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8/14/2019 Merokok Dan Kesehatan Anak

1/10

The prevalence and effects of environmental tobacco smoke exposureamong inner-city children: lessons for pediatric residents.

Kum-Nji P; Meloy LD; Keyser-Marcus LChildren's Hospital of Richmond, Virginia Commonwealth University School ofMedicine, Richmond, VA 23298, USA. [email protected]

PURPOSE: To determine the prevalence of environmental tobacco smoke (ETS)exposure, to explore the relationship between ETS exposure and the use ofhealth services, and to examine the degree to which pediatric residentsdocument ETS exposure status and counsel parents.

METHOD: In 2006, the authors recruited dyads of children (0-12 years old) andtheir mothers from an inner-city pediatric group practice clinic. Mothers

completed a survey, and the authors searched the children's medical charts. Theauthors compared ETS-exposed children with nonexposed children using chi-square, t test, and ANOVA analyses. They also ran logistic regression analyses toexamine the relationship between the use of health services and selected childand maternal variables.

RESULTS: More than 60% (142/232) of children were exposed to ETS, and morethan 69% (99/142) of those children had a mother who smoked. ETS exposuresignificantly predicted the overall number of sick visits, even after controlling forsociodemographic confounders (odds ratio = 7.44; 95% confidence internal =1.21-44.55). About 80% (187/232) of mothers reported that their child's

pediatrician had counseled them on the dangers of ETS exposure. Less than half(105/232) of the children's charts included their ETS exposure status.

CONCLUSIONS: Although pediatric residents often counsel parents on thedangers of ETS exposure, educators should teach residents to regard ETSexposure status as a fifth vital sign. By screening for and documenting ETSexposure status, residents can identify at-risk children and parents, who couldbenefit from counseling.

From MEDLINE/PubMed, a database of the U.S. National Library of Medicine.


2/10

Environmental tobacco smoke (ETS) exposure and respiratory morbidityin school age children.

Rev Port Pneumol. 2011; 17(1):20-6 (ISSN: 0873-2159)

Constant C; Sampaio I; Negreiro F; Aguiar P; Silva A; Salgueiro M; Bandeira TServio de Pediatria, Departamento da Criana e da Famlia, Clnica Universitriade Pediatria, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte EPE,Lisboa, Portugal. [email protected]

INTRODUCTION: Tobacco smoke is a risk factor for Chronic ObstructivePulmonary Disease and a major public health problem. Prenatal maternalsmoking and post-natal environmental tobacco smoke (ETS) lead to dose-dependent decrease in lung function and respiratory morbidity. Influence ofdifferent socioeconomic indicators and ETS in the home has also been suggested.

METHODS: Data on 313 children (52 % male) from 4 public schools in Lisbonwas analyzed [1st (46 %) and 4th graders]. ETS assessment and respiratorysymptoms were based on a self-answered questionnaire. All children performedstandard spirometry in the school setting and 54 % were acceptable according toATS/ERS criteria. Descriptive and bivariate analysis of the most relevantvariables was done, followed by multiple logistic regression analysis adjusted tothe variables with clinical/statistical relevance.

RESULTS: ETS in the home was found in 41 % (maternal smoking duringpregnancy 18 %, smoking mother 32 %, smoking father 38 %). Smoking fathers

had lower education and less qualified occupation. Cough was more frequent inchildren with a smoking mother (adjusted OR = 2.1 95CI 1.1-4.0) and wheezingin children with maternal smoking during pregnancy and smoking parents. Alldifferences were significant (p < 0.05). No association was found betweenparental education and cough/wheeze or ETS and respiratoryinfections/asthma/decreased spirometric values.

CONCLUSIONS: Children in Lisbon are frequently exposed to ETS which resultsin significant respiratory morbidity. Targeted interventions must have socialconditions in consideration. In this study, field spirometry was not helpful inearly detection of lung function disability in children associated with ETS.



3/10

Environmental tobacco smoke exposure increases Mycobacteriumtuberculosis infection risk in children. Int J Tuberc Lung Dis. 2011; 15(11):1490-6, i (ISSN: 1815-7920)

du Preez K; Mandalakas AM; Kirchner HL; Grewal HM; Schaaf HS; van Wyk SS;Hesseling ACDepartment of Paediatrics and Child Health, Desmond Tutu TB Centre,Stellenbosch University, Cape Town, Western Cape, South [email protected]

BACKGROUND: Data on the association between exposure to environmentaltobacco smoke (ETS) and Mycobacterium tuberculosis infection in children arelimited.

