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1.
Am J Perinatol ; 2020 Aug 30.
Artigo em Inglês | MEDLINE | ID: mdl-32862421

RESUMO

OBJECTIVE: Nicotine is an established neuroteratogen, and prenatal tobacco exposure alters the structure of the developing nervous system. An association between prenatal tobacco exposure and impaired neurologic function is less well established. We examine the association between prenatal tobacco exposure and childhood neurodevelopment among infants born preterm. STUDY DESIGN: Secondary analysis of a multicenter randomized controlled trial assessing the benefits of magnesium sulfate for the prevention of cerebral palsy in preterm infants. Women were included if they delivered a singleton and nonanomalous infant before 37 weeks. Exposure was any self-reported prenatal tobacco use. Primary outcome was the original trial composite outcome of moderate or severe cerebral palsy at 2 years of age, or stillbirth, or infant death by 1 year of age. Secondary outcomes included components of the composite and mild cerebral palsy at 2 years, Bayley Scales of Infant Development II motor and mental scores, death before two years, and use of auditory aids or corrective lenses. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) with 95% confidence intervals. RESULTS: Of 1,826 women included, 503 (27.5%) used tobacco. Tobacco users were more likely to be older, unmarried, and white; have a prior preterm birth; have received no prenatal care; and to use illicit drugs or alcohol. Gestational age at delivery, betamethasone exposure, and magnesium exposure were not different between groups. There were no differences in the composite primary outcome or in rates of cerebral palsy by tobacco use. Moderate developmental delay was more common among tobacco exposed in bivariate but not adjusted analysis (20.5 vs. 15.9%, p = 0.035). In adjusted analysis, tobacco exposure was associated with increased use of corrective lenses (5.0 vs. 2.9%, aOR: 2.28, 95% confidence interval: 1.28-4.07). CONCLUSION: Prenatal tobacco exposure is not associated with neurodevelopmental impairment in infants born preterm. However, tobacco exposure may be associated with impaired vision. KEY POINTS: · Tobacco exposure is not associated with impaired neurodevelopment in this preterm population.. · Prenatal tobacco exposure is associated with increased need for corrective lenses.. · Tobacco use in pregnancy may be a risk factor for poorer visual acuity in children..

2.
Gynecol Obstet Fertil Senol ; 48(7-8): 567-577, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32247092

RESUMO

INTRODUCTION: Smoking during pregnancy leads to fetal passive smoking. It is associated with several obstetrical complications and is a major modifiable factor of maternal and fetal morbidity. Long-term consequences also exist but are less well known to health professionals and in the general population. METHODS: Consultation of the Medline® database. RESULTS: Maternal smoking during pregnancy is associated in the offspring with sudden infant death syndrome (NP2), impaired lung function (NP2), lower respiratory infections and asthma (NP2), overweight and obesity (NP2), cancers (NP3), risk of tobacco use, nicotine dependence and early smoking initiation (NP2). Unadjusted analyses show associations between in utero tobacco exposure and cognitive deficits (NP3), impaired school performance (NP3) and behavioral disorders in children (NP2), which are in a large part explained by environmental factors. There is a cross-generational effect of smoking during pregnancy. For example, an increased risk of asthma is observed in the grandchildren of smoking women (NP4). The respective roles of ante- and post-natal smoking remain difficult to assess. CONCLUSION: These results highlight the importance of prevention measures against tobacco use in the general population, as well as screening measures and support for smoking cessation before or at the beginning of the pregnancy.

