)

Study Size

Exposure Group Comparison

Comments

   

Exposure Group1

Odds Ratio
(95% CI)

 
Schoendorf & Kiely
(1992)
United States
435 cases,
6,000 controls
•Any vs. no MS
during and after
pregnancy
White Black
3.1 3.1
(2.3-4.2) (2.2-4.3)
Restricted to infants with birth weights >2,500 g. Controlled for maternal age, education, and marital status. Smokers
(U.S. National Maternal and Infant   *Any vs. no MS after
pregnancy only
1.8 2.3
(1.0-3.0) (1.5-3.7)
in "during and after" category were heavier smokers than smokers in the
Health Survey)   *Other household
smokers (vs. no other
household smokers)
1.4 0.9
(1.0-1.9) (0.7-1.3)
"after only" category
Mitchell et al. (1993)
New Zealand
485 cases,
1,800 controls
*Any vs. no recent
MS
1.7 (1.2 -2.3) The first 3 ORs are adjusted for region season, breastfeeding, and bed sharing;
    *Any vs. no PS 1.4 (1.0-1.8) mother’s marital status, SES, age, and
    *Any vs. no other
household smokers
1.2 (0.8-1.6) smoking during pregnancy; infant’s age, sex, birthweight, race, and sleeping
    *MS cigs/day:
0

1-19

>20
No PS PS
1.0 1.0
(ref) (0.6-1.6)
2.6 4.4
(1.7-3.8) (3.3-6.0)
3.4 7.4
(2.0-5.8) (4.9-11.1)
position; and where appropriate, smoking by the mother, father and other household numbers.

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure.

 

 

TABLE 4.1 (continued)
SUDDEN INFANT DEATH SYNDROME (SIDS)
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

 

Authors (year)

Study Size

Exposure Group Comparison

Comments

   

Exposure Group 1,2

Odds Ratio (95% CI)
Unadjusted Adjusted

 
Klonoff-Cohen et al. 200 cases, *Any MS 3.1 (1.8, 5.6) 2.3 (1.0, 5.0) Adjusted ORs were controlled for birth
(1995) 200 controls *Any same-room MS 6.2 (2.6, 14.6) 4.6 (1.8, 11.8) weight, routine sleep position, medical
United States   *Any PS 3.5 (2.0, 6.3) 3.5 (2.0, 6.3) conditions at birth, prenatal care,
(Southern California)   *Any same-room PS 9.2 (3.7, 23.2) 8.5 (3.3, 21.6) breast feeding, and maternal smoking
    *Any household smoking 3.8 (2.3, 6.4) 3.5 (1.8, 6.8) during pregnancy.
    *Any same-room household smoking 6.2 (3.3, 11.7) 5.0 (2.4, 11.0)  
    Total number of
household smokers:
1
2
3

3.1 (1.8, 5.5)
5.2 (2.5, 10.7)
8.1 (1.5, 44.5
3.0 (1.5, 6.0)
5.3 (1.9, 14.5)
5.1 (0.7, 36.6)
 

  Total cig exposure/day
1 - 10
11 - 20
21

2.3 (1.1, 4.7)
3.5 (1.7, 7.1)
12.6 (4.3, 37.1)

2.4 (1.1,5.4)
3.6 (1.5, 8.8)
22.7 (4.8, 107.2)
 

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure.

2 All odds ratios are for postnatal exposure and are relative to infants with no smoke exposure.

 

 

TABLE 4.1 (continued)
SUDDEN INFANT DEATH SYNDROME (SIDS)
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

 

Authors (year)

Study Size

Exposure Group Comparison

Comments

   

Exposure Group1

Odds Ratio
(95% CI)

 
Blair et al. (1996)
United Kingdom
195 cases,
780 controls
*Any vs. no PS 2.5 (1.5-4.2) Matching by age and region. First OR is adjusted for maternal age, marital status, SES, maternal smoking, drug and alcohol use, gestational age, sleeping position, and breast feeding.
    * PS/no MS vs.
no PS or MS

3.4 (2.0-5.9)  
    * Household cigs/day:
0

1-19

20-39

40

1.0

2.5 (1.3-4.7)

4.0 (2.4-6.6)

7.6 (4.0-14.3)
 

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure.