OBJECTIVE: To examine the dose-response effect of ETS exposure on the risk ofM. tuberculosis infection in children in a high tuberculosis (TB) burden setting.

METHODS: This cross-sectional study included healthy South African childrenfrom impoverished urban communities. Data were collected on household ETSand M. tuberculosis exposure, demographics, socio-economic andanthropometric data, M. tuberculosis infection, human immunodeficiency virusand TB disease status.

RESULTS: Among 196 children (median age 6.8 years, range 0.3-15.9), 97(49.5%) were M. tuberculosis - i nfected (tuberculin skin test [TST] 10 mm)and 128 (65.3%) reported ETS exposure; of these, 81/128 (63.3%) were

exposed to 2 household smokers. The presence of 2 household smokers wasassociated with M. tuberculosis infection in univariate analysis, irrespective ofTST cut-off point. In analysis adjusting for M. tuberculosis exposure, socio-economic status, age and previous TB treatment, ETS exposure remainedassociated with M. tuberculosis infection. In univariate and multivariate analysis,pack-years of exposure were associated with risk of TB infection.

DISCUSSION: Exposure to ETS is associated with M. tuberculosis infection inchildren after adjustment for multiple variables, with a dose-responserelationship between the degree of ETS exposure and risk of infection. Publichealth interventions to reduce exposure to tobacco smoke among children inhigh TB burden settings are urgently needed.

From MEDLINE/PubMed, a database of the U.S. National Library ofMedicine.


4/10

Effect of environmental exposure to lead and tobacco smoke on inattentiveand hyperactive symptoms and neurocognitive performance in children. J Child Psychol Psychiatry. 2010; 51(9):1050-7 (ISSN: 1469-7610)

Cho SC; Kim BN; Hong YC; Shin MS; Yoo HJ; Kim JW; Bhang SY; Cho IH; Kim HWDivision of Child and Adolescent Psychiatry, Department of Neuropsychiatry,Seoul National University College of Medicine, Seoul, Korea.

BACKGROUND: The present study assessed the association between blood leadand urinary cotinine levels and inattentive and hyperactive symptoms andneurocognitive performance in children.

METHODS: A total of 667 children (age range 8-11) were recruited from nineschools in five Korean cities. The teachers and parents completed the Koreanversion of the Attention-deficit/hyperactivity disorder Rating Scales (K-ARS),and the children performed neurocognitive tests. Blood lead and urinary cotininelevels were then measured.

RESULTS: The inattentive, hyperactive, and total scores of the teacher-rated K-ARS were positively associated with blood lead level, and the results of thecontinuous performance test (CPT), Stroop Color-Word Test, and Children'sColor Trails Test were inversely associated with urinary cotinine level whencontrolled for age, gender, father's educational level, maternal IQ, child's IQ,residential area, birth weight, and cotinine (for lead) or lead (for cotinine). Theassociation between blood lead level and commission errors score on the CPTdisappeared when the effect of urinary cotinine level was controlled.

CONCLUSIONS: These findings indicate that environmental exposure to tobaccosmoke in children is associated with poor neurocognitive performance, and lowlevels of lead are associated with inattention and hyperactivity symptoms.



5/10

Smoking among young children in Hong Kong: influence of parentalsmoking .J Adv Nurs. 2010; 66(12):2659-70 (ISSN: 1365-2648)

Loke AY; Wong YPSchool of Nursing, The Hong Kong Polytechnic University, Hong [email protected]

AIMS: This paper is a report of a study comparing children with smoking parentsand those with non-smoking parents, in terms of knowledge and attitudetowards smoking and the influence of parents and peers on smoking initiation.

BACKGROUND: Adolescence is a developmental stage when smoking habits arelikely to start. Adolescents are most influenced by the smoking habits of theirparents and friends.

METHOD: A cross-section study was conducted with students aged 13-15 yearsin two schools in 2008, using a questionnaire that collected information on thesmoking habits of their parents and peers, knowledge and attitude towardssmoking, initiation and inclination towards smoking. Chi-square tests and binarylogistic regression were used to analyse the data.

RESULTS: A total of 257 of 575 (447%) students had smoking parent(s), and254% reported having peers who smoked. Children with non-smoking parentswere more likely than those with smoking parents to consider 'smoking asdisgusting' (673% vs. 459%), and to know that 'smoking is addictive' (805%

vs. 704%) and 'harmful to health' (818% vs. 677%). More of those withsmoking parents had tried smoking than those with non-smoking parents(132% vs. 38%).

CONCLUSION: Preventive programmes should involve smoking parents toincrease their awareness of the impact their smoking has on their children.Interventions should include problem-solving skills for children to deal withdaily stresses and thus eradicate the potential risk of smoking initiation .