3.
JAMA Netw Open ; 3(3): e201195, 2020 03 02.
Artigo em Inglês | MEDLINE | ID: mdl-32186745

RESUMO

Importance: The number of children with prenatal opioid exposure to medication for addiction treatment (MAT) with methadone and buprenorphine for maternal opioid use disorder is increasing, but the associations of this exposure with cognitive outcomes are not well understood. Objective: To examine the strength and consistency of findings in the medical literature regarding the association of prenatal exposure to MAT with early childhood cognitive development, particularly when accounting for variables outside MAT exposure. Data Sources: A search strategy obtained publications from PubMed, CINAHL, PsycINFO, Web of Science, and Embase from January 1972 to June 2019. Reference lists from identified articles were searched. Study Selection: Inclusion criteria were cohort studies, studies including children aged 1 to 60 months with at least 2 months of prenatal MAT exposure, studies using standardized direct-observation testing scales, and studies reporting means and SDs. Case reports, case series, historical controls, and reviews were excluded. Data Extraction and Synthesis: Two authors independently selected studies for inclusion, extracted data, and assessed study quality. Data extracted included demographic characteristics, covariates, sources of bias, and effect estimates. Meta-analysis was performed using random-effects models. This study was conducted according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. Data extraction and synthesis were conducted between January 2018 and August 2019. Main Outcomes and Measures: Cognitive test scores and demographic variability between exposed and unexposed groups. Results: A total of 16 unique cohorts, described in 27 articles and including 1086 children (485 [44.7%] with MAT exposure), were included in a quantitative synthesis. On meta-analysis, MAT exposure was associated with lower cognitive development scores (pooled standardized mean difference, -0.57; 95% CI, -0.93 to -0.21; I2 = 81%). Multiple subanalyses on demographic characteristics (ie, maternal education, race/ethnicity, socioeconomic status, prenatal tobacco exposure, infant sex) were conducted. In the subanalysis of studies with comparable prenatal exposure to tobacco smoke, the association of MAT exposure with cognitive scores was no longer statistically significant and became homogeneous (standardized mean difference, -0.11; 95% CI, -0.42 to 0.20; I2 = 0%). Conclusions and Relevance: In this study, predefined subanalyses demonstrated how poor recruitment, particularly imbalances in maternal tobacco use, could contribute to a negative overall association of cognitive development test scores with prenatal MAT exposure. Promoting tobacco cessation for pregnant women with opioid use disorder should be prioritized in this high-risk population.


Assuntos
Analgésicos Opioides/efeitos adversos , Disfunção Cognitiva/induzido quimicamente , Exposição Materna/efeitos adversos , Tratamento de Substituição de Opiáceos/efeitos adversos , Efeitos Tardios da Exposição Pré-Natal/psicologia , Buprenorfina/efeitos adversos , Desenvolvimento Infantil/efeitos dos fármacos , Pré-Escolar , Cognição/efeitos dos fármacos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Metadona/efeitos adversos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Gravidez , Complicações na Gravidez/tratamento farmacológico , Fatores de Risco
4.
Artigo em Inglês | MEDLINE | ID: mdl-32204415

RESUMO

The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother's and child's health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.

5.
J Pediatr ; 218: 35-41.e1, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31870605

RESUMO

OBJECTIVE: To evaluate a hospital-initiated intervention to reduce tobacco smoke exposure in infants in the neonatal intensive care unit. STUDY DESIGN: A randomized, controlled trial compared motivational interviewing plus financial incentives with conventional care on infant urine cotinine at 1 and 4 months' follow-up. Mothers of infants in the neonatal intensive care unit (N = 360) who reported a smoker living in the home were enrolled. Motivational interviewing sessions were delivered in both the hospital and the home. Financial incentives followed session attendance and negative infant cotinine tests postdischarge. RESULTS: The intervention effect on infant cotinine was not significant, except among mothers who reported high baseline readiness/ability to protect their infant (P ≤ .01) and mothers who completed the study within 6 months postdischarge (per protocol; P ≤ .05). Fewer mothers in the motivational interviewing plus financial incentives condition were smoking postdischarge (P ≤ .01). More mothers in the motivational interviewing plus financial incentives group reported a total home and car smoking ban at follow-up (P ≤ .05). CONCLUSIONS: Motivational interviewing combined with financial incentives reduced infant tobacco smoke exposure in a subset of women who were ready/able to protect their infant. The intervention also resulted in less maternal smoking postpartum. More robust interventions that include maternal and partner/household smoking cessation are likely needed to reduce the costly effects of tobacco smoke exposure on children and their families. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01726062.


Assuntos
Assistência ao Convalescente/métodos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Entrevista Motivacional/métodos , Abandono do Hábito de Fumar/métodos , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos
6.
Asian Pac J Cancer Prev ; 20(12): 3533-3537, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31870091

RESUMO

BACKGROUND: There is no safe level of exposure to second hand tobacco smoke (SHS). The World Health Organization has stressed that 100% smoke-free environments are the only effective way to protect the population from the harmful effects of exposure to SHS. DESIGN: A multiphase study with a descriptive cross-sectional questionnaire phase 1  and a phase 2 cluster randomized controlled trial (RCT), conceptualized to determine the effectiveness of a school-based 'tobacco free' health education intervention on adolescents' knowledge and attitude towards SHS. METHODS: Baseline assessment will include a questionnaire followed by estimation of salivary cotinine levels. The experimental arm will receive the 'tobacco free' intervention, which includes 40 min health education session delivered once a week for 3 consecutive weeks. Participants will also be given 'take home brochures' every week containing messages on the effects of tobacco and how to make their homes smoke-free. The sample of 250 participants, for the Phase 2 RCT, with salivary cotinine levels of > 0.1 ng/mL will be selected from the participants of the Phase 1 study. The effect of the intervention will be quantitatively assessed by estimating the salivary cotinine levels after the intervention. Participants in the control arm will receive conventional standard health education once. CONCLUSION: This research will help in assessing if there is any change in the salivary cotinine levels and the knowledge, attitude and behaviour scores after the health educational intervention and help in developing an effective school-based 'tobacco free' intervention program which could be incorporated into the school curriculum. This study has received the Public Health Research Initiative (PHRI) Research Grant of Rs. 18,99,205 and is registered with the Clinical Trial Registry of India (CTRI) with number CTRI/2018/09/015706 (Registered on 13/09/2018). Ethical approval has been obtained from The Institutional Ethics Committee (No.17021 dated 13 march 2017).


