Developing Asthma in Childhood from Exposure to Secondhand Tobacco Smoke: Insights from a Meta-Regression

Objective: Studies have identified associations between household secondhand tobacco smoke (SHS) exposure and induction of childhood asthma. However, the true nature and strength of this association remains confounded in many studies, producing inconsistent evidence. To look for sources of potential...

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Bibliographic Details
Published in:	Environmental health perspectives Vol. 115; no. 10; pp. 1394 - 1400
Main Authors:	Vork, Kathleen L, Broadwin, Rachel L, Blaisdell, Robert J
Format:	Journal Article
Language:	English
Published:	United States National Institute of Environmental Health Sciences. National Institutes of Health. Department of Health, Education and Welfare 01-10-2007 National Institute of Environmental Health Sciences
Subjects:	Adolescent Allergies Asthma Asthma - epidemiology Asthma in children Child Child, Preschool Childhood Children Cigarette smoking Cohort studies Confounding Factors (Epidemiology) Food allergies Health aspects Humans Incidence Infant Passive smoking Regression analysis Review Risk School age children Secondhand smoke Tobacco Smoke Pollution - adverse effects Tobacco smoking United States ETS meta-analysis childhood asthma secondhand tobacco smoke environmental tobacco smoke relative risk SHS meta-regression
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Summary:	Objective: Studies have identified associations between household secondhand tobacco smoke (SHS) exposure and induction of childhood asthma. However, the true nature and strength of this association remains confounded in many studies, producing inconsistent evidence. To look for sources of potential bias and try to uncover consistent patterns of relative risk estimates (RRs), we conducted a meta-analysis of studies published between 1970 and 2005. Data sources: Through an extensive literature search, we identified 38 epidemiologic studies of SHS exposure and the development of childhood asthma (that also controlled for atopy history) from 300 potentially relevant articles. Data synthesis: We observed substantial heterogeneity within initial summary RRs of 1.48 [95% confidence interval (CI), 1.32-1.65], 1.25 (1.21-1.30), and 1.21 (1.08-1.36), for ever, current, and incident asthma, respectively. Lack of control for type of atopy history (familial or child) and child's own smoking status within studies and age category altered summary RRs in separate metaregressions. After adjusting for these confounding characteristics, consistent patterns of association emerged between SHS exposure and childhood asthma induction. Our summary RR of 1.33 (95% CI, 1.14-1.56) from studies of incident asthma among older children (6-18 years of age) is 1.27 times the estimate from studies of younger children and higher than estimates reported in earlier meta-analyses. Conclusions: This new finding indicates that exposure duration may be a more important factor in the induction of asthma than previously understood, and suggests that SHS could be a more fundamental and widespread cause of childhood asthma than some previous meta-analyses have indicated.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 The authors declare they have no competing financial interests.
ISSN:	0091-6765 1552-9924
DOI:	10.1289/ehp.10155