6/10

Maternal smoking during pregnancy and primary headache in school-agedchildren: a cohort study.

Cephalalgia. 2012; 32(4):317-27 (ISSN: 1468-2982)

Fabbri CE; Barbieri MA; Silva AM; Gutierrez MR; Bettiol H; Speciali JG; Rona RJUniversity of So Paulo, So Paulo, Brazil.

BACKGROUND: It is not known whether smoking by mothers during pregnancyis associated with headache in their offspring.

METHODS: Two prospective cohorts of 869 children aged 10-11 years fromRibeiro Preto (RP) and 805 children aged 7-9 years from So Lus (SL) werestudied. Data on maternal smoking were collected at birth. Primary headachewas defined as a reporting of 2 episodes of headache in the past 2 weeks,without any associated organic symptoms.

RESULTS: Prevalence of headache was 28.1% in RP and 13.1% in SL as reportedby the mothers and 17.5% in RP and 29.4% in SL as reported by the children.Agreement between mothers' report and children's self-report of primaryheadache in the child was poor. After adjustment, children whose motherssmoked 10 cigarettes per day during pregnancy present ed higher prevalence ofprimary headache than their counterparts in both cohorts, as reported by themother and in RP as reported by the children.

CONCLUSIONS: Maternal smoking during pregnancy was associated with

headache in 7- to 11-year-olds. With one exception, the consistency of theresults, despite poor agreement between maternal and children reports ofheadache, indicates that maternal smoking during pregnancy may contribute toheadaches in their children.



7/10

Parental smoking, exposure to secondhand smoke at home, and smokinginitiation among young children.

Nicotine Tob Res. 2011; 13(9):827-32 (ISSN: 1469-994X)

Wang MP; Ho SY; Lam THSchool of Public Health, The University of Hong Kong, Pokfulam, Hong Kong.

INTRODUCTION: To investigate the associations of parental smoking andsecondhand smoke (SHS) exposure at home with smoking initiation amongyoung children in Hong Kong.

METHODS: A prospective school-based survey of Hong Kong primary 2-4students was conducted at baseline in 2006 and followed up in 2008. Self-administered anonymous questionnaires were used to collect information aboutsmoking, SHS exposure at home, parental smoking, and sociodemographiccharacteristics. Cross-sectional and prospective associations of SHS exposure athome and parental smoking with student smoking were analyzed using logisticregression adjusting for potential confounders.

RESULTS: Cross-sectional association between parental smoking and eversmoking was significant with adjustment of sociodemographic characteristicsbut became insignificant after adjusting for home SHS exposure. Home SHSexposure mediated the association between parental smoking and studentssmoking (p = .03). Prospectively, parental smoking was not associated withsmoking initiation after adjusting for home SHS exposure. Each day increase in

home SHS exposure significantly predicted 16% excess risk of smoking initiationafter adjusting for parental smoking. The prospective effect of parental smokingon smoking initiation was significantly mediated by baseline home SHS exposure(p < .01). Conclusions: Higher exposure to SHS at home predicted smokinginitiation of young Chinese children in Hong Kong independent of parentalsmoking status. On the other hand, the effect of parental smoking on smokinginitiation was mediated through SHS exposure at home. To prevent childrenfrom smoking as well as the harm of SHS exposure, parents and other familymembers should quit smoking or at least reduce smoking at home.



8/10

Parental smoking during pregnancy, early growth, and risk of obesity inpreschool children: the Generation R Study.

Am J Clin Nutr. 2011; 94(1):164-71 (ISSN: 1938-3207)

Durmus B; Kruithof CJ; Gillman MH; Willemsen SP; Hofman A; Raat H; Eilers PH;Steegers EA; Jaddoe VWGeneration R Study Group, Erasmus Medical Center, Rotterdam, Netherlands.

BACKGROUND: Maternal smoking during pregnancy seems to be associated withobesity in offspring. Not much is known about the specific critical exposureperiods or underlying mechanisms for this association.

OBJECTIVE: We assessed the associations of active maternal and paternalsmoking during pregnancy with early growth characteristics and risks ofoverweight and obesity in preschool children.

DESIGN: This study was a population-based, prospective cohort study from earlyfetal life until the age of 4 y in 5342 mothers and fathers and their children.Growth characteristics [head circumference, length, weight, and body mass index(BMI; in kg/m(2))] and overweight and obesity were repeatedly measured at theages of 1, 2, 3, and 4 y.