Assuntos
Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Serviços Preventivos de Saúde/métodos , Prevenção do Hábito de Fumar/métodos , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Criança , Cotinina/análise , Estudos Transversais , Exposição Ambiental , Feminino , Humanos , Índia , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Saliva/química , Instituições Acadêmicas , Inquéritos e Questionários , Tabaco/efeitos adversos
7.
JMIR Res Protoc ; 8(10): e12654, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31588910

RESUMO

BACKGROUND: Exposure to secondhand smoke (SHS) early in life increases the risk of sudden infant death syndrome (SIDS), asthma, and respiratory illnesses. Since children's primary exposure to SHS occurs in the home, these most vulnerable members of our society are not fully protected by recent increases in the adoption of smoking bans in public spaces. Although exposure to SHS is a quickly reversible cause of excess morbidity, few low-income homes strictly enforce smoking restrictions. OBJECTIVE: This study aims to test a novel approach to motivate the adoption of home smoking restrictions and to eliminate child SHS exposure by providing parents with objective data documenting home SHS exposure and "biomarker feedback" of child ingestion of tobacco toxins, that is, objective, laboratory-based results of assays performed on child urine, documenting levels of nicotine; cotinine; and NNAL (4-[methylnitrosamino]-1-[3-pyridyl]-1-butanol), which is a metabolite of the known tobacco carcinogen NNK (4-[methylnitro-samino]-1-[3-pyridyl]-1-butanone). METHODS: From 2011 to 2013, 195 low-income, female smokers with children aged ≤10 years residing in their homes were recruited into a two-arm randomized clinical trial. Participants were assigned to one of two groups: biomarker feedback (n=98) and health education (n=97). In-home assessments were administered at baseline, week 16, and week 26. Children's home SHS exposure and nicotine, cotinine, and NNAL levels from urine samples, measured through a passive nicotine dosimeter and a surface sample of residual tobacco smoke (ie, thirdhand smoke), were collected at all three time points. Primary outcome was dosimeter-verified, self-reported complete home smoking restrictions at 6 months after randomization. Secondary outcomes included parental self-report of smoking behavior change and child urine tobacco toxin (biomarker) change. RESULTS: Data collection and analyses are complete, and the results are being interpreted. CONCLUSIONS: The study protocol describes the development of a novel community-based controlled trial designed to examine the efficacy of biomarker feedback documenting home and child exposure to SHS on parental smoking behavior change. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/12654.

8.
Nicotine Tob Res ; 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31536116

RESUMO

INTRODUCTION: Compared to the general smoking population, low-income smokers face elevated challenges to success in evidence-based smoking cessation treatment. Moreover, their children bear increased disease burden. Understanding behavioral mechanisms related to successful reduction of child tobacco smoke exposure (TSE) could inform future smoking interventions in vulnerable, underserved populations. METHODS: Smoking parents were recruited from pediatric clinics in low-income communities and randomized into a multilevel intervention including a pediatric clinic intervention framed in best clinical practice guidelines ("Ask, Advise, Refer [AAR]) plus individualized telephone counseling (AAR+counseling), or AAR+control. Mediation analysis included treatment condition (independent variable), 12-month child cotinine (TSE biomarker, criterion), and four mediators: 3-month end-of-treatment self-efficacy to protect children from TSE and smoking urge coping skills, and 12-month perceived program (intra-treatment) support and bioverified smoking abstinence. Analyses controlled for baseline nicotine dependence, depressive symptoms, child age, and presence of other residential smokers. RESULTS: Participants (n=327) included 83% women and 83% African Americans. Multilevel AAR+counseling was associated with significantly higher levels of all four mediators (p's<.05). Baseline nicotine dependence (p<.05), 3-month self-efficacy (p<.05) and 12-month bioverified smoking abstinence (p<.001) related significantly to 12-month child cotinine outcome. The indirect effects of AAR+counseling intervention on cotinine via self-efficacy for child TSE protection and smoking abstinence (p's<.05) suggested mediation through these pathways. CONCLUSIONS: Compared to AAR+control, multilevel AAR+counseling improved all putative mediators. Findings suggest that fostering TSE protection self-efficacy during intervention and encouraging parental smoking abstinence may be key to promoting long-term child TSE-reduction in populations of smokers with elevated challenges to quitting smoking. IMPLICATIONS: Pediatric harm reduction interventions to protect children of smokers from tobacco smoke have emerged to address tobacco-related health disparities in underserved populations. Low-income smokers experience greater tobacco-related disease burden and more difficulty with smoking behavior change in standard evidence-based interventions than the general population of smokers. Therefore, improving knowledge about putative behavioral mechanisms of smoking behavior change that results in lower child exposure risk could inform future intervention improvements.

