Exposure to environmental tobacco smoke and respiratory tract infections in pre-school children – a cross-sectional study in Poland
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Department of Family Medicine and Community Nursing, Medical University, Bialystok, Poland
Department of Family Medicine, Medical University, Wroclaw, Poland
Family Medicine Department, Medical University, Warsaw, Poland
Department of Clinical Toxicology and Environmental Disease, Jagiellonian University Collegium Medicum, Cracow, Poland
Department of Pediatric Infectious Diseases, Medical University, Bialystok, Poland
Corresponding author
Dorota Bielska   

Department of Family Medicine and Community Nursing, Medical University, Bialystok, Poland
Ann Agric Environ Med. 2015;22(3):524-529
Knowledge of the harmful influence of environmental tobacco smoke (ETS) has a positive impact on changing social behaviours worldwide. In many homes smoking is totally prohibited; in some others, partial limitations of tobacco consumption have been introduced.

To study the correlation between the adopted rules of tobacco use in homes of 3-year-olds, and the kind and frequency of acute respiratory system infections within a 6-month period of attending pre-schools.

Material and Methods:
The study was performed among children attending municipal pre-schools in Białystok, Poland. The data was collected by anonymous questionnaires completed by the parents of 302 children aged 3 years chosen randomly from 1,200 children attending 51 pre-schools. The exposure of children to tobacco smoke was measured by determining cotinine to creatinine ratio (CCR) in urine.

In the 150 families of children who were surveyed, 210 were smokers. Every day, the smokers consisted of fathers (37.3%) and mothers (23.6%). The 3-year-old children were divided into 3 groups according to smoking habits in their homes: 28.5% of the children under examination came from homes where tobacco smoking was forbidden (mean CCR – 15.21ng/mg, SD=11.86), 26.2% came from homes where tobacco was smoked in separate rooms (mean CCR – 65.75 ng/ml, SD=81.51), 45.4% lived in homes where no rules connected with smoking had been established (mean CCR – 61.75 ng/ml, SD= 70.29). During the analyzed period of 6 months, 85% of the children had at least 1 respiratory tract infection (60% – upper, 16.9% – lower, 16.5% – upper and lower, 7.1% – otitis media).

The majority of the 3-year-old children who had lower respiratory tract infections required antibiotics and hospitalization. Living in a home where no tobacco rules were established may cause an increase of respiratory tract infections.

