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Parental smoking and children’s respiratory health: independent effects of prenatal and postnatal exposure
  1. Sam Pattenden1,
  2. Temenuga Antova2,
  3. Manfred Neuberger3,
  4. Bojidar Nikiforov4,
  5. Manuela De Sario5,
  6. Leticia Grize6,
  7. Joachim Heinrich7,
  8. Frantiska Hruba8,
  9. Nicole Janssen9,
  10. Heike Luttmann-Gibson10,
  11. Larissa Privalova11,
  12. Peter Rudnai12,
  13. Anna Splichalova13,
  14. Renata Zlotkowska14,
  15. Tony Fletcher1
  1. 1London School of Hygiene & Tropical Medicine, London, UK
  2. 2National Centre of Public Health Protection, Bulgaria
  3. 3Institute of Environmental Health, Center of Public Health, Medical University of Vienna, Austria
  4. 4National Centre of Hygiene, Medical Ecology & Nutrition, Bulgaria
  5. 5Department of Epidemiology, Health Authority of Rome, Rome, Italy
  6. 6Institute of Social and Preventive Medicine of the University of Basel, Basel, Switzerland
  7. 7Institute of Epidemiology, National Research Centre for Environment and Health, Neuherberg, Germany
  8. 8Department of Health Informatics and Statistics, Institute of Public Health, Banska Bystrica, Slovakia
  9. 9Institute for Risk Assessment Sciences, Utrecht University, Netherlands
  10. 10Harvard School of Public Health, Boston, Massachusetts USA
  11. 11Urals Regional Center for Environmental Epidemiology, Russia
  12. 12National Institute of Environmental Health, National Public Health Centre, Budapest, Hungary
  13. 13Centre of Occupational Medicine, Institute of Public Health Ostrava, Czech Republic
  14. 14Department of Epidemiology, Institute of Occupational Medicine & Environmental Health, Sosnowiec, Poland
  1. Correspondence to:
 Professor Manfred Neuberger
 Institute of Environmental Health, Kinderspitalgasse 15, A-1095 Wien, Austria; manfred.neuberger{at}


Objectives: Adverse effects have been reported of prenatal and/or postnatal passive exposure to smoking on children’s health. Uncertainties remain about the relative importance of smoking at different periods in the child’s life. We investigate this in a pooled analysis, on 53 879 children from 12 cross-sectional studies—components of the PATY study (Pollution And The Young).

Methods: Effects were estimated, within each study, of three exposures: mother smoked during pregnancy, parental smoking in the first two years, current parental smoking. Outcomes were: wheeze, asthma, “woken by wheeze”, bronchitis, nocturnal cough, morning cough, “sensitivity to inhaled allergens” and hay fever. Logistic regressions were used, controlling for individual risk factors and study area. Heterogeneity between study-specific results, and mean effects (allowing for heterogeneity) were estimated using meta-analytical tools.

Results: There was strong evidence linking parental smoking to wheeze, asthma, bronchitis and nocturnal cough, with mean odds ratios all around 1.15, with independent effects of prenatal and postnatal exposures for most associations.

Conclusions: Adverse effects of both pre- and postnatal parental smoking on children’s respiratory health were confirmed. Asthma was most strongly associated with maternal smoking during pregnancy, but postnatal exposure showed independent associations with a range of other respiratory symptoms. All tobacco smoke exposure has serious consequences for children’s respiratory health and needs to be reduced urgently.

  • tobacco smoke
  • fetus
  • child
  • respiratory symptoms
  • asthma

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  • Funding: The PATY study was funded by the EU 5th Framework Quality of Life Program (proposal no. QLRT-2001-02544). Details of funding of component studies were given with their publications.

  • There are no competing interests of the authors, as defined in BMJ1998;:–2.