9.
Taiwan J Obstet Gynecol ; 58(4): 454-459, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31307732

RESUMO

The abnormal development of placental vascularization leads to placental insufficiency, which further reduces the nutrient and trace exchange between maternal circulation and fetal circulation. These changes cause maternal and fetal complications. The objective of our systematic review was to explore the effects of maternal smoking on placental vascularization. The eligibility criteria were: articles with experimental, quasi-experimental or observational design, performed on human subjects, that study the association, correlation or causation between maternal smoking and changes in placental vascular network. A total of 33 full-text papers were assessed for eligibility, resulting in 12 original articles that were included in the systematic review. Doppler studies confirm reductions in blood flow velocity waveforms and increase in RI in the uterine, umbilical and fetal middle cerebral arteries. These findings are confirmed by morphometric measurements of fetal capillaries in villi that were shown to be smaller in smoke exposure groups.


Assuntos
Descolamento Prematuro da Placenta/etiologia , Exposição Materna/efeitos adversos , Insuficiência Placentária/diagnóstico por imagem , Resultado da Gravidez , Nascimento Prematuro/etiologia , Fumar/efeitos adversos , Descolamento Prematuro da Placenta/fisiopatologia , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Placenta/irrigação sanguínea , Placenta/diagnóstico por imagem , Insuficiência Placentária/fisiopatologia , Gravidez , Nascimento Prematuro/fisiopatologia , Medição de Risco , Ultrassonografia Pré-Natal/métodos
10.
Medicine (Baltimore) ; 98(28): e16454, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305478

RESUMO

OBJECTIVE: Tobacco smoke contains carcinogens known to damage somatic and germ cells. In this study, we investigated the effect of tobacco smoking on the risk of childhood acute lymphoblastic leukemia (ALL) and myeloid leukemia (AML). METHODS: Information about tobacco smoking exposures of the mother before, during, and after pregnancy was collected via PubMed, Embase, and Web of Science databases through November 5, 2018. We performed to evaluate the association between smoking exposure and the risk of childhood ALL and AML. Study selection, data abstraction, and quality assessment were performed by 2 independent reviewers. Random effects models were used to obtain summary odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Nineteen case-control studies of childhood leukemia (age < 15 years) conducted in 9 countries from 1974 to 2018. Maternal smoking exposures did not a significant association with childhood ALL (OR = 1.004, 95% CI 0.953-1.058, P = .881) and AML (OR = 0.92, 95% CI 0.815-1.038, P = .177) during exposure time windows. However, there was an association with paternal smoking and ALL (OR = 1.15, 95% CI 1.038-1.275, P = .007). Paternal smoking in AML showed there was no association with smoking exposures and childhood AML (OR = 1.133, 95% CI 0.943-1.362, P = .181). Next, maternal daily cigarettes consumption showed no associations with ALL (OR = 1.08, 95% CI 1.000-1.168, P = .051) during pregnancy. No association with maternal daily smoking and AML (OR = 0.909, 95% CI 0.682-1.211, P = .514). Paternal daily cigarettes consumption was associated with increased risks of childhood ALL (OR = 1.200, 95% CI 1.112-1.302, P = .000). The higher consumption of paternal smoking (more than 10 per day) was significantly related to childhood ALL. Paternal daily smoking consumption also was related to AML (OR = 1.242, 95% CI 1.031-1.496, P = .022). CONCLUSION: Maternal smoking before, during, or after pregnancy was not associated with childhood ALL or AML. However, paternal smoking was related to a significantly elevated risk of childhood ALL during pregnancy, but not for AML. Maternal daily smoking consumption was not associated with ALL or AML during pregnancy. The higher consumption of paternal smoking were, the higher the risk of childhood ALL or AML.