 

 

TABLE 4.2
COGNITION IN CHILDREN
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

Authors (year)

Design (n)

Outcome

Tobacco Exposure Comparison1,2

Comments

Location

Ages at Follow-up

Assessment

Exposure Group

Results

 
Rantakallio (1983)
Finland
Prospective
(1763 prenatally exposed, 1781 controls)
School ability in theoretical subjects •MS during
pregnancy:
<10 cig/day vs. 0
>10 cig/day vs. 0
Change in score:

-1.8%
-2.5% ^^^
MS adjusted for sex, maternal age, parental height, SES and family size. PS also adjusted for prenatal exposure and maternal education.
  14 year olds   *Any vs. no PS Inverse association  
Bauman et al.
(1989)
United States (North Carolina)
Prospective
(973)
8th graders
California Achievement Test *Cig/day smoked
by family:
0
1-19
20-39
>40
Mean total score:

618.8
610.0
606.8
602.9 ^
Non-smoking children only (confirmed by breath CO). Adjusted for age, sex, parental education, some psych characteristics. No control for SES, prenatal exposure.
Bauman et al.
(1991)
California
Prospective
(1,500-2,800)
5,10,16 year olds
PPVT
RAVEN
*Any vs. no parental smoking at age:
5
10
16
Score difference:
PPVT RAVEN

-0.06 -0.14
-1.55^^^ -0.89^
-0.92
Up to 30% had missing values for parental smoking. Father's smoking interpolated at ages 5 and 16. Adjusted for age, sex, race, birth weight, SES, income, parental education, prenatal exposure, and (in 16-year-olds) active smoking. Dose-response seen with PPVT scores in 10-year-olds.

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure; bullet (•) denotes on-ETS exposure; PPVT - Peabody Picture Vocabulary Test; RAVEN - Raven Colored Progressive Matrices Test,; MDI - Mental Development Index of the Bayley Scales of Infant Development; GCI - General Cognitive Index of the McCarthy Scales of Children's Abilities; HOME - Home Observation for Measurement of the Environment.

2 ns = not significant (p>0.05), ^p<0.05, ^^p<0.01, ^^^p<0.001, n = study size.

 

TABLE 4.2 (continued)
COGNITION IN CHILDREN
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

Authors (year)

Design (n)

Outcome

Tobacco Exposure Comparison1,2

Comments

Location

Ages at Follow-up

Assessment

Exposure Group

Results

 
Baghurst et al.et al.
(1992)
Port Pirie, Australia
Prospective
(548)
2 and 4 year olds
Bayley
(at 2 years)
McCarthy
(at 4 years)
*Any vs. no maternal postnatal smoking Score difference:
Bayley MDI -0.55
McCarthy
GCI -0.45
verbal -0.17
perceptual -0.67
quantitative 0.21
Adjusted for SES, maternal IQ, and HOME score. No control for prenatal exposure. Adjustment caused score differences to drop 65-90% and lose statistical significance.
Eskenazi and Trupin (1995)

California

Prospective
(2,124)
Five year olds
PPVT

RAVEN

No smoke exposure Mean score:

PPVT RAVEN

50.7 10.7

Adusted for parents’ education, socioeconomic status, race, birth order, preschool attendance, and other factors.
      *Maternal ETS during pregnancy 51.9 10.8  
      MS during pregnancy only 52.5^ 11.3^  
      *MS after pregnancy only 49.9 10.4  
      *MS during and after pregnancy 50.8 10.6  
      *Current cig/day smoked by mother:

1 - 9

10 - 19

20

Score difference from children of non-smoking mothers

PPVT RAVEN

-1.5^ -0.5^

-1.3 -0.3

-1.3 -0.6^

Adjusted for above factors as well as prenatal exposure

 

TABLE 4.3
BEHAVIOR IN CHILDREN
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

Authors (year)
Location

Design (n)
Ages at Follow-up

Outcome Assessment

Tobacco Exposure
Comparison1

Results

Comments1

Denson et al. (1975)
Saskatchewan
Retrospective
(20 cases,
40 controls)
5-15 year olds
Hyperactivity •MS during pregnancy
*PS during pregnancy
*Current MS
*Current PS
Parents of cases smoked more cig/day than parents of controls. p<0.05 only for MS. Matched by age,sex, and minimally by SES, no other adjustment for potential confounders. ORs could not be calculated from data presented.
Weitzman et al.et al. (1992)
US National Longitudinal
Prospective
(2,256)
4-11 year olds
Behavior Problem Index >14 (rating by mother) MS in cig/day:
•Pregnancy only:
<20 vs. 0
>20 vs. 0
OR (95% CI):

1.6 (1.0-2.5)
0.4 (0.1-1.6)
Only 19 women in high-dose pregnancy only category thus estimate unstable.
Survey of Youth     *Post-preg only:
<20 vs. 0
>20 vs. 0
1.2 (0.9-1.7)
2.0 (1.3-3.1)
Adjusted for age, sex, race, birth weight, health, HOME,
      *Both:
<20 vs. 0
>20 vs. 0
1.4 (1.1-1.8)
1.5 (1.1-2.2)
income, and maternal education, intelligence, self-esteem, marital status, alcohol use in pregnancy, employment.

