Maternal and paternal indoor or outdoor smoking and the risk of asthma in their children: A nationwide prospective birth cohort study☆
Introduction
Children are likely to be exposed to second hand tobacco smoke (SHS) at home (U.S. Department of Health and Human Services [USDHHS], 2006). A study in Japan has shown that 64.8% of 6-month old children live with smoking parent(s), and of those, 57.9% of parents smoke indoors at home (Kaneita et al., 2006). Although many previous studies have revealed the risk of SHS for childhood asthma (Royal College of Physicians, 2010, U.S. Department of Health and Human Services, 2006), a recent review by Burke et al. (2012) showed several evidence gaps in this field of research. There has been no prospective study of the risk of paternal smoking for asthma in children aged 2 years or less and only one study for children aged 3–4 years. Further, a wide range of estimated effect size of postnatal maternal smoking on incidence of childhood asthma was observed, indicating a need to confirm the results. One objective of our study was to approach these gaps. A previous study by Kanoh et al. (2012), using data from the Longitudinal Survey of Newborns in the 21st Century, reported a positive hazard risk between parental smoking and childhood asthma incidence. However, they did not focus on the gaps (i.e., did not use corresponding age categories) and did not use severity of asthma as an outcome. Furthermore, although parents are encouraged to smoke outdoors or not to smoke (Committee on Substance Abuse, 2001), the difference in the contribution of these parental smoking behaviors to the risk reduction of asthma among their children has not been sufficiently evaluated (Blackburn et al., 2003, Blizzard et al., 2003, Leung et al., 2004). Thus, the main objective of this study was to assess whether and how parental smoking behaviors, combined with indoor smoking status at home, were associated with the development and severity of childhood asthma from very young ages to 8 years old, using data from a large nationally representative birth cohort study.
Section snippets
Study population
The data used for this study were taken from the Longitudinal Survey of Newborns in the 21st Century which was conducted by the Japanese Ministry of Health, Labour, and Welfare from 2001 to 2009 (Ministry of Health, Labour and Welfare, 2013). The study sample included all infants born in Japan during the periods January 10–17, 2001, and July 10–17, 2001 using the national birth record (n = 53,575). Questionnaires were mailed when the infants were 0.5 years of age. The total number of respondents
Results
The baseline characteristics of study subjects according to the parental smoking categories are shown in Table 2. All covariates except for child's sex show statistically significant differences; i.e., maternal smoking groups showed lower birthweight, less exclusive breastfeeding, younger parental age, and lower equivalent household income.
The prevalence of outcomes within defined time durations are shown in Table 3 (numbers in Supplementary Table 25
Discussion
Using Japanese nationally representative large cohort data, we found an elevated association with asthma among the children who were exposed to SHS from parental smoking. This is consistent with the findings of preceding studies in Japan and other areas (USDHHS, 2006). The primary new findings of the present study were, (i) compared to children whose parents do not smoke tobacco, children whose parents smoke indoors at home showed increased association with having asthma in terms of both
Role of funding source
This study was supported by the Ministry of Health, Labour and Welfare (Grant; Comprehensive Research on Life-Style Related Diseases including Cardiovascular Diseases and Diabetes Mellitus (H25-010)), and the Ministry of Education, Culture, Sports, Science and Technology (Grant; Scientific Research on Innovative Areas KAKENHI 21119003). The funding sources had no role in the design and conduct of the study; the analysis and interpretation of the data; or the preparation, review, or approval of
Contributors
All authors contributed to and have approved the final manuscript.
Conflict of interest statement
All authors declare that they have no conflicts of interest.
Acknowledgments
We thank Dr Takahiro Hoshino, Dr Yuri Ito and Dr Jun Ito for their assistance in database formation, statistical methods and valuable comments. We also thank Dr Julia Mortimer for her English language editing.
References (35)
- et al.
Early life risk factors for current wheeze, asthma, and bronchial hyperresponsiveness at 10 years of age
Chest
(2005) - et al.
Intervention and policy issues related to children's exposure to environmental tobacco smoke
Prev. Med.
(2001) - et al.
Attributable causes of cancer in Japan in 2005—systematic assessment to estimate current burden of cancer attributable to known preventable risk factors in Japan
Ann. Oncol.
(2012) - et al.
Assessment of smoking behaviors in the home and their influence on children's passive smoking: development of a questionnaire
Ann. Epidemiol.
(2005) - et al.
Epidemiological study on passive smoking among Japanese infants and smoking behavior of their respective parents: a nationwide cross-sectional survey
Prev. Med.
(2006) - et al.
Longitudinal study of parental smoking habits and development of asthma in early childhood
Prev. Med.
(2012) - et al.
Tobacco smoking and the risk of subsequent primary cancer among cancer survivors: a retrospective cohort study
Ann. Oncol.
(2013) - et al.
Healthy lifestyle and preventable death: findings from the Japan Collaborative Cohort (JACC) study
Prev. Med.
(2009) - et al.
In utero and postnatal maternal smoking and asthma in adolescence
Epidemiology
(2006) - et al.
Impact of environmental tobacco smoke and active tobacco smoking on the development and outcomes of asthma and rhinitis
Curr. Opin. Allergy Clin. Immunol.
(2009)
Effect of strategies to reduce exposure of infants to environmental tobacco smoke in the home: cross sectional survey
BMJ
Parental smoking and infant respiratory infection: how important is not smoking in the same room with the baby?
Am. J. Public Health
Using nicotine measurements and parental reports to assess indoor air: the PIAMA birth cohort study. Prevention and incidence of asthma and mite allergy
Epidemiology
Prenatal and passive smoke exposure and incidence of asthma and wheeze: systematic review and meta-analysis
Pediatrics
How to minimize children's environmental tobacco smoke exposure: an intervention in a clinical setting in high risk areas
BMC Pediatr.
Public Health Advocacy and Tobacco Control: Making Smoking History
Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma
Am. J. Respir. Crit. Care Med.
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2019, Social Science and MedicineCitation Excerpt :For maternal characteristics, data on age, education, smoking habit, current working hours per week, employment status at 1 year before childbirth, and feeding status were obtained from the survey. Smoking habit was considered as confounder because smoking habit may crowd out spending on child rearing, or second-hand smoking might result in extra health care costs for children (Tabuchi et al., 2015), and smoking is also associated with social capital in some social contexts (Albert-Lorincz et al., 2018). For family characteristics, data on having siblings, living with partner, living with maternal grandmother or siblings, primary caregiver during the daytime, paternal working hours per week, gross annual household income, and urban/rural difference, defined as the difference in population size of the residential region were also obtained from the survey.
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Supplementary material can be found by accessing the online version of this paper at http://dx.doi.org and by entering doi:10.1016/j.drugalcdep.2014.12.001.