Assuntos
Leucemia Mieloide Aguda/epidemiologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Criança , Feminino , Humanos , Fatores de Risco
11.
Artigo em Inglês | MEDLINE | ID: mdl-31010129

RESUMO

Secondhand smoke (SHS), a common environmental exposure factor, has become a serious public health problem. Metabolic syndrome is another worldwide clinical challenge. Our study tried to determine the age differences in the relationship between SHS and the risk of metabolic syndrome. Studies were searched in PubMed and Web of Science from 11 November to 30 November 2018. Eighteen studies were finally included based on inclusion and exclusion criteria. The relationship between SHS and the risk indicators of metabolic syndrome was analyzed. The weighted mean difference (WMD) of fasting plasma glucose (FPG), insulin, body mass index (BMI), and waist circumference (WC), and the standard mean difference (SMD) of total cholesterol, triglycerides, and low- and high-density lipoprotein-cholesterol (LDL-C, HDL-C) were calculated in a meta-analysis. SHS was positively associated with the level of insulin and WC. According to the subgroup analysis based on age difference, SHS was positively associated with FPG in the upper age group, and positively associated with LDL-C and negatively associated with HDL-C in the lower age group. BMI showed a more obvious positive correlation in the adults group than in the children and the teenagers group. In conclusion, the association of metabolic syndrome with SHS varies with age. When exposed to SHS, older people may be more susceptible to glucose metabolic disorder, but younger people may be more susceptible to lipid metabolic disorder.


Assuntos
Envelhecimento/metabolismo , Síndrome Metabólica/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Fatores Etários , Glicemia/análise , Índice de Massa Corporal , Criança , HDL-Colesterol/sangue , Humanos , Insulina/sangue , Resistência à Insulina , Metabolismo dos Lipídeos , Síndrome Metabólica/sangue , Síndrome Metabólica/etiologia , Obesidade/sangue , Obesidade Abdominal/etiologia , Fatores de Risco , Triglicerídeos/sangue , Circunferência da Cintura
12.
Toxics ; 7(1)2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30832205

RESUMO

Preterm birth is an obstetric condition associated with a high risk of infant mortality and morbidities in both the neonatal period and later in life, which has also a significant public health impact because it carries an important societal economic burden. As in many cases the etiology is unknown, it is important to identify environmental factors that may be involved in the occurrence of this condition. In this review, we report all the studies published in PubMed and Scopus databases from January 1992 to January 2019, accessible as full-text articles, written in English, including clinical studies, original studies, and reviews. We excluded articles not written in English, duplicates, considering inappropriate populations and/or exposures or irrelevant outcomes and patients with known risk factors for preterm birth (PTB). The aim of this article is to identify and summarize the studies that examine environmental toxicants exposure associated with preterm birth. This knowledge will strengthen the possibility to develop strategies to reduce the exposure to these toxicants and apply clinical measures for preterm birth prevention.

13.
Int J Cancer ; 145(11): 2907-2916, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-30697705

RESUMO

Neuroblastoma (NB) is the most common extra-cranial tumour in children. Little is known about the aetiology of NB. The early age at onset and the embryonic nature suggest a role for perinatal exposures. We conducted a pooled analysis of two French national population-based case-control studies to explore whether there was an association between parental smoking and alcohol consumption and the risk of NB. The mothers of 357 NB cases and 1,783 controls from general population, frequency matched by age and sex, were interviewed on demographic, socioeconomic and perinatal characteristics, maternal reproductive story, and life-style and childhood environment. Unconditional logistic regression was used to estimate pooled odds ratios and 95% confidence intervals. A meta-analysis of our findings with those of previous studies was also conducted. Maternal smoking during pregnancy was slightly more often reported for the cases (24.1%) than for the controls (19.7%) (OR 1.3 [95% CI 0.9-1.7]; summary OR from meta-analysis 1.1 [95% CI 1.0-1.3]. Paternal smoking in the year before child's birth were not associated with NB as independent exposure (OR 1.1 [95% CI 0.9-1.4] but the association was stronger when both parents reported having smoked during pregnancy (OR 1.5 [95% CI 1.1-2.1]. No association was observed with maternal alcohol intake during pregnancy (OR 1.0 [95% CI 0.8-1.4], summary OR from meta-analysis 1.0 [95% CI 0.9-1.2]. Our findings provide some evidence of an association between maternal smoking during pregnancy and NB and add another reason to recommend that women refrain from smoking during pregnancy.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Neuroblastoma/epidemiologia , Fumar Tabaco/epidemiologia , Consumo de Bebidas Alcoólicas/efeitos adversos , Estudos de Casos e Controles , Pré-Escolar , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Exposição Materna/efeitos adversos , Razão de Chances , Exposição Paterna/efeitos adversos , Gravidez , Sistema de Registros , Fumar Tabaco/efeitos adversos
14.
Artigo em Inglês | MEDLINE | ID: mdl-30609776