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure; HOME - Home Observation for Measurement of the Environment-Short Form, n - study size.

 

TABLE 4.3 (continued)
BEHAVIOR IN CHILDREN
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

Authors (year)
Location

Design (n)
Ages at Follow-up

Outcome Assessment

Tobacco Exposure
Comparison1

Results

Comments

Eskenazi and Trupin (1995)
California
Prospective
(2,124)
Five year olds
Rated "active" by mother •No smoke exposure OR (95% CI)

Unadjusted Adjusted

1.0 1.0

Adjusted for parents’ education, socioecon-
omic status, race, birth
      *Maternal ETS
during pregnancy
1.6 (0.7, 3.3) 1.5 (0.7, 3.1) order, preschool attendance, and other
      •MS during
pregnancy only
1.1 (0.6, 2.0) 1.0 (0.5, 1.9) factors.
      *MS after
pregnancy only
1.4 (0.8, 2.7) 1.2 (0.6, 2.2)  
      *MS during and
after pregnancy
1.6 (1.2, 2.1) 1.2 (0.9, 1.7)  
      *Current cig/day
smoked by mother:

1 - 9

10 - 19

20

OR (95% CI)

Unadjusted Adjusted

1.2 (0.7, 1.9) 1.0 (0.6, 1.7)

1.5 (0.9, 2.3) 1.1 (0.8, 2.0)

1.8 (1.2, 2.6) 1.6 (0.9, 2.8)

Adjusted for above factors as well as prenatal exposure

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure.

TABLE 4.4
HEIGHT GROWTH IN CHILDREN
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

Authors (year)
Location

Design (n)
Ages at Follow-up

Source/Amount of Tobacco Exposure1

Height Difference
in cm

Comments

Rona et al. (1981)
United Kingdom
Cross-section
(4,961)
5-11 year olds
*Number of people
smoking >5 cig/day at
home
Inverse association
(p<0.05)
Adjusted for age, sex, parental heights, # sibs, SES, birth weight. No control for prenatal exposure.
Rona et al. (1985)
United Kingdom
Cross-section
(5,903)
5-11 year olds
*Every 10 cig/day smoked
at home by parents
-0.2 (p<0.01) Adjusted for age, sex, location, parental heights, # sibs, prenatal exposure, birth weight.
Chinn & Rona (1991)
United Kingdom
Cross-section
(11,224)
5-11 year olds
*Total cig/day smoked at
home by parents
No significant association Adjusted for same covariates as above, plus SES, ethnicity, school meals.
Rantakallio (1983)
Finland
(1,763 prenatally exposed,
1,781 controls)
•MS during pregnancy:
<10 cig/day vs. 0
>10 cig/day vs. 0

-0.6
-0.9 (p<0.05)
MS adjusted for sex, maternal age, parental height, SES and family size. PS also adjusted for prenatal
  14 year olds *Any vs. no PS Inverse association (ns) exposure and maternal education.
Berkey et al.(1984);
Ferris et al. (1985)

United States

Longitudinal cohort
(9,273)
6-11 year olds
Current cig/day:
•MS <10 vs. 0
>10 vs. 0

-0.5
-0.7 (p<0.001)
Adjusted for age, sex, location, parental education, gas cooking. No control for parental height,
    •PS >10 vs. 0
>10 vs. 0
-0.04
-0.1 (ns)
prenatal exposure, birth weight.
      No association between MS or PS and rate of growth  

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure; n - study size.

 

TABLE 4.4 (continued)
HEIGHT GROWTH IN CHILDREN
STUDIES THAT ASSESSED SOME SOURCE OF POSTNATAL ETS EXPOSURE

Authors (year)
Location

Design (n)
Ages at Follow-up

Source/Amount of Tobacco Exposure1

Height Difference
in cm

Comments

Eskenazi and Trupin (1995)
California
Prospective
(2,622)
Five year olds
*Maternal ETS during
pregnancy
Model I Model II

0.5 (-0.5, 1.4) 0.4 (-0.5, 1.3)

Model I adjusted for race, sex, birth order, and maternal education, age,

height, and body mass

    •MS during pregnancy only -0.3 (-1.1, 0.5) -0.01 (-0.8, 0.8) index.
    *MS after pregnancy only 0.5 (-0.3, 1.3) 0.5 (-0.3, 1.3) Model II adjusted for the above factors and birth
    *MS during and after pregnancy -0.5 (-0.9, -0.1) -0.02 (-0.4, 0.4) weight and gestational age.

1 Abbreviations: MS - maternal smoking; PS - paternal smoking; asterisk (*) denotes proxy measurement for ETS exposure;
bullet (•) denotes non-ETS exposure; n - study size.

 

 

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