RESULTS: In comparison with children from nonsmoking mothers, children frommothers who continued smoking during pregnancy had persistently smallerhead circumferences and heights until the age of 4 y, whereas their weights were

lower only until the age of 3 mo. This smaller length and normal to higher weightled to an increased BMI [SD score difference: 0.11; 95% CI: 0.02, 0.20; P < 0.05)]and an increased risk of obesity (odds ratio: 1.61; 95% CI: 1.03, 2.53; P < 0.05) atthe age of 4 y. In nonsmoking mothers, paternal smoking was not associated withpostnatal growth characteristics or risk of obesity in offspring. Maternal smokingduring pregnancy was associated with a higher BMI at the age of 4 y in childrenwith a normal birth weight and in those who were small for gestational age atbirth.

CONCLUSION: Our findings suggest that direct intrauterine exposure to smokeuntil late pregnancy leads to different height and weight growth adaptations andincreased risks of overweight and obesity in preschool children.



9/10

Secondhand tobacco smoke exposure and severity of influenza inhospitalized children.

J Pediatr. 2013; 162(1):16-21 (ISSN: 1097-6833)

Wilson KM; Pier JC; Wesgate SC; Cohen JM; Blumkin AKChildren's Hospital Colorado, Aurora, CO 80045, [email protected]

OBJECTIVE: To assess whether children with influenza who are exposed tosecondhand tobacco smoke (SHS) would have more severe illness than those notexposed.

STUDY DESIGN: We abstracted charts from pediatric inpatients with confirmedinfluenza from 2002-2009 for demographics, medical history, and smokeexposure. Severity indicators included intensive care, intubation, and length ofstay (LOS) in the hospital; potential confounding factors included demographicsand the presence of asthma or chronic conditions. All (2), t tests, and regressionanalyses were run using SPSS v. 18.0.

RESULTS: Of 117 children, 40% were exposed to SHS, who had increased needfor intensive care (30% vs 10%, P < .01) and intubation (13% vs 1%, P < .05),and had longer LOS (4.0 vs 2.4 days, P < .01). Children with chronic conditionsand SHS exposure required more intensive care (53% vs 18%, P < .05) and hadlonger LOS (10.0 vs 3.5 days, P < .01) than children not exposed to SHS withchronic conditions. In multivariate analyses controlling for potential

confounding factors, children with SHS exposure were 4.7 times more likely tobe admitted to intensive care (95% CI 1.4-18.5) and had a 70% longer LOS (95%CI 12%-230%).

CONCLUSIONS: Children with SHS exposure who are hospitalized with influenzahave more severe illness. Efforts are needed to immunize this population againstinfluenza, and eliminate children's exposure to SHS.



10/10

Relationship of environmental tobacco smoke to otitis media (OM) inchildren .

Int J Pediatr Otorhinolaryngol. 2012; 76(7):989-93 (ISSN: 1872-8464)

Csknyi Z; Czinner A; Spangler J; Rogers T; Katona GDepartment of Otorhinolaryngology, Heim Pal Children's Hospital, 13 Delej utca,H-1089 Budapest, Hungary.

INTRODUCTION: Many, but not all, studies have found a correlation betweenenvironmental tobacco smoke (ETS) and acute otitis media (AOM) and otheradverse otologic outcomes. Given its high personal and societal costs and thedivergent findings of the effect of ETS on middle ear disease, the aim of thecurrent study was to assess the impact and possible determinant factors of ETSon recurrent (two or more) episodes of AOM.

METHODS: The study was performed at Heim Pal Children's Hospital, Ear, Noseand Throat (ENT) Department, Budapest, Hungary. Caregivers of a conveniencesample of 412 children attending the ENT outpatient clinic were surveyed via a22-item questionnaire regarding demographics, socioeconomics, and smokingbehaviours of the child's family; as well as care-givers' self report of the numberof AOM episodes of the child.

RESULTS: Of the 412 participants, 155 (38%) children's parents smoked. Inbivariate analysis, two or more episodes of AOM correlated with reportedhearing problems, day care enrolment, parental employment and increased age

of the child. In multivariate logistic regression, parental smoking more thandoubled a child's risk for recurrent AOM while increased maternal employment(e.g. part-time or full-time versus unemployed) boosted risk up to fourfold.Among children whose parents smoked, half-packs of cigarettes smoked per dayand day care attendance doubled or nearly tripled, respectively, the risk ofrecurrent AOM episodes.

CONCLUSIONS: Childhood exposure to ETS is high among an ENT clinicpopulation of Hungarian children. Such exposure correlates with AOM episodes,ENT operations and conductive hearing loss. Data such as these argue for strictlaws smoke-free laws not only in Hungary, but also in Europe and around theworld.


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