RESUMO

There are health consequences to exposure to secondhand smoke (SHS). About two-thirds of children in China live with at least one person, usually a parent, who smokes at home. However, none of the reviews of interventions for reducing SHS have targeted children in China. The purpose of this study was to review the effectiveness of interventions for reducing parental SHS exposure at home among children in China. We searched various electronic databases for English and Chinese publications appearing between 1997 and 2017. Thirteen relevant studies were identified. Common strategies used in intervention groups were non-pharmacological approaches such as counseling plus self-help materials, and attempting to persuade fathers to quit smoking. Family interactions and follow-up sessions providing counseling or using text messages could be helpful to successful quitting. Several encouraging results were observed, including lower cotinine levels in children (n = 2), reduced tobacco consumption (n = 5), and increased quit rates (n = 6) among parents. However, the positive effects were not sustained 3~6 months after the interventions. Self-reported quitting without bio-chemical validation was the most common outcome measure. A study design using biochemical validations, a longer follow-up period, and targeting all people living with children in the same household is recommended.


Assuntos
Exposição Ambiental/prevenção & controle , Poluição por Fumaça de Tabaco , Criança , China , Habitação , Humanos , Pais , Fumar Tabaco/prevenção & controle
15.
Chest ; 155(1): 94-102, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30616740

RESUMO

BACKGROUND: Glutathione S-transferase (GST) genes are involved in the management of oxidative stress in the lungs. We aimed to determine whether they modify the associations between early life smoke exposure and adverse lung health outcomes. METHODS: The Melbourne Atopy Cohort study (a high-risk birth cohort) enrolled 620 children and followed them prospectively from birth. We recorded perinatal tobacco smoke exposure, asthma, and lung function at 12 (59%) and 18 years (66%) and genotyped for GSTM1, GSTT1, and GSTP1 (69%). RESULTS: GST genotypes were found to interact with tobacco smoke exposure on lung function outcomes (P interaction ≤ .05). Only among children with GSTT1 null genotypes was exposure to mother's, father's, or parental tobacco smoke in early life associated with an increased risk of reductions in prebronchodilator (BD) FEV1 and FVC at both 12 and 18 years. These associations were not seen in children with GSTT1 present. Similarly, only among children with GSTM1 null genotypes was exposure to father's or parental smoking associated with reductions in pre- and post-BD FEV1 and FVC at 18 years. Only among children with Ile/Ile genotypes of GSTP1 was exposure to mother's smoking associated with increased risk of reduced FEV1 at 18 years, but this was not the case among children with Val/Val or Ile/Val genotypes. CONCLUSIONS: Our study provides evidence of interaction between early tobacco smoke exposure and GST genotypes on lung function. Carriers of GST null mutations and GSTP1 Ile/Ile alleles may be more susceptible when exposed to tobacco smoke in early life. These findings support stronger recommendations to protect all infants from tobacco smoke exposure. TRIAL REGISTRY: Australian and New Zealand Clinical Trials Registry; No.: ACTRN12609000734268; URL: http://www.anzctr.org.au/.


Assuntos
Asma/fisiopatologia , Previsões , Glutationa S-Transferase pi/genética , Glutationa Transferase/genética , Polimorfismo Genético , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Asma/genética , Asma/metabolismo , Criança , DNA/genética , Feminino , Seguimentos , Fluxo Expiratório Forçado/fisiologia , Predisposição Genética para Doença , Genótipo , Glutationa S-Transferase pi/metabolismo , Glutationa Transferase/metabolismo , Humanos , Pulmão/fisiopatologia , Masculino , Estudos Retrospectivos , Fatores de Risco
16.
Nicotine Tob Res ; 21(11): 1462-1472, 2019 10 26.
Artigo em Inglês | MEDLINE | ID: mdl-29986089

RESUMO

INTRODUCTION: A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children's secondhand smoke (SHS) exposure at home. METHODS: Five databases were electronically searched for articles on children's SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children's SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. RESULTS: Eight studies gave results on the impact of public smoking bans on social inequalities in children's SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. CONCLUSIONS: First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children's SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. IMPLICATIONS: There are substantial social inequalities in children's SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children's SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children's SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children's SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.