Ruskamp J, Smit H, Rovers M, Hoekstra M, Schilder A, Brunekreef B et al. Neonatal total IgE and respiratory tract infections in children with intrauterine smoke exposure. Arch Dis Child. 2010; 95(6): 427–431.
Jones LL, Hashim A, McKeever T, Cook DG, Britton J, Leonardi-Bee J. Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis. Respir Res. 2011; 10(12): 5.
Constant C, Sampaio I, Negreiro F, Aguiar P, Silva A, Salgueiro M, Bandeira T. Environmental tobacco smoke (ETS) exposure and respiratory morbidity in school age children.Rev Port Pneumol. 2011; 17(1): 20–26.
Wilson KM, Klein JD, Blumkin AK, Gottlieb M, Winickoff JP. Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics 2011; 127(1): 85–92.
Public Health Europe (access: 2012.10.04).
Bartkowiak Z. Harmfulness of second-hand smoke. Otolar Pol. 1995; 49(3): 272–275.
Borland R, Young HH, Cummings KM, Hyland A, Anderson S, Fong GT. Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006; 15(Suppl III): iii42–50.
8. portal miejski (access: 2013.12.17) (in Polish).
Główny Urząd Statystyczny, 2009.p.29 (access: 2013.11.28) (in Polish).
Główny Urząd Statystyczny, Bank Danych Lokalnych, 2013 (access: 2013.12.17) (in polish).
Wojewódzki Inspektorat Ochrony Środowiska w Białymstoku, 2013.p.19–20 (accessed: 2013.12.02) (in Polish).
Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidem Rev. 1996; 18: 188–204.
Jung JW, Ju YS, Kang HR. Association between parental smoking behavior and children’s respiratory morbidity: 5-year study in an urban city of South Korea. Pediatr Pulmonol. 2012; 47(4): 338–345.
Protano C, Vitali M. The new danger of thirdhand smoke: why passive smoking does not stop at secondhand smoke. Environ Health Perspect. 2011; 119(10): A422. doi:10.1289/ehp.11039563.
Jurado D, Munoz C, De Dios Luna J, Fernandez-Crehuet M. Environmental tobacco smoke exposure in children: parental perception of smokiness at home and other factors associated with urinary cotinine in preschool children. J Expo Anal Environ Epidemiol. 2004; 14: 330–336.doi:1038/sj. Jea.7500329.
Protano C, Andreoli R, Manini P, Guidotti M, Vitali M. A tobacco-related carcinogen: assessing the impact of smoking behaviours of cohabitans on benzene exposure in children. Tob Control. 2012; 21: 325–329.
Protano C, Andreoli R, Manini P, Matteo V. How home-smokong habits affect children: a cross-sectional study using urinary cotinine measurement in Italy. Int J Public Health. 2012; 57: 885–892. doi:10.1007/s00038–012–0354–0b.
Matt GE, Quintana PJ, Destaillats H, Gundel LA, Sleiman M, Singer BC et al. Thirdhand tobacco smoke: emerging evidence and arguments for a multidisciplinary research agenda. Environ Health Perspect. 2011; 119(9): 1218–1226.
Dove MS, Dockery DW, Connolly GN. Smoke-free air laws and secondhand smoke exposure among nonsmoking youth. Pediatrics. 2010; 126(1): 80–87.
Dempsey DA, Meyers MJ, Oh SS, Nguyen EA, Fuentes-Afflick E, Wu AH, et al. Determination of Tobacco Smoke Exposure by Plasma Cotinine Levels in Infants and Children Attending Urban Public Hospital Clinics. Arch Pediatr Adolesc Med. 2012; 166(9): 851–856. doi: 10.1001/archpediatrics.2012.170.
Sabanty W, Bróździk H. Selected health indicators and cotinine concentrations in urine of boys attending Łódź elementary schools exposed to the impact of tobacco smoke at home. Cotinine as an indicator of exposure to the impact of tobacco smoke (second-hand smoking). Prz Pediatr. 2005; 34(1): 55–57.
Cook DG, Strachan DP, Carey IM. Health effects of passive smoking. 9. Parental smoking and spirometric indices in children.Thorax. 1998; 53(10): 884–893.
Li JS, Peat JK, Xuan W, Berry G. Meta-analysis on the association between environmental tobacco smoke (ETS) exposure and the prevalence of lower respiratory tract infection in early childhood. Pediatr Pulmonol. 1999; 27(1): 5–13.
Złotowska R. Second-hand smoking and respiratory system diseases in young elementary schoolchildren. Med Środow. 2001; 4(2): 25–32.
Krzywiecka M, Obuchowicz A, Bukowska C, Wielkoszyński T, Swietochowska-Chechlińska A, Kula-Gradzik J. Evaluation of infants and younger children passive smoking at home and prevalence of their lower respiratory tract infectious. Przegl Lek. 2006; 63(10): 827–830.
Mania M, Przybysz A, Kurylak A. Passive smoking and frequency of occurrence of disease symptoms in the respiratory system in children aged 0–7. Przegl Lek. 2006; 63(10): 831–833.
Baker RJ, Hertz-Picciotto I, Dostál M, Keller JA, Nozicka J, Kotesovec F, et al. Coal home heating and environmental tobacco smoke in relation to lower respiratory illness in Czech children, from birth to 3 years of age. Environ Health Perspect. 2006; 114(7): 1126–1132.
Złotowska R, Pattenden S, Heinrich J, Nehring U, Holk G, Jansen N et al. Atopy, second-hand smoking and the condition of respiratory system in schoolchildren. Acta Pneumonol Allergol Pediatr. 2006; 9(1): 10–15.
Badeńska B, Czerwionka-Szaflarska M. Analysis of results of exposure to passive smoking in pre- and postnatal period in children – authors’ own observations. Prz Pediatr. 2001; 32: 3–5.
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