Assuntos
Bem-Estar da Criança , Política Antifumo , Marginalização Social , Poluição por Fumaça de Tabaco/prevenção & controle , Adolescente , Poluição do Ar em Ambientes Fechados/legislação & jurisprudência , Poluição do Ar em Ambientes Fechados/prevenção & controle , Criança , Pré-Escolar , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Masculino , Poluição por Fumaça de Tabaco/legislação & jurisprudência
17.
Nicotine Tob Res ; 21(4): 416-423, 2019 03 30.
Artigo em Inglês | MEDLINE | ID: mdl-29228385

RESUMO

INTRODUCTION: We report on second-hand smoke (SHS) exposure based on saliva cotinine levels among children in Bangladesh-a country with laws against smoking in public places. METHODS: A survey of primary school children from two areas of the Dhaka district was conducted in 2015. Participants completed a questionnaire and provided saliva samples for cotinine measurement to assess SHS exposure with a cut-off range of ≥0.1ng/mL. RESULTS: Four hundred and eighty-one children studying in year-5 were recruited from 12 primary schools. Of these, 479 saliva samples were found sufficient for cotinine testing, of which 95% (453/479) were positive for recent SHS exposure. Geometric mean cotinine was 0.36 (95% CI = 0.32 to 0.40); 43% (208/479) of children lived with at least one smoker in the household. Only 21% (100/479) reported complete smoking restrictions for residents and visitors; 87% (419/479) also reported being recently exposed to SHS in public spaces. Living with a smoker and number of tobacco selling shops in the neighborhood had positive associations with recent SHS exposure. CONCLUSIONS: Despite having a ban on smoking in public places, recent SHS exposure among children in Bangladesh remains very high. There is an urgent need to reduce exposure to SHS in Bangladeshi children. IMPLICATIONS: Children bear the biggest burden of disease due to SHS exposure than any other age group. However, children living in many high-income countries have had a sharp decline in their exposure to SHS in recent years. What remains unknown is if children living in low-income countries are still exposed to SHS. Our study suggests that despite having a ban on smoking in public places, most primary school children in Dhaka, Bangladesh are still likely to be exposed to SHS.


Assuntos
Cotinina/análise , Saliva/química , Instituições Acadêmicas , Inquéritos e Questionários , Poluição por Fumaça de Tabaco/análise , Fumar Tabaco/epidemiologia , Adulto , Bangladesh/epidemiologia , Criança , Estudos Transversais , Exposição Ambiental/análise , Exposição Ambiental/prevenção & controle , Feminino , Humanos , Renda/tendências , Masculino , Pobreza/tendências , Poluição por Fumaça de Tabaco/prevenção & controle , Fumar Tabaco/efeitos adversos
18.
Chest ; 155(1): 88-93, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30359612

RESUMO

BACKGROUND: Current research suggests an association between the use of electronic nicotine delivery systems (ENDS) and asthma symptoms in youth, but little is known about the association of secondhand ENDS aerosol exposure and asthma control. The present study examines the relationship of secondhand ENDS aerosol exposure and asthma exacerbations among youth with asthma. METHODS: Youth who participated in the 2016 Florida Youth Tobacco survey (aged 11-17 years) with a self-reported diagnosis of asthma (N = 11,830) reported asthma attacks in the past 12 months, demographic characteristics, cigarette use, cigar use, hookah use, ENDS use, past 30-day secondhand smoke exposure, and past 30-day secondhand ENDS aerosol exposure. Weighted multivariable logistic regression models were used to examine the association between secondhand ENDS aerosol exposure and past 12-month asthma attack status, adjusting for covariates. RESULTS: Overall, 21% of youth with asthma reported having an asthma attack in the past 12 months, and 33% reported secondhand ENDS aerosol exposure. Secondhand ENDS aerosol exposure was associated with higher odds of reporting an asthma attack in the past 12 months, adjusting for covariates (adjusted OR, 1.27; 95% CI, 1.11-1.47). CONCLUSIONS: Secondhand exposure to ENDS aerosols may be related to asthma symptoms in youth. Physicians may need to counsel youth with asthma regarding the potential risks of exposure. Future research is necessary to evaluate the longitudinal relationship between secondhand ENDS aerosol exposure and asthma control.


Assuntos
Aerossóis/efeitos adversos , Asma/epidemiologia , Sistemas Eletrônicos de Liberação de Nicotina , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Criança , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Morbidade/tendências , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
19.
BMC Public Health ; 18(1): 1252, 2018 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-30424742

RESUMO

BACKGROUND: Second-hand smoke (SHS) causes numerous health problems in children such as asthma, respiratory tract infections and sudden infant death syndrome. The home is the main source of exposure to SHS for children, particularly for young children. We estimated the cost-effectiveness of a complex intervention designed to reduce SHS exposure of children whose primary caregiver feels unable or unwilling to quit smoking. METHODS: A cost-effectiveness analysis was carried out alongside an open-label, parallel, randomised controlled trial in deprived communities in Nottingham, England. A complex intervention combining behavioural support, nicotine replacement therapy and personalised feedback on home air quality was compared with usual care. A total number of 205 households were recruited, where the main caregivers were aged 18 and over, with a child aged under five years living in their household reporting smoking inside their home. Analyses for this study were undertaken from the National Health Service/Personal Social Services perspective. All costs were estimated in UK pounds (£) at 2013/14 prices. The primary outcome was the incremental cost-effectiveness of change in air quality in the home, measured as average 16-24 h levels of particulate matter of < 2.5 µm diameter (PM2.5), between baseline and 12 weeks. Secondary outcomes included incremental cost per quitter, quit attempts and cigarette consumption in the home. A non-parametric bootstrap re-sampling technique was employed to explore uncertainty around the calculated incremental cost-effectiveness ratios. RESULTS: The complex intervention achieved reduced PM2.5 by 21.6 µg/m3 (95% CI: 5.4 to 37.9), with an incremental cost of £283 (95% CI: £254-£313), relative to usual care. The incremental cost-effectiveness ratio was £131 (bootstrapped 95% CI: £72-£467) per additional 10µg/m3 reduction in PM2.5, or £71 (bootstrapped 95% CI: -£57-£309) per additional quitter. CONCLUSIONS: This trial targeted a socio-economically disadvantaged population that has been neglected within the literature. The complex intervention was more costly but more effective in reducing PM2.5 compared with the usual care. It offers huge potential to reduce children's' tobacco-related harm by reducing exposure to SHS in the home. The intervention is considered cost-effective if the decision maker is willing to pay £131 per additional 10µg/m3 of PM2.5 reduction. TRIAL REGISTRATION: The Smoke Free Homes trial was registered with isrctn.com on 29 January 2013 with the identifier ISRCTN81701383 .


Assuntos
Poluição do Ar em Ambientes Fechados/prevenção & controle , Exposição Ambiental/prevenção & controle , Habitação , Abandono do Hábito de Fumar/economia , Poluição por Fumaça de Tabaco/prevenção & controle , Adulto , Pré-Escolar , Análise Custo-Benefício , Inglaterra , Feminino , Humanos , Lactente , Masculino
20.
Environ Int ; 121(Pt 1): 643-648, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30316179

RESUMO

BACKGROUND: Environmental tobacco smoke (ETS) exposure in infants and children causes more frequent and severe asthma attacks, respiratory infections, ear infections, and sudden infant death syndrome. The aim of this study was to measure ETS exposure in children in Israel (ages 4-11 years) using urinary cotinine measurements, in order to compare exposure levels to other international populations, and to assess predictors of ETS exposure in children in Israel. METHODS: A subset of children who participated in the National Health and Nutrition Survey (RAV- MABAT) in 2015-2016 were invited to participate in the Second Israel Biomonitoring Survey. We analyzed urinary cotinine and creatinine concentrations in 103 children. Parents of study participants were interviewed in person on children's exposure to ETS at home and in other environments and on sociodemographic variables. We calculated creatinine-adjusted and unadjusted urinary cotinine geometric means in children and analyzed associations in univariable and multivariable analyses, between sociodemographic variables and parental - reported exposure, and urinary cotinine concentrations. RESULTS: Based on urinary creatinine measurement, over 60% of children are exposed to ETS (compared to <40% based on parental report). Linear regression showed a positive association between urinary cotinine concentration and reported ETS exposure (p = 0.001). Mean cotinine concentration among children whose parents reported that they are exposed to ETS at home (5.1 µg/l) was significantly higher than the concentration among children whose parents reported they are not exposed to ETS at home (1.6 µg/l, p < 0.001). There was an inverse relationship between total family income and urinary cotinine concentration (p < 0.05). In a multivariable model adjusted for ethnicity and other factors, family income was a significant predictor of urinary cotinine level (p = 0.04, slope = -0.49). Geometric mean creatinine adjusted concentrations in children in the current study were higher than in children in Canada and selected European countries. CONCLUSIONS: We found evidence of widespread exposure to ETS in children in the study. There is an urgent need to protect children in Israel from exposure to ETS.


Assuntos
Exposição Ambiental , Poluição por Fumaça de Tabaco/análise , Asma/etiologia , Criança , Pré-Escolar , Cotinina/urina , Creatinina/urina , Monitoramento Ambiental , Feminino , Humanos , Renda , Israel , Modelos Lineares , Masculino , Inquéritos Nutricionais , Pais , Infecções Respiratórias/etiologia , Fatores Socioeconômicos , Inquéritos e Questionários
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